Pub Date : 2023-01-01DOI: 10.20953/1817-7646-2023-3-37-55
T. Kriulina, T. Dvoryakovskaya, A. Surkov, D.S. Shubina, A.V. Bairashevskaуa, M.N. Ponomarchuk, E. Alexeeva, Ilia Y. Shilkrot
The survey of parents is one of the optimal opportunities to understand the drawbacks of healthcare to children with rheumatic diseases, since these drawbacks are not reflected in patient medical records, statistical data, and the opinion of the doctor. Parents surveys provide information on the subjective understanding of the disease symptoms, duration and characteristics of the child's route from the disease onset to the diagnosis and treatment initiation, choice of primary care physician, problems on the route, disease awareness, and subjective understanding of the legal field regulating healthcare to children with rheumatic diseases. Objective. To identify possible ways to improve the access to healthcare among children with juvenile arthritis (JA) by analyzing the information from their parents on the patient portrait, patient pathway, social burden of the disease, its impact on various aspects of the life of a child and the family, and legal field regulating healthcare to children with rheumatic diseases. Patients and methods. We conducted a cross-sectional study where we surveyed 306 parents of JA patients, including 56 children with JA with systemic onset, 230 with different JA variants without systemic manifestations, and 20 with an unspecified JA. The main parameters assessed were as follows: JA patient portrait, patient pathway, social burden of JA, parental awareness about the and legal field regulating healthcare to children with rheumatic diseases. We used Fisher's exact test and Pearson's χ2-test to assess the significance of differences. All the p-values given are based on two-sided tests. Differences were considered significant at р < 0.05. Results. According to parents, the most common clinical symptoms of JA without systemic manifestations at onset were restricted movements of joints (74.3%), arthralgia (71.7%), morning stiffness (62.2%); JA patients with a systemic onset had fever (78.5%) and rash (68%). Three-quarters of respondents (regardless of the JA type) visited a pediatrician within the first month after symptom onset. Only 52% of patients were referred for consultation to a pediatric rheumatologist within a month after symptom onset. More than one-third of patients were diagnosed with JA within a month; half of the patients, after 1–6 months; and 18% of patients, after 6 months. The majority of children (88%) started to receive biologicals later than 6 months after the diagnosis; 64% of JA patients with a systemic onset and 92% of JA patients without systemic manifestations. The disease negatively affected everyday life of the child and his/her family in 91% of cases. Sixty-one percent of respondents knew about the existence of clinical guidelines; 44% of them knew about the right to have the status of a “disabled child” without subsequent re-examination before the age of 18; 39% of respondents knew about the possibility to have the status of a “disabled child” in those children whose remission depends on the constant
{"title":"Situation with medical care for children with rheumatic disease on the example of juvenile arthritis: the view of patients and their parents","authors":"T. Kriulina, T. Dvoryakovskaya, A. Surkov, D.S. Shubina, A.V. Bairashevskaуa, M.N. Ponomarchuk, E. Alexeeva, Ilia Y. Shilkrot","doi":"10.20953/1817-7646-2023-3-37-55","DOIUrl":"https://doi.org/10.20953/1817-7646-2023-3-37-55","url":null,"abstract":"The survey of parents is one of the optimal opportunities to understand the drawbacks of healthcare to children with rheumatic diseases, since these drawbacks are not reflected in patient medical records, statistical data, and the opinion of the doctor. Parents surveys provide information on the subjective understanding of the disease symptoms, duration and characteristics of the child's route from the disease onset to the diagnosis and treatment initiation, choice of primary care physician, problems on the route, disease awareness, and subjective understanding of the legal field regulating healthcare to children with rheumatic diseases. Objective. To identify possible ways to improve the access to healthcare among children with juvenile arthritis (JA) by analyzing the information from their parents on the patient portrait, patient pathway, social burden of the disease, its impact on various aspects of the life of a child and the family, and legal field regulating healthcare to children with rheumatic diseases. Patients and methods. We conducted a cross-sectional study where we surveyed 306 parents of JA patients, including 56 children with JA with systemic onset, 230 with different JA variants without systemic manifestations, and 20 with an unspecified JA. The main parameters assessed were as follows: JA patient portrait, patient pathway, social burden of JA, parental awareness about the and legal field regulating healthcare to children with rheumatic diseases. We used Fisher's exact test and Pearson's χ2-test to assess the significance of differences. All the p-values given are based on two-sided tests. Differences were considered significant at р < 0.05. Results. According to parents, the most common clinical symptoms of JA without systemic manifestations at onset were restricted movements of joints (74.3%), arthralgia (71.7%), morning stiffness (62.2%); JA patients with a systemic onset had fever (78.5%) and rash (68%). Three-quarters of respondents (regardless of the JA type) visited a pediatrician within the first month after symptom onset. Only 52% of patients were referred for consultation to a pediatric rheumatologist within a month after symptom onset. More than one-third of patients were diagnosed with JA within a month; half of the patients, after 1–6 months; and 18% of patients, after 6 months. The majority of children (88%) started to receive biologicals later than 6 months after the diagnosis; 64% of JA patients with a systemic onset and 92% of JA patients without systemic manifestations. The disease negatively affected everyday life of the child and his/her family in 91% of cases. Sixty-one percent of respondents knew about the existence of clinical guidelines; 44% of them knew about the right to have the status of a “disabled child” without subsequent re-examination before the age of 18; 39% of respondents knew about the possibility to have the status of a “disabled child” in those children whose remission depends on the constant","PeriodicalId":38157,"journal":{"name":"Voprosy Prakticheskoi Pediatrii","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67752924","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}
Pub Date : 2023-01-01DOI: 10.20953/1817-7646-2023-1-153-160
Yuliia V. Kotova, E. Inyushkina, E. Kondratyeva, L.A. Beznosova
A pediatrician faces with the differential diagnosis of oncological, oncohematological diseases which could have rheumatological "masks". According to medical literature, the most important symptoms are the joint pain at night, diffuse bone pain and organomegaly. Among the laboratory markers of oncological/oncohematological diseases the most important are bi-/trilineage cytopenia, high level of ESR, LDH, uric acid; including in the differential diagnosis of the neoplastic process in the detection of unilateral sacroiliitis without damage of other joints is necessary. The clinical case of a patient with Lagerhans cell histiocytosis is presented for differential diagnosis with the debut of spondyloarthritis for increasing the alertness of pediatricians and rheumatologists in children with musculoskeletal pain. Key words: Lagerhans cell histiocytosis, juvenile idiopathic arthritis, juvenile ankylosing spondylitis
{"title":"The clinical case of debut of Lagerhans cell histiocytosis under the rheumatological disease mask","authors":"Yuliia V. Kotova, E. Inyushkina, E. Kondratyeva, L.A. Beznosova","doi":"10.20953/1817-7646-2023-1-153-160","DOIUrl":"https://doi.org/10.20953/1817-7646-2023-1-153-160","url":null,"abstract":"A pediatrician faces with the differential diagnosis of oncological, oncohematological diseases which could have rheumatological \"masks\". According to medical literature, the most important symptoms are the joint pain at night, diffuse bone pain and organomegaly. Among the laboratory markers of oncological/oncohematological diseases the most important are bi-/trilineage cytopenia, high level of ESR, LDH, uric acid; including in the differential diagnosis of the neoplastic process in the detection of unilateral sacroiliitis without damage of other joints is necessary. The clinical case of a patient with Lagerhans cell histiocytosis is presented for differential diagnosis with the debut of spondyloarthritis for increasing the alertness of pediatricians and rheumatologists in children with musculoskeletal pain. Key words: Lagerhans cell histiocytosis, juvenile idiopathic arthritis, juvenile ankylosing spondylitis","PeriodicalId":38157,"journal":{"name":"Voprosy Prakticheskoi Pediatrii","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67749376","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}
Pub Date : 2023-01-01DOI: 10.20953/1817-7646-2023-1-28-35
T. A. Gutyrchik, A. B. Malakhov, A. Sedova, P. Berezhanskiy, N. Kolosova, T. Yushina
The variety of clinical symptoms in the post-COVID period and the long period of their persistence determine the relevance of timely and adequate rehabilitation of patients. Patients and methods. The observational study involved 40 children aged 7 to 18 years at the stage of rehabilitation after COVID-19 with lung damage. Two groups of patients were identified: the control group (n = 20) received standard therapy (inhaled glucocorticosteroids (IGCs), vitamins, anticoagulants); the study group (n = 20) received ammonium glycyrrhizinate (AG) in addition to standard therapy for 30 days. The groups underwent a physical examination, measurement of spirometry, scoring of general and respiratory symptoms and adverse events on days 1, 14, and 30 of therapy. Results. By day 30 of AG therapy, the frequency of cough decreased by 30% in the study group, and the symptom of weakness was eliminated in 50% of children; in the control group, cough persisted in all patients (p = 0.01), weakness was recorded in 90% of patients (p = 0.005). In the study group compared to the control, there was a significantly faster regression of symptom severity. By the 30th day of observation, VAS cough scores in the study group were 0.75 ± 0.4 points, which was 2.5 times lower than in the control group (1.85 ± 0.3 points, p = 0.002); weakness scores in patients in the study group were 2.8 times lower than in the control (0.45 ± 0.4 and 1.25 ± 0.3 points, respectively, p = 0.005). In all patients in the study group, the normalization of spirometry was recorded by day 30, while the majority of control group patients had no such positive dynamics. Conclusion. The inclusion of AG in a course of 30 days in the complex rehabilitation of patients after COVID-19 with lung damage provides a rapid regression of the severity of respiratory and general symptoms of the post-COVID period, which can significantly improve the quality of life of patients and the prognosis of the disease. Key words: coronavirus infection, COVID-19, post-COVID syndrome, children, rehabilitation, ammonium glycyrrhizinate, glycyrrhizic acid
{"title":"Experience of rehabilitation of children with lung damage associated with COVID-19 in the post-covid period","authors":"T. A. Gutyrchik, A. B. Malakhov, A. Sedova, P. Berezhanskiy, N. Kolosova, T. Yushina","doi":"10.20953/1817-7646-2023-1-28-35","DOIUrl":"https://doi.org/10.20953/1817-7646-2023-1-28-35","url":null,"abstract":"The variety of clinical symptoms in the post-COVID period and the long period of their persistence determine the relevance of timely and adequate rehabilitation of patients. Patients and methods. The observational study involved 40 children aged 7 to 18 years at the stage of rehabilitation after COVID-19 with lung damage. Two groups of patients were identified: the control group (n = 20) received standard therapy (inhaled glucocorticosteroids (IGCs), vitamins, anticoagulants); the study group (n = 20) received ammonium glycyrrhizinate (AG) in addition to standard therapy for 30 days. The groups underwent a physical examination, measurement of spirometry, scoring of general and respiratory symptoms and adverse events on days 1, 14, and 30 of therapy. Results. By day 30 of AG therapy, the frequency of cough decreased by 30% in the study group, and the symptom of weakness was eliminated in 50% of children; in the control group, cough persisted in all patients (p = 0.01), weakness was recorded in 90% of patients (p = 0.005). In the study group compared to the control, there was a significantly faster regression of symptom severity. By the 30th day of observation, VAS cough scores in the study group were 0.75 ± 0.4 points, which was 2.5 times lower than in the control group (1.85 ± 0.3 points, p = 0.002); weakness scores in patients in the study group were 2.8 times lower than in the control (0.45 ± 0.4 and 1.25 ± 0.3 points, respectively, p = 0.005). In all patients in the study group, the normalization of spirometry was recorded by day 30, while the majority of control group patients had no such positive dynamics. Conclusion. The inclusion of AG in a course of 30 days in the complex rehabilitation of patients after COVID-19 with lung damage provides a rapid regression of the severity of respiratory and general symptoms of the post-COVID period, which can significantly improve the quality of life of patients and the prognosis of the disease. Key words: coronavirus infection, COVID-19, post-COVID syndrome, children, rehabilitation, ammonium glycyrrhizinate, glycyrrhizic acid","PeriodicalId":38157,"journal":{"name":"Voprosy Prakticheskoi Pediatrii","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67750264","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}
Pub Date : 2023-01-01DOI: 10.20953/1817-7646-2023-1-43-54
E. Kondratyeva, E. Loshkova, N. Ilenkova, Yu.L. Mizernitskiy, L. Klimov, Y. Melyanovskaya, L. V. Stepanova, S. Dyakova, A. Bogorad, S. Dolbnya, V. A. Kuryaninova, E. Zhekaite, N. Odinaeva
Objective. To study the associative relation between genetic variants (c.1206T>C, c.1175-9G>T, c.152T>C, c.1174+283G>A) of the VDR gene with clinically significant manifestations of bronchial asthma, complications and response to therapy. Patients and methods. The analysis of variants of FokI, TaqI, BsmI of the VDR gene was carried out in 160 patients with bronchial asthma. Results. The combination of asthma and allergic rhinitis was more often observed with genotypes AA and GA c.1174+283G>A compared with GG (p = 0.021), allele A compared with G (p = 0.023), TT and CT c.1206T>C(A>G) TaqI vs. CC (p = 0.003), allele T compared to C (p = 0.003). The combination of symptoms of the "atopic march" was more often recorded in TT genotype c.1206T>C(A>G) TaqI compared to TC and CC (p = 0.046), AA and GA c.1174+283G>A versus GG (p = 0.017) and allele A compared to G (p = 0.021). The protective effect on the severity of asthma is expressed in the CC genotype c.1206T>C(A>G) TaqI compared to TC and TT (p = 0.035), the C allele versus T (p = 0.040), as well as in relation to the control for CC and CT compared to TT c.1206T>C(A>G) TaqI (p = 0.048) and allele C vs T (p = 0.024). The risk of omalizumab administration is lower for CC and TC genotypes c.1206T>C(A>G) TaqI compared to TT (p = 0.037) and for the C allele compared to T (p = 0.035). Vitamin D availability is lower for TT and TC genotypes c.152T>C FokI compared to CC genotype (p = 0.045). Conclusion. The genetic risk of realization of phenotypic manifestations of asthma – severity, level of control, combination of symptoms of "atopic march" and response to therapy for all studied polymorphic variants of the VDR gene is described. Key words: asthma, VDR gene, vitamin D, inflammation, children, 25(OH)D
{"title":"The role of the VDR gene in the formation of clinical manifestations, complications and response to therapy in bronchial asthma","authors":"E. Kondratyeva, E. Loshkova, N. Ilenkova, Yu.L. Mizernitskiy, L. Klimov, Y. Melyanovskaya, L. V. Stepanova, S. Dyakova, A. Bogorad, S. Dolbnya, V. A. Kuryaninova, E. Zhekaite, N. Odinaeva","doi":"10.20953/1817-7646-2023-1-43-54","DOIUrl":"https://doi.org/10.20953/1817-7646-2023-1-43-54","url":null,"abstract":"Objective. To study the associative relation between genetic variants (c.1206T>C, c.1175-9G>T, c.152T>C, c.1174+283G>A) of the VDR gene with clinically significant manifestations of bronchial asthma, complications and response to therapy. Patients and methods. The analysis of variants of FokI, TaqI, BsmI of the VDR gene was carried out in 160 patients with bronchial asthma. Results. The combination of asthma and allergic rhinitis was more often observed with genotypes AA and GA c.1174+283G>A compared with GG (p = 0.021), allele A compared with G (p = 0.023), TT and CT c.1206T>C(A>G) TaqI vs. CC (p = 0.003), allele T compared to C (p = 0.003). The combination of symptoms of the \"atopic march\" was more often recorded in TT genotype c.1206T>C(A>G) TaqI compared to TC and CC (p = 0.046), AA and GA c.1174+283G>A versus GG (p = 0.017) and allele A compared to G (p = 0.021). The protective effect on the severity of asthma is expressed in the CC genotype c.1206T>C(A>G) TaqI compared to TC and TT (p = 0.035), the C allele versus T (p = 0.040), as well as in relation to the control for CC and CT compared to TT c.1206T>C(A>G) TaqI (p = 0.048) and allele C vs T (p = 0.024). The risk of omalizumab administration is lower for CC and TC genotypes c.1206T>C(A>G) TaqI compared to TT (p = 0.037) and for the C allele compared to T (p = 0.035). Vitamin D availability is lower for TT and TC genotypes c.152T>C FokI compared to CC genotype (p = 0.045). Conclusion. The genetic risk of realization of phenotypic manifestations of asthma – severity, level of control, combination of symptoms of \"atopic march\" and response to therapy for all studied polymorphic variants of the VDR gene is described. Key words: asthma, VDR gene, vitamin D, inflammation, children, 25(OH)D","PeriodicalId":38157,"journal":{"name":"Voprosy Prakticheskoi Pediatrii","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67750388","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}
Pub Date : 2023-01-01DOI: 10.20953/1817-7646-2023-2-102-110
O. Goncharova, E. Mashkovtseva, Y. Nartsissov
Perinatal hypoxia is a common cause of developmental delays, disorders of the nervous and cardiovascular systems, and immune disorders. Early comprehensive rehabilitation of children with hypoxic lesions to the central nervous system can alleviate pathological manifestations and normalize the process of development. This review discusses different aspects of metabolic therapy for the rehabilitation of such children and describes the results of some studies assessing the efficacy of Glycine and Biotredin in children with various disorders. The combination of these two drugs proved to be effective in premature infants of various gestational age through normalizing their neurological status and improving weight and growth parameters. The article also describes the principles of metabolic correction of speech disorders in the critical preschool period, as well the mechanisms underlying the effect of the drugs on the cellular metabolism of the nervous system. Key words: hypoxia, metabolic therapy, preterm birth, glycine, speech disorders
{"title":"Metabolic therapy in the rehabilitation of children with the consequences of perinatal hypoxia","authors":"O. Goncharova, E. Mashkovtseva, Y. Nartsissov","doi":"10.20953/1817-7646-2023-2-102-110","DOIUrl":"https://doi.org/10.20953/1817-7646-2023-2-102-110","url":null,"abstract":"Perinatal hypoxia is a common cause of developmental delays, disorders of the nervous and cardiovascular systems, and immune disorders. Early comprehensive rehabilitation of children with hypoxic lesions to the central nervous system can alleviate pathological manifestations and normalize the process of development. This review discusses different aspects of metabolic therapy for the rehabilitation of such children and describes the results of some studies assessing the efficacy of Glycine and Biotredin in children with various disorders. The combination of these two drugs proved to be effective in premature infants of various gestational age through normalizing their neurological status and improving weight and growth parameters. The article also describes the principles of metabolic correction of speech disorders in the critical preschool period, as well the mechanisms underlying the effect of the drugs on the cellular metabolism of the nervous system. Key words: hypoxia, metabolic therapy, preterm birth, glycine, speech disorders","PeriodicalId":38157,"journal":{"name":"Voprosy Prakticheskoi Pediatrii","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67750737","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}
Pub Date : 2023-01-01DOI: 10.20953/1817-7646-2023-2-111-115
A. I. Safina, E. N. Vyzhlova, V. Malinovskaya
This article describes cases of acute respiratory viral infections in children during the tridemic characterized by simultaneous circulation of various strains of influenza virus, respiratory syncytial virus, and SARS-CoV-2 viruses. The differential diagnosis based on clinical manifestations alone is extremely challenging, while laboratory methods for rapid pathogen identification are lacking. This dictates the need to revise antiviral therapy tactics. The new approach implies the inclusion of interferon alpha-2b with antioxidants that have a wide range of antiviral activity. Early initiation of treatment with interferon alpha-2b prior to pathogen identification ensures good therapeutic results. High frequency of mixed infections and risk of complications in children with functional and morphofunctional abnormalities necessitates higher doses of interferon alpha-2b and longer treatment, particularly in patients with severe infections (influenza, COVID-19, or their combination). Key words: influenza, ARVI, COVID-19, tridemic, children, interferon, antioxidants
{"title":"Challenges in the diagnosis and treatment of acute respiratory infections in children during the tridemic","authors":"A. I. Safina, E. N. Vyzhlova, V. Malinovskaya","doi":"10.20953/1817-7646-2023-2-111-115","DOIUrl":"https://doi.org/10.20953/1817-7646-2023-2-111-115","url":null,"abstract":"This article describes cases of acute respiratory viral infections in children during the tridemic characterized by simultaneous circulation of various strains of influenza virus, respiratory syncytial virus, and SARS-CoV-2 viruses. The differential diagnosis based on clinical manifestations alone is extremely challenging, while laboratory methods for rapid pathogen identification are lacking. This dictates the need to revise antiviral therapy tactics. The new approach implies the inclusion of interferon alpha-2b with antioxidants that have a wide range of antiviral activity. Early initiation of treatment with interferon alpha-2b prior to pathogen identification ensures good therapeutic results. High frequency of mixed infections and risk of complications in children with functional and morphofunctional abnormalities necessitates higher doses of interferon alpha-2b and longer treatment, particularly in patients with severe infections (influenza, COVID-19, or their combination). Key words: influenza, ARVI, COVID-19, tridemic, children, interferon, antioxidants","PeriodicalId":38157,"journal":{"name":"Voprosy Prakticheskoi Pediatrii","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67750811","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}
Pub Date : 2023-01-01DOI: 10.20953/1817-7646-2023-3-18-24
O. Savchenko, E. Pavlinova
Objective. To study the importance of fetal cardiac dysfunction in the genesis of perinatal brain damage in premature newborns. Patients and methods. A prospective cohort comparative study included 59 preterm infants with gestational age from 26 to 32 weeks and body weight from 590 to 1990. Newborns were divided into 2 groups at the 1st month of life: the main group (n = 38), which included children with structural brain lesions, and the control group (n = 21) with favorable neurological outcomes. There were no statistically significant differences in either body weight or gestational age between the groups. At the antenatal stage, all underwent ultrasound doppler sonography of uteroplacental blood flow, and the cerebral-placental ratio was calculated. The following markers were determined at the 1st day of postnatal life: levels of lactate, cerebral natriuretic propeptide and soluble type 2 tumor suppressor in the umbilical cord blood of a newborn (enzyme-linked immunosorbent assay); neurosonography of the brain with the determination of blood flow and doppler echocardiography. Neurological outcomes were assessed after 1 month of life after the control neurosonography of brain. The data are presented in the form of median, maximum and minimum values – Me [min; max]. The obtained data were processed using the Statistica 6.1 program. The Mann–Whitney and Fisher χ2 criteria with the Yeats correction were calculated. The differences were considered significant at p equal to 0.05. Results. The pulsation index in the umbilical cord artery was significantly higher (1.270 [1.120; 1.320] versus 0.984 [0.798; 1.120]) in the fetuses of the main group, Its values indicating severe disorders of fetal-placental hemodynamics were more often recorded (in 15–39.5% cases versus 4–19.1%). The significant decrease in the cerebroplacental ratio was significantly more often recorded (in 18–47.4% cases versus 2–9.5%) in the same group. The levels of lactate (3.6 [2.1; 5.2] versus 2.25 [1.3; 3.05] mmol/L) and cerebral natriuretic propeptide (243.2 [84.17; 1385] versus 111.6 [64.8; 2903] pg/ml, respectively) were significantly elevated in the umbilical cord blood, in newborns of the main group. The newborns of the main group had significantly lower levels of systolic, diastolic and mean blood pressure, at the first hours of life. They also had a reduced level of blood flow in the superior vena cava (Me = 65 ml/kg/min; 9 (23.7%) children had a periventricular leukomalacia, 18 (47.4%) – intraventricular hemorrhages of the II–III degree, and 2 (5.3%) had a stroke. Conclusion. It is very important to pay attention of pediatricians-neonatologists to the antenatal period. Treating the fetus as a patient, early assessment of hemodynamics and timely diagnosis of fetal cardiac dysfunction and other developmental abnormalities will reduce the incidence of disabling perinatal diseases and the level of perinatal mortality. Key words: antenatal diagnosis, umbilical cord blood lactat
{"title":"Fetal cardiac dysfunction: effects on perinatal outcomes in preterm infants","authors":"O. Savchenko, E. Pavlinova","doi":"10.20953/1817-7646-2023-3-18-24","DOIUrl":"https://doi.org/10.20953/1817-7646-2023-3-18-24","url":null,"abstract":"Objective. To study the importance of fetal cardiac dysfunction in the genesis of perinatal brain damage in premature newborns. Patients and methods. A prospective cohort comparative study included 59 preterm infants with gestational age from 26 to 32 weeks and body weight from 590 to 1990. Newborns were divided into 2 groups at the 1st month of life: the main group (n = 38), which included children with structural brain lesions, and the control group (n = 21) with favorable neurological outcomes. There were no statistically significant differences in either body weight or gestational age between the groups. At the antenatal stage, all underwent ultrasound doppler sonography of uteroplacental blood flow, and the cerebral-placental ratio was calculated. The following markers were determined at the 1st day of postnatal life: levels of lactate, cerebral natriuretic propeptide and soluble type 2 tumor suppressor in the umbilical cord blood of a newborn (enzyme-linked immunosorbent assay); neurosonography of the brain with the determination of blood flow and doppler echocardiography. Neurological outcomes were assessed after 1 month of life after the control neurosonography of brain. The data are presented in the form of median, maximum and minimum values – Me [min; max]. The obtained data were processed using the Statistica 6.1 program. The Mann–Whitney and Fisher χ2 criteria with the Yeats correction were calculated. The differences were considered significant at p equal to 0.05. Results. The pulsation index in the umbilical cord artery was significantly higher (1.270 [1.120; 1.320] versus 0.984 [0.798; 1.120]) in the fetuses of the main group, Its values indicating severe disorders of fetal-placental hemodynamics were more often recorded (in 15–39.5% cases versus 4–19.1%). The significant decrease in the cerebroplacental ratio was significantly more often recorded (in 18–47.4% cases versus 2–9.5%) in the same group. The levels of lactate (3.6 [2.1; 5.2] versus 2.25 [1.3; 3.05] mmol/L) and cerebral natriuretic propeptide (243.2 [84.17; 1385] versus 111.6 [64.8; 2903] pg/ml, respectively) were significantly elevated in the umbilical cord blood, in newborns of the main group. The newborns of the main group had significantly lower levels of systolic, diastolic and mean blood pressure, at the first hours of life. They also had a reduced level of blood flow in the superior vena cava (Me = 65 ml/kg/min; 9 (23.7%) children had a periventricular leukomalacia, 18 (47.4%) – intraventricular hemorrhages of the II–III degree, and 2 (5.3%) had a stroke. Conclusion. It is very important to pay attention of pediatricians-neonatologists to the antenatal period. Treating the fetus as a patient, early assessment of hemodynamics and timely diagnosis of fetal cardiac dysfunction and other developmental abnormalities will reduce the incidence of disabling perinatal diseases and the level of perinatal mortality. Key words: antenatal diagnosis, umbilical cord blood lactat","PeriodicalId":38157,"journal":{"name":"Voprosy Prakticheskoi Pediatrii","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67753274","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}
Pub Date : 2023-01-01DOI: 10.20953/1817-7646-2023-1-103-110
M. Kondratiev, A. Petrova, A.S. Gryzunova, S. N. Lavrentiev, N. I. Zakharova, O. Serova, V.A. Krasnova, K. Zhybanisheva
The hemostatic system is complex and evolves continuously since gestation and well into the adult years, in a process known as “developmental hemostasis”. This article presents information about the functioning of the hemostatic system in normal and pathological conditions (birth asphyxia) in newborns, reflects fundamental differences in hemostatic functioning during the neonatal period and the possibilities in maintaining normal hemostasis in conditions of physiological deficiency of both clotting factors and the anticoagulant system. The article highlights various methods of diagnosing the hemostatic system used in neonatology. The so-called global hemostasis tests are being introduced into neonatal practice. The study of hemostasis using thromboelastography technique allows to correct for the patient's real body temperature and estimate both the interaction of platelets and clotting factors and examine the plasma hemostasis component in isolation. The effects of neonatal asphyxia and therapeutic hypothermia procedures on the hemostatic system are poorly understood. This review article attempts to summarize the data available in the world scientific literature concerning this problem. Key words: newborns, developing hemostasis, asphyxia, hypoxic-ischemic encephalopathy, thromboelastography, coagulation, therapeutic hypothermia
{"title":"Changes in primary and secondary hemostasis as a predictor of adverse neonatal outcomes in birth asphyxia","authors":"M. Kondratiev, A. Petrova, A.S. Gryzunova, S. N. Lavrentiev, N. I. Zakharova, O. Serova, V.A. Krasnova, K. Zhybanisheva","doi":"10.20953/1817-7646-2023-1-103-110","DOIUrl":"https://doi.org/10.20953/1817-7646-2023-1-103-110","url":null,"abstract":"The hemostatic system is complex and evolves continuously since gestation and well into the adult years, in a process known as “developmental hemostasis”. This article presents information about the functioning of the hemostatic system in normal and pathological conditions (birth asphyxia) in newborns, reflects fundamental differences in hemostatic functioning during the neonatal period and the possibilities in maintaining normal hemostasis in conditions of physiological deficiency of both clotting factors and the anticoagulant system. The article highlights various methods of diagnosing the hemostatic system used in neonatology. The so-called global hemostasis tests are being introduced into neonatal practice. The study of hemostasis using thromboelastography technique allows to correct for the patient's real body temperature and estimate both the interaction of platelets and clotting factors and examine the plasma hemostasis component in isolation. The effects of neonatal asphyxia and therapeutic hypothermia procedures on the hemostatic system are poorly understood. This review article attempts to summarize the data available in the world scientific literature concerning this problem. Key words: newborns, developing hemostasis, asphyxia, hypoxic-ischemic encephalopathy, thromboelastography, coagulation, therapeutic hypothermia","PeriodicalId":38157,"journal":{"name":"Voprosy Prakticheskoi Pediatrii","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67749446","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}
Pub Date : 2023-01-01DOI: 10.20953/1817-7646-2023-1-111-123
E. Zhekaite, E. Kondratyeva, E. Loshkova, Yuliia V. Kotova, M. I. Erokhina, M.G. Malinovskaya
Bone mineral density decline is one of the significant problems in pediatrics due to the high prevalence of this pathology, the peculiarities of its course in childhood, and the necessity for early detection of changes in bone mineral density to prevent fractures. Osteoporosis is a multifactorial metabolic disease of the skeleton characterized by low bone mass, microarchitectural deterioration of bone tissue, and increased bone fragility and brittleness. Objective. To highlight current diagnostic approaches for early detection of bone mineral density decline in children and adolescents. A review of the available medical literature was conducted. The basic pathogenetic mechanisms of bone mineral density disorders and osteoporosis development were presented. Current diagnostic approaches were considered, namely the main laboratory and instrumental markers of osteoporosis in children, including changes in Z-score of more than 2 SD (according to bone densitometry), the level of biochemical markers of resorption and bone tissue formation (c-terminal telopeptide, oxyproline, osteocalcin, acid and alkaline phosphatase, etc.), and questionnaires. Conclusion. New diagnostic algorithms will allow targeted prevention and treatment of bone mineral density decline in high-risk patients at an early stage, preventing the development of pathological fractures. Key words: hypovitaminosis D, densitometry, bone metabolism markers, bone mineral density, osteoporosis, polymorphism
{"title":"Decline in bone mineral density in children","authors":"E. Zhekaite, E. Kondratyeva, E. Loshkova, Yuliia V. Kotova, M. I. Erokhina, M.G. Malinovskaya","doi":"10.20953/1817-7646-2023-1-111-123","DOIUrl":"https://doi.org/10.20953/1817-7646-2023-1-111-123","url":null,"abstract":"Bone mineral density decline is one of the significant problems in pediatrics due to the high prevalence of this pathology, the peculiarities of its course in childhood, and the necessity for early detection of changes in bone mineral density to prevent fractures. Osteoporosis is a multifactorial metabolic disease of the skeleton characterized by low bone mass, microarchitectural deterioration of bone tissue, and increased bone fragility and brittleness. Objective. To highlight current diagnostic approaches for early detection of bone mineral density decline in children and adolescents. A review of the available medical literature was conducted. The basic pathogenetic mechanisms of bone mineral density disorders and osteoporosis development were presented. Current diagnostic approaches were considered, namely the main laboratory and instrumental markers of osteoporosis in children, including changes in Z-score of more than 2 SD (according to bone densitometry), the level of biochemical markers of resorption and bone tissue formation (c-terminal telopeptide, oxyproline, osteocalcin, acid and alkaline phosphatase, etc.), and questionnaires. Conclusion. New diagnostic algorithms will allow targeted prevention and treatment of bone mineral density decline in high-risk patients at an early stage, preventing the development of pathological fractures. Key words: hypovitaminosis D, densitometry, bone metabolism markers, bone mineral density, osteoporosis, polymorphism","PeriodicalId":38157,"journal":{"name":"Voprosy Prakticheskoi Pediatrii","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67749671","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}
Pub Date : 2023-01-01DOI: 10.20953/1817-7646-2023-2-123-128
I.S. Samolygo, A. Aminova, S. I. Erdes, T.Yu. Eryushova, N.V. Davidenko, T. Zubova
Crohn's disease (granulomatous enteritis, granulomatous colitis, terminal ileitis) is a chronic relapsing disease characterized by transmural granulomatous inflammation with segmental lesions often of the small and large intestine. Eosinophilic colitis is a rare disease characterized by high level of eosinophilic infiltrate in the colon wall in patients with symptoms, more often manifested by abdominal pain or diarrhea. We face more often with the unique combination of these two diseases, characterized by different types of immunological reactions. We presented the clinical case of Crohn's disease and eosinophilic colitis in a 15-year-old boy. We face more often with the unique combination of these two pathological conditions, characterized by different types of immunological reactions, The article presents the clinical case of Crohn's disease and eosinophilic colitis in a 15-year-old boy. The aim of this clinical case is to increase the knowledge of practitioners about inflammatory bowel diseases, to point out possible combinations of different immunological inflammatory reactions in one patient, and the difficulties in diagnosing and managing this kind of patients. Key words: Crohn's disease, eosinophilic colitis, diagnosis, treatment, hormone-resistant form, targeted therapy, children
{"title":"Clinical observation of a patient with small and large intestine lesions with Crohn's disease and eosinophilic colitis","authors":"I.S. Samolygo, A. Aminova, S. I. Erdes, T.Yu. Eryushova, N.V. Davidenko, T. Zubova","doi":"10.20953/1817-7646-2023-2-123-128","DOIUrl":"https://doi.org/10.20953/1817-7646-2023-2-123-128","url":null,"abstract":"Crohn's disease (granulomatous enteritis, granulomatous colitis, terminal ileitis) is a chronic relapsing disease characterized by transmural granulomatous inflammation with segmental lesions often of the small and large intestine. Eosinophilic colitis is a rare disease characterized by high level of eosinophilic infiltrate in the colon wall in patients with symptoms, more often manifested by abdominal pain or diarrhea. We face more often with the unique combination of these two diseases, characterized by different types of immunological reactions. We presented the clinical case of Crohn's disease and eosinophilic colitis in a 15-year-old boy. We face more often with the unique combination of these two pathological conditions, characterized by different types of immunological reactions, The article presents the clinical case of Crohn's disease and eosinophilic colitis in a 15-year-old boy. The aim of this clinical case is to increase the knowledge of practitioners about inflammatory bowel diseases, to point out possible combinations of different immunological inflammatory reactions in one patient, and the difficulties in diagnosing and managing this kind of patients. Key words: Crohn's disease, eosinophilic colitis, diagnosis, treatment, hormone-resistant form, targeted therapy, children","PeriodicalId":38157,"journal":{"name":"Voprosy Prakticheskoi Pediatrii","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67750709","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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