Vol 11, No 4 (2012)
SOCIAL PEDIATRICS AND HEALTH CARE
7-12 1057
Abstract
The role of the family and social factors in psychosomatic development of children and adolescents and the influence of the perinatal period on their further mental health are discussed in this article. A particular emphasis is put on the breast feeding in the formation of psychosomatic health. The authors also mention the role of the educational parental practices in socialization of children and adolescents, prevention of deviant behavioral forms development and adaptation to school education. The article also contains a discussion of pathogenic influence of the new information technologies on children’s and adolescents’ state of mind, which causes new kind of pathological dependencies (internet-addiction).
Key words: mental health, family, perinatal psychology, breast feeding, educational practices, school dysadaptation, internetaddiction.
Key words: mental health, family, perinatal psychology, breast feeding, educational practices, school dysadaptation, internetaddiction.
LITERATURE REVIEW
14-20 1189
Abstract
The article represents the results of efficacy and safety evaluation of the human monoclonal antibodies — golimumab, according to the data of international multicenter randomized double-blind placebo-controlled trials, including patients with active stage of rheumatoid arthritis. It was shown, that golimumab was reliably more effective than placebo both when administered hypodermic and intravenous. The safety profile of golimumab is comparable to that of the other tumor necrosis factor alpha blockers. The review also contains information on the 3d phase of golimumab efficacy and safety research in patients with juvenile idiopathic arthritis.
21-28 1061
Abstract
The article deals with the mechanisms of metabolism of linoleic and α-linoleic polyunsaturated fatty acids as precursors of long-chain polyunsaturated fatty acids — arachidonic (ω-6 family) and docosahexaenoic acid (ω-3 famyli). The authors demonstrate the results of modern experimental and clinical trials, studying their influence on cognitive development and vision keenness in animals, preterm and term infants.
ORIGINAL ARTICLES
T. M. Bzarova,
E. I. Alexeeva,
A. N. Fetisova,
N. A. Zurikova,
S. I. Valieva,
R. V. Denisova,
E. V. Mitenko,
T. V. Sleptsova,
K. B. Isaeva,
E. G. Chistyakova,
N. I. Taibulatov,
M. V. Ryazanov,
A. V. Anikin,
E. I. Zelikovich,
G. V. Kurilenkov,
E. L. Semikina
29-37 1015
Abstract
The results of the study of etanercept (soluble tumor necrosis factor alpha receptors) efficacy and safety in treatment of 97 patients with early and late onset of juvenile idiopathic arthritis are demonstrated in this article. The observation period was 12 months. In 48 weeks of anti-TNF treatment the achievement of clinical remission, decrease and normalization of laboratory markers of disease activity, complete restoration of joints function and improvement of life quality was established in 100% of children with early onset and 71% of children with late onset of arthritis. The drug was withdrawn in 13 (14%) patients: in 5 (6%) due to inefficiency, in 3 (4%) — due to development of side effects.
38-46 834
Abstract
A high prevalence of allergic diseases in children causes necessity of searching for effective methods of prophylaxis of such disorders. The aim of the study was to substantiate the efficacy of hypoallergenic products of additional food in order to prevent atopy development. The participants of the study were children at the age of 4–6 months old with complicated family history, cutaneous manifestations of allergy of mild severity. According to the results of the study, a low sensitizing potential of examined products of additional food and efficacy of their usage in atopic process development were proved. The received data suggest that these hypoallergenic products of additional food can be recommended in primary and secondary prophylaxis in children with risk of allergy.
E. V. Kulagina,
Z. A. Chernaya,
A. N. Shkoporov,
E. V. Khokhlova,
B. V. Efimov,
Yu. M. Golubtsova,
L. I. Kafarskaya
47-53 753
Abstract
The study deals with qualitative and quantitative structure of normal intestinal microflora in newborns before and after feeding with the formula «Agusha Gold 1» containing the strain B. lactis BB12. The specific structure of the intestinal bifidobacreria is studied in detail by means of the real-time polymerase chain reaction. It was demonstrated, that during the feeding with this formula there was a tendency towards development of the microbiota and specific structure of the intestinal bifidobacteria similar to those of the breast-fed children.
54-59 844
Abstract
Cystic fibrosis is a common hereditary disease, characterized by multiple organ dysfunction, including early and severe involvement of respiratory system. The disease is caused by CFTR (cystic fibrosis transmembrane conductance regulator) gene mutation. Respiratory tract involvement is a main factor, predicting outcome, mortality, life quality and morbidity of patients. Genetic examination of Chuvash children demonstrated, that 53,5% of patients’ chromosomes are carriers of E92K mutation. According to genetic epidemiology of cystic fibrosis, Chuvash ethnic group is unique, as the prevalence of mutation E92K in it is almost twice higher than the most common and «severe» mutation in the world — F508del. The significant predominance of E92K determined the clinical presentation of cystic fibrosis in the examined group, because this mutation refers as «mild». The critical moment in treatment of this disorder is influence on sputum viscosity. Dornase alpha proved itself as an effective drug, which advantages among other agents, improving sputum rheological properties, are caused not only by unique mucolytic effect, but also anti-inflammatory and antibacterial actions.
60-64 778
Abstract
The complaints on relapsing abdominal pain in children are not uncommon in paediatric practice. It is known, that approximately 50%
of pains are caused by psychogenic factors, so such patients demand specialized psychological and psychotherapeutic medical care. The aim of this study was to establish the association between relapsing abdominal pain in children with emotional disturbances and social environment in development of this disease. The study included 2 groups of patients — with and without relapsing abdominal pain, 100 children in each group. During the study the authors used the clinical method of psychiatric interviewing, the modified method of E. G. Eidemiller’s and V. V. Justitskis’s «Standard family condition», A. J. Vargi’s and V. V. Stolin’s questionnaire of the parental care. It was
shown, that 88% of children with relapsing abdominal pain had complaints on mental health: fatigability (61%), headaches (62%), sleep disturbances (33%), anxiety (46%), disturbances of mood (19%). The most significant psychogenies are stress factors related to school. Relapsing abdominal pain can also be caused by parental deprivation. Therefore, 65% of children with abdominal pain need specialized psychological or psychotherapeutic medical care.
of pains are caused by psychogenic factors, so such patients demand specialized psychological and psychotherapeutic medical care. The aim of this study was to establish the association between relapsing abdominal pain in children with emotional disturbances and social environment in development of this disease. The study included 2 groups of patients — with and without relapsing abdominal pain, 100 children in each group. During the study the authors used the clinical method of psychiatric interviewing, the modified method of E. G. Eidemiller’s and V. V. Justitskis’s «Standard family condition», A. J. Vargi’s and V. V. Stolin’s questionnaire of the parental care. It was
shown, that 88% of children with relapsing abdominal pain had complaints on mental health: fatigability (61%), headaches (62%), sleep disturbances (33%), anxiety (46%), disturbances of mood (19%). The most significant psychogenies are stress factors related to school. Relapsing abdominal pain can also be caused by parental deprivation. Therefore, 65% of children with abdominal pain need specialized psychological or psychotherapeutic medical care.
PROFESSIONAL DEVELOPMENT
L. S. Namazova-Baranova,
T. V. Kulichenko,
A. E. Malakhova,
E. V. Starovoitova,
M. D. Bakradze,
I. L. Chashchina,
I. L. Mitushin
65-72 1019
Abstract
The detailed analysis of official guidelines aiming optimization of diagnostics and treatment of home-acquired pneumonia (HAP) in children shows, that a number of diagnostic and therapeutic approaches to this condition are not always evidence-based. Everyday clinical practice demonstrates, that diagnostics and treatment of HAP in children do not often correlate with any of the present standards.The aim of this study is to discuss difficult and unresolved questions of HAP diagnostics and treatment in infants and young children, basing on the analysis of real clinical cases.
74-80 752
Abstract
The article contains a comparative analysis of shin fracture treatment in 102 children at the age of 4–18 years old. The main group consisted of 51 (50%) children, who received postoperative treatment according to the method of pneumatic imitation of weightbearing both on health and injured limbs with «Korvit» apparatus. The control group consisted of 51 (50%) patients who did not received the afore-mentioned method of postoperative treatment. The groups were comparable on age, trauma mechanism and localization, surgical operation and complex postoperative therapy. Children of the first group were found to have shorter period of time needed to achievement of pain relief, soft tissue swelling decrease, restoration of the movements in adjacent joints and somatometry values normalization, which allowed earlier verticalization and shorter period of hospitalization.
EXCHANGE OF EXPERIENCE
E. I. Alexeeva,
T. M. Bzarova,
S. I. Valieva,
R. V. Denisova,
K. B. Isaeva,
A. M. Chomakhidze,
E. G. Chistyakova,
T. V. Sleptsova,
E. V. Mitenko,
N. I. Taibulatov
82-88 801
Abstract
Treatment of juvenile idiopathic arthritis (JIA) is one of the most important challenges in paediatric rheumatology. The results of the retrospective observational study of adalimumab (anti TNF human monoclonal antibodies) efficacy and safety in real clinical practice in treatment of 56 patients with JIA and primary or secondary resistance to other genetically engineered biological agents (48 — infiximab, 2 — etanercept, 5 — rituximab, 1 — abatacept) are demonstrated in this article. Adalimumab was administered hypodermically at the dosage of 40 mg per 2 weeks. The efficacy was assessed according to the criteria of ACR (pediatric). In 4 weeks of treatment in 100% of patients the 30% improvement was established, in 80% of patients — 50% improvement, and in 60% of patients — 70% improvement. In 25 weeks of treatment 30% improvement was documented in 100% of patients (56), 50% improvement — in 91% (51), 70% improvement — in 74% (41). Inactive stage of the disease was established in 24 weeks in 55% of children; in 1 year — in 85%; remission was established in 55% of children. No severe side effects were found. Therefore, the received data show that adalimumab is effective in patients with JIA, both with primary and secondary resistance to other biological agents.
A. N. Obedin,
S. V. Minaev,
I. V. Kirgizov,
A. E. Aleksandrov,
E. A. Tovkan,
N. M. Romaneeva,
T. A. Khoranova,
L. A. Сhitaeva
90-94 881
Abstract
The influence of several factors, impacting on the development of purulent-septic complications in newborns with congenital gastrointestinal tract malformations was studied. As independent variables they were chosen both binary and numeral ones. Furthermore, the authors investigated the combined effect of different factors of pre-admission (primary and secondary) medical care, which had shown a high possibility of influence on the complications development during the preliminary analysis. The total amount of various analyzed predicting factors of purulent-septic complications after surgical procedures was 42. Three main groups of risk factors were established. These groups were associated with: 1) type of the performed post-operative analgesia and child sex; 2) disturbances of the intestinal wall permeability; 3) disturbances of the intestinal wall perfusion. In order to develop an appropriate model the method of logistic regression with variables normalization quazi-Newton approach was used. This model has high enough possibilities to predict both positive (risk of purulent-septic complications) and negative (absence of such risk) results. The rate of correctly predicted cases of
complications is 76%, the rate of their absence — 84%.
complications is 76%, the rate of their absence — 84%.
95-98 769
Abstract
Gluten enteropathy is a hereditary disease of the small intestine. It is characterized by the intolerance of specific cereal proteins leading to development of hyperregenerative atrophy of the small intestine mucous membrane. The diagnosis is based on complex evaluation of clinical, serological, endoscopic and morphological findings. The correctness of the diagnosis is confirmed by the reverse development of the morphological changes at the background of gliadin free diet.
99-105 1080
Abstract
Immunotherapy is one of the most important areas in the complex of health improvement of frequently ill children. The aim of this study was to establish the causes of the generally accepted rehabilitation measures failure and to assess the efficacy of the differential approach to the management of children with relapsing respiratory infections, suitability and efficacy of immunotropic drugs involvement into the complex rehabilitation program. The observation group consisted of 90 so called frequently ill children at the age of 3–14 years old. They were performed a complex clinical and laboratory examination, determining the causes of relapsing infectious syndrome. The children from the control group received etiotropic treatment depending on revealed etiological factor. The children from the main group received a 60-day long course of immunomodulator Pidotimod. The following issues were assessed: the frequency of acute respiratory infections during 6-month observation, the duration of the infections, the frequency of the complications and the necessity of antibacterial treatment. The positive dynamics of the infectious syndrome course in children from both groups was established. However, patients received complex therapy with immunomodulator had significantly lower rate of acute respiratory infections and
complications, and they also had a significantly lower necessity in antibacterial drugs use.
Key words: children, relapsing respiratory infections, treatment, immunotherapy.
complications, and they also had a significantly lower necessity in antibacterial drugs use.
Key words: children, relapsing respiratory infections, treatment, immunotherapy.
106-110 892
Abstract
The group of «frequently ill children» according to different authors accounts for 20–75% of children population. Results of clinical researches suggest that use of vitamin-mineral complexes in such children is a perspective method of prophylaxis. Including into these complexes prebiotic components is of a particular interest. Such complexes with prebiotics not only contribute to immune response intensification, but improve intestinal microflora, decrease the rate of respiratory infections and fevers and improve the general condition of children with compromised allergic history. The authors share their own experience of vitamin-mineral complex with prebiotics «ALFAVIT In chills season for children» usage in frequently ill children at the age of 3–7 years.
111-115 755
Abstract
The current data of the scientific research of breast milk composition are represented in this article. The author produces proofs of the necessity of inclusion into artificial formulas different functional components found in breast milk. There are also shown the main principles of artificial milk formulas adaptation.
116-121 829
Abstract
The results of an open-label uncontrolled trial, assessing the tolerability and clinical efficacy of the dry milk formula «Bellakt Optimum 1» enriched with prebiotics (fructo- and galacto-oligosaccharides) are demonstrated in this article. Twenty five children at the age from 1 to 4 months were being observed. Data on medical history, physical examination, evolution of weight and height values, the results of the coproscopy and microbiological assay of faeces before the beginning of the investigation and 1 month after were used as control methods. All the patients ate the formula willingly, there were neither allergic reactions, nor signs of dyspepsia. According to the repeated examination, the amount of children with I type steatorrhea decreased from 36% to 12%; with II type steatorrhea — from 24% to 4%; with colonization of the bowels with conditionally pathogenic microorganisms — from 52% to 28%.
122-127 847
Abstract
As it was reported by World Health Organization, the annual number of deaths caused by pneumococci reaches 1,6 million people including 700 thousand of children of 0–5 years old. Pneumococcal meningitis is one of the most severe manifestations of pneumococcal infection. S. pneumoniae keeps one of the leading positions in aetiological structure of bacterial meningitis. Data on serotypes distribution of pneumococci in children of the early age in the Russian Federation are limited. In this study serotypes of pneumococci from pediatric patients with pneumococcal meningitis (children aged 0–7 years, n =35) isolated in 1981–2010 in Moscow were identified. Screening for sensitivity of strains to penicillin was performed, as well as molecular typing by MLST approach. The most frequent serotypes causing pneumococcal meningitis in children aged 0–7 years were 19F, 7F, 14 and 1. Most of MDR-strains were collected in 2007–2009. Among MDR-strains and those demonstrating increased resistance to antibiotics, several new allelic patterns were described.
128-132 1153
Abstract
This article represents the results of the study, which aim was to develop percentile charts of height, weight and head circumference of Russian children with trisomy 21 at the age of 0–12 months. Nowadays there are no charts for the evaluation of physical development of children with Down syndrome in Russia. 514 children with cytogenetically confirmed Down syndrome and upbringing in families were examined. The repeated measurements of height, weight and head circumference according to the standard methods were performed at the age from 0 to 1 year. The total amount of measurements, according to which results there were made percentile charts of height, weight and head circumference, was 4538. The developed charts can be successfully used in practice of the out-patient pediatrician in order to assess physical development of a child with Down syndrome.
134-138 947
Abstract
Chronic pancreatitis is a multietiological disorder characterized by progressive structural changes of the pancreas and development of its eccrine and endocrine insufficiency. The potential causes of chronic pancreatitis in children include obstruction of the pancreas ducts due to cholelithiasis, chronic cholecystitis with biliary sludge, excretory ducts anomalies; obesity and hyperlipidemia; abdominal traumas and infectious pancreatic diseases. Recently new possible variants of chronic pancreatitis — autoimmune and hereditary — have been diagnosed due to the widening of diagnostic potentials. Fifty children and adolescents with chronic pancreatitis were diagnosed. It was shown, that obstructive chronic pancreatitis was found in 50%, obesity-associated. According to the literature, more than 70% of children with idiopathic chronic pancreatitis have genetic mutations in genes SFTR, PRSS1 and SPINK1, both single and associated. These lead to imbalance of the trypsinogen activation and inactivation in the pancreas tissue. Severe mutations can be an independent cause of chronic pancreatitis, mild ones manifest after the impact of some external factors. Regardless of the cause of the disease, the mandatory component of the treatment is enzyme replacement therapy with the preference to microspherical forms.
139-142 896
Abstract
Acute tonsilittis and episodes of chronic tonsilittis relapses are the most common infectious inflammatory diseases of the throat. A significant risk of development of different organs diseases associated with tonsilittis and worsening of the life quality in a patient with soar throat cause the currency of the rational antibacterial treatment. A special feature of tonsilittis in children is a high prevalence of viral and atypic diseases. A possibility of clarithromycin usage as a first-line drug in empiric systemic antibacterial treatment of acute tonsilittis is analysed in this article.
142-147 869
Abstract
Respiratory syncytial virus plays a significant role in etiology of respiratory infections in infants, and preterm children have much
higher risk of severe course of the disease, than common population of children at the age less than 2 years old. Palivizumab is used
efficiently to prevent this infection. The aim of this study was to assess the efficacy of the costs on palivizumab in preterm children
in the Russian Federation. The assessment was based on meta-analysis of randomized clinical trials. According to the World Health organization recommendations, the acceptable value of the variable «costs/efficacy» must not be higher than threefold of the gross domestic product per person. On the assumption of this fact, the coefficient «costs/efficacy» for the Russian Federation according to the 2011 year results must not be higher than 1140 thousand rubles per 1 extra year of life. Analysis from the position of health care system shows, that coefficient «costs/efficacy» with palivazumab usage in children with gestation age from 28 to 32 weeks ranges
from 594,4 to 1030,4 thousand roubles per 1 extra year of life when starting the prophylaxis during first 6 month of life. Under the social perspective of the study (accounting for direct and indirect costs) the coefficient «costs/efficacy» decreases to 515,8–951,8 thousands roubles per 1 extra year of life. Thereby, nowadays the prophylaxis of severe respiratory cyncytial infection with palivazumab is acceptable according to the economical point of view in preterm children with the gestation age 32 weeks and less when starting during first 6 months of life.
higher risk of severe course of the disease, than common population of children at the age less than 2 years old. Palivizumab is used
efficiently to prevent this infection. The aim of this study was to assess the efficacy of the costs on palivizumab in preterm children
in the Russian Federation. The assessment was based on meta-analysis of randomized clinical trials. According to the World Health organization recommendations, the acceptable value of the variable «costs/efficacy» must not be higher than threefold of the gross domestic product per person. On the assumption of this fact, the coefficient «costs/efficacy» for the Russian Federation according to the 2011 year results must not be higher than 1140 thousand rubles per 1 extra year of life. Analysis from the position of health care system shows, that coefficient «costs/efficacy» with palivazumab usage in children with gestation age from 28 to 32 weeks ranges
from 594,4 to 1030,4 thousand roubles per 1 extra year of life when starting the prophylaxis during first 6 month of life. Under the social perspective of the study (accounting for direct and indirect costs) the coefficient «costs/efficacy» decreases to 515,8–951,8 thousands roubles per 1 extra year of life. Thereby, nowadays the prophylaxis of severe respiratory cyncytial infection with palivazumab is acceptable according to the economical point of view in preterm children with the gestation age 32 weeks and less when starting during first 6 months of life.
148-152 807
Abstract
In the study, safety for influenza vaccine in combination with diphtheria vaccine, tetanus and measles vaccine, rubella vaccine, and epidemic parotitis in children of 6–7 years old was assessed. All vaccines showed good tolerability and low reactogenicity for combined immunization. Influenza «Grippol plus» vaccine is safe and highly immunogenic, and does not cause cross antibody suppression being applied in combination with mentioned National Immunization Schedule vaccines.
153-157 1132
Abstract
Rational diet, age-appropriate for the growing organism needs, provides normal physical and mental development and prevents
alimentary-dependent diseases at every age stage. Deficiency of vitamins, minerals and other essential nutrients, gradually progressing against the background of imbalanced diet, leads to development of multisystem disorder, which then can become chronic. It is important that paediatricians pay great attention to supplementation in children’s nourishment of ω-3 polyunsaturated fatty acids, which have significant influence on visual apparatus, intellectual development and different organs and systems functions. The easing of the adaptation syndrome at the beginning of school education and supplementation of attention deficit can be achieved by the courses of vitamin complexes PIKOVIT, which demonstrated high efficiency and safety even in allergic disorders and are recommended by the specialists of Moscow Scientific Centre of Children Health.
alimentary-dependent diseases at every age stage. Deficiency of vitamins, minerals and other essential nutrients, gradually progressing against the background of imbalanced diet, leads to development of multisystem disorder, which then can become chronic. It is important that paediatricians pay great attention to supplementation in children’s nourishment of ω-3 polyunsaturated fatty acids, which have significant influence on visual apparatus, intellectual development and different organs and systems functions. The easing of the adaptation syndrome at the beginning of school education and supplementation of attention deficit can be achieved by the courses of vitamin complexes PIKOVIT, which demonstrated high efficiency and safety even in allergic disorders and are recommended by the specialists of Moscow Scientific Centre of Children Health.
V. A. Skvortsova,
T. E. Borovik,
O. K. Netrebko,
O. L. Lukyanova,
N. G. Zvonkova,
N. A. Mayanskii,
E. A. Kopyl'tsova,
O. S. Mel’nichuk,
A. A. Surganova,
E. L. Semikina
158-166 979
Abstract
The article contains the results of the study of clinical and biochemical blood markers of iron metabolism in infants. This study represents a part of the research, aimed to scientific confirmation of the statements associated with additional food introduction and stated in the «National program of the infants feeding optimization in the Russian Federation». In controlled conditions the children were divided into 2 main groups: feeding with breast milk and with artificial milk formulas. Each group was divided into sub-groups according to the age of the additional food introduction: 4, 5 or 6 months. The received data suggest that the iron content was appropriate in both groups at the age of 4 months before the additional food introduction; there was a gradual decrease of several values after that, especially marked in children feeding with breast milk and later introduction of additional food. The comparative analysis showed that at the age of 9 months the lowest values were in breast-fed children with additional food introduction at the age of 6 months. This can be associated not only with late additional food introduction, but also with difficulties occurring when beginning it at this age and leading to insufficient supply with certain nutrients, including iron. The detailed analysis of diets for children of different sub-groups will be discussed in the next article.
167-175 836
Abstract
The authors discuss the questions of functional digestion disorders dietotherapy with artificial milk formula «CELIA DIGEST» enriched with probiotics in infants. During the study the composition and the properties of afore-mentioned formula as well as the special features of its usage in dietotherapy of functional digestion disorders in children were examined. The results of the clinical evaluation of this formula efficacy in infants at the age from 0 to 2 months old in comparison to the course of functional digestion disorders symptoms in breast-fed children are represented in the article.
176-181 763
Abstract
The bacterial lysates mechanism of action on the children immune system increasing the organism resistance against upper respiratory tract infections is described in this article. The authors represent a short review of safety and efficacy trials of the drug for acute respiratory diseases prophylaxis and treatment. The good tolerance of the drug was confirmed in all age groups. The therapeutic action of the drug consists of shortening of the disease duration and lowering of the acute respiratory infections domplications rate. Due to their immunomodulation effect it is reasonable to include the bacterial lysates into the treatment and rehabilitation of children with acute respiratory infections and other bronchial and lung diseases.
182-186 815
Abstract
The authors describe new technologic potentials for breast-feeding support in nursing mothers with the help of breast pumps. The results of the clinical trial on comparative evaluation of the new model of manual breast pump Philips AVENT of Natural line and previous model of Classic line are represented in the article.
CLINICAL OBSERVATIONS
187-192 742
Abstract
The article represents a history case of successful usage of tolicizumab (anti-interleukin 6 monoclonal antibodies) in treatment of severe systemic juvenile idiopathic arthritis, resistant to previous standard antirheumatic therapy. Tocilizumab treatment led to distal joints function restoration and improvement of life quality in a short period of time. The drug prevented the continued progression of incapacitating injury and induced the clinical and laboratory remission of the disease.
193-195 693
Abstract
Treatment of patients with congenital combined coagulation disorder and thrombohemorrhagic syndrome is associated with a number of difficulties, one of them is need of permanent vascular access in order to provide appropriate pathogenetic therapy. The article contains a clinical case, representing a subject matter of searching for means of providing a permanent vascular access in a child with congenital combined deficiency of vitamin K dependent clotting factors (II, VII, IX, X, S- and C-protieins) and severe course of thrombohemorrhagic syndrome.
ISSN 1682-5527 (Print)
ISSN 1682-5535 (Online)
ISSN 1682-5535 (Online)
