SOVREMENNAYA PEDIATRIYA № 4 – 2013
IX school-workshop with international participation «Modern possibilities of diagnosis and treatment of complex immunodeficiency disorders in children» (Mukachiv, april, 2013). Resolution.
Championship of emergency teams ended with the victory of the citizen of Kiev.
WНО: clearing bulletin №286 measles. February, 2013.
Order № 59 from 29.01.2013 of the ministry of health of Ukraine uniform clinical protocol of the medical care for children with gastroesophageal reflux disease.
Henker J., Mгller S., Laass M. W, Schreiner A., Schulze J.
The probiotic Escherichia coli strain Nissle 1917 (ECN) for successful maintenance of remission of ulcerative colitis in children and adolescents: an opened pilot study.
Considering that for about 20% of patients with ulcerative colitis are children or adolescents it is necessary to conduct treatment taking into account the individual needs of children. E. coli Nissle 1917 (EcN) — is a probiotic with the evidence base, which is an alternative to mesalazine (5-ASA) for the maintenance of remission of UC in adults and also as perspective mean of this type of therapy. The present open pilot study was conducted with the aim to examine the benefits of EcN for maintenance therapy in young patients with UC. To 34 patients in the age from 11 to 18 years with UC in remission was ordered either EcN (2 capsules once a day, n = 24) or 5-ASA (on average 1.5 g / day, n = 10); patients were under observation during the year. As a result, the recurrence rate was 25% (6/24) in the EcN group and 30% (3/10) in the 5-ASA group. Data on the overall health and development has been favorable without the reports about serious side effects. Therefore, maintenance therapy during the UC with the probiotic EcN application is also effective in younger patients.
Key words: children, adolescents, ulcerative colitis, maintenance therapy, probiotic EcN.
Kunovskaya L. M.
The role and value of endocervical microflora of pregnant women in development of intestinal microbiocenosis of infants with clinical signs of intrauterine infection.
Objectives: to study the species composition and condition of the vaginal microbiocenosis in pregnant women of the risk group; to evaluate the effect of disbiotic disorders of vaginal microbiocenosis in pregnant women on the processes of adaptation, microbial colonization and formation of intestinal microbiocenosis in infants with clinical signs of intrauterine infection (IUI).
Patients and methods. The study included 300 infants with clinical signs of IUI and their mother. With the use of standard bacteriological methods the vaginal swabs, amniotic fluid, placenta, fetal membranes, cord and two loci of newborns (nose and throat) are examined. It is used probiotic Saccharomyces boulardіi (Enterol 250) with the aim of correction of identified disorders of intestinal biocenosis in children.
Results. Bacteriological tests of vaginal swabs of pregnant women and gastric aspirates of their infants had shown the growth of pathogenic microflora. In most of cases were verified polymicrobial associations of gram-positive cocci as Staphylocoscus epidemidis and Staphulococsus aureus in combination with Candida and opportunistic Escherichia coli.
Conclusions. In the discharges form maternal passages and infant gastric aspirate microflora was identical to the mother that is indicating on correlation interaction between rising way of IUI in infants and vaginal disbiotic disorders in pregnant women. Inclusion of probiotic Saccharomyces boulardіi (Enterol 250) to the complex medical treatment of infants with clinical signs of IUI contributed to significant (p <0.05) elimination of pathogenic microflora and the formation of the intestinal microbiota in the vast majority of infants (81.7%) with Lactobacillus spp. and Bifidobacterium spp. colonies domination
Key words: vaginal microbiocaenosis, pregnant women, newborn, intrauterine infection, probiotic.
Berezhnoi V. V., Kozachuk V. G.
Hepatitis B vaccine prevention: expert view on international strategy of protection.
Summary. Over the last years, viral hepatitis is not only medical but also social and economic problem. Modern control methods with hepatitis B virus (HBV) define a comprehensive approach focused on three elements of epidemic process – the source of the virus, the gap modes of transmission of the virus and the protection of sensitive population. The most effective and long-term way of protection against HBV is immune prophylaxis. Universal mass vaccination of infants against HBV protects them by the way of preventing of life-threatening consequences of infection in future such as chronization of disease and the probability of cirrhosis progression and hepatocellular carcinoma. The introduction of flexible vaccination regimen to the National Immunization Schedule recommended by WHO, by two or three doses of vaccine against HBV in the content of combined hexavalent vaccines will increase the level of vaccination coverage against HBV in Ukraine at the very least to the level of vaccination coverage with three doses of DTP at the same time reducing the number of injections for children and visits to the clinic that will promote improvement and timeliness of vaccination.
Key words: viral hepatitis B, prevention, vaccination, comprehensive hexavalent combination vaccine.
Haritonyuk R. O.
Tendency of children morbidity by infectious pathology in the Rivne region.
The analysis of infectious morbidity of the child population in Rivne region and comparing of its specific series with average Ukrainian is conducted. The tendencies of morbidity by infectious pathology controlled by specific immune prophylaxis means are shown.
Key words: infectious diseases, children, immune prophylaxis.
Геппе Н. А., д-р мед. н., проф., Фарбер И. М., канд. мед. н., Старостина Л. С., канд. мед. н., Батырева О. В., Озерская И. В., Малявина У. С.
Подбор рациональных методов терапии острых инфекционных и персистирующих аллергических ринитов легкой и средней степени тяжести у детей с использованием метода компьютерной бронхофонографии.
Ключевые слова: дети, аллергия, аллергический ринит, острый ринит, персистирующий ринит, деконгестанты, Виброцил®.
Aryayev N. L., Shevchenko I. M., Kuzmenko I. V., Titkova E. V.
LGG® in the complex treatment of atopic dermatitis in children.
Objective: To study the efficacy and safety of Lactobacillus rhamnosus GG (Preema® kids) in the complex treatment of atopic dermatitis (AD) in children.
Patients and methods. A comparative controlled study was conducted in parallel groups, selected by the method of stratified randomization among children with AD at the age of 2,5–18 months. Children of the main group (n = 27) had received orally Preema® kids preparation by 10 drops per day during the month.The children of the control group (n = 30) had received standard therapy of AD. For evaluation of patients condition was used the scale of atopic dermatitis severity, SCORAD and dermatology life quality index of babies IDLQI.
Results. In the setting Lactobacillus rhamnosus GG application in children with was observed reduction in the severity course of disease. After 14 days the odds ratio of transition of heavy and moderate course of AD into mild by SCORAD evaluation in the intervention group was 0.18 (95% CI 0,05–0,62) in the control group — 0.27 (95% CI 0.09–0.82). According to the results of ROC-analysis also was considered more effective inclusion of LGG to the complex therapy of AD — in the main group the area under the curve was 0.76 (95% CI 0.63–0.89, p = 0.006) in the control group — it was at the level of 0.68 (95% CI 0,55–0,82, p = 0.03).
Conclusions. Application of probiotic Lactobacillus rhamnosus GG in the complex treatment of AD in children promotes positive dynamics of clinical manifestations of the disease. The Preema® kids preparation well tolerated and have no side effects. A convenient form of use, good organoleptic properties, andthe possibility of a single dose during the day can reduce the psycho&traumatic effect from therapy and to achieve a better compliance.
Key words: atopic dermatitis, treatment, children, Lactobacillus rhamnosus LGG.
Nyan'kovskiy S. L., Gerasimov S. V., Sekretar' L. B., Voznyak A. V., Sadova O. R., Gromik N. E.
The effectiveness of levocetirizine in allergic rhinitis in children.
Objective: To optimize the treatment of allergic rhinitis (AR) in children.
Patients and methods. In the study took part children in the age of 6–12 years who had moderate manifestations of intermittent moderate or persistent mild AR during the last 12 months. Symptoms of disease were assessed by parents / patients by 4-point scale: «0» — no symptoms, «1» — a slight symptom, «2» — moderate symptoms, «3» — strongly pronounced symptom and entered in the special journal; the overall disease activity was determined as the sum of total points for a week. Children from the main group had received levocetirizine (L-zet) syrup at a dose of 10 mg daily during four weeks. Children of the control group had received cromolyn sodium four times per day in the form of nasal spray, and if necessary, in the form of eye drops.
Results. In the end of the first week of treatment with levocetirizine total nasal symptom severity decreased by more than half, while with the use of sodium cromoglycate — on 30%, the difference between the two groups was 18% (p <0.05). Several smaller differences were observed in the second week, but the severity of ocular symptoms did not have a difference that is conceptually consist with published data. Small differences between the groups at the second week of treatment may also be associated with slower development of sodium cromoglycate action.
Conclusions. Levocetirizine (L-zet) oral form increases the effectiveness of nasal form of sodium cromoglycate during the treatment of persistent mild or intermittent moderate AR in children. High efficiency, good safety profile and convenient mode of reception allow recommending levocetirizine in the treatment schemes of these forms of AR in children.
Key words: allergic rhinitis, antihistamines, levocetirizine.
Marushko Yu. V., Melnikov O. F., Grachova M. G., Movchan O. S.
Effectivness of the use of «Amizonchik» during the acute respiratory infections in children in the age of 3–6.
Objective: Clinical and immunological evaluation of the effectiveness of the use of «Amizonchik» preparation during the acute respiratory infections (ARI) in children in the age of 3–6 years.
Patients and methods. A total of 36 children in the age of 3–6 years with ARI were under observation. The clinical examination included as follows: the collection and details of complaints, medical history, physical examination and oropharingoscopy in the dynamics of the disease. The patients of the main group (28 patients) had received «Amizonchik» by 4–7 ml three times a day depending on the age during 6 days; the patients of the control group (7 children) had received general complex therapy. For estimation of the dynamics of subjective and objective data was used visual analogue 4-point scale: where 0 points isthe absence of symptoms, for 3 points — its maximum expression.
Results. Already for the next day of treatment with «Amizonchik» preparation has been marked improvement in general condition, reducing of intoxication syndrome and decreased body temperature. The use of preparation in the complex treatment of acute respiratory infections led to a decline of proinflammatory cytokines — interleukin-1β, and alpha-interferon in the oropharyngeal secret. The preparation was well tolerated by children, side effects were not marked. In the control group considered more slow positive dynamics of patient's condition, clinical and immunological parameters.
Conclusions. «Amizonchik» preparation can be used in the treatment of acute respiratory infections in children in the age of 3–6 years. Use of preparation in the complex treatment of acute respiratory diseases promotes more rapid recovery and normalization of immunological parameters.
Key words: acute respiratory infections, immunological parameters, Amizonchik.
Kryuchko T. A., Kushnereva T. V., Kolenko I. O., Habertyur Yu. M.
Acute pharyngitis in children: the questions of etiology and treatment.
Objective: To estimate the effectiveness of Tonzipret during the treatment of acute pharyngitis in preschool age children in the setting of ARVI.
Patients and methods. A total of 50 children aged from 1 to 6 years with ARVI and an acute pharyngitis were under observation. The main group of patients consisted those (n = 25), to whom was ordered Tonzipret in the oro-dispersible tablet form as a topical treatment of acute pharyngitis. The control group (n = 25) received oral antiseptics based on dequalinium chloride. The effectiveness of treatment was evaluated by five-grade scale on the 1st and 5th day of treatment. In the observation groups average index score was calculated for the reason of comparison of clinical manifestations dynamics. The maximum sum of points in the patient was — 48.
Results. In the group of children with Tonzipret administration a more pronounced positive dynamics of the main manifestations of disease (pain in the throat, difficulties in swallowing, cough) was marked; the dynamics of the general intoxication symptoms (malaise, headache, AVI) in both groups had no significant differences. It is marked a high efficiency of the treatment in 80% of patients with Tonzipret application, moderate — 12% and the lowest — in 8%, and well tolerated in 92% of patients.
Conclusions. During the choice of treatment means of pharyngitis ethological factor, the child's age and the severity of symptoms should be considered. At the viral nature of the disease faster positive dynamics is observed in case of use of combined preparation Tonzipret, which has expressed analgesic and anti-inflammatory effect.
Key words: acute pharyngitis, children of preschool age, etiology, treatment, Tonzipret.
Marushko Yu. V., Gracheva M. G.
Experience of the use of combined natural preparation in the treatment and prevention of respiratory diseases in children.
Summary. There literature data on the use of complex homeopathic preparation «Aflubin» for prevention and treatment of acute respiratory infections in children are summarized. Analysis of conducted data allows recommending Aflubin as preparation for prevention during the epidemic rise and sporadic disease so for the complex treatment of acute respiratory disease in clinical practice in inpatient and outpatient settings.
Key words: acute respiratory diseases, children, prevention, treatment, homeopathic preparation, Aflubin.
Dudnik V. M., Izyumets O. I., Layko L. I., Dobizha M. V., Nezhivenko T. P., Gomon R. A.
Differential diagnostics of neonatal jaudice.
Summary. The principles of the differential diagnosis of neonatal jaundice and diseases of other etiology with similar clinical and paraclinical manifestations are shown. The value of prenatal analysis and multidisciplinary character of Neonatology as a science so like practice is underlined.
Key words: Neonatology, pediatrics, jaundice, bilirubin.
Shadryn О. G., Platonova О. M.
Monitoring of irritable bowel syndrome prevalence in child population of Ukraine.
Material and methods. The prospective longitudical study was conducted in 2010–2012 gg by the statistucal analysis of unified forms of medical records in accordance with the order of the PHM of Ukraine No. 59 from 29.01.2013 «Rev. approval of unified clinical protocols of health care for children with the dis;eases of the organs of digestive system».
The results show, that implementation of unified medical records allowed to improve the indentification of IBS in the primary health care facilities. There were determined regions with unsatisfactory level of the implementation of the contemporary diagnostic criteria. The highest levels of IBS prevalence rmined for IBS in adolescents living in the southern regions of Ukraine (Crimea, Odessa and Mykolaiv regions). In the 2010–2012 the prevalence was levelled but there was a peak of prevalence in 2011 explaining by the successful implementation of the Rome III criteria.
Conclusions: 1. The IBS prevalence among Ukrainian children is different from the world level and by 40–50 % less than in East Europe and Russia.
2. The highest prevalence of IBS among children is registered in the southern region of Ukraine (0,32 ‰).
3. The low level of the detection of IBS could be explained by the lack of folow-up pofessional training of professionals on the issues of the application of contemporary diasgnostic criteria and hyperdiagnostics of organic pathology.
Key words: irritable bowel syndrome, standardization, children health, monitoring.
Marushko R. V.
Clinical and immunological features of chronic nonspecific non-ulcerative colitis in infants.
Objective: To study the activity of cytokines for determination of their pathogenic role and effective action of the individual factors of the immune system in infants with chronic non-specific non-ulcerative colitis (CNNC).
Patients and methods. It is studied 60 children in the age from 1 to 3 years with CNNC, who were under hospitalization. The control group consisted of 30 apparently healthy children of appropriate age. Immunological status of children was evaluated on the base of determination of cytokine concentration in the blood serum by the method of Enzyme-Immuno-Sorbent-Assay.
Results. It is found that during the CNNC in infants and the concentration and ratio of the different groups of cytokines in the blood serum undergoes significant changes — increasing the concentration of pro-inflammatory cytokines (IL-1α, IL-6, IL-8, TNF-α) and decreases the level of inflammatory cytokines (IL -4 is the IL-10), wherein the content growth factors is changing — by increased hepatocytes growth factor and reduced intestinal trefoil factor.
Conclusions. Found changes of cytokines state can be regarded as a violation of the immunoregulatory mechanisms that is the basis of pathogenesis of the formation of a chronic inflammatory process in the infant's intestine.
Key words: infants, cytokines, chronic non-specific non-ulcer colitis.
Dudnik V. M.
Benefits of the use of phytoneering preparation «Iberogast» in the complex treatment of chronic gastroduodenitis in children during the acute stage.
Objective: To study the effectiveness of phytopreparation «Iberogast» in the treatment of chronic gastroduodenitis (CGD) in children during the acute stage.
Patients and methods. The study included 58 children aged from 8 to 18 years with an established clinical diagnosis of CGD. All children underwent clinical and laboratory examination, including a rapid urease test for H. pylori and ultrasound of the digestive tract. The observation was carried out in the dynamics at 7 and 14 days of treatment and after 1 and 6 months of therapy, the data were entered in a special form. In the complex therapy «Iberogast» was ordered to 30 children of the main group and 28 children of comparison group had only standard therapy.
Results. Therapy with «Iberogast» application was effective in 86.6% of children. In children from the main group were marked more rapid relief of dyspeptic and asthenovegetative syndromes (on 11.7% and 14.8%, respectively), motor disorders (96.7%), normalization of the inflammatory response (63.3%) than in patients who were under conventional therapy only. Dynamic observation after a month of therapy had shown absents of complaints concerning the pain, diarrhea and asthenovegetative syndromes in children in the main group. «Iberogast» tolerability was satisfactory, refuse from receiving and allergic reactions were not found.
Conclusions. The results of the study allow us to recommend the use of phytopreparation «Iberogast» in children in order to increase the effectiveness of the complex treatment of CGD during the acute stage.
Key words: chronic gastroduodenitis, aggravation, phytopreparation, Iberogast.
Kozakevich V. K., Kozakevich O. B.
Nutrition and forming of healthy intestinal microflora in infants.
Objective: To examine and give an objective assessment to the clinical effectiveness of the use of domestic formula «Malyutka premium 1» with prebiotics and nucleotides in the nutrition of infants.
Patients and methods. In the observation group were 23 bottle feeding children in the age from 10 days to 4 months with «Malyutka premium 1» milk formula application. A comparison group consisted of 24 children, who were treated by other formulas. Follow-up was 30 days.
Results. Clinical observations had shown good tolerability of the new formula. During the testing product period of adaptation was wholly satisfactory in the examined children and refuses from milk formula were not marked. The intervention of enriched with prebiotics and nucleotides product resulting to lower frequencies, and for the end of observation – also to reduce of intestinal colic symptoms; according to the data of microbiological analysis of feces was found a significant increase in the concentration of bifido -and lactobacilli, reducing of opportunistic pathogenic microflora.
Conclusions. A milk formula «Malyutka premium 1» well tolerated and meet the children's requirements of the first year of life in important nutrient materials. The feeding of children in the first months of life with milk formula enriched with prebiotic oligosaccharides complex provides the effect similar to the effect of breast milk, – improves the processes of digestion and intestinal biocenosis indicators.
Key words: artificial feeding, prebiotics, oligosaccharides, GOS / FOS, children of the first months of life.
Marushko Y., Nagornaya K.
Experience of the use of combined preparation of iron, copper and manganese in children with bilj iary pathology and ironjdeficiency conditions.
Objective: To study the effect of complex medical therapy with the use of combined preparation of iron, copper and manganese (TOT'HEMA) on iron metabolism indicators and clinical course of chronic biliary pathology (CBP) in older school-age children with biliary tract diseases and iron-deficiency conditions.
Patients and methods.There were supervised 39 children in the age of 11–16 years with CBP, who were undergoing in hospital treatment due to the primary disease exacerbationwere under observation. In 29 (74%) patients was founded anemia of I degree and latent iron deficiency was observed in 10 (26%) other patients. From the 5th day of hospitalization the main group patients (25 children) additionally received TOT'HEMA preparation by 5 mg / kg per day in recalculation on elemental iron, but no more than 150 mg per day. For children of the control group (14 children) were given recommendations for a balanced diet with inclusion foods rich in iron. Clinical observation was conducted during the 6 months after hospitalization.
Results. Correction of iron metabolism and microelements in children with CBP contributes not only to the elimination of asthenic-vegetative symptoms and other clinical manifestations of iron deficiency but also more complete and sustained clinical remission of biliary tract diseases. It is established that TOT'HEMA effectively restores iron deficiency in such patients and it is safe and well tolerated.
Conclusions. Children with biliary system pathology are required the examination for iron-deficiency conditions. Administration of «TOT'HEMA» in the complex treatment improves the condition of red blood and favorably affects on the course of biliary pathology.
Key words: iron-deficiency, children, biliary pathology, combined preparation «TOT'HEMA».
Kriuchko T. A., Vovk Yu. A., Tkachenko O. Yu, Nesina I. N., Lukanin A. V.
Modern approaches to correction of the secondary lactase deficiency in infants.
Objective: To evaluate the effectiveness of lactase replacement therapy in the complex treatment of infants with the symptoms of transient secondary lactase deficiency (LN).
Patients and methods. A total of 44 children aged from 1 to 6 months without burdening by allergic anamnesis who had a clinical picture of the secondary or transient LN were under observation. All children up to the onset of the disease were exclusively breastfed. The first group comprised 24 children (12 boys and 12 girls) to whom LN correction was performed by the use of «Mamalak» preparation. In the control group (20 children) specific medical LN therapy is not performed. The dynamics of normalization of digestion was estimated at 2, 5, 7 day and 2, 4 weeks from the start of the observation.
Results. Conducted studies have shown good tolerability of replacement therapy in all observed children (more than one was not eliminated from the study) and its effectiveness in eliminating symptoms of LN. Due to use of Mamalak for the end of the first week already have been shown normalization of the frequency and consistency of feces, stopped pain syndrome, significantly reduced the frequency and volume of regurgitation. Children of the control group for the absence of dynamics have been carried out replacement of three breastfeeding on lactose-free formulas. This tactic was effective in 16 (80.0%) patients.
Conclusions. The use of enzyme replacement therapy by lactase allow quickly and effectively improve the overall health of the child, frequency and consistency of feces, speed up the healing process and maintain breastfeeding.
Key words: lactase deficiency, the children of the first year of life, replacement therapy, Mamalak.
Kramaryov S. A., Vygovskaya O., Yankovskyi D. S., Dyment G. S.
Experience of the use of multiprobiotic Simbiter® in the clinic of children's diseases.
Summary. A study of the effectiveness of multiprobiotic Simbiter® during the invasive acute intestinal infections with the aim to prevent side effects from the part of gastrointestinal tract in children with different infectious diseases due to the antibiotic therapy in the complex treatment of infectious mononucleosis of the Epstein—Barr viral etiology, of chronic active form of the Epstein-Barr virus infection; multiprobiotic impact on the frequency of appearance and durtion of symptoms of the acute respiratory viral infections in healthy children during the autumn-winter season. It is shown high clinical and laboratory and preventive effectiveness of multiprobiotic Simbiter® and also its safety.
Key words: multiprobiotic, Simbiter®, children, acute intestinal infections, infectious mononucleosis, chronic form of the Epstein-Barr virus infection, acute respiratory viral infections, prevention.
Bobrova V. I., Vorobienko Y. I., Koshovaia A.A.
Features of cytoprotective therapy in children with chronic gastroduodenal pathology.
Objective: To study the effectiveness of the treatment of chronic gastroduodenal pathology (HGDP) with the inclusion of polyunsaturated omega-3 fatty acids to the complex therapy.
Patients and methods. A total of 136 children in the age from 12 to 17 years with verified HGDP were under observation. For all children were conducted such interventions as fibroesophagogastroduodenoscopy of the upper digestive tract, the intragastric pH-metry, endoscopy with target biopsy of antrum mucous coat and the duodenum mucous coat for morphological studies, serology with the use of immunoenzyme assay with determination of Ig G antibodies to H.pylori. Complex treatment included eradicative, antisecretory, cytoprotective therapy. For the treatment complex of 32 smokers and 76 non-smokers children was included «Smart OmegaТМ Q10» preparation 1 capsule per day for 1 month.
Results. In the setting of conduct therapy was not found differences in the periods of the disappearance of pain syndrome, but it is found significant benefits of inclusion of «Smart OmegaТМ Q10» regarding relief of dyspeptic symptoms. On the control histological study in all patients was marked a decrease level of inflammation of the mucous coat of the stomach and the duodenum mucous coat. Damage of mucosal barrier after treatment often was preserved in patients-smokers.
Conclusions. In children with HGDP take place substantial disorders of cytoprotective functions of GDZ. Inclusion of omega 3 fatty acids to the complex therapy promotes reducing of inflammation and improves cytoprotective properties of the mucous coat of the stomach and the duodenum mucous coat, accelerates the regression of clinical manifestations of disease.
Key words: children, chronic gastroduodenal pathology, omega-3 polyunsaturated fatty acids.
Marushko Yu. V., Gischak T. V.
Experience of the use of «Cholosas» during the functional disorders of biliary tract.
The review of the scientific literature on the diagnosis and treatment of functional disorders of the biliary tract (FDBT) in children is presented. The possibilities of application of the preparation from the hips (Cholosas) in the complex of treatment and rehabilitation interventions in patients with FDBT are shown.
Key words: functional disorders of the biliary tract, children, cholagogue preparations Cholosas.
Maydannik V. G., Mityuryaeva I. O., Kuchta N. M., Moysienko M. B., Terletskii R. V.
Modern effective methods of treatment of vegetative dysfunction by hypertensive type in children.
Objective: To study the effectiveness and safety of the use of combination of homeopathic preparations «Homvionervin» and «Homviotenzin» in the complex treatment of vegetative dysfunction by hypertensive type in children.
Patients and methods. The study included 48 children in the age from 10 to 17 years, in the comprehensive results of which had been diagnosed vegetative dysfunction (VD) by hypertensive type. Clinico-psychological and instrumental examinations performed prior to treatment and at the end of the second month of treatment. For 30 patients in the complex treatment were ordered preparations of «Homviotenzin» and «Homvionervin» per 1 tablet 3 times a day for 2 months in combination with parenteral administration of vitamins B1 and B6. In the complex treatment were included massage conduction, physiotherapy and psychological correction. For 18 patients of the control group was ordered the same treatment complex with the exception of Homviotenzin and Homvionervin preparations.
Results. Application of Homviotenzin and Homvionervin by two-month course in the complex treatment of VD contributed to a stable normalization of blood pressure, reduction of a symptoms of cerebroasthenic syndrome, normalization of functional condition of vegetative state of homeostasis, brain and cervical hemodynamics and improvement of the quality of life. Safety of preparations is found in the present study.
Conclusions. Preparations «Homvionervin» and «Homviotenzin» can be recommended for widespread use in the complex treatment of patients with VD by hypertensive type by two-months and longer courses.
Key words: vegetative dysfunction by hypertensive type, complex treatment, Homviotenzin, Homvionervin.
Kasianova A. Yu., Zhovnir V. A., Fedevych O. M., Chasovsky K. S., Yemets I. M.
Follow-up psychomotor development of children with congenital heart disease after cardiopulmonary bypass using autologous umbilical cord blood.
Objectives: To estimate follow up psychomotor development of children that underwent cardiopulmonary bypass (CPB) surgery for congenital heart disease (CHD) with the use of autologous umbilical cord blood in the first hours of life.
Methods: The Bayley Scales of Infant Development (BSID$II) was used to study the cognitive and motor development. The study involved 80 children of 1 to 2 years of age with CHD. Study group included 20 children that underwent surgery with CPB and autologous umbilical cord blood; the two conventional groups included 45 and 15 children respectively, depending on the use or no-use of donor blood.
Results: average mental (MDI) and psychomotor (PDI) indices were within normal limits in all groups of children. The study group showed MDI 96,7 +16,84 (p = 0,26) and PDI 90,81 +12,42 (p = 0,25).
Conclusions: CPB in neonates can be safely performed in the first hours of life using autologous umbilical cord blood leading to comparatively good results compared to the conventional groups.
Key words: children, congenital heart defects, surgical correction, cognitive function, psychomotor development indices, autologous umbilical cord blood.
Kaladze N.N., Soboleva E. M., Skoromnaya N. N.
Dynamics of quantitative products indicators and melatonin secretion rhythm in patients with juvenile rheumatoid arthritis at the stage of sanatorium and resort rehabilitation with the use of electric sleep therapy.
Objective: To study the features of the quantitative products and melatonin secretion rhythm in children with JRA and the impact of electric sleep therapy on melatonin productive epiphysis activity.
Patients and methods. A total of 40 children with rheumatoid arthritis at the age from 4 to 16 years were under observation. Joint and visceral form of the disease was diagnosed in 15 children, mostly articulate — in 25 patients. Patients of the first group (control group, n = 20) underwent traditional sanatorium and resort treatment; for patients of the second group (study group, n = 20) additionally was ordered electro sleep therapy by the course of 10 procedures alternate days. A content of melatonin in the body is determined by the concentration of its major metabolite — 6-sulfatoxymelatonin (COMT-6) in urine.
Results. Sanatorium and resort treatment supplemented by electro sleep therapy had a more pronounced effect on the modified bio-rhythms in children with JRA. Correctional effect was in the reliable (p <0,001) increase of the daily content of melatonin and its night-level (p <0,001), that is indicated about a tendency to normalization of the rhythm of its secretion.
Conclusions. The use of electro sleep therapy in the complex of the sanatorium and resort rehabilitation of patient with JRA helps to normalize hormonal regulation and leveling of internal desynchronosis manifestations due to restoration of disorders of circadian rhythm of melatonin secretion.
Key words: children, juvenile rheumatoid arthritis, melatonin, electric sleep therapy, sanatorium and resort treatment.
Maydannyk V. G., Mityuryaeva I. O., Kuchta N. M., Moysienko M. B., Terletskii R. V.
New opportunities in the treatment of hypotensive conditions in children.
Objective: To evaluate the efficacy and safety of the use of homeopathic sedative preparation «Homvionervin» in the complex treatment of hypotensive conditions in children.
Patients and methods. The study included 56 children aged from 10 to 17 years, in the results of a comprehensive survey of which had been diagnosed vegetative dysfunctions (VD) by hypotensive type. Clinico-psychological and instrumental examinations were performed prior to treatment and at the end of the second month. Homvionervin were appointed to 36 children of the main group: per 1 tablet 3 times a day for two months, in combination with parenteral administration of vitamin B1 is the B6. To the complex of treatment were included massage conduction, physiotherapy and psychological correction. In th control group 20 patients had received the same treatment complex, but without application of Homvionervin.
Results. Homvionervin increases the efficiency of anti-stress complex treatment of patients with VD by hypotensive type, which is manifests by a stable normalization of blood pressure, the disappearance of specific cerebroasthenic symptoms (headache, dizziness), increased levels of mental and emotional state, in particular, indicators of health, activity, mood, and also decrease of the level of situational and trait anxiety and improvement of the quality of life.
Conclusions. «Homvionervin» preparation can be recommended for widespread use in the complex treatment of patients with VD by hypotensive type by two months and longer course in conjunction with vitamins and minerals in the setting of massage conduction, physiotherapy and psychotherapy.
Key words: vegetative dysfunction by hypotensive type, children, complex treatment, homeopathic preparation, Homvionervin.
Letyago A. V.
Effect of sanatorium and resort treatment on microcirculation disorders during the osteoarthritis in adolescents.
Objective: To evaluate the effect of the sanatorium and resort treatment on microcirculatory processes in the affected joints during the osteoarthritis in adolescents.
Patients and methods. A total of 45 adolescents in the age 13–18 years with osteoarthritis were examined. Verification pathology was carried out using X-ray of the affected joints and ultrasound study. For the aim of microcirculation study was used the method of Capillaroscopy of the nail bed, which was conducted in the morning on an empty stomach. All the patients received cartilage-modifying and non-steroidal anti-inflammatory preparations and 13 patients of the second group additionally received a complex of the sanatorium and resort treatment that is included climatotherapy, health food, exercises, massage, readjustment of chronic foci of infection, mud packs and laser irradiation of the affected joints.
Results. In the second group of patients has been found a significant improvement in microcirculation — vascular, endovascular, perivascular links. This was reflected in the increase in the number of functional capillaries, absence of expressive jaws flexuosity, reducing of the frequency of disorders in the speed of blood circulation and red blood cell aggregation.
Conclusions. The presented results are pointed out on the importance of using the sanatorium and resort treatment in the complex treatment of osteoarthrosis.
Key words: Osteoarthritis, adolescents, microcirculation, sanatorium and resort treatment.
Lezhenko G. A., Pashkova E. E., Rudova E. I., Pantyushenko L. I.
Experience of the use of Cefixime in the treatment of urinary tract infection in children.
Objective: To evaluate the clinical and bacteriological efficacy of cefixime (Cefix) in the treatment of urinary tract infections in children.
Patients and methods. In the study were included 70 children with urinary tract infections in the active stage of inflammation: 22 patients with acute cystitis, 28 — with acute pyelonephritis and 20 — with aggravated chronic pyelonephritis. In all patients the diagnosis was confirmed by anamnesis data, clinical and laboratory, radiological, microbiological researches and ultrasound examination of the urinary system. In the complex treatment for all children was administrated cefixime in a dose of 8 mg / kg once or 4 mg / kg twice per day. During the cystitis the duration of treatment course was 5 days, in case of pyelonephritis — 10–14 days.
Results. In the setting of treatment by cefixime positive dynamics was marked in all patients with cystitis and acute pyelonephritis and in 19 (95.0%) of patients with chronic pyelonephritis. Already on the 2–3rd day of treatment the body temperature was dropped to normal, also noted disappeared pain in the lumbar region and dysuric manifestations and an appetite improvement; At 7–8 days of treatment in all patients was observed sterilization of urine, and an 8-10th day of treatment- full normalization of clinical analysis of blood and urinary symptoms. Cefix is well tolerated by patients.
Conclusions. The use of cefixime (Cefix) as a medication of antibiotic therapy during the cystitis and uncomplicated course of pyelonephritis in children is etiologically grounded, highly effective and safe.
Key words: cystitis, pyelonephritis, oral cephalosporins, cefixime, children.
Lavrenchuk O. V., Driyanskaya V. E., Bagdasarova I. V., Petrina O. P.
Anti-relapse treatment of chronic urinary tract infections in children.
Objective: To estimate the effectiveness of anti-relapse treatment with the use of «Furomag» in children with chronic infection of the urinary system (IUS).
Patients and methods. The 52 children aged from 1–17 years with chronic IUS — 45 patients with pyelonephritis (PN) and 7 patients with cystitis had took part in the examination. All the children had a recurrent course of IUS and at the beginning of the study were at the stage of exacerbation. All patients were at the stage of clinical and laboratory remission and observed before treatment. The observation lasted eight months. Children with PN received a course of antibiotic treatment by preparations of cephalosporin rate during 10–14 days with the transition to Furomag at a dose of 5 mg / kg / per day, which was conducted during 14 days. Subsequent anti-relapse treatment was continued by «Furomag» (1.5 mg / kg / day, once at night). Depending on the duration of preventive treatment patients were divided into groups: the first group received preparation during one month, the second group — six months.
Results. It is found high efficiency of long-term use of the preparation «Furomag» in children with recurrent course of chronic IUS, especially during the secondary obstructive PN; revealed sufficient sensitivity of microorganisms to the preparation in all patients and the absence of immunosuppressive effect on the state of local immunity by the parameters of SLPI in children with chronic IUS; identified satisfactory tolerance of «Furomag» preparation in children of all ages.
Conclusions. High effect of prolonged application of Furomag in children with recurrent course of chronic IUS and an acceptable tolerability allow recommending preparation for use in pediatric practice.
Key words: children, urinary tract infection, chronic pyelonephritis, cystitis, anti-relapse treatment, Furomag.
Rymarenko N. V., Usova S. V., Romanenko S. P., Chvetko S. T.
Case study: successful treatment of visceral leishmaniasis in a child of early age in crimea.
Summary. The article shows the case of visceral leishmaniasis in 4 months old child taken from own clinical experience.
Key words: visceral leishmaniasis, treatment, children.
Bondarenko A. V., Chernyshova L. I., Golovatyuk I. V., Gabrys G. M., Kasian O. I., Egorova L. M.
Features of clinical course and diagnosis of incomplete Kawasaki syndrome.
Summary. Kawasaki syndrome – is an acute systemic vasculitis with potential serious complications. During the partial clinical course the clinical syndrome is often diagnosed untimely. In the article the literature review of author's own observations according to the incomplete Kawasaki syndrome is presented. In all cases, most of the major symptoms such as (rash, changes in the palms and soles and scleritis) were intermittent or absent, the most persistent symptoms were fever and inflammatory changes in the general blood count. In one case it was confirmed by postmortem diagnosis, in the other two — by effectiveness of specific therapy. Taking into account the potential danger of consequences of disease, to the differential diagnosis of febricity in infants should be always included Kawasaki syndrome; the use of high-dose intravenous immunoglobulin is justified in assumption of this syndrome in child.
Key words: Kawasaki syndrome, systemic vasculitis, coronary artery disease, aneurysm, intravenous immunoglobulin.
Korenev M. M., Ovsyannikova L. M., Vodolazhskiy M. L., Sydorenko T. P., Fomina T. V., Koshman T. V.
Information and analytical estimation of the research on dissertations, presented in Ukraine in 2007–2011 in clinical pediatrics, school and adolescent medicine.
The paper presents the structure of the topical fields in reference to dissertations, carried out in Ukraine in 2007–2011 in clinical pediatrics, in adolescent and school medicine. The amount and quantitative indices of the components of information and innovative resources, obtained as a result of research, have been established.
Key words: dissertations, children and adolescents health care, information and innovative resources of research.
Indigo children: two truths.