Pub Date : 2023-08-10DOI: 10.24110/0031-403x-2023-102-4-40-45
P. Ananin, A. Milovanova, T. Vashurina, O. Zrobok, E. S. Stoliarevich, K. Kulikov, A. Tsygin
It is believed that IgA nephropathy (IgAN) in childhood is predominantly manifested by hematuria with episodes of macrohematuria and has a relatively favorable course. The purpose of this research was to analyze the frequency of the use of mycophenolate mofetil (MMF) in children with IgAN in the Nephrology Department of the National Medical Research Center for Children’s Health (Moscow, Russia) and to evaluate the results of treatment in terms of the severity of proteinuria and the presence of a decrease in renal function by glomerular filtration. Materials and methods used: to assess the clinical course, histological features and kidney function during therapy, Authors analyzed the results of 737 biopsies performed in 2018-2022. Results: 126 biopsy specimens with predominant IgA deposition and mesangial proliferation and/or crescents were identified, 20 of them were excluded from further analysis due to the clinical picture of IgA vasculitis. 17 (16% of the remaining 106) patients had nephrotic-level of proteinuria prior to the biopsy, 11 had a history of acute kidney injury and 9 had a persistent decrease in glomerular filtration renal function. Steroid therapy with prednisolone at a dose of 0.5 to 1 mg/kg was carried out in 21 children, 14 (66.7%; CI 45.4-84.1%) of them had relapse or resistance. MMF therapy was started in 16 (11 boys and 5 girls) patients, median age of the therapy initiation was 13.4 [7.9; 15.3] y/o, 6 had a decrease in glomerular filtration rate (GFR) in the range of 64 to 85 ml/min. Kidney biopsy specimens were ere scored according to the Oxford classification MEST-C criteria. During the follow-up period (median 27.6 [20.0; 49.4] months), 14 (88% CI; 66-98) of 16 achieved complete (10) or partial remission, 2 patients had proteinuria of more than 1 g/l. Of 56 patients (median age 13.3 [9.6; 14.9] months) with a follow-up period of more than 6 months, a decrease in GFR was recorded in 5 (31.3%; CI 12.5-55.5) patients on MMF therapy and 4 (22.2%; CI 7.5-44.3) patients who received only a course of steroids and a single one (4.5%; CI 0.3-18.5) who received ACE inhibitor only. Analysis of biopsy results showed an increased risk of reduced GFR in patients with tubular atrophy. Conclusion: MMF therapy may have limited efficacy for proteinuria in IgAN though it does not prevent the GFR decline.
{"title":"IgA NEPHROPATHY IN CHILDREN AND THE LIMITED OPTIONS FOR THE IMMUNOSUPPRESSIVE THERAPY","authors":"P. Ananin, A. Milovanova, T. Vashurina, O. Zrobok, E. S. Stoliarevich, K. Kulikov, A. Tsygin","doi":"10.24110/0031-403x-2023-102-4-40-45","DOIUrl":"https://doi.org/10.24110/0031-403x-2023-102-4-40-45","url":null,"abstract":"It is believed that IgA nephropathy (IgAN) in childhood is predominantly manifested by hematuria with episodes of macrohematuria and has a relatively favorable course. The purpose of this research was to analyze the frequency of the use of mycophenolate mofetil (MMF) in children with IgAN in the Nephrology Department of the National Medical Research Center for Children’s Health (Moscow, Russia) and to evaluate the results of treatment in terms of the severity of proteinuria and the presence of a decrease in renal function by glomerular filtration. Materials and methods used: to assess the clinical course, histological features and kidney function during therapy, Authors analyzed the results of 737 biopsies performed in 2018-2022. Results: 126 biopsy specimens with predominant IgA deposition and mesangial proliferation and/or crescents were identified, 20 of them were excluded from further analysis due to the clinical picture of IgA vasculitis. 17 (16% of the remaining 106) patients had nephrotic-level of proteinuria prior to the biopsy, 11 had a history of acute kidney injury and 9 had a persistent decrease in glomerular filtration renal function. Steroid therapy with prednisolone at a dose of 0.5 to 1 mg/kg was carried out in 21 children, 14 (66.7%; CI 45.4-84.1%) of them had relapse or resistance. MMF therapy was started in 16 (11 boys and 5 girls) patients, median age of the therapy initiation was 13.4 [7.9; 15.3] y/o, 6 had a decrease in glomerular filtration rate (GFR) in the range of 64 to 85 ml/min. Kidney biopsy specimens were ere scored according to the Oxford classification MEST-C criteria. During the follow-up period (median 27.6 [20.0; 49.4] months), 14 (88% CI; 66-98) of 16 achieved complete (10) or partial remission, 2 patients had proteinuria of more than 1 g/l. Of 56 patients (median age 13.3 [9.6; 14.9] months) with a follow-up period of more than 6 months, a decrease in GFR was recorded in 5 (31.3%; CI 12.5-55.5) patients on MMF therapy and 4 (22.2%; CI 7.5-44.3) patients who received only a course of steroids and a single one (4.5%; CI 0.3-18.5) who received ACE inhibitor only. Analysis of biopsy results showed an increased risk of reduced GFR in patients with tubular atrophy. Conclusion: MMF therapy may have limited efficacy for proteinuria in IgAN though it does not prevent the GFR decline.","PeriodicalId":39654,"journal":{"name":"Pediatriya - Zhurnal im G.N. Speranskogo","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73514687","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 : 2023-08-10DOI: 10.24110/0031-403x-2023-102-4-198-203
Y. Kozlov, S. Poloyan, A. A. Marchuk, A. Rozhanski, A. A. Byrgazov, K. Kovalkov, V. Kapuller, A. Narkevich, S.A. Muravjev
This research represents a new technique for assessing ureteral patency in a patient with renovascular hydronephrosis using the ICG navigation. Materials and methods used: a clinical case of successful treatment of obstruction of pyeloureteral junction of the left kidney caused by aberrant lower pole vessels using laparoscopic hitching performed under fluoroscopic control. The surgical intervention was performed with the use of Rubina® NIR/ICG telescopes with HOPKINS® rod lens system by KARL STORZ, Germany. The Rubina components offer various visualization modes for the ICG-NIRF signal. Depending on the preferences of the surgeon and the application of the ICG-NIRF, the data can be displayed in different modes: image overlay mode, monochrome mode, color mapping mode. After confirmation of ureteral patency using ICG imaging, a laparoscopic hitching was performed. Results: the use of ICG visualization was very helpful in identifying the ureter that stained intensely after indocyanine green injection into the lumen of the pelvis with a ureteral catheter. This test confirmed the absence of an internal type of obstruction of pyeloureteral junction and made it possible to opt for hitching. In the ICG-NIRF data overlay mode, the ureter was stained in intense green. When the monochrome mode was used, the upper third of the ureter was stained intensely white. Finally, the ICG-NIRF signal intensity mapping mode of the proximal ureter turned green-blue. The next day after the vascular hitching, a control ultrasound examination of the kidney was performed with the measurement of the anteroposterior diameter of the pelvis, which demonstrated a decrease in the size of the pelvis to 20 mm. A follow-up study performed six months after the surgical intervention showed further decrease in the anteroposterior diameter of the pelvis to 8 mm. Conclusion: thus, ICG navigation is a promising method for minimally invasive evaluation of pyeloureteral junction patency in patients with vasorenal hydronephrosis.
{"title":"ICG NAVIGATION IN THE TREATMENT OF HYDRONEPHROSIS CAUSED BY ABERRANT LOWER POLAR RENAL VESSELS IN A 5-YEAR-OLD BOY: A CLINICAL CASE","authors":"Y. Kozlov, S. Poloyan, A. A. Marchuk, A. Rozhanski, A. A. Byrgazov, K. Kovalkov, V. Kapuller, A. Narkevich, S.A. Muravjev","doi":"10.24110/0031-403x-2023-102-4-198-203","DOIUrl":"https://doi.org/10.24110/0031-403x-2023-102-4-198-203","url":null,"abstract":"This research represents a new technique for assessing ureteral patency in a patient with renovascular hydronephrosis using the ICG navigation. Materials and methods used: a clinical case of successful treatment of obstruction of pyeloureteral junction of the left kidney caused by aberrant lower pole vessels using laparoscopic hitching performed under fluoroscopic control. The surgical intervention was performed with the use of Rubina® NIR/ICG telescopes with HOPKINS® rod lens system by KARL STORZ, Germany. The Rubina components offer various visualization modes for the ICG-NIRF signal. Depending on the preferences of the surgeon and the application of the ICG-NIRF, the data can be displayed in different modes: image overlay mode, monochrome mode, color mapping mode. After confirmation of ureteral patency using ICG imaging, a laparoscopic hitching was performed. Results: the use of ICG visualization was very helpful in identifying the ureter that stained intensely after indocyanine green injection into the lumen of the pelvis with a ureteral catheter. This test confirmed the absence of an internal type of obstruction of pyeloureteral junction and made it possible to opt for hitching. In the ICG-NIRF data overlay mode, the ureter was stained in intense green. When the monochrome mode was used, the upper third of the ureter was stained intensely white. Finally, the ICG-NIRF signal intensity mapping mode of the proximal ureter turned green-blue. The next day after the vascular hitching, a control ultrasound examination of the kidney was performed with the measurement of the anteroposterior diameter of the pelvis, which demonstrated a decrease in the size of the pelvis to 20 mm. A follow-up study performed six months after the surgical intervention showed further decrease in the anteroposterior diameter of the pelvis to 8 mm. Conclusion: thus, ICG navigation is a promising method for minimally invasive evaluation of pyeloureteral junction patency in patients with vasorenal hydronephrosis.","PeriodicalId":39654,"journal":{"name":"Pediatriya - Zhurnal im G.N. Speranskogo","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75379347","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 : 2023-08-10DOI: 10.24110/0031-403x-2023-102-4-140-146
N. Bolotova, K. Cherednikova, N. Filina, L. Garifulina, O. Logacheva
Bibliographical review representing the modern approach to the features of the taxonomic composition of the microbiota of the gastrointestinal tract as the largest microbiome of the human body. Modern views on the relationship in the “intestine-microbiota-brain” system are given. The main theories concerning the relationship and the role of macro- and microorganisms in the formation of metabolic disorders, in particular, in the pathogenesis of obesity, are considered as well.
{"title":"MODERN VIEW ON THE ROLE OF THE INTESTINAL MICROBIOTA IN THE DEVELOPMENT OF METABOLIC DISORDERS","authors":"N. Bolotova, K. Cherednikova, N. Filina, L. Garifulina, O. Logacheva","doi":"10.24110/0031-403x-2023-102-4-140-146","DOIUrl":"https://doi.org/10.24110/0031-403x-2023-102-4-140-146","url":null,"abstract":"Bibliographical review representing the modern approach to the features of the taxonomic composition of the microbiota of the gastrointestinal tract as the largest microbiome of the human body. Modern views on the relationship in the “intestine-microbiota-brain” system are given. The main theories concerning the relationship and the role of macro- and microorganisms in the formation of metabolic disorders, in particular, in the pathogenesis of obesity, are considered as well.","PeriodicalId":39654,"journal":{"name":"Pediatriya - Zhurnal im G.N. Speranskogo","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81714178","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 : 2023-08-10DOI: 10.24110/0031-403x-2023-102-4-28-39
E. N. Kulakova, A. Savchenko, T. L. Nastausheva, L. Stahurlova, T. G. Zvyagina, A.Yu. Mokrousova, E.M. Kovalik, Yu.V. Khoroshilova, D.O. Rudneva
Transition of adolescents with kidney diseases from pediatric into adult healthcare system is usually accompanied by clinical, social and psychological problems that are often caused by a patient’s unreadiness. The development of programs intent for the transition preparation requires studying of the peculiarities of the healthcare system resources use by adolescents aged 15 to 17 years old. The purpose of this research was to determine the hospitalisation rate in the nephrology care unit, the nosological structure of diagnosed diseases and the demographic features of hospitalised adolescents aged 15 to 17 y/o. Methods used: a single-centre cross-sectional descriptive study based on a 10-year database of the Nephrology Care Unit named after V.P. Sitnikova of the Voronezh Oblast Regional Children’s Clinical Hospital No. 1 (Voronezh, Russia). Results: 14522 admissions, 24.6% (n=3574) of which were adolescents aged 15 to 17 y/o were analysed: 55.4% (n=1981) boys/44.6% (n=1593) girls. The median hospitalisation rate for patients aged 15 to 17 y/o per 100000 of the corresponding population within the 10-year period was 609.7 in boys and 537.4 in girls. The diagnosis from N10 to N16 ICD-10 code blocks was mainly registered in adolescents of this age group (50% in girls (95% CI 47.5%-52.4%) and 38.2% in boys (95% CI 36.0%-40.3%)). Statistically significant differences in the nosological structure of the diseases between girls and boys were found (p<0.001). The analysed 10-year period was characterised by a positive trend in the registration of the main diagnosis in adolescents from the N17 to N19 ICD-10 code blocks (р=0,023). The average age of the last hospital admission among the patients who completed follow-up in the paediatric nephrology service was 15 [13-17] y/o, of which 26.9% of adolescents were hospitalised at the age of 17 y/o. Conclusion: primary data were obtained to develop a system for preparing adolescents for their transition from paediatric into adult healthcare systems.
患有肾脏疾病的青少年从儿科过渡到成人医疗保健系统通常伴随着临床、社会和心理问题，这些问题往往是由患者的不准备引起的。为过渡准备计划的发展意图需要研究15至17岁青少年使用医疗保健系统资源的特点。本研究的目的是确定肾脏科护理部门的住院率、诊断疾病的分类学结构以及15至17岁住院青少年的人口统计学特征。使用的方法:基于沃罗涅日州第一地区儿童临床医院(沃罗涅日，俄罗斯)以V.P. Sitnikova命名的肾病科护理单位10年数据库的单中心横断面描述性研究。结果:14522例入院患者中，15 ~ 17岁青少年占24.6% (n=3574)，其中男孩占55.4% (n=1981)，女孩占44.6% (n=1593)。在这10年期间，相应人口中15至17岁患者每10万人的住院率中位数为男孩609.7人，女孩537.4人。ICD-10代码块N10至N16的诊断主要记录在该年龄组的青少年中(女孩占50% (95% CI 47.5%-52.4%)，男孩占38.2% (95% CI 36.0%-40.3%))。男孩和女孩的疾病分类学结构差异有统计学意义(p<0.001)。所分析的10年期间的特点是，从N17到N19 ICD-10代码块中，青少年的主要诊断登记呈积极趋势(χ = 0.023)。在儿科肾脏科完成随访的患者中，最后一次住院的平均年龄为15岁[13-17岁]，其中26.9%的青少年在17岁时住院。结论:获得了初步数据，以开发一个系统，为青少年从儿科过渡到成人医疗保健系统做准备。
{"title":"ADOLESCENTS WITH URINARY SYSTEM DISEASES IN THEIR FINAL STAGE OF PEDIATRIC NEPHROLOGY CARE: A CROSS-SECTIONAL STUDY BASED ON A REGIONAL HOSPITAL’S 10-YEAR DATABASE","authors":"E. N. Kulakova, A. Savchenko, T. L. Nastausheva, L. Stahurlova, T. G. Zvyagina, A.Yu. Mokrousova, E.M. Kovalik, Yu.V. Khoroshilova, D.O. Rudneva","doi":"10.24110/0031-403x-2023-102-4-28-39","DOIUrl":"https://doi.org/10.24110/0031-403x-2023-102-4-28-39","url":null,"abstract":"Transition of adolescents with kidney diseases from pediatric into adult healthcare system is usually accompanied by clinical, social and psychological problems that are often caused by a patient’s unreadiness. The development of programs intent for the transition preparation requires studying of the peculiarities of the healthcare system resources use by adolescents aged 15 to 17 years old. The purpose of this research was to determine the hospitalisation rate in the nephrology care unit, the nosological structure of diagnosed diseases and the demographic features of hospitalised adolescents aged 15 to 17 y/o. Methods used: a single-centre cross-sectional descriptive study based on a 10-year database of the Nephrology Care Unit named after V.P. Sitnikova of the Voronezh Oblast Regional Children’s Clinical Hospital No. 1 (Voronezh, Russia). Results: 14522 admissions, 24.6% (n=3574) of which were adolescents aged 15 to 17 y/o were analysed: 55.4% (n=1981) boys/44.6% (n=1593) girls. The median hospitalisation rate for patients aged 15 to 17 y/o per 100000 of the corresponding population within the 10-year period was 609.7 in boys and 537.4 in girls. The diagnosis from N10 to N16 ICD-10 code blocks was mainly registered in adolescents of this age group (50% in girls (95% CI 47.5%-52.4%) and 38.2% in boys (95% CI 36.0%-40.3%)). Statistically significant differences in the nosological structure of the diseases between girls and boys were found (p<0.001). The analysed 10-year period was characterised by a positive trend in the registration of the main diagnosis in adolescents from the N17 to N19 ICD-10 code blocks (р=0,023). The average age of the last hospital admission among the patients who completed follow-up in the paediatric nephrology service was 15 [13-17] y/o, of which 26.9% of adolescents were hospitalised at the age of 17 y/o. Conclusion: primary data were obtained to develop a system for preparing adolescents for their transition from paediatric into adult healthcare systems.","PeriodicalId":39654,"journal":{"name":"Pediatriya - Zhurnal im G.N. Speranskogo","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90770187","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 : 2023-08-10DOI: 10.24110/0031-403x-2023-102-4-124-133
M. Matveeva, Y. Samoilova, D. Kudlay, D. Podchinenova, T. Sivolobova, T. S. Liulka, I. Dolgalev, M. Koshmeleva
Neuropilin is of wide scientific and practical interest in the development of pathological conditions in both adult and pediatric patients. Modern scientific researches expand the role of this protein in various systems of the child's body both intrauterine and after birth. The results of recent studies related to the role of neuropilin, its effects and relationship with the development of various chronic diseases are considered in this bibliographical review of PubMed, ClinicalKey covering 2018-2023 with the purpose of expanding the understanding of neuropilin as a protein involved in the intranatal development of the fetus and metabolic processes in the extrauterine period. Further studies of neuropilin would clarify its role in the development of chronic noninfectious diseases and therapeutic approaches in pediatric practice.
{"title":"NEUROPILIN AS A NEW MARKER FOR CHRONIC NONINFECTIOUS DISEASES","authors":"M. Matveeva, Y. Samoilova, D. Kudlay, D. Podchinenova, T. Sivolobova, T. S. Liulka, I. Dolgalev, M. Koshmeleva","doi":"10.24110/0031-403x-2023-102-4-124-133","DOIUrl":"https://doi.org/10.24110/0031-403x-2023-102-4-124-133","url":null,"abstract":"Neuropilin is of wide scientific and practical interest in the development of pathological conditions in both adult and pediatric patients. Modern scientific researches expand the role of this protein in various systems of the child's body both intrauterine and after birth. The results of recent studies related to the role of neuropilin, its effects and relationship with the development of various chronic diseases are considered in this bibliographical review of PubMed, ClinicalKey covering 2018-2023 with the purpose of expanding the understanding of neuropilin as a protein involved in the intranatal development of the fetus and metabolic processes in the extrauterine period. Further studies of neuropilin would clarify its role in the development of chronic noninfectious diseases and therapeutic approaches in pediatric practice.","PeriodicalId":39654,"journal":{"name":"Pediatriya - Zhurnal im G.N. Speranskogo","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83601290","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 : 2023-08-10DOI: 10.24110/0031-403x-2023-102-4-166-171
T. I. Kurdyukova, O. Krasnorutskaya, D.Iu. Bugrimov, A. Shevtsov, G. Golosnaya
Respiratory infections are one of the leading diseases currently and almost 2/3 of these infectious processes occur in childhood. The pathogenesis of recurrent respiratory infections is based on the failure of the links of the immune system, mainly caused by a violation of the immune homeostasis of the mucous membranes of the nasopharynx and oropharynx. The purpose of this research was to determine the effect of the immunomodulatory therapy using sodium deoxyribonucleate on the microbiota of the oropharynx in children with recurrent respiratory infections. A single-center randomized placebo-controlled closed experimental study was performed in 90 pediatric patients with recurrent respiratory infections aged 1 to 6 y/o in May 2021-Nov. 2021 on the basis of the private medical center “Center for Modern Pediatrics” located in Voronezh, Russia. The main group consisted of 46 (23 boys and 23 girls aged 4 [3; 5] y/o) who had been given the sodium deoxyribonucleate drug nasally for 30 days. The control group of 44 (22 boys and 22 girls aged 4 [3; 5] y/o) had been given a placebo (a sterile 0.1% sodium chloride fluid) according to the same prescription scheme. The concentration of secretory immunoglobulin was determined by the enzyme immunoassay; the composition of the microbiota was studied by the genetic sequencing of the 16S ribosomal RNA gene. All of the participants in both groups were examined twice: at the start of the study and 90 days after. A statistically significant decrease in the relative amount of Proteobacteria and an increase in the relative amount of Firmicutes and Actinobacteriota, an increase in the concentration of sIgA was found against the background of the use of the drug, which in tis turn indicates an increase in the activity of mucosal immunity (p<0.001). Conclusion: thus, the use of sodium deoxyribonucleate in children aged 1 to 6 years old with recurrent respiratory infections leads to a statistically significant decrease in the relative amount of Proteobacteria and an increase in the relative amount of Firmicutes and Actinobacteriota in the oropharynx; increased activity of mucosal immunity, as evidenced by an increase in the concentration of sIgA.
{"title":"IMMUNOMODULATORY THERAPY USING SODIUM DEOXYRIBONUCLEATE AND THE OROPHARYNGEAL MICROBIOTA IN CHILDREN AGED 1 TO 6 YEARS OLD WITH RECURRENT RESPIRATORY INFECTIONS","authors":"T. I. Kurdyukova, O. Krasnorutskaya, D.Iu. Bugrimov, A. Shevtsov, G. Golosnaya","doi":"10.24110/0031-403x-2023-102-4-166-171","DOIUrl":"https://doi.org/10.24110/0031-403x-2023-102-4-166-171","url":null,"abstract":"Respiratory infections are one of the leading diseases currently and almost 2/3 of these infectious processes occur in childhood. The pathogenesis of recurrent respiratory infections is based on the failure of the links of the immune system, mainly caused by a violation of the immune homeostasis of the mucous membranes of the nasopharynx and oropharynx. The purpose of this research was to determine the effect of the immunomodulatory therapy using sodium deoxyribonucleate on the microbiota of the oropharynx in children with recurrent respiratory infections. A single-center randomized placebo-controlled closed experimental study was performed in 90 pediatric patients with recurrent respiratory infections aged 1 to 6 y/o in May 2021-Nov. 2021 on the basis of the private medical center “Center for Modern Pediatrics” located in Voronezh, Russia. The main group consisted of 46 (23 boys and 23 girls aged 4 [3; 5] y/o) who had been given the sodium deoxyribonucleate drug nasally for 30 days. The control group of 44 (22 boys and 22 girls aged 4 [3; 5] y/o) had been given a placebo (a sterile 0.1% sodium chloride fluid) according to the same prescription scheme. The concentration of secretory immunoglobulin was determined by the enzyme immunoassay; the composition of the microbiota was studied by the genetic sequencing of the 16S ribosomal RNA gene. All of the participants in both groups were examined twice: at the start of the study and 90 days after. A statistically significant decrease in the relative amount of Proteobacteria and an increase in the relative amount of Firmicutes and Actinobacteriota, an increase in the concentration of sIgA was found against the background of the use of the drug, which in tis turn indicates an increase in the activity of mucosal immunity (p<0.001). Conclusion: thus, the use of sodium deoxyribonucleate in children aged 1 to 6 years old with recurrent respiratory infections leads to a statistically significant decrease in the relative amount of Proteobacteria and an increase in the relative amount of Firmicutes and Actinobacteriota in the oropharynx; increased activity of mucosal immunity, as evidenced by an increase in the concentration of sIgA.","PeriodicalId":39654,"journal":{"name":"Pediatriya - Zhurnal im G.N. Speranskogo","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78147193","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 : 2023-08-10DOI: 10.24110/0031-403x-2023-102-4-147-158
E. Zubareva, D. Generalova, A. Santimov, G. Novik, O. Tamrazova, S. Grechanyi
Mental health disorders in pediatric rheumatologists’ practice are often unrecognized and insufficiently taken into account by pediatric rheumatologists when managing patients suffering from juvenile idiopathic arthritis (JIA). The chronic pain syndrome, which complicates the course of JIA, largely has a psychosomatic basis and is associated both with the severity of mental disorders in the patients themselves and with the characteristics of parent-child relationships. The purpose of the research was to study the severity of manifestations of mental disorders, emotional regulation and parent-child relationships in pediatric patients with JIA with chronic pain syndrome in comparison with patients with acne. Materials and methods used: a single-center simultaneous study of adolescents aged 11 to 17 y/o was conducted in Oct.-Dec. 2022. Using a visual analogue scale, the severity of pain was assessed separately by the participants in the study and their parents; patients assessed their general condition, whilst the physician determined the overall assessment of the current activity of the disease. All of the participants had completed the Difficulties in Emotion Regulation Scale (DERS), Parental bonding instrument (PBI) and Strengths and Difficulties Questionnaire (SDQ) questionnaires. Results: the main group consisted of 30 suffering from JIA with chronic pain syndrome. The comparison group consisted of 40 with acne. In patients with JIA, the values in the scales “Behavioral problems” (p=0.001), “Hyperactivity” (p=0.001), “Problems with peers” (p=0.001), “Emotional detachment” (assessment of mothers and fathers, p=0.001) and “Hyper care” (assessment of mothers and fathers, p=0.001) were statistically significantly lower, whilst higher in the values for “Prosocial behavior” (p=0.026), “Awareness of own emotions” (p=0.001), “Emotional warmth” (assessment of mothers and fathers, p=0.001) and “Encouraging independence” (assessment of mothers and fathers, p=0.001). Conclusion: JIA patients with chronic pain syndrome demonstrated more favorable mental health outcomes compared to patients with acne, which is traditionally considered as a factor in the mental adjustment disorder of adolescents that negatively affects the emotional state, self-esteem and the quality of life.
{"title":"MENTAL HEALTH DISORDERS IDENTIFICATION IN PEDIATRIC PATIENTS WITH JUVENILE IDIOPATHIC ARTHRITIS WITH CHRONIC PAIN SYNDROME","authors":"E. Zubareva, D. Generalova, A. Santimov, G. Novik, O. Tamrazova, S. Grechanyi","doi":"10.24110/0031-403x-2023-102-4-147-158","DOIUrl":"https://doi.org/10.24110/0031-403x-2023-102-4-147-158","url":null,"abstract":"Mental health disorders in pediatric rheumatologists’ practice are often unrecognized and insufficiently taken into account by pediatric rheumatologists when managing patients suffering from juvenile idiopathic arthritis (JIA). The chronic pain syndrome, which complicates the course of JIA, largely has a psychosomatic basis and is associated both with the severity of mental disorders in the patients themselves and with the characteristics of parent-child relationships. The purpose of the research was to study the severity of manifestations of mental disorders, emotional regulation and parent-child relationships in pediatric patients with JIA with chronic pain syndrome in comparison with patients with acne. Materials and methods used: a single-center simultaneous study of adolescents aged 11 to 17 y/o was conducted in Oct.-Dec. 2022. Using a visual analogue scale, the severity of pain was assessed separately by the participants in the study and their parents; patients assessed their general condition, whilst the physician determined the overall assessment of the current activity of the disease. All of the participants had completed the Difficulties in Emotion Regulation Scale (DERS), Parental bonding instrument (PBI) and Strengths and Difficulties Questionnaire (SDQ) questionnaires. Results: the main group consisted of 30 suffering from JIA with chronic pain syndrome. The comparison group consisted of 40 with acne. In patients with JIA, the values in the scales “Behavioral problems” (p=0.001), “Hyperactivity” (p=0.001), “Problems with peers” (p=0.001), “Emotional detachment” (assessment of mothers and fathers, p=0.001) and “Hyper care” (assessment of mothers and fathers, p=0.001) were statistically significantly lower, whilst higher in the values for “Prosocial behavior” (p=0.026), “Awareness of own emotions” (p=0.001), “Emotional warmth” (assessment of mothers and fathers, p=0.001) and “Encouraging independence” (assessment of mothers and fathers, p=0.001). Conclusion: JIA patients with chronic pain syndrome demonstrated more favorable mental health outcomes compared to patients with acne, which is traditionally considered as a factor in the mental adjustment disorder of adolescents that negatively affects the emotional state, self-esteem and the quality of life.","PeriodicalId":39654,"journal":{"name":"Pediatriya - Zhurnal im G.N. Speranskogo","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73831704","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 : 2023-08-10DOI: 10.24110/0031-403x-2023-102-4-10-15
L. Kiseleva, S. Vasilyeva, A. Solovieva, K. A. Borodina, T.N. Skachkova, N. V. Maikova, Y.N. Pychina
In accordance with the criteria for assessing the quality of medical care for prematurely born children, a study of serum creatinine is carried out on the first day of life. Elevated levels of the metabolite raise doubts about the advisability of prescribing a control analysis. The purpose of the study was to assess the level of serum creatinine in late preterm infants (34 to 36 weeks of gestation) in the early neonatal period for the correct interpretation of physiological changes in the blood. A retrospective cohort study of medical records was carried out, including an assessment of serum creatinine in late preterm infants on the first and on the 4th to 6th days of life. Two groups of participants were formed from 117 children: group 1 consisted of 62 premature babies with intrauterine growth restriction; group 2 included 55 premature babies with average physical development. The average creatinine level in late preterm infants varied from 85.0 (75.8; 101.6) µmol/l on the first day of life to 43.9 (28.8; 56.0) µmol/l on days 4th to 6th of life (p=0.001). Difference in creatinine level in children from G1 and G2 on the first day of life and at the end of the early neonatal period was not detected (p=0.864, p=0.104, respectively). A significant correlation was noted between the serum creatinine level in mother and child (p=0.001). The serum creatinine level in children in the first day of life is affected by the time of the day the blood sampling for analysis was taken. Thus, the average creatinine level in children at the beginning of the first day of life was 76.0 (68.4; 81.8) µmol/l and 101.6 (93.4; 110.9) µmol/l at the end of the first day of life (p=0.001). The high creatinine level in the first day of life reflects the maternal serum index with its subsequent decrease by the end of the early neonatal period which should be taken into account when assessing the postnatal adaptation of late preterm infants.
{"title":"SERUM CREATININE LEVEL IN LATE PRETERM INFANTS IN THE EARLY NEONATAL PERIOD","authors":"L. Kiseleva, S. Vasilyeva, A. Solovieva, K. A. Borodina, T.N. Skachkova, N. V. Maikova, Y.N. Pychina","doi":"10.24110/0031-403x-2023-102-4-10-15","DOIUrl":"https://doi.org/10.24110/0031-403x-2023-102-4-10-15","url":null,"abstract":"In accordance with the criteria for assessing the quality of medical care for prematurely born children, a study of serum creatinine is carried out on the first day of life. Elevated levels of the metabolite raise doubts about the advisability of prescribing a control analysis. The purpose of the study was to assess the level of serum creatinine in late preterm infants (34 to 36 weeks of gestation) in the early neonatal period for the correct interpretation of physiological changes in the blood. A retrospective cohort study of medical records was carried out, including an assessment of serum creatinine in late preterm infants on the first and on the 4th to 6th days of life. Two groups of participants were formed from 117 children: group 1 consisted of 62 premature babies with intrauterine growth restriction; group 2 included 55 premature babies with average physical development. The average creatinine level in late preterm infants varied from 85.0 (75.8; 101.6) µmol/l on the first day of life to 43.9 (28.8; 56.0) µmol/l on days 4th to 6th of life (p=0.001). Difference in creatinine level in children from G1 and G2 on the first day of life and at the end of the early neonatal period was not detected (p=0.864, p=0.104, respectively). A significant correlation was noted between the serum creatinine level in mother and child (p=0.001). The serum creatinine level in children in the first day of life is affected by the time of the day the blood sampling for analysis was taken. Thus, the average creatinine level in children at the beginning of the first day of life was 76.0 (68.4; 81.8) µmol/l and 101.6 (93.4; 110.9) µmol/l at the end of the first day of life (p=0.001). The high creatinine level in the first day of life reflects the maternal serum index with its subsequent decrease by the end of the early neonatal period which should be taken into account when assessing the postnatal adaptation of late preterm infants.","PeriodicalId":39654,"journal":{"name":"Pediatriya - Zhurnal im G.N. Speranskogo","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75015585","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 : 2023-08-10DOI: 10.24110/0031-403x-2023-102-4-193-197
M. A. Romashin, N. B. Guseva, E. Mlynchik, S. S. Nikitin
Dysfunction of the pelvic organs in children with myelodysplasia is a complex multifaceted problem. In some patients with long-term vesicoureteral reflux, as a complication of neurogenic bladder dysfunction, reflux nephropathy (RN) develops in a chronic kidney disease (CKD) outcome. One of the most effective as well as minimally invasive surgical interventions in this case is chemodenervation of the detrusor with botulinum toxin. This intervention in most cases not only improves the quality of life of patients, but also prevents further development of RN helping children to avoid traumatic augmentation surgery in the future. However, the duration of the chemodenervation effect is often insufficient. In the Authors’ opinion, synergistic conservative therapy aimed at improving regional blood circulation and correcting energy deficit is a must in order to improve the results. The result of the synergy of surgical and conservative treatment and their effectiveness are described in the presented clinical case observation.
{"title":"EFFICIENCY OF DETRUSOR CHEMODENERVATION WITH BOTULINUM TOXIN IN COMBINATION WITH CONSERVATIVE THERAPY IN A CHILD WITH NEUROGENIC BLADDER AND MYELODYSPLASIA: A CLINICAL CASE","authors":"M. A. Romashin, N. B. Guseva, E. Mlynchik, S. S. Nikitin","doi":"10.24110/0031-403x-2023-102-4-193-197","DOIUrl":"https://doi.org/10.24110/0031-403x-2023-102-4-193-197","url":null,"abstract":"Dysfunction of the pelvic organs in children with myelodysplasia is a complex multifaceted problem. In some patients with long-term vesicoureteral reflux, as a complication of neurogenic bladder dysfunction, reflux nephropathy (RN) develops in a chronic kidney disease (CKD) outcome. One of the most effective as well as minimally invasive surgical interventions in this case is chemodenervation of the detrusor with botulinum toxin. This intervention in most cases not only improves the quality of life of patients, but also prevents further development of RN helping children to avoid traumatic augmentation surgery in the future. However, the duration of the chemodenervation effect is often insufficient. In the Authors’ opinion, synergistic conservative therapy aimed at improving regional blood circulation and correcting energy deficit is a must in order to improve the results. The result of the synergy of surgical and conservative treatment and their effectiveness are described in the presented clinical case observation.","PeriodicalId":39654,"journal":{"name":"Pediatriya - Zhurnal im G.N. Speranskogo","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74467127","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 : 2023-08-10DOI: 10.24110/0031-403x-2023-102-4-210-216
Y. Kozlov, S. Poloyan, K. Kovalkov, C. Ochirov, V. Kapuller, A. Narkevich, S. Eshkabilov, B. Ergashev, V. S. Cheremnov, V. G. Pogorelko, Stanislav Ivanov
Isolated H-type tracheoesophageal fistula is a rare anomaly of the respiratory tract which accounts for 4% of all malformations of the trachea and esophagus. Authors report patients with this developmental anomaly who underwent fistula dissection by the same single surgeon and at different surgical facilities with particular emphasis on preoperative diagnosis and treatment. Thoracoscopic transsection of H-type tracheoesophageal fistula was performed by a single surgeon in 5 patients (3 boys and 2 girls) with R. Gross congenital isolated type E fistulas who were admitted at 2 to 12 weeks of age. The patients were in three surgical facilities located in the cities of Irkutsk and Tomsk (both - Russia), Tashkent (Republic of Uzbekistan). In the final part the methods of preoperative examination, the parameters of the surgical intervention and the results of postoperative observation are given. All 5 procedures were successfully performed thoracoscopically without conversion into open intervention. The duration of the surgical intervention varied from 45 to 135 minutes. The average intervention period was 78.0±35.8 minutes (median - 60.0 [52.5; 112.5] minutes). The mean duration of mechanical ventilation in this group was 33.6±10.0 hours (median - 36.0 [24.0; 42.0] hours) with the longest interval being 48 hours in a patient with pre-existing respiratory distress. The exact time range to complete oral nutrition has been well documented and ranged from 5 to 8 days. Esophageal and tracheal suture failure was not recorded in patients with H-type tracheoesophageal fistula. Two patients required Nissen surgery for hiatal hernia at 6 months and 1 year after initial H-type tracheoesophageal fistula ligation. All patients are currently on full oral nutrition. The follow-up period in this group ranged from 12 to 60 months. These patients showed no signs of recurrence of the fistula. Patients were evaluated for vocal cord paresis if clinical stridor was observed postoperatively. However, no recurrent nerve injury was found in any of the patients in this series of cases. Authors did not record signs of chest asymmetry, pterygoid scapula, laxity of the shoulder girdle or clinically significant scoliosis. Thoracoscopy allows direct visualization and dissection of an H-type tracheoesophageal fistula. Authors believe this technique allows achieving better mobilization of the posterior mediastinal organs than in thoracotomy, which probably expands the scope of thoracoscopic access in the treatment of this disease.
{"title":"CASE SERIES OF THORACOSCOPIC TREATMENT OF CONGENITAL ISOLATED H-TYPE TRACHEOESOPHAGEAL FISTULAS IN INFANTS","authors":"Y. Kozlov, S. Poloyan, K. Kovalkov, C. Ochirov, V. Kapuller, A. Narkevich, S. Eshkabilov, B. Ergashev, V. S. Cheremnov, V. G. Pogorelko, Stanislav Ivanov","doi":"10.24110/0031-403x-2023-102-4-210-216","DOIUrl":"https://doi.org/10.24110/0031-403x-2023-102-4-210-216","url":null,"abstract":"Isolated H-type tracheoesophageal fistula is a rare anomaly of the respiratory tract which accounts for 4% of all malformations of the trachea and esophagus. Authors report patients with this developmental anomaly who underwent fistula dissection by the same single surgeon and at different surgical facilities with particular emphasis on preoperative diagnosis and treatment. Thoracoscopic transsection of H-type tracheoesophageal fistula was performed by a single surgeon in 5 patients (3 boys and 2 girls) with R. Gross congenital isolated type E fistulas who were admitted at 2 to 12 weeks of age. The patients were in three surgical facilities located in the cities of Irkutsk and Tomsk (both - Russia), Tashkent (Republic of Uzbekistan). In the final part the methods of preoperative examination, the parameters of the surgical intervention and the results of postoperative observation are given. All 5 procedures were successfully performed thoracoscopically without conversion into open intervention. The duration of the surgical intervention varied from 45 to 135 minutes. The average intervention period was 78.0±35.8 minutes (median - 60.0 [52.5; 112.5] minutes). The mean duration of mechanical ventilation in this group was 33.6±10.0 hours (median - 36.0 [24.0; 42.0] hours) with the longest interval being 48 hours in a patient with pre-existing respiratory distress. The exact time range to complete oral nutrition has been well documented and ranged from 5 to 8 days. Esophageal and tracheal suture failure was not recorded in patients with H-type tracheoesophageal fistula. Two patients required Nissen surgery for hiatal hernia at 6 months and 1 year after initial H-type tracheoesophageal fistula ligation. All patients are currently on full oral nutrition. The follow-up period in this group ranged from 12 to 60 months. These patients showed no signs of recurrence of the fistula. Patients were evaluated for vocal cord paresis if clinical stridor was observed postoperatively. However, no recurrent nerve injury was found in any of the patients in this series of cases. Authors did not record signs of chest asymmetry, pterygoid scapula, laxity of the shoulder girdle or clinically significant scoliosis. Thoracoscopy allows direct visualization and dissection of an H-type tracheoesophageal fistula. Authors believe this technique allows achieving better mobilization of the posterior mediastinal organs than in thoracotomy, which probably expands the scope of thoracoscopic access in the treatment of this disease.","PeriodicalId":39654,"journal":{"name":"Pediatriya - Zhurnal im G.N. Speranskogo","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88305100","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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