Pub Date : 2023-01-01DOI: 10.20953/1817-7646-2023-2-22-36
I. Tsulukiya, E. Alexeeva, T. Dvoryakovskaya, A. Fetisova, A. Anikin, A. M. Nesterov, E. Semikina, A. A. Zhuzhula, O. Lomakina, K. Isaeva, A.M. Сhomakhidze, C.V. Chibisova, I. Kriulin, E. Krekhova, M.S. Botova, N. Kondratyeva, M. Shingarova
Including the tumor necrosis factor TNF inhibitors (TNFi) in the management guidelines for children with juvenile non-systemic juvenile idiopathic arthritis (JIA) has significantly increased the effectiveness of antirheumatic treatment. However, the guidelines of TNFa withdrawal when disease remission is achieved remains unclear. Objective. To study the efficacy and safety of different TNFi withdrawal regimens in patients with juvenile idiopathic arthritis without systemic manifestations due to the achievement of long-term disease remission. Patients and methods: The prospective simple randomized trial included 76 patients with JIA without non-systemic juvenile idiopathic arthritis, with a disease remission duration of ≥24 months, developed under the conditions of treatment with TNFi. Of these, 38.2% are male, the average age is 11.6 years; 67 (88.2%) patients received etanercept (0.8 mg / kg / week. subcutaneously 1 time per week), the rest – adalimumab (24 mg/m2 subcutaneously 1 time in 2 weeks). Depending on the withdrawal regimen, patients were divided into three groups: in the I group, one-time withdrawa was presented, in the II group, the interval between administrations was of two times and the III group was reduced by a dose of two times. The main indicator of the study: preservation of the stage of inactive disease / remission (according to the criteria for remission of C. Wallace) for 6, 12 and 18 months after the withdrawal of TNFi. Results. At the time of withdrawal of TNFi, the average duration of the disease was 7.3 years, the duration of therapy with TNFa was 5 years, remission – was 4.4 years. For 6, 12 and 18 months after the withdrawal of TNFi, the stage of remission persisted in 44 (57.9%), 21 (27.6%) and 18 (23.7%) patients. Exacerbation of disease was registered in 58/76 (76%) patients. Biologic therapy was resumed in 56/58 children, in all cases the stage of inactive disease was reached. Among patients with exacerbation of JIA, 23/56 (41%) continued to receive disease-modifying antirheumatic drugs. Predictors of successful withdrawal of TNFa in patients with non-systemic JIA 6 and 12 months after discontinuation of the biological therapy were the female sex, the absence of HLA B27, antinuclear factor and long-term methotrexate therapy; predictors of exacerbation - increasing in the serum concentration of calprotectin (S-100 protein), the presence of subclinical synovitis according to ultrasound and MRI of the joints and uveitis. Conclusion. After the withdrawal of TNFi, the remission stage for 6 and 12 months persisted more than in half and one third of patients. The withdrawal regimens did not affect the duration of the remission of disease. The resumption of biological therapy in the exacerbation stage of JIA made it possible to reach the remission stage in most patients. Predictors of successful withdrawal of TNFi in patients with non-systemic JIA 6 and 12 months after discontinuation of the biological therapy were the fe
{"title":"Efficacy and safety of different withdrawal regimens for tumor necrosis factor (TNF)-alpha inhibitors in long-term remission of non-systemic juvenile idiopathic arthritis: results of the prospective simple randomized trial","authors":"I. Tsulukiya, E. Alexeeva, T. Dvoryakovskaya, A. Fetisova, A. Anikin, A. M. Nesterov, E. Semikina, A. A. Zhuzhula, O. Lomakina, K. Isaeva, A.M. Сhomakhidze, C.V. Chibisova, I. Kriulin, E. Krekhova, M.S. Botova, N. Kondratyeva, M. Shingarova","doi":"10.20953/1817-7646-2023-2-22-36","DOIUrl":"https://doi.org/10.20953/1817-7646-2023-2-22-36","url":null,"abstract":"Including the tumor necrosis factor TNF inhibitors (TNFi) in the management guidelines for children with juvenile non-systemic juvenile idiopathic arthritis (JIA) has significantly increased the effectiveness of antirheumatic treatment. However, the guidelines of TNFa withdrawal when disease remission is achieved remains unclear. Objective. To study the efficacy and safety of different TNFi withdrawal regimens in patients with juvenile idiopathic arthritis without systemic manifestations due to the achievement of long-term disease remission. Patients and methods: The prospective simple randomized trial included 76 patients with JIA without non-systemic juvenile idiopathic arthritis, with a disease remission duration of ≥24 months, developed under the conditions of treatment with TNFi. Of these, 38.2% are male, the average age is 11.6 years; 67 (88.2%) patients received etanercept (0.8 mg / kg / week. subcutaneously 1 time per week), the rest – adalimumab (24 mg/m2 subcutaneously 1 time in 2 weeks). Depending on the withdrawal regimen, patients were divided into three groups: in the I group, one-time withdrawa was presented, in the II group, the interval between administrations was of two times and the III group was reduced by a dose of two times. The main indicator of the study: preservation of the stage of inactive disease / remission (according to the criteria for remission of C. Wallace) for 6, 12 and 18 months after the withdrawal of TNFi. Results. At the time of withdrawal of TNFi, the average duration of the disease was 7.3 years, the duration of therapy with TNFa was 5 years, remission – was 4.4 years. For 6, 12 and 18 months after the withdrawal of TNFi, the stage of remission persisted in 44 (57.9%), 21 (27.6%) and 18 (23.7%) patients. Exacerbation of disease was registered in 58/76 (76%) patients. Biologic therapy was resumed in 56/58 children, in all cases the stage of inactive disease was reached. Among patients with exacerbation of JIA, 23/56 (41%) continued to receive disease-modifying antirheumatic drugs. Predictors of successful withdrawal of TNFa in patients with non-systemic JIA 6 and 12 months after discontinuation of the biological therapy were the female sex, the absence of HLA B27, antinuclear factor and long-term methotrexate therapy; predictors of exacerbation - increasing in the serum concentration of calprotectin (S-100 protein), the presence of subclinical synovitis according to ultrasound and MRI of the joints and uveitis. Conclusion. After the withdrawal of TNFi, the remission stage for 6 and 12 months persisted more than in half and one third of patients. The withdrawal regimens did not affect the duration of the remission of disease. The resumption of biological therapy in the exacerbation stage of JIA made it possible to reach the remission stage in most patients. Predictors of successful withdrawal of TNFi in patients with non-systemic JIA 6 and 12 months after discontinuation of the biological therapy were the fe","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":"67751634","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: 10.20953/1817-7646-2023-1-124-135
A. Khavkin, Stanislav Sitkin
The gut mycobiome comprises no more than 0.1% of its microbiota; however, it plays an important role in human health and disease. The balance of the mycobiome affects the stability of the microbiome, while the interaction between gut bacteria and fungi can be both beneficial and detrimental to the latter. The interaction between the mycobiome and the host is achieved through modulating the immune system and affecting the metabolism, which, in turn, can modulate the outcome of the disease. Fungal gut dysbiosis, for which we propose the term “dysmycobiosis”, is closely related not only to gastrointestinal disorders (such as inflammatory bowel diseases, irritable bowel syndrome, celiac disease, colorectal cancer, and pancreatic ductal adenocarcinoma), but also to various extraintestinal pathologies, including chronic liver disease, metabolic disorders, and neurological disorders. The investigation of the mechanisms underlying gut dysmycobiosis will promote the development of novel diagnostic and therapeutic targets for inflammatory and other human diseases. Gut mycobiome modulation is a promising therapeutic strategy encompassing dietary interventions, probiotics (both bacterial and fungal), and non-toxic metabolites. Key words: Candida albicans, gut mycobiome, dysmycobiosis, inflammatory bowel disease, fungal metabolites, probiotics, Saccharomyces boulardii, Saccharomyces cerevisiae
{"title":"Gut mycobiome and dysmycobiosis: clinical significance and therapeutic perspectives","authors":"A. Khavkin, Stanislav Sitkin","doi":"10.20953/1817-7646-2023-1-124-135","DOIUrl":"https://doi.org/10.20953/1817-7646-2023-1-124-135","url":null,"abstract":"The gut mycobiome comprises no more than 0.1% of its microbiota; however, it plays an important role in human health and disease. The balance of the mycobiome affects the stability of the microbiome, while the interaction between gut bacteria and fungi can be both beneficial and detrimental to the latter. The interaction between the mycobiome and the host is achieved through modulating the immune system and affecting the metabolism, which, in turn, can modulate the outcome of the disease. Fungal gut dysbiosis, for which we propose the term “dysmycobiosis”, is closely related not only to gastrointestinal disorders (such as inflammatory bowel diseases, irritable bowel syndrome, celiac disease, colorectal cancer, and pancreatic ductal adenocarcinoma), but also to various extraintestinal pathologies, including chronic liver disease, metabolic disorders, and neurological disorders. The investigation of the mechanisms underlying gut dysmycobiosis will promote the development of novel diagnostic and therapeutic targets for inflammatory and other human diseases. Gut mycobiome modulation is a promising therapeutic strategy encompassing dietary interventions, probiotics (both bacterial and fungal), and non-toxic metabolites. Key words: Candida albicans, gut mycobiome, dysmycobiosis, inflammatory bowel disease, fungal metabolites, probiotics, Saccharomyces boulardii, Saccharomyces cerevisiae","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":"67749684","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: 10.20953/1817-7646-2023-1-36-42
T. Maksimycheva, E. Kondratyeva
Nutritional status is associated to lung function and survival. Body mass index (BMI) is used to determine nutritional status, last studies of the body composition show that the most informative indicators correlated with lung function are data about body composition, the ratio of fat and fat-free body mass. In Russian Federation the body composition of children with cystic fibrosis is poorly studied. Objective. To assess the body composition before starting targeted therapy in children with cystic fibrosis Patients and methods. 103 children aged 5 to 17 years were examined. The median age of the children is 12 ± 5 years. Male – 47 (45.6%), female – 53 (53%). The children were divided into 3 groups: 1 group – BMI ≥50 percentile, 2 group – BMI <50 > 10 percentile, 3 group – BMI ≤10 percentile. In the studied groups were analysed: anthropometric indicators, nutritional status, bioelectrical impedance analysis (BIA), external respiration function. Cross-sectional study design. Conclusion. Patients with cystic fibrosis may have high risk of developing sarcopenia with normal level of BMI ( progressive and generalised skeletal muscle disorder involving the accelerated loss of muscle mass and function ). Measurement of body composition, including data of the lean body mass ratio, insufficiency of the protein in the diet and the entire energy metabolism, will improve the nutritional status of children, reduce the risk of respiratory and metabolic complications in patients with cystic fibrosis. Kewords: bioimpedance, body composition, children, cystic fibrosis, metabolism, fat-free body weight, body fat mass, body mass cell, phase angle
{"title":"Bioimpedance analysis (BIA) of body composition in patients with cystic fibrosis","authors":"T. Maksimycheva, E. Kondratyeva","doi":"10.20953/1817-7646-2023-1-36-42","DOIUrl":"https://doi.org/10.20953/1817-7646-2023-1-36-42","url":null,"abstract":"Nutritional status is associated to lung function and survival. Body mass index (BMI) is used to determine nutritional status, last studies of the body composition show that the most informative indicators correlated with lung function are data about body composition, the ratio of fat and fat-free body mass. In Russian Federation the body composition of children with cystic fibrosis is poorly studied. Objective. To assess the body composition before starting targeted therapy in children with cystic fibrosis Patients and methods. 103 children aged 5 to 17 years were examined. The median age of the children is 12 ± 5 years. Male – 47 (45.6%), female – 53 (53%). The children were divided into 3 groups: 1 group – BMI ≥50 percentile, 2 group – BMI <50 > 10 percentile, 3 group – BMI ≤10 percentile. In the studied groups were analysed: anthropometric indicators, nutritional status, bioelectrical impedance analysis (BIA), external respiration function. Cross-sectional study design. Conclusion. Patients with cystic fibrosis may have high risk of developing sarcopenia with normal level of BMI ( progressive and generalised skeletal muscle disorder involving the accelerated loss of muscle mass and function ). Measurement of body composition, including data of the lean body mass ratio, insufficiency of the protein in the diet and the entire energy metabolism, will improve the nutritional status of children, reduce the risk of respiratory and metabolic complications in patients with cystic fibrosis. Kewords: bioimpedance, body composition, children, cystic fibrosis, metabolism, fat-free body weight, body fat mass, body mass cell, phase angle","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":"67750295","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: 10.20953/1817-7646-2023-3-100-107
Post-COVID syndrome is "a post-COVID-19 condition that develops in people with a history of probable or confirmed infection with the SARS-CoV-2 virus, usually within 3 months of the onset of COVID-19 and characterized by the presence of symptoms for at least 2 months, as well as the inability to explain them with an alternative diagnosis, according to the WHO definition, Experts believe that about 20–50% of COVID-19 survivors have a Post-COVID Conditions (PCC) clinic. The reasons for the development of PCC are still not founded. Post-COVID syndrome may be associated with long-term persistence of SARSCoV-2, quantitative and qualitative changes in the microbiome/virome, autoimmune reactions, hypercoagulability, endothelial dysfunction, etc More data is accumulating regarding the reactivation of herpesviruses as one of the leading causes of RCC. Most often, the Epstein–Barr virus is considered as a "causal factor". Key words: herpesviruses, post-COVID, Post-COVID Conditions
{"title":"Reactivation of herpesviruses is one of the possible reasons of post-COVID-19","authors":"","doi":"10.20953/1817-7646-2023-3-100-107","DOIUrl":"https://doi.org/10.20953/1817-7646-2023-3-100-107","url":null,"abstract":"Post-COVID syndrome is \"a post-COVID-19 condition that develops in people with a history of probable or confirmed infection with the SARS-CoV-2 virus, usually within 3 months of the onset of COVID-19 and characterized by the presence of symptoms for at least 2 months, as well as the inability to explain them with an alternative diagnosis, according to the WHO definition, Experts believe that about 20–50% of COVID-19 survivors have a Post-COVID Conditions (PCC) clinic. The reasons for the development of PCC are still not founded. Post-COVID syndrome may be associated with long-term persistence of SARSCoV-2, quantitative and qualitative changes in the microbiome/virome, autoimmune reactions, hypercoagulability, endothelial dysfunction, etc More data is accumulating regarding the reactivation of herpesviruses as one of the leading causes of RCC. Most often, the Epstein–Barr virus is considered as a \"causal factor\". Key words: herpesviruses, post-COVID, Post-COVID Conditions","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":"67752442","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: 10.20953/1817-7646-2023-3-25-36
M.S. Botova, K. Isaeva, A. Chomakhidze, O. Lomakina, K. Chibisova, E. Alexeeva, T. Dvoryakovskaya, I. Kriulin, T. Kriulina, E. Krekhova, I. Tsulukiya, N. Kondratieva, A. Fetisova, M. Shingarova, Marta Kokina, A. Surkov, E. Chistyakova, D.A. Yureva, A.Yu. Krachkovskaya
Background. A register is a critical component of the healthcare system. It consists of the informational part (number of patients, spectrum and severity of pathology, dynamics of each patient's condition, administration of specific drugs, and therapeutic effects) and an analytical part (treatment efficacy, planning individual and regional needs for specific drugs and therapeutic effects, development and evaluation of management protocols, etc.). In Russia, despite the existence of the National Federal Register, the number of parameters collected is limited; the Register lacks information about the disease course, clinical characteristics of patients, outcomes, and treatment costs. Thus, the existing shortcomings of the Federal Registry do not allow us to address the problems related to the management of the healthcare quality for patients with systemic juvenile idiopathic arthritis (sJIA). Objective. To analyze geographical, demographic, and clinical characteristics of sJIA patients receiving biologicals, time to diagnosis, and time to admission to a Federal Center according to the Federal Register of the Russian Federation. Patients and methods. We conducted a retrospective study that included 927 sJIA patients receiving biologicals according to the Federal Register. Results. The majority of patients resided in the Central and Volga Federal Districts (221 (23.8%) and 206 (22.3%), respectively). Half of the patients (n = 472 (50.8%)) had their disease onset before the age of 5 years. The following symptoms were registered at disease onset: fever (n = 908 (98%)), rash (n = 748 (80.7%)), enlarged liver and/or spleen (n = 562 (60.6%)), and serositis (n = 198 (21.4%)). A total of 708 children (76.4%) had active arthritis at the moment of disease onset, whereas 130 patients developed arthritis later. Median time to the development of articular syndrome was 24 months. Median time between the disease onset and the diagnosis was 2.93 months. Median time between the first symptoms and admission to a Federal Center was 6.7 months. Conclusion. Analysis of data from the Federal Register of sJIA patients receiving biologicals demonstrated that sJIA in the Russian population is characterized by an acute and early onset with severe extra-articular manifestations, and articular syndrome. The diagnosis was usually verified and the patients were hospitalized to specialized rheumatology departments of Federal Centers within 5 months. Key words: Federal Register, systemic juvenile idiopathic arthritis, biological, disease course
{"title":"Characteristics of systemic juvenile idiopathic arthritis in patients receiving biologicals: the results of the analysis of the Federal Russian Register","authors":"M.S. Botova, K. Isaeva, A. Chomakhidze, O. Lomakina, K. Chibisova, E. Alexeeva, T. Dvoryakovskaya, I. Kriulin, T. Kriulina, E. Krekhova, I. Tsulukiya, N. Kondratieva, A. Fetisova, M. Shingarova, Marta Kokina, A. Surkov, E. Chistyakova, D.A. Yureva, A.Yu. Krachkovskaya","doi":"10.20953/1817-7646-2023-3-25-36","DOIUrl":"https://doi.org/10.20953/1817-7646-2023-3-25-36","url":null,"abstract":"Background. A register is a critical component of the healthcare system. It consists of the informational part (number of patients, spectrum and severity of pathology, dynamics of each patient's condition, administration of specific drugs, and therapeutic effects) and an analytical part (treatment efficacy, planning individual and regional needs for specific drugs and therapeutic effects, development and evaluation of management protocols, etc.). In Russia, despite the existence of the National Federal Register, the number of parameters collected is limited; the Register lacks information about the disease course, clinical characteristics of patients, outcomes, and treatment costs. Thus, the existing shortcomings of the Federal Registry do not allow us to address the problems related to the management of the healthcare quality for patients with systemic juvenile idiopathic arthritis (sJIA). Objective. To analyze geographical, demographic, and clinical characteristics of sJIA patients receiving biologicals, time to diagnosis, and time to admission to a Federal Center according to the Federal Register of the Russian Federation. Patients and methods. We conducted a retrospective study that included 927 sJIA patients receiving biologicals according to the Federal Register. Results. The majority of patients resided in the Central and Volga Federal Districts (221 (23.8%) and 206 (22.3%), respectively). Half of the patients (n = 472 (50.8%)) had their disease onset before the age of 5 years. The following symptoms were registered at disease onset: fever (n = 908 (98%)), rash (n = 748 (80.7%)), enlarged liver and/or spleen (n = 562 (60.6%)), and serositis (n = 198 (21.4%)). A total of 708 children (76.4%) had active arthritis at the moment of disease onset, whereas 130 patients developed arthritis later. Median time to the development of articular syndrome was 24 months. Median time between the disease onset and the diagnosis was 2.93 months. Median time between the first symptoms and admission to a Federal Center was 6.7 months. Conclusion. Analysis of data from the Federal Register of sJIA patients receiving biologicals demonstrated that sJIA in the Russian population is characterized by an acute and early onset with severe extra-articular manifestations, and articular syndrome. The diagnosis was usually verified and the patients were hospitalized to specialized rheumatology departments of Federal Centers within 5 months. Key words: Federal Register, systemic juvenile idiopathic arthritis, biological, disease course","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":"67753364","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: 10.20953/1817-7646-2023-1-8-15
O. N. Solodovnikova, A. Dyagileva, A. A. Erovichenkov, D. V. Troshansky, O. Gosteva, A. Nurpeisova, Y. Khlypovka, А. Tsygankov, А.К. Shakaryan, N.S. Ipatov, I. N. Tyurin, D. Protsenko
In recent years, healthcare professionals are actively developing new systemic approaches to monitor vital signs at the bedside of a sick child by a nurse. One of these approaches is the Pediatric Early Warning Systems (PEWS). Objective. To standardize approaches to early detection of risks and timely prevention of clinical deterioration in children treated in hospitals for infectious diseases using the PEWS scale. Patients and methods. This study was conducted between September 28 and October 29, 2021 in the Pediatric Department for Infectious Diseases, Central Clinical Hospital No 40 and included 749 patients aged from 1 month to 19 years. The majority of patients were under 6 years of age. MS Excel 2021 was used for statistical analysis. Fisher's exact test with Yate's correction was used to identify significant changes. Results. As many as 352 patients (47.0 ± 1.8%) had no risk for poor prognosis (PEWS 0). We found no significant differences between the groups of children studied (acute upper respiratory infection, unspecified, n = 412; other and unspecified gastroenteritis and colitis of infectious origin, n = 233) in the frequency of PEWS scores. Thirteen out of 25 patients with PEWS ≥5 were admitted to the intensive care unit, whereas the remaining 12 patients received timely adequate care in specialized departments. Conclusion. Our first experience with the PEWS scale allows us to recommend it for pediatric hospitals. The PEWS scale is aimed at early detection of clinical signs associated with a risk of possibly deterioration in children treated in the departments of infectious diseases and helps to identify patients that require more extensive examination and treatment. Key words: children, infection, monitoring, risks, condition, scale, deterioration
{"title":"Standardization of approaches to early detection of risks for clinical deterioration in children treated in hospitals for infectious diseases","authors":"O. N. Solodovnikova, A. Dyagileva, A. A. Erovichenkov, D. V. Troshansky, O. Gosteva, A. Nurpeisova, Y. Khlypovka, А. Tsygankov, А.К. Shakaryan, N.S. Ipatov, I. N. Tyurin, D. Protsenko","doi":"10.20953/1817-7646-2023-1-8-15","DOIUrl":"https://doi.org/10.20953/1817-7646-2023-1-8-15","url":null,"abstract":"In recent years, healthcare professionals are actively developing new systemic approaches to monitor vital signs at the bedside of a sick child by a nurse. One of these approaches is the Pediatric Early Warning Systems (PEWS). Objective. To standardize approaches to early detection of risks and timely prevention of clinical deterioration in children treated in hospitals for infectious diseases using the PEWS scale. Patients and methods. This study was conducted between September 28 and October 29, 2021 in the Pediatric Department for Infectious Diseases, Central Clinical Hospital No 40 and included 749 patients aged from 1 month to 19 years. The majority of patients were under 6 years of age. MS Excel 2021 was used for statistical analysis. Fisher's exact test with Yate's correction was used to identify significant changes. Results. As many as 352 patients (47.0 ± 1.8%) had no risk for poor prognosis (PEWS 0). We found no significant differences between the groups of children studied (acute upper respiratory infection, unspecified, n = 412; other and unspecified gastroenteritis and colitis of infectious origin, n = 233) in the frequency of PEWS scores. Thirteen out of 25 patients with PEWS ≥5 were admitted to the intensive care unit, whereas the remaining 12 patients received timely adequate care in specialized departments. Conclusion. Our first experience with the PEWS scale allows us to recommend it for pediatric hospitals. The PEWS scale is aimed at early detection of clinical signs associated with a risk of possibly deterioration in children treated in the departments of infectious diseases and helps to identify patients that require more extensive examination and treatment. Key words: children, infection, monitoring, risks, condition, scale, deterioration","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":"67750781","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: 10.20953/1817-7646-2023-3-122-126
A. Vitebskaya, N. V. Frolkova, N. Kolosova, E. Frolkova
The administration of inhaled corticosteroids (ICS) might cause dose-dependent hyperglycemia and poorer glycemic control in patients with earlier diagnosed carbohydrate metabolism disorders. However, not in all patients, ICS affects glycated hemoglobin, the main marker of diabetes mellitus. Objective: to assess the effect of ICS on the glycemic profile of patients with type 1 diabetes mellitus (DM1). We demonstrated how ICS can affect the glycemic profile in DM1 patients on the example of two cases. ICS can cause short-term increase in blood glucose in some DM1 patients, comparable to postprandial levels; however, ICS does not compromise glycemic control. Nevertheless, such cases have to be managed by a pulmonologist and a pediatric endocrinologist for individual correction of therapy. Key words: type 1 diabetes mellitus, children, inhaled corticosteroids, bronchial obstruction, carbohydrate metabolism, glycemic profile
{"title":"Effect of inhaled corticosteroids on the glycemic profile in patients with type 1 diabetes mellitus","authors":"A. Vitebskaya, N. V. Frolkova, N. Kolosova, E. Frolkova","doi":"10.20953/1817-7646-2023-3-122-126","DOIUrl":"https://doi.org/10.20953/1817-7646-2023-3-122-126","url":null,"abstract":"The administration of inhaled corticosteroids (ICS) might cause dose-dependent hyperglycemia and poorer glycemic control in patients with earlier diagnosed carbohydrate metabolism disorders. However, not in all patients, ICS affects glycated hemoglobin, the main marker of diabetes mellitus. Objective: to assess the effect of ICS on the glycemic profile of patients with type 1 diabetes mellitus (DM1). We demonstrated how ICS can affect the glycemic profile in DM1 patients on the example of two cases. ICS can cause short-term increase in blood glucose in some DM1 patients, comparable to postprandial levels; however, ICS does not compromise glycemic control. Nevertheless, such cases have to be managed by a pulmonologist and a pediatric endocrinologist for individual correction of therapy. Key words: type 1 diabetes mellitus, children, inhaled corticosteroids, bronchial obstruction, carbohydrate metabolism, glycemic profile","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":"67752479","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: 10.20953/1817-7646-2023-1-161-162
E. Skripchenko, E. Egorova, N. Skripchenko, A. Vilnitz, N. V. Marchenko, N. F. Pulman, I. Petrov, T. Koslova
The XXI century is a century of viral infections, but bacterial infections are still important in the development of infectious pathology. The clinical case reflects the features of neuroinfections in children with chronic Herpes virus and streptococcal infections. The disease progression is described in a child with an unfavorable premorbid background and the causes are discussed. The role of streptococcal infections is presented: chronic course and development of poststreptococcal disorders are typical. It is possible a reactivation of varicella zoster virus in children who had chickenpox, which can contribute the progression of nervous system disorder. Therapy includes antiviral and antibacterial medicines and Cytoflavin – a medicament with a complex mechanism of pathogenetic action, which achieves a successful outcome with the recovery of patient with acute disseminated meningoencephalitis. Key words: meningoencephalitis, streptococcus, Herpes viruses, children, Cytoflavin
{"title":"Acute disseminated meningoencephalitis associated with chronic streptococcal infection","authors":"E. Skripchenko, E. Egorova, N. Skripchenko, A. Vilnitz, N. V. Marchenko, N. F. Pulman, I. Petrov, T. Koslova","doi":"10.20953/1817-7646-2023-1-161-162","DOIUrl":"https://doi.org/10.20953/1817-7646-2023-1-161-162","url":null,"abstract":"The XXI century is a century of viral infections, but bacterial infections are still important in the development of infectious pathology. The clinical case reflects the features of neuroinfections in children with chronic Herpes virus and streptococcal infections. The disease progression is described in a child with an unfavorable premorbid background and the causes are discussed. The role of streptococcal infections is presented: chronic course and development of poststreptococcal disorders are typical. It is possible a reactivation of varicella zoster virus in children who had chickenpox, which can contribute the progression of nervous system disorder. Therapy includes antiviral and antibacterial medicines and Cytoflavin – a medicament with a complex mechanism of pathogenetic action, which achieves a successful outcome with the recovery of patient with acute disseminated meningoencephalitis. Key words: meningoencephalitis, streptococcus, Herpes viruses, children, Cytoflavin","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":"67749528","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: 10.20953/1817-7646-2023-1-72-79
A. Khavkin, A. Zavyalova, V. Novikova, E. Yablokova, I.Yu. Churakovа, M. Yakovleva, M. I. Erokhina, E. V. Chibrina, E. Lisovskaya
Objective. Any severe chronic disease affects the physical development and nutritional status of the child. In Crohn's disease, this effect is complex, because. the gastrointestinal tract is involved in the pathological process, the absorption of nutrients is impaired, and more often the losses exceed the intake of basic nutrients and energy. Patients and methods. In a single-center observational study in the gastroenterology department of a multidisciplinary pediatric hospital, anthropometry data were evaluated in 94 patients (44.7% boys, 55.3% girls) aged 3 to 17 years (mean age 7 years) with a verified diagnosis of Crohn's disease, receiving treatment. Children are divided into age groups according to the WHO classification. Assessment of physical development (height, weight, BMI) was carried out according to the WHO Anthro and WHO AnthroPlus programs. Statistical processing of the material was carried out using the IBM Stata 12 application software package. The hypothesis of normal distribution was tested using the Shapiro–Wilk and Kolmogorov–Smirnov tests. In order to detect differences between the samples, the Kruskall–Wallis test was used; for a posterior comparisons, the Bonferroni correction was used. Results. Most often, children with this diagnosis seek specialized medical care in the period of second childhood (n = 25), adolescence (n = 44) and late adolescence (n = 17). There is a shift in the Z-score of growth to the zone of low values in the groups of the first and second childhood. Among patients of adolescence and youth, there are children with medium and high growth. Body weight deficiency was found in children of the first and second childhood. Deficient BMI is more common in children of adolescence and youth, at the same time, obesity occurs among these patients, but much less frequently than in the general population. Key words: BMI, сhildren, Crohn's disease, physical development
目标。任何严重的慢性疾病都会影响儿童的身体发育和营养状况。在克罗恩病中，这种影响很复杂，因为。胃肠道参与病理过程，营养物质的吸收受损，更多时候损失超过基本营养物质和能量的摄入。患者和方法。在一所多学科儿科医院消化科进行的一项单中心观察研究中，对94名年龄在3至17岁(平均年龄7岁)确诊为克罗恩病并接受治疗的患者(44.7%为男孩，55.3%为女孩)的人体测量数据进行了评估。根据世界卫生组织的分类，儿童被分为不同的年龄组。身体发育评估(身高、体重、BMI)根据WHO anthroo和WHO AnthroPlus规划进行。采用IBM Stata 12应用软件包对材料进行统计处理。采用Shapiro-Wilk检验和Kolmogorov-Smirnov检验对正态分布假设进行检验。为了检测样本之间的差异，使用了Kruskall-Wallis检验;后验比较采用Bonferroni校正。结果。通常，患有这种诊断的儿童在第二童年时期(25人)、青春期(44人)和青春期晚期(17人)寻求专门的医疗护理。在第一和第二童年组中，生长的z分数向低值区域转移。在青少年患者中，有中高生长的儿童。体重不足在第一和第二童年的儿童中被发现。BMI不足在青少年和青年儿童中更为常见，同时，肥胖也发生在这些患者中，但比一般人群少得多。关键词:BMI;儿童;克罗恩病
{"title":"Features of physical development and nutritional status of children with Crohn disease","authors":"A. Khavkin, A. Zavyalova, V. Novikova, E. Yablokova, I.Yu. Churakovа, M. Yakovleva, M. I. Erokhina, E. V. Chibrina, E. Lisovskaya","doi":"10.20953/1817-7646-2023-1-72-79","DOIUrl":"https://doi.org/10.20953/1817-7646-2023-1-72-79","url":null,"abstract":"Objective. Any severe chronic disease affects the physical development and nutritional status of the child. In Crohn's disease, this effect is complex, because. the gastrointestinal tract is involved in the pathological process, the absorption of nutrients is impaired, and more often the losses exceed the intake of basic nutrients and energy. Patients and methods. In a single-center observational study in the gastroenterology department of a multidisciplinary pediatric hospital, anthropometry data were evaluated in 94 patients (44.7% boys, 55.3% girls) aged 3 to 17 years (mean age 7 years) with a verified diagnosis of Crohn's disease, receiving treatment. Children are divided into age groups according to the WHO classification. Assessment of physical development (height, weight, BMI) was carried out according to the WHO Anthro and WHO AnthroPlus programs. Statistical processing of the material was carried out using the IBM Stata 12 application software package. The hypothesis of normal distribution was tested using the Shapiro–Wilk and Kolmogorov–Smirnov tests. In order to detect differences between the samples, the Kruskall–Wallis test was used; for a posterior comparisons, the Bonferroni correction was used. Results. Most often, children with this diagnosis seek specialized medical care in the period of second childhood (n = 25), adolescence (n = 44) and late adolescence (n = 17). There is a shift in the Z-score of growth to the zone of low values in the groups of the first and second childhood. Among patients of adolescence and youth, there are children with medium and high growth. Body weight deficiency was found in children of the first and second childhood. Deficient BMI is more common in children of adolescence and youth, at the same time, obesity occurs among these patients, but much less frequently than in the general population. Key words: BMI, сhildren, Crohn's disease, physical development","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":"67750033","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: 10.20953/1817-7646-2023-2-83-90
S. Belmer
Acute intestinal infections (AIIs) have always been a significant problem in all age groups, particularly in children under 5 years of age. AIIs are characterized by high incidence and can result in severe or even life-threatening dehydration. Therefore, rehydration is the first and compulsory component of the treatment in these patients. In addition to oral rehydration, probiotics are crucial for AII treatment. Probiotics are live microorganisms that can improve the health of the host when prescribed in adequate doses. Multiple microorganisms with probiotic activity have been isolated so far. Saccharomyces boulardii, a probiotic yeast, has a special place among all probiotics. One of its strains, S. boulardii CNCM I-745, has demonstrated its high probiotic activity and safety in numerous randomized clinical trials and confirmed by meta-analyses. In particular, in a randomized controlled trial SABINA conducted in Argentina, S. boulardii CNCM I-745 showed higher efficacy than Bacillus clausii in reducing the duration of acute diarrhea in children. In 2023, the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) provided updated recommendations for the use of probiotics for the management of AIIs. Among other things, it states that S. boulardii CNCM I-745 can be recommended for the management of acute gastroenteritis in children, since there is evidence of reduced duration of diarrhea. Thus, isolation of S. boulardii CNCM I-745 provided new treatment options for a wide range of diseases, including AIIs. Key words: acute intestinal infections, acute gastroenteritis, acute enteritis, probiotics, S.boulardii CNCM I-745, treatment, children, recommendations, Enterol
{"title":"Saccharomyces boulardii CNCM I-745 and acute intestinal infections: new data and an old problem","authors":"S. Belmer","doi":"10.20953/1817-7646-2023-2-83-90","DOIUrl":"https://doi.org/10.20953/1817-7646-2023-2-83-90","url":null,"abstract":"Acute intestinal infections (AIIs) have always been a significant problem in all age groups, particularly in children under 5 years of age. AIIs are characterized by high incidence and can result in severe or even life-threatening dehydration. Therefore, rehydration is the first and compulsory component of the treatment in these patients. In addition to oral rehydration, probiotics are crucial for AII treatment. Probiotics are live microorganisms that can improve the health of the host when prescribed in adequate doses. Multiple microorganisms with probiotic activity have been isolated so far. Saccharomyces boulardii, a probiotic yeast, has a special place among all probiotics. One of its strains, S. boulardii CNCM I-745, has demonstrated its high probiotic activity and safety in numerous randomized clinical trials and confirmed by meta-analyses. In particular, in a randomized controlled trial SABINA conducted in Argentina, S. boulardii CNCM I-745 showed higher efficacy than Bacillus clausii in reducing the duration of acute diarrhea in children. In 2023, the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) provided updated recommendations for the use of probiotics for the management of AIIs. Among other things, it states that S. boulardii CNCM I-745 can be recommended for the management of acute gastroenteritis in children, since there is evidence of reduced duration of diarrhea. Thus, isolation of S. boulardii CNCM I-745 provided new treatment options for a wide range of diseases, including AIIs. Key words: acute intestinal infections, acute gastroenteritis, acute enteritis, probiotics, S.boulardii CNCM I-745, treatment, children, recommendations, Enterol","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":"67752408","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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