Vol 10, No 3 (2011)
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EDITORIAL
7–11 829
Abstract
The article summarizes the results of diversified epidemiological and clinical study performed in Russian Federation. The peculiarities of tuberculosis infection in modern epidemiological situation, clinical symptoms of a disease and risk factors of its development are described. New risk groups of tuberculosis infection are children who need common observation within management of inflammatory rheumatic diseases and other chronic pathology treated with immunosuppressive agents. Authors show the necessity of differentiative approach to the prophylaxis and early diagnostics of tuberculosis within phthisiologic and common pediatric healthcare services.
Key words: children, tuberculosis, prevalence, risk factors.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (3): 7–11)
Key words: children, tuberculosis, prevalence, risk factors.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (3): 7–11)
SOCIAL PEDIATRICS AND HEALTH CARE
12–15 593
Abstract
With the help of «SOC/PEDIATRIA-3» software we have studied «true» adolescent morbidity from 2006 to 2008 inclusive. We have analyzed data from 723 adolescents including the results of their profound physical examination. We have calculated the index of accumulated morbidity by appealability. We have obtained valid data upon «true» adolescent morbidity.
Key words: adolescents, morbidity, database, profound checks.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (3): 12–15)
Key words: adolescents, morbidity, database, profound checks.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (3): 12–15)
16–20 506
Abstract
Organization of palliative care provided to children with oncology and other life-threatening (fatal) conditions and diseases must be a compulsory part of a state pediatric healthcare service. In this article various organizational issues of the above mentioned service are being discussed.
Key words: children, pediatric oncology, palliative care, organization.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (3): 16–20)
Key words: children, pediatric oncology, palliative care, organization.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (3): 16–20)
21-23 471
Abstract
The article contains results of quality of life assessment of adolescents with deviant behavior using SF-36 questionnaire. Overall results as well as more specific ones are presented showing various data before and after performing of health promotion programs in summer health camps. A positive trend of the level of quality of life has been demonstrated in adolescents with deviant behavior against the background of health improvement. An important role of adolescent quality of life assessment in substantiation of social care has been shown.
Key words: quality of life, adolescents, deviant behaviour.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (3): 21–23)
Key words: quality of life, adolescents, deviant behaviour.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (3): 21–23)
ORIGINAL ARTICLES
E.I. Alexeeva,
R.V. Denisova,
S.I. Valieva,
T.M. Bzarova,
K.B. Isaeva,
E.G. Chistyakova,
T.V. Sleptsova,
E.V. Mitenko
24–32 507
Abstract
This article contains results of the research of tocilizumab treatment efficacy and safety in 39 patients with severe systemic juvenile idiopathic arthritis, resistant to standard immunosuppressive treatment. Tocilizumab efficacy analysis has shown 50% of patients with inactive disease after 6 months of treatment, and 57% of patients with inactive disease after 12 months. Among adverse events were mild and moderate infections and such laboratory abnormalities as low leukocyte and neutrophiles count.
Key words: children, juvenile idiopathic arthritis, systemic arthritis, tocilizumab, treatment.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (3): 24–32)
Key words: children, juvenile idiopathic arthritis, systemic arthritis, tocilizumab, treatment.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (3): 24–32)
E.G. Boichenko,
E.M. Petrova,
I.A. Garbusova,
Yu.A. Nikitina,
T.N. Kulakova,
T.A. Makarova,
M.B. Belogurova,
G.G. Radulesku,
T.D. Viktorovich,
E.D. Chavpetsova,
L.I. Shats,
G.I. Uleiskaya,
I.S. Martynkevich,
Y.S. Ogorodnikova,
E.E. Zueva
33-42 705
Abstract
Regardless the success gained in treatment of acute lymphoblastic leukaemia, several problems still remain to be solved, such as: overcoming primary drug resistance and minimizing the amount of relapses as well as decreasing of chemotherapy toxicity without detriment to the final outcome of the treatment. Development of an optimal chemotherapeutical strategy still remains a hot issue. Objective: to evaluate an efficacy of two modifications of German protocol COALL-92 in treatment of ALL in children in St.-Petersburg. Methods: the retrospective analysis of results of treatment in patients under 18 years old with ALL was performed. The diagnosis was confirmed according to international criteria. The treatment was performed via protocols PECO-92 and COALL-St.-Petersburg-92. Results: 438 initial patients with ALL were treated in St.-Petersburg clinics during the period from 01.01.1993 to 01.01.2007. At the time of analysis the probability of event-free survival (pEFS) was 60% in group of PECO-92 protocol and 70% — in COALL group (plog-rank = 0,048), probability of relapse-free survival (рRFS) was 65 and 74% (plog-rank = 0,002), probability of overall survival was (pOS) 78 and 70%, correspondingly (plog-rank = 0,079). Conclusion: inclusion of protocol treatment in practice of St.-Petersburg hospitals resulted in significant improvement of treatment results in children with ALL. The problem of both versions of COALL protocol is high rate of postremission mortality due to high toxicity of intensive stage if chemotherapy.
Key words: children, acute lymphoblastic leukemia, intensive chemotherapy.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (3): 33–42)
Key words: children, acute lymphoblastic leukemia, intensive chemotherapy.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (3): 33–42)
L.M. Ogorodova,
I.A. Deev,
O.S. Fedorova,
A.E. Sazonov,
I.V. Petrova,
O.V. Eliseeva,
E.M. Kamaltynova,
Yu.A. Petrovskaya
43-47 668
Abstract
Tomsk region is the territory precinctive with infection of Opisthorchis felineus. The rates of prevalence of this infection in the region differ according to the data from several studies (from 15 to 80%). Objective: to evaluate the prevalence of helminthiasis with O. felineus in children in Tomsk and its region via PCR-diagnosticum of opisthorchiasis. Methods: 896 children 7–15 years old from different districts of Tomsk region were examined. Faeces were PCR-tested for the detection of O. felineus. Results: the prevalence of O. felineus-invasion in children in Tomsk region is 27.7%, in north and north-east regions the prevalence is even higher (35.1%), than in south regions (20.4%; p < 0.005). Conclusion: the study showed high prevalence of O. felineus invasion in children 7–15 years old living in Tomsk region.
Key words: children, Opisthorchis felineus, prevalence.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (3): 43–47)
Key words: children, Opisthorchis felineus, prevalence.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (3): 43–47)
48–54 694
Abstract
High incidence and unfavorable clinical course of opportunistic infections in children with HIV-infections lead to the study of risk factors of their development. Objective: to reveal risk factors of local and generalized opportunistic infections in children with parenteral HIV-infection. Methods: at the first stage of a study, risk factors of local opportunistic infections starting in 12 months after parenteral HIV-infection were retrospectively estimated in 98 children. At the second stage, prospective observation during 120 months with analysis of risk factors of generalized opportunistic infections was performed. Results: local opportunistic infections were detected in 41% of patients in 12 months after HIV-infection. Independent predictors of their development were infantile age at the moment of HIV-infection (OR 3.7; 95% CI 1.0–13.2) and acute HIV-infection (OR 4.4; 95% CI 1.3–15.1). Generalized opportunistic infections were detected in 46% of patients during 120 months of observation. Independent risk factors of generalization were the presence of local opportunistic infection in medical history (OR 2.7; 95% CI 1.2–6.1), delay of physical development > 10% (OR 4.2; 95% CI 1.4–12.8) and the level of CD4+ lymphocytes < 15% at the time of initial examination (OR 46.1; 95% CI 9.9–213.1). Conclusion: authors demonstrated the significance of clinical and laboratory tests of immune system and virus replication intensity for the prognosis of development of local and generalized opportunistic infections in children with HIV-infection.
Key words: children, HIV-infection, opportunistic infection, risk factors.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (3): 48–54)
Key words: children, HIV-infection, opportunistic infection, risk factors.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (3): 48–54)
55–59 506
Abstract
In real practice, treatment of patients with bronchial asthma (BA) is accompanied by unreasonable increase of healthcare resources consumption because of unplanned visits to the doctor due to health worsening, hospital treatment of exacerbations and emergency calls. Objective: to evaluate an effectiveness of children’s with bronchial asthma observations by allergologist. Methods: the dynamics of clinical and functional signs and frequency of emergency claims was analyzed in 115 children with BA who were observed by allergologist once in 3 months during one year. Results: in 3 months of regular observation by allergologist the number of children with day and night symptoms of BA and patients with daily rescue use of short-acting 2-agonists decreased, there were fewer children with limitations of physical activity. The number of patients with normal FEV1 increased in 6 months. Regular observation with allergologist resulted in reduction of number of patients with exacerbations and hospitalizations, shortening of acute period of BA and hospital stay, decreasing of emergency claims rate compared to those who were observed by GPs. Conclusion: regular observation by allergologist once in 3 months results in stabilization of clinical and functional state in patients with BA and decreases the consumption of emergency care resources.
Key words: children, bronchial asthma, allergologist, clinical and functional state, healthcare resources.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (3): 55–59)
Key words: children, bronchial asthma, allergologist, clinical and functional state, healthcare resources.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (3): 55–59)
PROFESSIONAL DEVELOPMENT
60-64 602
Abstract
Initial immunodeficiencies are genetically conditioned defects of immune system; they are the basis for generalized infections including those induced by mycobacteria of tuberculosis complex. The lesions of skeleton in those patients are of different types depending on the kind of immunodeficiency. The article presents the results of clinical observation, conservative and surgical treatment of 12 children with mycobacterial lesions of skeleton on the ground different initial immunodeficiencies — severe combined immune deficiency, chronic granulematosis and insufficiency of interferon and interleukin 12.
Key words: children, initial immunodeficiency, mycobacterial infection, bone lesions, surgical treatment.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (3): 60–64)
Key words: children, initial immunodeficiency, mycobacterial infection, bone lesions, surgical treatment.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (3): 60–64)
65–69 584
Abstract
Change of tolerance to the tuberculin is the predictor of the infection with Mycobacterium tuberculosis (MBT) and high risk of clinically significant tuberculosis. Besides, phthisiatritians need integral objective criteria for the estimation of anti-infectious immunity. Objective: to evaluate prognostic value of risk factors of clinically significant tuberculosis development in children with changed tolerance to tuberculin. Methods: the study included children with turn of tuberculin test or hyper reaction to the tuberculin (the size of papule must be 17 мм). The risk of tuberculosis development was estimated by multifactorial modeling. All patients from high risk group (n = 29) received preventive chemotherapy (isoniazid or its combination with pyrazinamide), parents of all children with low risk of tuberculosis (n = 20) refused anti-tuberculosis treatment. Results: changes of tolerance to tuberculin and the size of papule were equal in both groups: mean difference for children with high risk is 3.2 mm (95% CI 0.7–5.7), for children with low risk — 2.4 mm (95% CI 0.1–4.7). At the time of first examination, X-ray changes in lungs (intensification of vascular reflection, hypoplasia of pulmonary artery, thickening of pleura, presence of calcified focuses) were detected in 6 (21%) patients from high risk group. Repeated examination was performed in 12 months. Calcified focuses in intrathoracic lymphonodules were revealed in another one child from this group. Conclusion: prognostic criteria of tuberculosis show objective need of preventive treatment. In case of absence of these criteria further observation of children by general practitioners is recommended.
Key words: children, tuberculosis, immune system, diagnostics, chemotherapy.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (3): 65–69)
Key words: children, tuberculosis, immune system, diagnostics, chemotherapy.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (3): 65–69)
70–75 1088
Abstract
Skin tuberculin Mantoux test is widely used for the revelation of latent tuberculosis infection (LTI). Low specificity of the test (high rate of false-positive reactions due to the cross-sensitizing to vaccine strain Mycobacterium bovis BCG) results in difficulties in its interpretation. New method of LTI and active tuberculosis diagnostics is Diaskintest; it contains proteins CFP 10 and ESAT 6 which are absent in genome of M. bovis BCG and in most non-tuberculosis mycobacteria. The article presents results of a study of diagnostical value of Diaskintest (0.2 mkg/0.1 ml) and Mantoux test (with 2 TU PPD-L) in adolescents who had contacted with patients with tuberculosis. 143 adolescents from 2 colleges were examined, Diaskintest was performed in all of them, Mantoux test — in 131 patients, X-ray imaging including computer tomography — in all patients. Diaskintest demonstrated high sensitivity and specificity in diagnostics of tuberculosis in adolescents who had a contact with infected persons. 77.9% had positive Mantoux test (102/131), 5.6% — positive Diaskintest (8/143). Diaskintest revealed 5 cases of tuberculosis and 3 cases of LTI.
Key words: adolescents, tuberculosis, Mantoux test, Diaskintest, diagnostics.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (3): 70–75)
Key words: adolescents, tuberculosis, Mantoux test, Diaskintest, diagnostics.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (3): 70–75)
76–79 508
Abstract
The article analyzes dynamics of incidence of tuberculosis in children 0–14 years old in Moscow (1993–2000 years). The role of antituberculosis healthcare services in revelation of infected children increases while the participation of general healthcare services in this process becomes low. The structure of tuberculosis in children according to clinical forms and revelation methods is studied. Changes in group structure of revealed patients with relative stabilization of children’s morbidity come due to increase of secondary tuberculosis rate and late diagnostics of out-of-pulmonary disease.
Key words: children, tuberculosis, morbidity, diagnostics.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (3): 76–79)
Key words: children, tuberculosis, morbidity, diagnostics.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (3): 76–79)
A DOCTOR’S AID
80–85 1004
Abstract
Normal intestinal microflora is necessary for human health. Sour milk products influence the composition and functional state of intestinal micro flora. Multiple studies showed high probiotic activity of Lactobacillus rhamnosus GG (ATCC 53103, LGG) and its safety in children and adults. LGG has beneficial effect on functional disorders of intestinal motor function, and in treatment of allergic and inflammatory diseases. These effects are realized through TLR2 receptors activating NFkB-mediated signal way and regulating cytokines synthesis. Besides, LGG blocks interaction of mast cells and IgE and favors to the expression of H4 histamine receptors. LGG (ATCC 53103) are included in liquid yoghurts («Tyoma» for children from 8 months old), kefir, tan, cottage cheese and other food produced by Bio Balance.
Key words: children, nutrition, Lactobacillus rhamnosus GG, probiotics, sour milk products, food allergy.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (3): 80–85)
Key words: children, nutrition, Lactobacillus rhamnosus GG, probiotics, sour milk products, food allergy.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (3): 80–85)
86–91 449
Abstract
The article analyzes several problems of breast feeding existing. The data on composition of breast milk in different groups of women, recommended terms of beginning and duration of breast feeding are presented. Authors discuss principles of effectiveness evaluation and advantages of prolonged breast feeding on the basis of comparative estimation of physical and psychical development and morbidity of children with different types of feeding. Methods of breast feeding optimization including modern electronic breast pump use are described.
Key words: infants, breast feeding, breast pumps.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (3): 86–91)
Key words: infants, breast feeding, breast pumps.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (3): 86–91)
92–96 463
Abstract
The market of drugs proposes some new medicines which are labeled by manufacturers as immunomodulating agents. Most of them are not licensed and they have no any evidence of their efficacy. In opposite, non-specific ribosomal modulator (Ribomunyl) is the wellstudied drug with good database on its efficacy and safety. The article presents a description of drug’s effect on the immune system of a child for increase of organism’s resistance to the most widespread causative agents of infections of ENT-organs and airways.
Key words: children, respiratory infections, recurrent course, immunomodulators, treatment.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (3): 92–96)
Key words: children, respiratory infections, recurrent course, immunomodulators, treatment.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (3): 92–96)
97–102 438
Abstract
The article describes the significance of amino acids’ combination in protein and their excess or insufficiency in serum milk formulas for the health of infants. Results of evaluation of nutritive quality of proteins in experimental diets are presented.
Key words: children, milk formula, protein, Prolacta.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (3): 97–102)
Key words: children, milk formula, protein, Prolacta.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (3): 97–102)
103–107 546
Abstract
Respiratory infections, relapses of ear, nose, throat infections, acute and chronic bronchial infections — these are the most common infantile infections. Regardless the wide range of medications, treatment of recurrent ENT and respiratory infections is not always effective especially in the group of frequently ill children. This article contains analysis of the necessity of immunomodulation therapy of recurrent respiratory infections as a part of complex prophylaxis and treatment of infants.
Key words: children, acute respiratory infection, polyoxidonium, treatment.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (3): 103–107)
Key words: children, acute respiratory infection, polyoxidonium, treatment.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (3): 103–107)
108–113 552
Abstract
The article discusses the questions of diagnostical algorithm, classification and approaches to the treatment with laxative drugs, prokinetics and diet. The classification of laxative drugs and their use in pediatric practice are presented.
Key words: children, chronic constipation, diagnostics, treatment, laxative drugs.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (3): 108–113)
Key words: children, chronic constipation, diagnostics, treatment, laxative drugs.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (3): 108–113)
114–118 689
Abstract
High incidence of various pediatric gastroenterologic diseases including congenital still remains an important issue for a Russian healthcare. The latter may be attended by relative or total excretory pancreatic failure with the following symptoms: stool abnormalities, abdominal pain, meteorism, weakness, low appetite and physical exercise, weight reduction and growth retardation. Pancreatic enzymes that contribute to protein, lipids and carbohydrates digestion are often used as a replacement therapy in pediatric care. Nowadays there is a plenty of choice among enzymatic medications. However, not all aforesaid medications can ensure adequate replacement treatment especially in children with chronic pancreatic failure. That is why among agents of choice are modern and highly effective microgranulated encapsulated pancreatines. For example Micrazim.
Key words: children, pancreas, pancreatic failure, enzymotherapy.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (3): 114–118)
Key words: children, pancreas, pancreatic failure, enzymotherapy.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (3): 114–118)
119–123 647
Abstract
The article discusses the problem of basis therapy in patients with chronic Pseudomonas aeruginosa infection and cystic fibrosis. Authors showed the safety, good tolerance and high efficacy of constant treatment with special tobramycin solution delivered by nebulizer (Tobi) in children including ones under 6 years old. Even first inhalations of tobramycin result in decrease of Pseudomonas aeruginosa rate in bacterial inoculation or to it complete removal. The drug helps stabilization of clinical and functional state of patients, improvement of airflow and common state, and to clinical remission.
Key words: children, cystic fibrosis, chronic Pseudomonas aeruginosa infection, tobramycin, nebulizer therapy.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (3): 119–123)
Key words: children, cystic fibrosis, chronic Pseudomonas aeruginosa infection, tobramycin, nebulizer therapy.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (3): 119–123)
124–130 567
Abstract
The article presents modern data on etiology of acute and chronic inflammatory diseases of airways in children. Special attention is given to the treatment with oral antibiotics and to the meaning of these drugs. Authors give a literature review of biological, pharmacokinetic and anti-microbal activities of macrolides and particularly azithromycin. Detailed characteristics of effects of macrolide antibiotic azithromycin and tactics of its administration for the treatment of airways diseases in children are presented. The article describes nonantibacterial effects of azithromycin: anti-inflammatory, immunomodulatory and mucoregulatory ones. New activities of azithromycin are structural and functional defence of respiratory epithelium and ability to prevent adhesia of microorganisms. These properties of a drug widen the indications of its administration. The reasonability of its use for treatment of out-of-hospital pneumonias including atypical ones (mycoplasmal and chlamidia pneumonias) and in patients with exacerbations of chronic inflammatory bronchopulmonary diseases was show.
Key words: children, acute and chronic respiratory diseases, pneumococcus, hemophilus influenza, azithromycin.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (3): 124–130)
Key words: children, acute and chronic respiratory diseases, pneumococcus, hemophilus influenza, azithromycin.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (3): 124–130)
131–136 639
Abstract
The incidence of Hepatitis A still remains one the highest among other types of viral hepatitis in many countries in the world including Russia. An important epidemiological trait of the disease is its high prevalence among children. This article contains results of the comparative analysis of prevalence of hepatitis A in two indicator groups — children 3–6 years old and adults 20–29 years old from 78 regions of the Russian Federation. Antiviral collective immunity was assessed by the levels of IgG to hepatitis A virus (anti-HAV) in 2009 among children 0–17 y. o. and adults 20–39 y. o. from St. Petersburg (in total among 872 patients). Judging upon incidence of hepatitis A infection and rate of anti-HAV detection it was stated that St. Petersburg is a region with interim endemicity that requires planned immunization according to the WHO recommendations.
Key words: children, hepatitis A, incidence, epidemiology.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (3): 131–136)
Key words: children, hepatitis A, incidence, epidemiology.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (3): 131–136)
137–140 897
Abstract
In the past decade we have witnessed a dramatic increase in the incidence of prolonged neonatal hyperbilirubinemia. The reason for that is still unknown. Neither there’re any standardised guidelines for treatment of infants with prolonged jaundice. The article contains results of the literature review related to methods of treatment of neonatal prolonged hyperbilirubinemia.
Key words: neonates, hyperbilirubinemia, jaundice, treatment.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (3): 137–140)
Key words: neonates, hyperbilirubinemia, jaundice, treatment.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (3): 137–140)
CLINICAL OBSERVATIONS
141–149 531
Abstract
The article presents a clinical case of severe systemic juvenile rheumatoid arthritis, refractory to traditional immunosuppressive treatment and with insufficient efficacy of chimeric homogenous anti-TNF-a antibodies. The patient received 2 courses of anti-Blymphocyte’s- CD20-antibodies that helped to arrest all systemic manifestations of the disease. Articular syndrome was arrested only with the help of soluble receptors to TNF a — ethanercept, given in following dose — 0.4 mg per kg of body mass. The patient has been on treatment with ethanercept for 24 weeks. Joint tenderness and exudation were diminished already after the first 4 weeks of treatment, also there was a dramatic increase in joint motion range. After 6 months of therapy we have managed to improve the patients and his family quality of life.
Key words: children, juvenile rheumatoid arthritis, ethanercept, treatment.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (3): 141–149)
Key words: children, juvenile rheumatoid arthritis, ethanercept, treatment.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (3): 141–149)
150–156 760
Abstract
This article contains an example of a successful clinical use of human monoclonal antibodies to tumor necrosis factor (TNF) — adalimumab in patients with severe juvenile idiopathic spondylitis, characterized by resistance to standard antirheumatic treatment and secondary resistance to recombinant (chimeric) antibodies to TNF. Adalimumab treatment in a short time has helped to overcome secondary ineffectiveness of infliximab treatment, to rapidly decrease the activity of the disease, to reach functional improvement of peripheric joints, to improve patient’s quality of life. The aforesaid medication has stopped steady progression of further incapacitation of the patient and has evoked clinical remission of the disease.
Key words: children, juvenile idiopathic spondylitis, adalimumab, treatment.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (3): 150–156)
Key words: children, juvenile idiopathic spondylitis, adalimumab, treatment.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (3): 150–156)
157–165 427
Abstract
The article presents a case report of aggressive rapidly progressive severe polyarticular juvenile rheumatoid arthritis (JRA) resistant to standard immunosuppressive treatment. Patient with extra-early (up to 6 months) arthritis was successfully treated with genetically engineered biological agent infliximab. Pain decreased significantly after first injection of a drug, the second injection resulted in decrease of laboratory activity, third one completely stopped exudative lesion of joints, morning stiffness, and restored functional activity of a child. Thus, after 6 months the disease was transferred to inactive phase, motions of joints restored, there was no need in nonsteroid anti-inflammatory drugs. Cardiovascular symptoms stopped as well. The case report showed high efficacy of tumor necrotizing factor _ blocker infliximab in patients with aggressive clinical course and markers of unfavorable prognosis at very early stages of JRA before irreversible lesions of joints happen.
Key words: children, early juvenile rheumatoid arthritis, infliximab, treatment.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (3): 157–165)
Key words: children, early juvenile rheumatoid arthritis, infliximab, treatment.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (3): 157–165)
166–169 500
Abstract
The data of clinical and instrumental examination of two infantile patients with obstructive hypertrophic cardiomyopathy in association with marked multisystem involvement as a picture of inherited malformation syndromes are given.
Key words: infants, hypertrophic cardiomyopathy, LEOPARD syndrome, Noonan syndrome.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (3): 166–169)
Key words: infants, hypertrophic cardiomyopathy, LEOPARD syndrome, Noonan syndrome.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (3): 166–169)
170–174 454
Abstract
Opportunities of effective treatment of juvenile arthritis became wide because of introduction of genetically engineered biological drugs to the clinical practice during last years. One of the genetically engineered drugs of first choice for the treatment of refractory types of juvenile arthritis is tumor necrotizing factor blocker infliximab. Nowadays the problem of its primary and secondary inefficiency becomes topical. The article presents an experience of treatment with abatacept in patient with polyarticular type of juvenile rheumatoid arthritis with eyes lesion. Successful treatment with abatacept in patient with high active polyarthritis and uveitis resistant to infliximab proves reasonability of therapy of different clinical symptoms of juvenile arthritis with abatacept.
Key words: children, juvenile rheumatoid arthritis, infliximab, abatacept, treatment.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (3): 170–174)
Key words: children, juvenile rheumatoid arthritis, infliximab, abatacept, treatment.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (3): 170–174)
SHORT REPORTS
INFORMATION FROM THE UNION OF PEDIATRICIANS OF RUSSIA
ISSN 1682-5527 (Print)
ISSN 1682-5535 (Online)
ISSN 1682-5535 (Online)
