Vol 10, No 4 (2011)
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SOCIAL PEDIATRICS AND HEALTH CARE
5–9 592
Abstract
Myopia — is the most common vision defect, that is being formed due to impaired school routine, work and recreation conditions, motion activity and against the background of increased physical and psychological stress. Study objective: study lifestyle peculiarities of myopic schoolchildren. Methods: 349 pupils from 5–9 forms of a school with profound studying of various subjects were interviewed using a specially designed questionnaire. After a preventive examination the schoolchildren were divided into two groups according to ophthalmologists report, comparable by age and gender (162 myopic vs 182 without myopia). Results: all participants were poorly informed about myopia and possible preventive care, and during breaks behaved themselves in an unreasonable way judging from the positions of vision care. At home myopic children tended to spend more time doing their homework and on extracurricular studies, as well as on reading; these children in general spent more time watching TV or working on a computer; failed to rest properly, couldn’t switch from one type of activity to another, were working under conditions of unreasonable vision workload. In contrast to participants from control group, myopic schoolchildren spent less time resting: they were sleeping less and spent less time outdoors. Conclusion: revealed lifestyle peculiarities of modern myopic schoolchildren must become a target for preventive care. Their irrational lifestyle can be corrected by correction of daily routine, better organization of extracurricular exercises, visual exercises, better education of schoolchildren about disease risk factors.
Key words: schoolchildren, myopia, risk factors.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (4): 5–9)
Key words: schoolchildren, myopia, risk factors.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (4): 5–9)
ORIGINAL ARTICLES
10–15 552
Abstract
High incidence of different types of allergy in children forces us to study the atopy formation peculiarities and methods of its effective prophylaxis. The objective: to study the peculiarities of formation of alimentary allergy in infants. Methods: the study included newborns. Authors studied the family history of allergic diseases. The process of allergy development in system «mother–fetus–child» and influence of several risk factors were detected. Results: authors showed the role of hereditary factor, excessive use of food with high sensitizing potential, artificial feeding with mixtures containing cow milk proteins, and deviations in formation of normal intestinal micro biocenosis in atopy formation in children. Conclusion: authors proposed the method of revelation children with high risk of alimentary allergy. Obtained data proves the necessity of stage-by-stage combined measures for the prophylaxis of allergic pathology in ontogenesis.
Key words: newborns, atopy, alimentary allergy, IgE.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (4): 10–15)
Key words: newborns, atopy, alimentary allergy, IgE.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (4): 10–15)
V.A. Aksenova,
L.А. Barishnikova,
N.I. Klevno,
E.А. Sokolskaya,
Е.N. Dolzhenko,
А.М. Shuster,
V.А. Martyanov,
D.А. Kudlay,
N.Yu. Nikolenko,
А.А. Kurilla
16–22 775
Abstract
In modern epidemiologic conditions revealing of children under the maximal risk of TB infection is the most important object of pediatric phtisiology. Study object: efficacy enhancement of early TB diagnmostics among children and adolescents in public healthcare system. Methods: a multicenter study was carried out in the city of Moscow, Samara and Ryazan regions. Children and adolescents under high risk of TB infection were included into this study. The study consisted of three phases: first — Diaskintest intracutaneous test assessment in children and adolescents within TB dispensery; second — same procedure performed among children and adolescents not registered in TB despensery but taken care of by a local pediatrician; third — among pupils of secondary complementary education institutions. Results: first phase of the study showed that every second child, registered in TB dispensery due to MTB contamination, which was revealed via traditional diagnostic procedures, receives unreasonable chemoprophylaxis. Among pediatric patients (second phase) TB was diagnosed in 2.3% of total amount of children from this group and among 26.7% of Diaskintestpositive patients. Testing patients in the third phase of the study (pupils of of secondary complementary education institutions) revealed TB infection in 0.6% of tested and in 21.2% among Diaskintest-positive patients. Conclusion: Diaskintest use as a screening method among children helps revealing patients under highest risk of TB infection.
Key words: children, tuberculosis, diagnostics, Diaskintest, Mantoux test.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (4): 16–22)
Key words: children, tuberculosis, diagnostics, Diaskintest, Mantoux test.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (4): 16–22)
LITERATURE REVIEW
23–28 946
Abstract
Out-of-hospital pneumonia is one of significant problems among infections of low airways in children. According to the data from international studies, the incidence of out-of-hospital pneumonia is 34–40 cases of 1,000 children per year. The prevalence of this disease in Russia is lower: different data show 4–12 cases of 1,000 children 1 month old-15 years old. Low prevalence is related to more rough criteria of pneumonia diagnostics. Out-of hospital pneumonia doesn’t result in death frequently, but in developing countries it is the leading cause of children’s mortality. Every year 700 thousands — 1 million children die because of pneumococcal infection. That’s why the questions of timely diagnostics, adequate treatment and specific prophylaxis are topical. The literature review is performed for highlighting of questions of pneumonia development and diagnostics of patients with opportunity of efficient specific prophylaxis.
Key words: children, pneumonia, immunodeficiency state, prophylaxis.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (4): 23–28)
Key words: children, pneumonia, immunodeficiency state, prophylaxis.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (4): 23–28)
30–35 658
Abstract
In the recent decade, thanks to rapid development of new immunologic, morphologic and biologic methods we have achieved dramatic progress in understanding of celiac disease aetiopathogenesis. The whole image of the disease has been changed and enlarged — now it’s defined as an immunemediated multisystemic disease, that is caused by gluten and corresponding prolamines among genetically vulnerable individuals, that is characterized by a variety of gluten-dependant clinical features, specific antibodies, HLA DQ2 and DQ8 haplotypes and enteropathy. According to this novel approach, we regard possibilities of celiac disease diagnostic algorithm improvement, especially among patients from risk groups.
Key words: celiac disease, autoimmune disease, enteropathy, gluten, gliadine peptides, tissue transglutaminase, haplotypes HLA DQ2, DQ8.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (4): 30–35)
Key words: celiac disease, autoimmune disease, enteropathy, gluten, gliadine peptides, tissue transglutaminase, haplotypes HLA DQ2, DQ8.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (4): 30–35)
36–40 503
Abstract
The article contains pneumococcal infection prevalence survey among HIV-positive children. Questions of pneumococcal infection prevention using pneumococcal conjugated vaccine are discussed in the article. Recommendations upon immunization of HIV-positive children and children born to HIV-positive women against pneumococcal infection are given in the article as well.
Key words: children, HIV-infection, pneumococcal infection, pneumococcal conjugated vaccine.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (4): 36–40)
Key words: children, HIV-infection, pneumococcal infection, pneumococcal conjugated vaccine.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (4): 36–40)
41–46 604
Abstract
The literature review analyzes the results of Imudon administration in pediatrics. The drug contains a mixture of purified lyzates of bacteria which are the most frequent causative agents of pathologic processes in oral cavity and throat. Presented data show high efficacy and safety of a drug.
Key words: frequently sick children, respiratory infections, topical immunocorrector, clinical studies.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (4): 41–46)
Key words: frequently sick children, respiratory infections, topical immunocorrector, clinical studies.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (4): 41–46)
PROFESSIONAL DEVELOPMENT
62–69 551
Abstract
The first year of child’s life is the most important and intensive stage in formation of stable intestinal microbiocenosis. Main factors resulting in stability are primary colonization, tolerance, barrier function of epithelium, main protective systems of gastrointestinal tract, breast milk, and probiotics. The creation or restoration of microbiocenosis is achieved by different techniques of microbal population management: breast feeding, adopted milk mixtures fortified with probiotics in terms of lack or absence of breast milk. Beneficial effects of probiotics are strain-specific. Detailed scientific dossier of a strain Lactobacillus GG (АТСС 53103, LGG) is described. The strain is included in sour-milk products «TYOMA» for children 6 months and older.
Key words: children, colonization, intestinal flora, micro biocenosis, breast milk, probiotic bacteria, food.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (4): 62–69)
Key words: children, colonization, intestinal flora, micro biocenosis, breast milk, probiotic bacteria, food.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (4): 62–69)
70–77 826
Abstract
The article presents modern review and proper data on topical problem of strokes in children. The incidence of stroke in children is 3 cases for 100,000 children per year, 40% of them — children under 5 years old. More then a half of children have stable motor and cognitive disorders, in 20% of them experience repeated strokes. There are many etiological factors of the disease; the main ones are pro thrombotic state of hemostasis, disorders of vessels, infections and traumas. Diagnostics of a stroke includes magneticresonance imaging and angiography, several laboratory tests and detection of the level of homocysteine. The tables describe basis and neuroprotection treatment in acute period of ischemic stroke. Authors give special attention to the stroke as an interdisciplinary problem treated by resuscitation specialists, pediatricians, neurologists, infectious diseases specialist and hematologists.
Key words: children, stroke, thrombophilia, disorder of vessels, dissection, actovegin.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (4): 70–77)
Key words: children, stroke, thrombophilia, disorder of vessels, dissection, actovegin.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (4): 70–77)
47–60 1465
Abstract
The first lection in the course «Endocrinopathies» discusses main rules of endocrinology, main causes and key stages of endocrine pathology development, etiology and pathogenesis of the most frequent hypophysial disorders with their symptoms and mechanisms, and several types of adenohypophysial pathology. Author gives some tests and situational tasks for the evaluation of the level of knowledge, and the answers to the tests.
Key words: endocrinopathy, hypopituitarism, hyperpituitarism, acromegalia, diabetes insipidus, syndrome of inadequate secretion of ADH.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (4): 47–60)
Key words: endocrinopathy, hypopituitarism, hyperpituitarism, acromegalia, diabetes insipidus, syndrome of inadequate secretion of ADH.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (4): 47–60)
EXCHANGE OF EXPERIENCE
78–82 718
Abstract
The article presents the results of analysis of health state in 75 mature healthy infants. 35 children had breast feeding, and 40 ones received dry milk formula «Baby Premium 1». The duration of observation was 3 months. Physical development and results of laboratory analyses in children with artificial feeding were comparable with indices of children from group of breast feeding. Adopted milk formula can be the source of all necessary food and functional ingredients sufficient for normal growth and physical development of infants; it can be recommended for the nutrition of children until birth.
Key words: breast feeding, artificial feeding, physical development, coprological analysis.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (4): 78–82)
Key words: breast feeding, artificial feeding, physical development, coprological analysis.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (4): 78–82)
83–88 859
Abstract
The article presents information on treatment of children with frequent mixed infections (herpes-viral and intracellular). Examination of frequently sick children included combination of diagnostic methods (microbiological, serological) for the selection of combined therapy. Inosine pranobex (Isoprinosine) used as a part of complex treatment of mixed infection in frequently sick children favored to decrease of the duration of main clinical symptoms and to elimination of antibodies to infectious agents in respiratory tract or to decrease of their titre in most frequently sick children. Good therapeutic effect was detected in children with herpes viral infection.
Key words: frequently sick children, respiratory infections, herpes virus, inosine pranobex, treatment.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (4): 83–88)
Key words: frequently sick children, respiratory infections, herpes virus, inosine pranobex, treatment.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (4): 83–88)
89–92 445
Abstract
The article presents the results of a study of ribosomal complex (Ribomunyl) in prophylaxis of acute respiratory infections (ARI) in frequently and long sick children with moderate bronchial asthma. The data from multicenter studies and the results of proper experience show beneficial effect of the drug on the dynamics of main clinical symptoms of ARI in children with moderate bronchial asthma. Ribosomal complex decreases of the need of treatment with antibiotics and improves the recovery.
Key words: frequently sick children, bronchial asthma, acute respiratory infection, ribosomal complex, prophylaxis.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (4): 89–92)
Key words: frequently sick children, bronchial asthma, acute respiratory infection, ribosomal complex, prophylaxis.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (4): 89–92)
93–99 545
Abstract
The article presents modern data on the formula of breast milk and principles of adaptation of children’s milk mixtures. Authors show the reasonability of inclusion of some ingredients in the mixtures. The proper experience of nutrition with children’s milk formula «Agusha Gold 1» is presented, its influence on physical development of infants first 6 months old is analyzed. The product is welltolerated with children without allergic family history and with infants from risk groups of atopy and ones with minimal allergic symptoms (not related to cow milk proteins). Most children with mild and changeable allergic symptoms showed total absence of dry skin on cheeks and rash.
Key words: breast milk, breast feeding, children’s milk formulas, bifidobacteria, oligosaccharides, allergy prophylaxis.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (4): 93–99)
Key words: breast milk, breast feeding, children’s milk formulas, bifidobacteria, oligosaccharides, allergy prophylaxis.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (4): 93–99)
100–104 548
Abstract
Authors present the results of a study of pathogenetic mechanisms leading to the urinary tract infections in children with vesicoureteric reflux. Urine pH test with ammonium chloride detected decreasing of acidogenetic function of kidneys in children with urinary tract infection. Conventional antibacterial treatment of acute urinary tract infection combined with herbal medication Canephron N resulted in restoration of acidogenetic function of distal tubules and reducing of inflammation in urinary tract. Supportive treatment with herbal medication normalized urine flow with minimization of residual portion of urine. The treatment resulted in decrease of risk of recurrent urinary tract infections including pyelonephritic ones.
Key words: children, urinary infections, vesico-ureter reflux, antibacterial treatment, Canephron N, treatment.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (4): 100–104)
Key words: children, urinary infections, vesico-ureter reflux, antibacterial treatment, Canephron N, treatment.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (4): 100–104)
105–110 481
Abstract
The article presents a data from a clinical study describing different clinical effects of lactulose. The direction of drug’s efficacy depends on different dose of lactulose. The use of prebiotic dose (milk mixture «Bifidus 1, 2») improves the state of intestinal micro flora, favors to the increase of efficacy of usually used treatment and decreases the probability of unfavorable rehabilitation period in infants with infectious enterocolitis and intestinal disbiosis.
Key words: infants, infectious enterocolitis, intestinal micro flora, short-chain fatty acids, lactulose.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (4): 105–110)
Key words: infants, infectious enterocolitis, intestinal micro flora, short-chain fatty acids, lactulose.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (4): 105–110)
111–114 874
Abstract
The prevalence of breast feeding in Sverdlovsk region during last 5 years is analyzed. An adherence to breast feeding increases in presence of regional social support of pregnant and nursing women and provision with dry specialized milk mixture «Bellakt Mama». All artificially fed children 0–8 months old received adopted mixture «Bellakt 0–12», and children under 3 years old have opportunity (if they have social need) to receive liquid and past-like milk products for children’s nutrition, dry milk products for children after 1 year old and quick-dissolving cereals. Special attention is given to children’s nutrition in boarding schools. Rachitis, hypotrophy, functional intestinal disorders and other alimentary-dependent states are diagnosed 1.3 times frequently and anemia — 1.7 times frequently in children from orphans’ houses and boarding schools than in whole population. For the correction of micronutrient deficiency in infants, fortified milk drink «Be Healthy» («Bud Zdorov») was developed; it contains prophylactic doses of vitamins (A, D, E, C, PP) and microelements (iodine, iron, zinc, selenium).
Key words: infants, health, nutrition, milk mixture
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (4): 111–114)
Key words: infants, health, nutrition, milk mixture
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (4): 111–114)
115–118 531
Abstract
Acute viral rhinitis is one of the most frequent reasons for the administration of drugs in pediatrics. Complex treatment of acute rhinitis with isotonic solution of sterile oceanic water (Marimer) and nasal oxymetazoline results in shortening the duration of clinical symptoms of rhinitis.
Key words: children, acute respiratory viral infection, rhinitis, oxymetazoline, irrigation therapy.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (4): 115–118)
Key words: children, acute respiratory viral infection, rhinitis, oxymetazoline, irrigation therapy.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (4): 115–118)
V.А. Skvortsova,
Т.E. Borovik,
М.I. Bakanov,
А.V. Migali,
Т.N. Stepanova,
Е.N. Basargina,
L.М. Kuzenkova
119–125 2152
Abstract
Malnutrition is widely spread among infants with severe, especially chronic pathology. Effective treatment of the underlying disease is impossible without adequate diet therapy that includes clinical nutritive products with specially designed composition. Rational feeding positively influences metabolic processes and adds to body mass gain.
Key words: malnutrition, hypotrophy, infants, special clinical nutrition, short-life proteins.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (4): 119–125)
Key words: malnutrition, hypotrophy, infants, special clinical nutrition, short-life proteins.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (4): 119–125)
126–128 446
Abstract
The article summarizes an experience of on-line parents consulting on the question s of vitamins deficiency in children and adolescents. Authors give recommendations to pediatric specialists how to implement achieved knowledge into clinical practice. This kind of parents consulting forms proper understanding of health state of their children.
Key words: children, parents, vitamins deficiency, on-line consulting.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (4): 126–128)
Key words: children, parents, vitamins deficiency, on-line consulting.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (4): 126–128)
129–132 521
Abstract
Pidotimod is per oral immunomodulator; its efficacy is conditioned by activation of different components of immune system. The efficacy of pidotimod was studied in frequently sick children; its influence on the production of pro- and anti-inflammatory cytokines with leucocytes in peripheral blood was evaluated. The study was performed ex vivo with 15 samples of peripheral blood of frequently sick children 4 years old. The rate of interferon (IFN) status, sensitivity to pidotimod, concentration of pro-inflammatory (IFN , Interleukin [Il] 18) and anti-inflammatory (Il 4, 10) cytokines were detected before and after processing the samples with the drug. Pidotimodex vivo induced more than 4 times increase of initially low production of IFN with leucocytes of peripheral blood (from 11.5 ± 3.4 to 51.8 ± 8.3 U/ml). It did not influence the production of IFN _ (432 ± 49 and 448 ± 30 U/ml — before and after processing the samples correspondingly). The drug stimulated production of IFN ex vivo; the concentration of IFN compared to its spontaneous production increased from 2.3 ± 0.9 to 11.8 ± 1.6 picogram/ml correspondingly. Stimulation of PGA-induced production of IFN was less expressed; it increased in correlation with the time of exposition 1.5–2.5 times higher compared to induction of IFN synthesis without the drug. The drug favored to increase of Il 18 level (spontaneous — from 23.5 ± 3.5 to 49.1 ± 2.2 pg/ml, induced — from 34.2 ± 2.4 to 47.8 ± 4.4 pg/ml) and Il 10 (from 6.7 ± 1.3 to 15.5 ± 0.9 pg/ml and from 20.6 ± 1.2 to 42.7 ± 2.5 pg/ml correspondingly). As the production of cytokines increased because of pidotimod, the level of Il 4 (as spontaneous, as induced one) decreased from 2.6 ± 0.8 to 0.5 ± 0.2 pg/ml correspondingly. Thus, pidotimod ex vivo stimulates the synthesis of IFN , Il 10 and 18 and decreases the level of Il 4. These effects favor to the activation of Th1 immune response of organism.
Key words: frequently sick children, cytokines, pidotimod.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (4): 129–132)
Key words: frequently sick children, cytokines, pidotimod.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (4): 129–132)
A DOCTOR’S AID
133–139 617
Abstract
Dietotherapy is the basis of intestinal colics treatment in infants who have combined and artificial feeding. The article presents results of scientific studies and characterizes differentiated approach to the administration of dietotherapy for the treatment of intestinal colics. The components of the diet are: decomposed protein, decreased concentration of lactose, structured fat and probiotic culture.
Key words: infants, intestinal colics, dietotherapy, hydrolyzed protein, palmitic acid.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (4): 133–139)
Key words: infants, intestinal colics, dietotherapy, hydrolyzed protein, palmitic acid.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (4): 133–139)
140–144 598
Abstract
Cow’s milk is used for the nutrition of children and adults since ancient times; its favorable effects are described in medical and popular literature. During the last years, some unfavorable effects of extensive use of milk in nutrition of infants were revealed. First of all, cow’s milk is strong risk factor of iron-deficient anemia in infants. Besides, the study of big group of children who received big volumes of milk during first 6–24 months of life showed that that type of diet increase the risk of obesity and related pathological states in older age. Comparison of compound and effects of cow’s and breast milk is presented. Authors reviewed literature data on influence of cow’s milk on the risk of acne. The question of the use of cow’s milk in adults’ diet is still under discussion.
Key words: children, milk, diet, safety, efficacy.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (4): 140–144)
Key words: children, milk, diet, safety, efficacy.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (4): 140–144)
145–152 515
Abstract
Early treatment with Pulmozyme (dornase alfa) and its prolonged use in combination with basis therapy results in decrease of exacerbation rate, prolongation of remission of bronchopulmonary process with normal ventilation functions of lungs and gives patients with cystic fibrosis an opportunity to live an active life. The drug is effective as a conservative treatment of chronic sinusitis polyposis; it’s frequent complication of cystic fibrosis. Dornase alfa has 3 clinical effects: strong mucolytic, anti-inflammatory and antibacterial effect. That is the reason for the treatment of other chronic bronchopulmonary diseases with this drug. Efficacy of dornase alpha depends on rough maintenance of the terms of drug use.
Key words: children, dornase alfa, cystic fibrosis, chronic bronchopulmonary diseases, chronic rhinosinusitis, nasal polyposis, nebulizer therapy.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (4): 145–152)
Key words: children, dornase alfa, cystic fibrosis, chronic bronchopulmonary diseases, chronic rhinosinusitis, nasal polyposis, nebulizer therapy.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (4): 145–152)
ISSN 1682-5527 (Print)
ISSN 1682-5535 (Online)
ISSN 1682-5535 (Online)
