Vol 13, No 4 (2014)
SOCIAL PEDIATRICS AND HEALTH CARE
7-11 1088
Abstract
Introduction: Despite of the spreading of adverse consequences associated with alcohol use in the Russian society, there is only a limited number of complex social and hygienic studies of adolescents from families experiencing alcohol using problems. Patients and methods: Behaviour and lifestyle of 119 adolescents aged 15–17 years from families with problem drinking from Moscow were studied and compared with control group. The methods of research were in-depth interviews and questionnaires. Results: It was shown that adolescents from families with alcohol problems have a number of disadvantages, such as the psychological climate in the family, living conditions, the use of physical punishment in the family. It was shown the higher level of dissatisfaction with housing and living conditions (42,9 and 24,4%; p <0,5), unsatisfactory family climate (26,9% vs 12,6%; p <0,5), physical forms of punishment (26,9% vs 11,8% p <0,5). The frequency of alcohol consumption is significantly higher among adolescents from families with alcohol drinking problems (11,8% vs 0,8%; p <0,05). Teens tend to earlier (before 20 years) marriage than their peers in the comparison group (22,7 vs 9,2%; p <0,05). the ideal period for entry into sexual relations before the age of 15 years is accepted by 18,5% of adolescents from main group (5,9% in comparison group; p <0,05).The particular importance is the fact of underdeveloped healthy behavior (low involvement in the educational and health-preserving activities, high frequency of consumption of alcoholic beverages, the earliest being included in the smoking, the beginning of the sexual life before 18 years etc.). Conclusion: Results show the necessity of the early identifying of adolescents from families with alcohol problems and the providing them medical and social support. Special emphasis should be on measures to form a responsible health-preserving behavior between adolescents. Medical and psychosocial care should be given at the level of health and social care departments in children's polyclinics.
LITERATURE REVIEW
T. E. Borovik,
G. V. Yatsyk,
L. S. Namazova-Baranova,
N. G. Zvonkova,
N. N. Semenova,
О. L. Lukoyanova,
P. E. Sadchikov,
I. L. Gol'dman,
E. R. Sadchikova,
I. А. Belyaeva,
T. V. Bushueva
12-19 1206
Abstract
Modern data on efficiency and safety of a recombinant human lactoferrin (hLf) and prospects of its use in pediatric practice are presented in the review of literary data. The unique anti-infectious properties of biologically active protein of the hLf, its high antimicrobic, antiviral, antifungal and anti-parasitic activity are noted. Ability to stimulate natural immunity, to interact with other antimicrobic peptides, in particular, with lysozyme and secretory leukocyte protease inhibitor is analysed. In this regard it is indicated prospects of application of the hLf in treatment of prematurely born and hypotrophic children, patients with chronic nutritional deficiency for the purpose of prevention of infectious diseases and correction of inflammatory changes in the organism of a child, including
acute respiratory virus and enteric infections in children. It is expedient to apply hLf in surgical practice for reduction of a degree of manifestation of the acute pro-inflammatory response, and also for prevention of infectious complications, especially after abdominal operations, in complex treatment of children with a severe generalized infection and multi-organ failure, for prevention of intrahospital nosocomial infections in children hospitals.
Key words: children, prematurely born, nutritional deficiency, infections, lactoferrin, recombinant human lactoferrin.
acute respiratory virus and enteric infections in children. It is expedient to apply hLf in surgical practice for reduction of a degree of manifestation of the acute pro-inflammatory response, and also for prevention of infectious complications, especially after abdominal operations, in complex treatment of children with a severe generalized infection and multi-organ failure, for prevention of intrahospital nosocomial infections in children hospitals.
Key words: children, prematurely born, nutritional deficiency, infections, lactoferrin, recombinant human lactoferrin.
ORIGINAL ARTICLES
20-25 1130
Abstract
Aim: To create the Russian-language version of the standardized international questionnaire Health Utilities Index (HUI) applicable for children's age, on the basis of the relevant international requirements to linguistic ratification and validation of tools. Patients and methods: 427 children of the first and 233 children of the second health group have taken part in the research. Average age of patients made
10.8 ± 4.6 years. Criteria validity of the HUI questionnaire was assessed by comparison of patients' answers who had the different health status, a convergent validity — by comparison of the HUI attributes with scales of the PedsQL questionnaire, reliability — by calculation of Cronbach's alfa and the analysis of correlations between questions of the HUI classification. Results: Between the first and second health group there were significant distinctions on each attribute of the HUI questionnaire (p < 0.001). Average value of a number of the reduced attributes significantly differed depending on the state of health of patients: the worse the state of health is, the higher number of limited attributes is (p < 0.05). Significant correlations between the scales estimating similar concepts on questionnaires HUI and PedsQL are established. In assessment of the reliability Cronbach's according to the HUI3 and HUI2 system made 0.79 and 0.8, respectively. Significant
correlations between the questions estimating identical attributes (sight, hearing, speech, cognitive abilities) are shown. The validity and reliability assessment executed for children with various state of health, allowed to assess all attributes of the HUI2 and HUI3 systems. The received results showed satisfactory psychometric properties of the new language version of a questionnaire. Conclusion: The offered
Russian version of the international questionnaire HUI is a validated tool for the development of utility coefficients for various chronic diseases in children, creation of the national catalogue of these coefficients, carrying out of clinical economic researches.
10.8 ± 4.6 years. Criteria validity of the HUI questionnaire was assessed by comparison of patients' answers who had the different health status, a convergent validity — by comparison of the HUI attributes with scales of the PedsQL questionnaire, reliability — by calculation of Cronbach's alfa and the analysis of correlations between questions of the HUI classification. Results: Between the first and second health group there were significant distinctions on each attribute of the HUI questionnaire (p < 0.001). Average value of a number of the reduced attributes significantly differed depending on the state of health of patients: the worse the state of health is, the higher number of limited attributes is (p < 0.05). Significant correlations between the scales estimating similar concepts on questionnaires HUI and PedsQL are established. In assessment of the reliability Cronbach's according to the HUI3 and HUI2 system made 0.79 and 0.8, respectively. Significant
correlations between the questions estimating identical attributes (sight, hearing, speech, cognitive abilities) are shown. The validity and reliability assessment executed for children with various state of health, allowed to assess all attributes of the HUI2 and HUI3 systems. The received results showed satisfactory psychometric properties of the new language version of a questionnaire. Conclusion: The offered
Russian version of the international questionnaire HUI is a validated tool for the development of utility coefficients for various chronic diseases in children, creation of the national catalogue of these coefficients, carrying out of clinical economic researches.
A. N. Fetisova,
E. I. Alexeeva,
T. M. Bzarova,
S. I. Valieva,
V. V. Chernikov,
I. V. Vinyarskaya,
R. V. Denisova,
K. B. Isaeva,
E. G. Chistyakova,
Т. V. Sleptsova,
N. I. Taibulatov
26-32 892
Abstract
Aim: To assess the influence of the genetically engineered biologic drug etanercept on the quality of life of patients with juvenile idiopathic arthritis (JIA). Patients and methods: The research included 85 children with poly-and oligoarticular variant of the JIA at the age of 5 (2; 17) years. The assessment of the quality of life of patients was carried out by means of the parental version of a special questionnaire
CHAQ (Childhood Health Assessment Questionnaire), Health Utilities Index Mark 3 (HUI3) questionnaire. The doctor and parents of the patient also assessed the global activity of the illness by the 100-mm visual analog scale (VAS) before the etanercept prescription and in 1, 6 and 12 months. All patients before the etanercept prescription received immunodepressants. Results: Fast dynamics of the increase of an average point of the quality of life (the response in 1 month after the therapy beginning) was noted by the attributes of a questionnaire of HUI3 «emotions» — from 0.82 (± 0.18) to 0.90 (± 0.13), p =0.001, «cognitive abilities» — from 0.85 (± 0.17) to 0.91 (± 0.18), p =0.006, and «pain» — from 0.78 (± 0.23) to 0.91 (± 0.1), p < 0.001. In 12 months of the treatment the average point of the quality of life raised also by such attributes as «locomotivity» — from 0.85 (± 0.3) to 0.99 (± 0.06), p < 0.0001, and «fine motor skills» — from 0.9 (± 0.19) to 0.98 (± 0.05), p < 0.001. Conclusion: Treatment with the etanercept provided the improvement of the quality of life of children with the JIA and their families, improvement of physical activity and emotional state of patients.
Key words: children, juvenile idiopathic arthritis, etanercept, quality of life, Health Utilities Index Mark 3.
CHAQ (Childhood Health Assessment Questionnaire), Health Utilities Index Mark 3 (HUI3) questionnaire. The doctor and parents of the patient also assessed the global activity of the illness by the 100-mm visual analog scale (VAS) before the etanercept prescription and in 1, 6 and 12 months. All patients before the etanercept prescription received immunodepressants. Results: Fast dynamics of the increase of an average point of the quality of life (the response in 1 month after the therapy beginning) was noted by the attributes of a questionnaire of HUI3 «emotions» — from 0.82 (± 0.18) to 0.90 (± 0.13), p =0.001, «cognitive abilities» — from 0.85 (± 0.17) to 0.91 (± 0.18), p =0.006, and «pain» — from 0.78 (± 0.23) to 0.91 (± 0.1), p < 0.001. In 12 months of the treatment the average point of the quality of life raised also by such attributes as «locomotivity» — from 0.85 (± 0.3) to 0.99 (± 0.06), p < 0.0001, and «fine motor skills» — from 0.9 (± 0.19) to 0.98 (± 0.05), p < 0.001. Conclusion: Treatment with the etanercept provided the improvement of the quality of life of children with the JIA and their families, improvement of physical activity and emotional state of patients.
Key words: children, juvenile idiopathic arthritis, etanercept, quality of life, Health Utilities Index Mark 3.
33-39 962
Abstract
Background: Chronic bronchitis and bronchiolitis in children with congenital malformation are often characterized by the severe course of disease. The efficiency of treatment of those conditions can be increased through addition of sodium chloride (NaCl), hypertonic saline which takes a hydrostatic and osmotic effect on mucous membrane of the bronchial tree in broncholytic therapy. Aim: To evaluate the efficiency of 3% NaCl hypertonic solution inhalation in children with chronic bronchitis/bronchiolitis in the setting of bronchi congenital malformation (Kartagener's syndrome and primary ciliary dyskinesia). Patients and methods: The participants
of this study were 28 children in the age of 4–17.5 years with chronic bronchitis/bronchiolitis in the setting of Kartagener's syndrome and primary ciliary dyskinesia in the first days o facute exacerbation of the disease (15 patients in treatment group and 13 patients in control group). In the therapy scheme of treatment group the 3 NaCl hypertonic solution in administered dose of 2 ml was applied 2 times/day during 14 days besides other treatment methods. Results: In patients with chronic bronchiolitis 3% NaCl hypertonic saline inhalation in administered dose of 2 ml twice a day had improved the clinical presentation of disease; by the 14th day of study
the FEV-1 value improved from 70.0 ± 2.1 to 82 ± 3.2% (p = 0.024). The side effects in form of cough aggravation were registered in 13% cases. Among additional criteria of efficiency the improvement of MОС-75 from 52.1 ± 5.2 to 71.2 ± 1.4% (p = 0.011) was also marked in patients. The adverse experience, such as shivering, hypoexcitability and sleep disturbance, were registered in 7% of cases. Conclusion: Inhalation of 3% NaCl hypertonic saline allows the fast arresting of wheezing and eliminates the mycostasis in children with chronic bronchitis/bronchiolitis.
of this study were 28 children in the age of 4–17.5 years with chronic bronchitis/bronchiolitis in the setting of Kartagener's syndrome and primary ciliary dyskinesia in the first days o facute exacerbation of the disease (15 patients in treatment group and 13 patients in control group). In the therapy scheme of treatment group the 3 NaCl hypertonic solution in administered dose of 2 ml was applied 2 times/day during 14 days besides other treatment methods. Results: In patients with chronic bronchiolitis 3% NaCl hypertonic saline inhalation in administered dose of 2 ml twice a day had improved the clinical presentation of disease; by the 14th day of study
the FEV-1 value improved from 70.0 ± 2.1 to 82 ± 3.2% (p = 0.024). The side effects in form of cough aggravation were registered in 13% cases. Among additional criteria of efficiency the improvement of MОС-75 from 52.1 ± 5.2 to 71.2 ± 1.4% (p = 0.011) was also marked in patients. The adverse experience, such as shivering, hypoexcitability and sleep disturbance, were registered in 7% of cases. Conclusion: Inhalation of 3% NaCl hypertonic saline allows the fast arresting of wheezing and eliminates the mycostasis in children with chronic bronchitis/bronchiolitis.
PROFESSIONAL DEVELOPMENT
40-47 2629
Abstract
The reasons and conditions, types, key links of mechanisms of the vitamin metabolism disorders, clinical manifestations of the separate hypo-, hyper- and dysvitaminosis, their pathogenesis are discussed in the lecture.
48-53 5232
Abstract
One of 20 modern children and teenagers has attention deficit hyperactivity disorder (ADHD). New diagnostic criteria of ADHD according to DSM-V classification which contain the following main changes are considered in the article: age of onset — to 12 years; the requirement to cross-situational character of symptoms is strengthened; the ADHD age dynamics is reflected and the threshold number of symptoms for adult patients is entered; the comorbidity with autism spectrum disorders is allowed. Peculiarities of examination of children and teenagers with ADHD are discussed. Treatment of a syndrome must be complex and should include methods of behavior correction, psychotherapy, neuropsychological correction. Medicinal therapy demands the sufficient duration as the improvement of a state has to extend not only on the main manifestations of ADHD, but also on a social psychological aspect of patients' life. As the examination of a group of children with ADHD showed, during long courses of treatment by hopantenic acid for overcoming not only the main symptoms, but also violations of adaptation and social psychological functioning (improvement of a self-assessment, communication with people around and social activity)
treatment terms must be not less than 4–6 months. The development and application of complex correction under ADHD should be carried out in due time and have individual character.
treatment terms must be not less than 4–6 months. The development and application of complex correction under ADHD should be carried out in due time and have individual character.
EXCHANGE OF EXPERIENCE
54-62 923
Abstract
Diagnostic-related groups (DRG) are being implemented in Russian Federation since 2012 for hospital and day hospital payment. Unification of provider-payment methods and increase of health care efficiency are considered as the main goal of DRG. Presently the 2d version of Russian DRG model is approved by the Federal Fund of mandatory medical insurance, order from 14.11.2013 № 229. Treatment of children is mostly paid for by the same rules as adults’ treatment just now. There are several separate neonatal groups, as well as separate groups for diabetes and acute leukemia in children. The federal DRG model should be used in all regions of Russia, still it’s not final now and has to be improved. For example, number of pediatric groups will be increased. Each DRG has its own weight coefficient for calculating the tariff. The regions in RF can use correction coefficients to adjust the model. Besides regions can extract subgroups from basic DRG on the basis of standard methodology.
63-69 1178
Abstract
For the harmonious development of the child in early and preschool age diet should be balanced not only for proteins, fats and carbohydrates, but also include a sufficient amount of vitamins, trace elements and minerals. Manifesting high biological activity, vitamins are essential for sustaining growth and tissue regeneration, they participate in reproductive function, provide immune reactivity, maintain normal function of all organs and tissues. Many experts believe that without further supplementation of vitamins and minerals into the diet of a child, fully balanced diet is not possible, especially in a period of intense growth and development.
70-73 954
Abstract
Treatment of atopic dermatitis (AD) is most often based on the relief of symptoms. Two fundamental basis of AD — dry skin and itching — determine the main objectives of treatment of this chronic inflammatory diseases of the skin. With this purpose, the patients are recommended to use moisturizers (emollients) and topical anti-inflammatory drugs — corticosteroids, and/or calcineurin inhibitors. However, there are studies conclusively proving the existence of subclinical inflammation associated with impaired barrier function of
the skin, production of cytokines and infiltration of lymphocytes. The new strategy of treatment — proactive therapy aimed at achieving control and maintenance of remission of atopic dermatitis. This will allow you to achieve faster control the symptoms of AD and to reduce the risk of recurrence of the disease.
the skin, production of cytokines and infiltration of lymphocytes. The new strategy of treatment — proactive therapy aimed at achieving control and maintenance of remission of atopic dermatitis. This will allow you to achieve faster control the symptoms of AD and to reduce the risk of recurrence of the disease.
74-77 894
Abstract
Topical therapy of atopic dermatitis in children is a complex and multifactorial problem. Irrational choice of means of treatment may lead to the deterioration of the child, cause complications of dermatosis, promote the development of «atopic march». Topical treatment’s «Gold standard» is topical corticosteroids. The application of these medicines is not limited to conventional dosage forms such as cream and ointment. The features of the new formulations are presented (emulsions with different lipid concentration), the recommendations on their practical use are stated, the clinical experience of their application in the treatment of children with atopic dermatitis is described.
78-82 1002
Abstract
The drugs and phytoaromatic substances increases the efficacy of balneotherapy. Mineral, medicinal and aromatic baths are widely used in complex rehabilitation of patients from 1 month of age. Aromatic phyto-baths have a complex mechanism of action and a wide variety of therapeutic effects. Today special products based on natural plant components and essential oilsare are developed to prepare the aromatic phyto-baths. Only officially registered industrial drugs with clinical efficacy and safety were proven by clinical researches can be recommended for the pediatric using. Our studies demonstrated a positive impact aromatic phyto-baths to the dynamics of clinical symptoms at the patients with acute respiratory infections, atopic dermatitis; and also were revealed an increase of adaptive organism reserves.
83-87 1421
Abstract
Farmer cheese is a food source of the milk protein, easily acquired milk fat, vitamins, folic and nicotinic acid, macro- and microelements, methionine — irreplaceable amino acid with lipotropic action. Recommendations on farmer cheese inclusion to a food ration of a tender age child are provided. The data on the range and advantages of the children farmer cheese made by ultrafiltration method allowing to receive a product with the optimum organoleptic properties, enriched with serumal proteins with necessary amount of calcium and phosphorus, with high degree of microbiological purity are submitted.
88-92 1329
Abstract
The necessity of maintenance of breast feeding of a child in the first months of his life causes the need for development of preventive measures and plugged duct treatment. Results of use of electric breast pumps by mothers under impossibility of breast feeding by a physiological way are presented. It is shown that modern breast pumps, optimally imitating a peristaltic sucking of a child, allow to reduce time for expression, and also to make it painless and comfortable. It supports mothers' desire of long breast feeding, providing, thus, formation of a child health.
93-95 1654
Abstract
Frequent respiratory infections are the risk factor of development of chronic inflammatory diseases of a respiratory tract, bronchial asthma, and owing to arising disorders in the immunity system at the level of mucous membranes they can lead to an inflammation of a mucous membrane of a digestive and urogenital tract. Traditionally the prevention of acute respiratory infections includes sanitation of the centers of infections, and also elimination of dysbiosis and immune imbalance with the application of probiotics and bacterial immunomodulators. Therewith the probiotic means are necessary not only for restoration of normal microflora on mucous membranes (first of all, in a gastrointestinal tract), but also for optimization of immunocorrective therapy, especially when oral immunomodulators are used.
N. G. Zvonkova,
Т. E. Borovik,
N. N. Semenova,
Т. V. Bushueva,
I. М. Guseva,
V. А. Skvortsova,
Т. N. Stepanova,
S. V. Nekrasova
96-100 785
Abstract
The data on the value of milk and dairy products in the nutrition of children aged from 1 to 3 years are provided. In the Russian consumer market for children of this age there are new products on the basis of cow and goat milk, so-called third formulas, which have the balanced structure, contain optimum amount of vitamins, mineral substances, enriched with pre- and probiotics, long chain polyunsaturated fatty acids, nucleotides and are functional food products. The results of randomized researches testifying to positive influence of «the third formulas» on a state of health of children, their provision with vitamins and mineral substances are presented.
A DOCTOR’S AID
102-109 1113
Abstract
Aim: To assess the frequency of occurrence and the intensity of hypermobility of joints in children and teenagers of Tver in comparison
with other regions of the Russian Federation. Patients and methods: 564 children and teenagers at the age from 3 to 17 years were examined. The presence of hypermobility of joints was determined by Beighton method. Anthropometrical measurements were taken, physical development of children was assessed. Results: The hypermobility of joints is characteristic practically for all children at the age of 3–4 years and most of children of 5–7 years. On average it meets in 71% of children of a preschool age and 31% of school students of Tver, making 35–40% in children of midchildhood; it is noted in every fourth child of 13–15 years and every tenth 16–17-year-old teenager. The hypermobility of joints of girls is 20% more than of boys. The high-grade hypermobility is characteristic for tall and thin teenagers; in midchildhood the children who in comparison with agemates are smaller in growth and weight are more flexible. The article presents the comparison of own data with the results of other similar researches. Conclusion: The frequency of occurrence of hypermobility of joints considerably differs in different age groups of children. The increased flexibility is physiological norm for the majority of preschool children, further it decreases in direct ratio to the age of a child.
with other regions of the Russian Federation. Patients and methods: 564 children and teenagers at the age from 3 to 17 years were examined. The presence of hypermobility of joints was determined by Beighton method. Anthropometrical measurements were taken, physical development of children was assessed. Results: The hypermobility of joints is characteristic practically for all children at the age of 3–4 years and most of children of 5–7 years. On average it meets in 71% of children of a preschool age and 31% of school students of Tver, making 35–40% in children of midchildhood; it is noted in every fourth child of 13–15 years and every tenth 16–17-year-old teenager. The hypermobility of joints of girls is 20% more than of boys. The high-grade hypermobility is characteristic for tall and thin teenagers; in midchildhood the children who in comparison with agemates are smaller in growth and weight are more flexible. The article presents the comparison of own data with the results of other similar researches. Conclusion: The frequency of occurrence of hypermobility of joints considerably differs in different age groups of children. The increased flexibility is physiological norm for the majority of preschool children, further it decreases in direct ratio to the age of a child.
O. I. Simonova,
О. А. Ereshko,
D. А. Makarova,
S. Yu. Semykin,
I. Yu. Asaturova,
V. Yu. Brisin,
K. S. Volkov,
А. Yu. Tomilova
110-117 1045
Abstract
Background: The basis of the treatment of patients with cystic fibrosis (CF) is kinesitherapy — a special respiratory gymnastics and drainage of a bronchial tree. The increase of efficiency of a complex of medical rehabilitation measures can be reached by the application of a method of the high-frequency chest wall oscillation (HFCWO). Aim: To develop additional criteria of the individual program of classes by HFCWO system for children with CF. Patients and methods: The research involved 43 children with CF at the age of 2 years 10 months — 17.5 years whose treatment included 14 HFCWO procedures. During the first 4 classes 10 children from them received the oscillations calculated according to the age, and from the 5th class — according to the severity of CF course and indicators of a volume of the forced expiration for the first second (VFE1) — subgroup I. The patients, included in the subgroup II (n = 33), from the first occupation received the oscillations calculated on the severity of CF course and according to VFE1 indicators. Results: In the subgroup I during the first 4 classes there were no improvements of the peakflowmetry indicators (р >0.05), all children had complaints to discomfort from the procedure. From the 5th class clinical functional dynamics started being noted, to the 8th class indicators amounted to the subgroup II in which positive changes were registered from the first class. To the 14th occupation the VFE1 indicators improved in I and II subgroups: with a high CF severity (from 42.5 ± 5.5 to 58.1 ± 1.6%; р = 0.015) and with a course of medium severity (from 71.1 ± 1.2 to 80.0 ± 2.8%; р = 0.025). In addition all patients showed the improvement of the peakflowmetry indicators and excursion of a chest wall (cm; р <0.05), including patients with a high CF severity (р = 0.012). Conclusion: The efficiency of the classes with application of the HFCWO method, focused on the CF severity and VFE1 indicators, is higher than application of a method taking into account the age of patients.
118-130 962
Abstract
Aim: The purpose of the study was to evaluate the efficiency of using the osmotic laxative polyethyleneglycol 4000 (PEG) for treatment of constipation in children. Patients and methods: Under the medical practice, the 30-days course of osmotic laxative polyethyleneglycol 4000 (PEG) administration in compliance with instruction for use was scheduled for 31 children within the age group from 5 to 17 years (average age 10.0 ± 3.5 years) in order to treat the constipation. The progress of clinical presentation and electric activity indices in different regions of gastrointestinal tract was evaluated by method of Peripheral Electrogastroenterography (PEGEG). Results: Before the start of the study most children had reported the stool retention (90%), straining efforts (87%), constrained defecation (81%) and hard stool (77%). About 50% of children had reported the long time spent in the toilet (68%) and scybalous stool (55%). As a result of the treatment the stool frequency has normalized and other constipation presentations have significantly reduced in all patient. Large bowel eclectic activity indices indicated the continuous impairment of its content evacuation. Simultaneously, the progress evaluation of electric activity progress in different regions of gastrointestinal tract (Pi/PS) and the large bowel rhythmicity ratio (Kritm) indicated the improvement on its peristalsis contractility. The adverse undesired effects of medication intake were registered in no patients. Conclusion: PEG4000 is efficient and safe remedy for treatment of constipation inn children.
131-135 771
Abstract
Aim: The purpose of the study is to evaluate the clinical efficiency of electrodynamic rehabilitation methods in teenager sportsmen with
supporting-motor apparatus (SMA) injuries. Patients and methods: 46 boys in the age of 14–16 with SMA injuries participated in the study. 20 boys received only conventional rehabilitation remedies (physiotherapy, remedial gymnastics, massage and taping), while the treatment of other 26 boys was enhanced with the DENS therapy. Duration of procedures was 30–40 minutes, duration of the whole treatment course — 10–14 days. The clinical effect of the DENS therapy was evaluated according the progress of clinical symptoms and life quality indices assessment result (before and immediately after and one month after the rehabilitation course), sing the evidentiary medicine methods. Results: After the two-week course of the DENS therapy the absolute risk reduction (ARR) in the teenagers with
SMA injuries was fluctuating between 34.6 (8.7–60.5)% (physical performance) and 56.9% (33.1–80.8%; school performance; р = 0.022), while the relative risk reduction (RRR) by the same indicators was equal to 69.2% (16.2–88.7%) and 71.1% (39.8–86,2%; р = 0.002). The relative risk (RR) was registered at the level of 0.31 (0.11–0.89; р = 0.022) and 0.29 (0.14–0.86; р = 0.0002). The ARR value higher than 50% always indicates the clinically significant effect while the ARR value between 25 and 50% indicates the clinically significant effect very often. The following indicators according to the MDASI questionnaire were significantly improved within the test group: pain (p = 0.001), sleet disturbance (p = 0.050) and feeling of depression (p = 0.045). According to the PedsQL™4.0 questionnaire data, the significant improvement of the emotional performance (from 83.7 ± 6.97 to 91.2 ± 3.75) was registered in the point II. Conclusion: The rehabilitation course showed significant clinical effect in young sportsmen with SMA injuries. Introduction of the DENS therapy
significantly reduces the frequency of adverse outcomes and improves the clinical effect of rehabilitation.
supporting-motor apparatus (SMA) injuries. Patients and methods: 46 boys in the age of 14–16 with SMA injuries participated in the study. 20 boys received only conventional rehabilitation remedies (physiotherapy, remedial gymnastics, massage and taping), while the treatment of other 26 boys was enhanced with the DENS therapy. Duration of procedures was 30–40 minutes, duration of the whole treatment course — 10–14 days. The clinical effect of the DENS therapy was evaluated according the progress of clinical symptoms and life quality indices assessment result (before and immediately after and one month after the rehabilitation course), sing the evidentiary medicine methods. Results: After the two-week course of the DENS therapy the absolute risk reduction (ARR) in the teenagers with
SMA injuries was fluctuating between 34.6 (8.7–60.5)% (physical performance) and 56.9% (33.1–80.8%; school performance; р = 0.022), while the relative risk reduction (RRR) by the same indicators was equal to 69.2% (16.2–88.7%) and 71.1% (39.8–86,2%; р = 0.002). The relative risk (RR) was registered at the level of 0.31 (0.11–0.89; р = 0.022) and 0.29 (0.14–0.86; р = 0.0002). The ARR value higher than 50% always indicates the clinically significant effect while the ARR value between 25 and 50% indicates the clinically significant effect very often. The following indicators according to the MDASI questionnaire were significantly improved within the test group: pain (p = 0.001), sleet disturbance (p = 0.050) and feeling of depression (p = 0.045). According to the PedsQL™4.0 questionnaire data, the significant improvement of the emotional performance (from 83.7 ± 6.97 to 91.2 ± 3.75) was registered in the point II. Conclusion: The rehabilitation course showed significant clinical effect in young sportsmen with SMA injuries. Introduction of the DENS therapy
significantly reduces the frequency of adverse outcomes and improves the clinical effect of rehabilitation.
136-139 1284
Abstract
Aim: The purpose of the study was to evaluate the endocrine profile condition in adolescent girls with abnormal uterine bleeding. Patients and methods: The participants of the study were 110 adolescent girls in the age between 11 and 15 years taken to hospital by emergency indication in the period between 2010–2013 years with dysfunctional uterine bleeding for the term from 3 to 48 days. In the first day of hospitalization before starting the hormonal therapy all patients underwent the physical examination, ultrasonic examination of pelvic organs and endocrine profile assessment. Concentration of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) and the levels of mammotropic hormone, thyrotropic hormone, estradiol, progesterone and testosterone in their blood were determined. Besides that physicians assessed the complete blood count indices: hemoglobin concentration, erythrocyte number and hematocrits. Results: It was determined that the predisposing causes of abnormal uterine bleeding development in adolescents: high somatic pathology frequency, abnormalities of neuroendocrinal system and menstrual cycle. Gynecological pathology in adolescents is represented by significant disorders of menstrual function establishment expressed in the later beginning of menstruation, its intensity and duration. The authors also note the higher frequency of inflammatory diseases such as adnexitis, edeitis, vulvovaginitis and coleitis in comparison with the control group (37.3 and 30%, respectively). Another tendency was observed while studying the endocrine profile: in patients with hyperestrogenism the normal or increased content of FSH at the normal or lowered LH concentration is observed. At the same time, in patients with hypestrogenism FSH concentration at the lower limits of the age group is lowered, while LH concentration is lowered or normal. Conclusion: Abnormal uterine bleeding in adolescents in the most cases is developing in the setting of relative hyper- or hypestrogenism and the clinical presentation of the condition depends on this indicator.
N. E. Sannikova,
T. V. Borodulina,
L. Н. Malyamova,
O. S. Shelestovskaya,
N. A. Belokonova,
T. A. Martynova,
N. S. Sokolova
140-144 931
Abstract
Background: Modern approaches to feeding the children in the first year of life, especially when the artificial formula milk is indicated, necessitate the individual approach to the selection of formula in order to adequately provide the organism with micro- and macronutrients. Aim: The purpose of the study was to evaluate the effect of examined formula milk enriched in pro- and prebiotics on growth and development of the children in the first year of life. Patients and methods: The participants of the study were 75 children in the age between 1 and 5 months at the different feeding types. Group I (n = 25) was given a standard adapted formula milk, Group II (n = 24) — standard formula milk of the same brand, Group III (n = 26) — breast milk. Results: The study showed that when feeding with the breast milk body weight deficiency was observed in 19.4% of children, while body weight excess — in 15.4% of children. When feeding with the artificial milk, the excessive body weight was observed in 18.4%, while the body weight deficiency was recorded only in 12.2% of children. The analysis of examination results of children in the first year of life on the different feeding types showed the positive effect of the adapted formula milk on the health and development indices: the number of children with optimal physical and neuropsychic development has grown (from 72 to 88%), the functional condition of the gastrointestinal tract has recovered (posseting has reduced from 88 to 16% cases, flatulence — from 36 to 4%, intestinal constipation — from 60 to 4%, stool disorders — from 36 to 4%). Conclusion: The examined adapted formula milk can be successfully used in children in the first year of life when breast feeding is impossible.
SHORT REPORTS
145-149 900
Abstract
The article referred to the use of herbal drugs in treatment of acute rhinosinusitis in children. Topical aspects of the etiology, pathogenesis, clinical manifestations and diagnosis of acute rhinosinusitis in children are disscussed. The advantages of application of herbal drugs in such pathology are discussed indications for these drugs and possible side effects. The results of research of the efficacy and safety of herbal drugs for the treatment and prevention of acute sinusitis in children are adduced.
CLINICAL OBSERVATIONS
150-155 800
Abstract
The article describes successful case of the methotrexate monotherapy through subcutaneous administration (15 mg/m2 of body surface per week) for treatment of the polyarticular juvenile idiopathic arthritis in the girl in the age of 4. After 6 and 12 months of the methotrexate therapy the significant reduction of the clinical and laboratory disease activity indices and increase in functional activity of the child according to the pediatric ACR criteria for 50 and 90% respectively were observed. No adverse experience during the monotherapy was recorded. Development of inactive disease phase after 15 months of treatment allows predicting the development of pharmacological remission in patient in the prospective. Timely (immediately after the disease was diagnosed) administration of methotrexate allowed preventing the disablement of the child and improving the life quality of both the patient and her family.
K. B. Isaeva,
E. I. Alexeeva,
R. V. Denisova,
T. V. Sleptsova,
Т. М. Bzarova,
S. I. Valieva,
E. V. Mitenko,
E. G. Chistyakova,
А. М. Chomakhidze
156-161 781
Abstract
The case of early debut and heavy course of juvenile idiopathic arthritis in the patient at the age of 1 year and 8 months, associated with uveitis refractory to the therapy by methotrexate and nonsteroid antiinflammatory preparations is presented. The given clinical example shows high therapeutic efficiency of the adalimumab. To the 8th week of treatment inflammatory changes in conjunctiva were stopped, to the 12th week the stage of inactive illness was registered, i.e. the patient had no inflammatory changes in joints, uveitis activity signs, increase of laboratory indicators of illness activity. Duration of remission of articulate syndrome and uveitis made 9 months.
ISSN 1682-5527 (Print)
ISSN 1682-5535 (Online)
ISSN 1682-5535 (Online)
