ORIGINAL ARTICLES
The article is devoted to the study of features of lower respiratory tract infection associated with respiratory syncytial virus. 40 cases of RSV-bronchiolitis in preterm children under year with/without bronchopulmonary dysplasia were analyzed. It was established that disease in those groups of patients had severe course because of the respiratory failure, which dominates in clinical pictures as symptoms of bronchial obstruction and apnea. Treatment of severe RSV-infection often demand admission to intensive care unit, supplemental oxygen and/or mechanical ventilation.
The purpose of research — improvement of CNS pathology diagnostic in children with enterovirus-71 infection during epidemic and interepidemic periods. The study involved 64 patients with enterovirus-71 infection at the age from 6 months to 14 years with CNS pathology, including 52 patients during epidemic period and 12 children during interepidemic period. The disease is characterized by the appearance at the first two days of fever, murrian-like, catarrhal, lymphoproliferative syndromes. On the third day of illness joined symptoms of meningitis, meningoencephalitis, encephalomyelopoliradiculoneuropathy and neuropathy. CNS pathology during interepidemic period often occurs in children with burdened history, not attending organized groups, is characterized by high frequency ncephalomyelopoliradiculoneuropathy and neuropathy, often associated with febrile fever and splenomegaly, a rare manifestation murrian-like syndrome. These features should be considered in the disease diagnosis during epidemic and interepidemic periods
A retrospective study of 42 cases of acute flaccid paralysis (AFP) in children aged between 7 months and 15 years, registered at the Municipal Clinical Hospital №1 throughout a 7 year period (2007—2014), was performed to investigate the features of pediatric Guillian-Barre Syndrome (GBS). GBS has shown to be the most common cause of AFP in children, with prevalence of 74% of all 31 cases. Clinical manifestations, functional status, laboratory and electrodiagnostic data were evaluated in group of 31 children in order to highlight particular features of childhood GBS in Russia. The highest frequency of GBS was observed in children aged between 1 to 3 with the median 6 [3; 11] years. Boys with GBS outnumbered girls by a 2,1:1 ratio. No seasonal dependence has been observed, with children equally suffering from this disease without a seasonal pattern throughout the year. According to the electrophysiological and clinical data, 24 children were diagnosed with acute inflammatory demyelinating polyradiculoneuropathy (AIDP) (77%), 5 with acute motor axonal neuropathy (AMAN) (16%) and 2 with аcute motor-sensory axonal neuropathy (AMSAN) in a total of cases (7%). Several exclusive features of GBS in children for Russia were discovered. The most common initial symptom was limb pain, with the impartial sensory disturbance found only in 13% of the patients observed, 10% of which were paresthesias and the remaining 3% belonging to hypostesias. Children reached the nadir state rapidly, the median time from onset to nadir was 9.5 [6,25; 12,5] days. Cranial nerve dysfunction at nadir was observed in a greater percentage of patients (51%) compared to that of 23% cases at the onset, with the facial palsy increasing from 10 to 32% and the bulbar palsy from 12 to 19%. The patients were given intravenous immunoglobulin in various doses: from 0.2 to 1.75 mg/kg per course (0.5 [0.5; 0.8] g/kg) and/or plasmapheresis with a median volume of 93 [81; 100] ml/kg per course. The treatment has shown to be effective for the majority of patients, but three children was resistant to the intravenous immunoglobulin. An important feature of pediatric GBS is a nonthreatening prognosis at the point of discharge, with the length of hospitalization numbering in with a median of 28 [20,5; 38] days.
This article presents the analysis of indicators of CD4 lymphocyte count and viral load in the natural history (in the absence of ART) in perinatally HIV-infected children. It was revealed that perinatal way of transmission is characterized by a higher rate of immunodeficiency progression. It may be associated with intrauterine infection, as well as an early defeat HIV immature immune system of the child. The concentration of virus in perinatally infected children since the beginning of the observation and in 30 months after infection is more than in parenterally infected children in 5 and 2 times, respectively, which determines a infavourable version of the disease in perinatally infected children.
VACCINATION
A study is devoted to the development of new bacterial diphtheria vaccines aimed at prevention adhesion of microbial cells to host’s pharyngeal epithelial cells and thus limit colonization of mucous membranes, bacteria carrier state formation and promoted to C. diphtheriaе circulation decrease among the population. As a base of the candidate-vaccine we suggest the diphtheria bacterial antigenic preparation obtained by use of electro-magnetic radiation of ultrahigh frequency from a culture of C. diphtheriaе, var. gravis, tox +.
PROBLEMS OF THERAPY
To optimize selection of antiviral agents for children in routine practice of ARVI management, a double-center, prospective, open-label, randomized study of efficacy and tolerability of schemes including Ergoferon, Cagocel, Arbidol in children > 3 years was performed throughout two epidemic seasons (fall 2012 — spring 2014). In total 152 children with ARVI symptoms lasting for no more than 48 hours were randomized into 3 groups, i.e. Ergoferon (group E, n = 67), Cagocel (group C, n = 40), Arbidol (group A, n = 45). At visits 2 and 3 proportion of children with normalized body temperature (primary criterion) and intensity of intoxication and catarrhal syndrome were evaluated. At visit 3 the following parameters were measured: efficacy index (efficacy and tolerability assessment by the doctor using CGI scale) and evaluation of safety and tolerability of the study drug by parents/representatives of the child; incidence of medical product prescriptions was recorded, i.e. the total number of prescriptions per group, incidence and duration of administration of individual groups of agents. To analyze and evaluate the data obtained, conventional methods of parametric and non-parametric statistics were applied. Groups C and A were not statistically different in baseline characteristics and throughout efficacy criteria assessment. A new group 2 (n=85) was generated out of these groups for further analysis. At visit 2 group 1 and group 2 showed normalization in morning and evening body temperature in 76% and 79% in group 1, respectively, vs. 73% and 79% — in group 2 (2, p > 0.05). 100% subjects in group 1 and 98% — in group 2 did not have intoxication signs, or the rank value of mild intoxication did not exceed 1 (mild). Proportion of subjects with mild catarrhal syndrome at rank 2—3 in group 1 vs. baseline reduced from 15% to 3%, in group 2 — from 18% to 8%. At visit 3, 94% subjects in group 1 and 95% — in group did not show clinical intoxication signs. Almost every one in three children in both groups had catarrhal signs completely resolved by the end of the treatment, in 70% and 65% cases in groups 1 and 2 severity of catarrhal syndrome did not exceed rank 1 (2, p > 0.05). No adverse effects associated with the study scheme components have been reported during the study. Efficacy and tolerability evaluation by the doctors using CGI in group 1 was 3.37 ± 0.65 (M ± SD, 95% CI 3.22-3.53) vs. 3.23 ± 0.77 (M ± SD, 95%CI 3.08—3.39) in group 2 (Т-test, p = 0.38). In group 1 maximum rating (4 scores) was assigned by the doctors in 46%, minimum one (2 scores) — in 9%, while in group 2 the equivalent proportions were 40% and 16%, respectively (p = 0.44 for maximum score and p = 0.17 for minimum score). Therapeutic efficacy evaluation by parents in group 1 was 3.73 ± 0.57 (M ± SD, 95% CI 3.59-3.87) vs. 3.35 ± 0.72 (M ± SD, 95%CI 3.20—3.50) in group 2; Т-test, p = 0.04. According to frequency assessment, positive scoring (4-5 scores) was more prevalent among parents in group 1: 71% vs. 44% (group 2), 2 test, p = 0.001, minimum scoring (2 scores) was less common in group 1: 1.5% vs. 12% (group 2),?2 test, p = 0.02. Evaluation of therapeutic tolerability by parents in group 1 (4.04 ± 0.53, 95%CI 3.91—4.18) was higher as compared to group 2 (3.82 ± 0.53, 95%CI 3.71—3.93); Т-test, p = 0.01. Maximum scoring (5 scores) was obtained in group 1 in 16% cases, in group 2 — 6% (2 test, p = 0.03). Analysis of additional drug prescriptions revealed that 3.6 ± 1.2 prescriptions have been made on average in group 1 vs. 5.0 ± 1.2 in group 2 (Т-test, р = 0.01). Proportion of children receiving more than 5 drugs was 18% in group 1 vs. 32% in group 2 (2 test, p = 0.05). Seven drugs were given to 3% children in group 1 and 12% — in group 2 (exact Fisher’s test, p = 0.067). Duration of therapy with H1-histamine blockers in group 1 was 5 days (Me: 5.0 (5.0; 6.0) vs. 8.5 days (Me: 8.5 (7.5; 10.0) in group 2 (U-test, р = 0.006). Therefore, comparable clinical efficacy and tolerability of anti-ARVI therapeutic schemes were revealed in children using Ergoferon, Cagocel and Arbidol. At that Ergoferon group showed higher therapeutic quality scoring (efficacy and tolerability), both according to the doctors (CGI scale) and parents. Reduced number of prescriptions and duration of drug therapy in Ergoferon group for ARVI management were revealed.
The paper presents the results of observation of 103 children aged from 10 months to 15 years with EBV-associated infectious mononucleosis (IM), determined in 32% by acute primary Epstein-Barr virus infection (AEBVI) and in 68% of cases by reactivation of chronic Epstein-Barr virus infection (CEBVI). Clinical and laboratory characteristics of the course, depending on the form of infection, were investigated. As a clinical outcome of infectious mononucleosis in patients with primary infection latent infection after a year is formed 5.8 times more often than in patients with chronic Epstein-Barr virus infection (CEBVI). The high efficiency of recombinant interferon monotherapy in patients with primary acute infection was recorded and the expediency of combined etiotropic therapy in the treatment of chronic Epstein-Barr virus infection was found out.
TO HELP OF PRACTICAL PEDIATRICS
Development of inflammatory bronkholegochny process in children is followed by the permanent changes in system of an eritron aggravating finally the phenomena of a hypoxia of bodies and fabrics. Work purpose: studying of average diameter of erythrocytes at children of early age, patients with pneumonia and ARVI. Determination of average diameter of erythrocytes was carried out by a diffraction method on identical structure of chaotic objects at 36 children with pneumonia and at 41 children with a ARVI aged from 4 months till 3 years. The control group was made by 20 almost healthy children of the same age. During the sharp period of a disease the average diameter of erythrocytes was authentically increased both at pneumonia, and at a ARVI. Reliable difference of these indicators when comparing a toxic syndrome at pneumonia and a ARVI is revealed. Thus, at children of early age, patients with pneumonia and ARVI, in dynamics of a disease the natural changes of average diameter of erythrocytes having differential and diagnostic and predictive value are revealed.
Meningococcal infection (MI) for many years has occupied one of the most important places in the structure of acute neuroinfections in children. Some decline in MI morbidity in recent years has reduced the alertness of doctors to early detection of the disease that in some cases becomes the cause of late hospitalization, development
of decompensated shock and ineffective resuscitation. The purpose of the given research is to identify the causes of deaths from generalized forms of MI and the prospects of mortality reduction. The paper gives the expert analysis of 22 medical histories of children who died of generalized forms of MI during the period from 2005 to 2014 in Krasnoyarsk. The work describes the features of the clinical picture of MI generalized forms in children at the present stage, reveals the causes of deaths during the period of sporadic morbidity in the Krasnoyarsk Territory and determines the adverse prognostic features that indicate the particular severity and the development of fulminant course of the disease.
We performed retrospective cohort study to identify factors associated with bacterial complications of chickenpox in children. We included 128 children with chickenpo x who were hospitalized between 2000 and 2014. Binary logistic regression was used to reveal factors associated with bacterial complications. Male gender and age 3 to 6 years were positively associated with occurrence of invasive bacterial complications. We found association between atopic dermatitis and pyoderma (noinvasive bacterial complications of chickenpox). Prescribtion of acyclovir decreased the odds of invasive bacterial complications.
In this article presents the data of ultrasound examination of 150 children with chronic hepatitis В (ChHB). Ultrasound research which combined with clinical and laboratory data do not always reflect the true picture of the pathological process in the liver, while differences may vary between 14—37%. It is shown that the inclusion of additional Doppler echography in allow not only improve the efficiency of diagnosis of ChHB activity (by 35.3%), but also broaden our understanding about the state of the parenchyma of the liver and spleen, collateral circulation disorders and severity of portal hypertension. Regardless of the age, set to the same orientation of structural and functional disorders of hepatic vessels, the basic and indirect diagnostic criteria of portal hypertension has been developed.
Based on the questioning of 160 people the social aspects of the formation of the parental compliance to immunize their children against influenza were studied. It was found that 96% of parents are aware of the possibility of preventing influenza by vaccination. However only 33.7% of them annually performed immunization. Among the reasons for failure of vaccination the most common is the fear of complications (38.9%), opinion about the poor quality of vaccines (25.8%), inefficiency of vaccines (19.6%). High social role of district pediatricians in formation of the parental compliance to immunize their children against influenza has been proven.
CASE FROM PRACTICAL
Discribe the case of severe flow of а trichinosis in a girl 15 years old. The symptoms are an acute to x ico-allergological syndrome, generalized swelling myalgia and myasthenia with the full adynamia, infectios-toxicology kidney, an acute hypoalbuminemia with development polyserositis, adsence eosinophilia.
ISSN 2618-8139 (Online)