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- SOVREMENNAYA PEDIATRIYA № 1 – 2013
SOVREMENNAYA PEDIATRIYA № 1 – 2013
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Moiseenko R. A., Danilenko G. N., Ponomareva L. I.
The features of health dynamics of pupils of the primary and middle school.
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Purpose of the study: To determine the age and gender features of dynamics of pathological attack and physical development of pupil of the primary and middle school on the base of longitudinal study.
Patients and methods. The 223 of pupils of the upper secondary school (112 boys and 111 girls) in the dynamics of learning from the first to the ninth classes were under observation. The health status of pupils is studied by the results of the in-depth medical examination of such experts as pediatrician, otolaryngologist, endocrinologist, neuropsychiatrist, ophthalmologist and psychologist. In the work paper the comprehensive method of health examination is used. The harmonious physical development of pupils is determined.
Results. According to the comprehensive medical examinations during the study the significant decline in health of pupils with improved overall pathological prevalence (PP) is found. At the beginning of the study (first class) the main pathologies were mental and behavioral disorders, diseases of the respiratory system, the pathology of the musculoskeletal system, diseases of the circulatory system and the endocrine system. During the study in the primary school there were significant structural changes and the most common were respiratory diseases, the second place went to endocrinopathy in third!mental disorder and behavior and the fourth position took up eye diseases and its appendage apparatus. During the pass into middle school becomes urgent pathology of the endocrine system which at this stage has won first place ranking, mental and behavioral disorders at a second position, respiratory diseases — at the third and the musculoskeletal system — the fourth. In the dynamics of the distribution of students by groups of health the following gender differences were found. In the primary school and at the beginning of study in the middle school (fifth and seventh classes), the second group of health often registered among the girls than the boys, and the third — the opposite situation were observed in boys of senior classes (eighth to ninth classes).
Conclusions. Dynamics of pathological prevalence data, harmonious physical development, groups of health among pupils during the study in the primary and middle school has the wave-like nature with a negative trend in the first three years of study at the end of the fifth class and at the beginning of the study in the sixth class, in the eighth class and at the end of ninth class, reflecting the critical periods of the formation of the health of pupils associated with the child's adaptation to the conditions of learning and the process of growth and development.
Key words: health, pupils, pathological prevalence, physical development.
Mokiya-Serbina S. A., Vasilenko N. V., Litvinova T. V., Virina V. A.
Differentiated tactics of use of probiotics in the threatment of atopic dermatitis in infants.
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Purpose: To study the effectiveness of the «Enterozhermina» preparation during the atopic dermatitis (AD) in infants with intestinal dysbiosis of the II-III degree, accompanied by a strong growth of opportunistic pathogen flora (OPF) and relapsing course of dermato!allergic process.
Patients and methods. A total of 13 infants with intestinal dysbiosis of the II-III degree with moderate to severe atopic dermatitis were under observation. A complex of study is included: general clinic examination, evaluation of atopic dermatitis severity by EASI; coprological examinations; microbiological examinations of feces. The administration of «Enterozhermina» preparation was 1 bottle per day during 1 month. The duration of follow-up was 5-6 months. The studies were conducted in the dynamics: before the administration of a treatment, after 2 and 4 weeks from the beginning of the treatment.
Results. The microbial landscape of the intestine in all children is characterized by decreased of a number of bifidobacteria and lactoflora and increased opportunistic pathogen flora. Among the opportunistic pathogen flora the prevalent was staphylococci; in 6 children were found microbial associations: staphylococci and fungi of the genus Candida, Staphylococcus and Klebsiella. Clinical symptoms analyses in the dynamics had shown a significant improvement in the children on the 14th day of the treatment: intensity reduction of congestion and exudation, swelling, itching, sleep improvement.
Conclusions. Enterozhermina is an effective and important component of the complex treatment of children of the first year of life with persistent clinical signs of moderate and severe atopic dermatitis, accompanied by functional disorders and dysbiotic disorders of the gastrointestinal tract.
Key words: children, atopic dermatitis, digestive microbiocaenosis, probiotics Bacillus clausii, Enterozhermina.
Nedelskaya S. N., Yartseva D. A., Mazur V. I., Solodova I. V., Bessikalo T. G., Tarasevich T. V.
Allergic rhinitis and bronchial asthma of pollen etiology in children: a retrospective study of the clinical course.
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Objective: to study the course of pollen allergy on the cohort of children who were admitted to the hospital to the allergological department of KD «Zaporizhzhya City Multidisciplinary Children's Hospital № 5» with the relevant symptoms.
Patients and methods. The study design involves the analysis of children's disease archival histories admitted to the hospital to the department with respiratory symptoms in August-September 2004-2009yy. The 859 histories of children's diseases aged from 5 to 18 years were selected for the analysis.
Results. It is shown, that in the Zaporizhzhya region the «rejuvenation» of pollen allergy is observed; it is proved that isolated pollen asthma – a pathology that occurs in 3.4% of patients with pollen fever and for the rest asthma combined with allergic rhinitis. Main factors of perinatal, allergic history and living conditions, leading to a worsening of rhinitis and pollen formation in patients with bronchial asthma were marked. At the same time on the basis of mathematical modeling were demonstrated that in 75% of patient's asthma is debuted during 5 years. The most important prognostic factor is the lack of adequate and timely anti-inflammatory treatment of rhinitis. Own algorithm of the using of pharmaceutical preparations for the control of rhinitis symptoms is given.
Conclusion. Patients with pollen allergic rhinitis have a very quickly forming of bronchial asthma, especially if the debut of allergic rhinitis occurred before the age of 8. Moreover, in a quarter of these patients asthma manifestation takes place in the first year after the debut of the pollen rhinitis. One of the main reasons for the rapid accession of asthma should be considered not only the factors of genetic predisposition and living condition of the patient, but also the lack of adequate treatment of allergic rhinitis. The use of modern pharmaceutical preparation against the pollen rhinitis in combination with allergen specific immunotherapy will allow preventing heavier course of pollen fever and asthma connection.
Key words: pollen fever, children, risk factors, prognosis.
Проф. Ключников С. О.
Препараты от кашля в амбулаторной практике педиатра.
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Berezhnoi V. V., Kozachuk V. G., Ruban I. I., Glyadelova N. P., Kirnos A. I., Korneva V. V., Koroleva V. A., Lischinskaya M.
Estimation of efficiency of irrigation therapy in the complex treatment of acute rhinitis in children.
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Purpose: To investigate the clinical efficacy and safety of a hypertonic solution Kviks ® in the treatment of acute rhinitis in children.
Patients and methods. The 62 children aged from 1 year to 15 years with acute rhinitis in the setting of the acute respiratory viral infection for the period 2011–2012 were under observation. In the first group were included 22 children (35.48%) who are in the setting of the etiopathogenic therapy (antiviral, antiinflammatory drugs, mucolytics, antipyretics) received Kviks®. The 20 patients (32.26%) of the 2nd group in the setting of the traditional treatment received Kviks® and local decongestants (alpha-2-adrenoceptor agonist). To the 3rd-group were included 20 (32.26%) of patients who had received standard treatment, and local decongestants (alpha-2-agonists). The criteria for the effectiveness of therapy were significant reduction of symptoms, duration of the illness and the use of local decongestants, dynamics of rhynoscopic picture. Estimation of each symptom was performed using a 3-point scale: 0 — no sign, 1 — easily expressed, 2 — moderate, 3 — pronounced.
Results. At the initial examination condition was moderate in 33 (53.2%) children, mild — in 29 (46.77%). Irrigation therapy with Kviks ®, both mono- and in combination with nasal decongestants contributed to the rapid relief of clinical symptoms of acute rhinitis. The use of hypertonic saline Kviks ® allow reducing the use of vasoconstrictor agents and thus prevent the development of complications. There were no side effects associated with the use of Kviks ® spray, all patients had good tolerance of preparation.
Conclusions. The high therapeutic efficacy, safety and usability allow recommending Kviks® hypertonic solution for widespread application in pediatric practice.
Key words: children, acute rhinitis, irrigation therapy, Kviks.
Okhotnikova E. N., Rudenko S. N., Kolomiets E.
Recurrent respiratory tract infections in children and their immunoprophylaxis in the terms of the modern ideas about the immunomodulatory activity of immunotropic preparations.
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The article deals with the problem of frequent incidence of children with acute respiratory infections (ARI). It is shown that at the present time there are opportunities to effectively prevent repeated ARI in children. Data from numerous studies improved the preventative effect of bacterial immunomodulators chosen according to the features of recurrent acute respiratory infections and the age of the child. The characteristic to the modern immunotropic preparations is shown. Emphasizes that immunoprophylaxis is just a one of the many links in the system health of children with recurrent acute respiratory infections. Equally important are the normalization of the daily regimen and rest, adequate nutrition, rational therapy of ARI and acute respiratory exacerbations of chronic respiratory infections, treatment of opportunistic diseases, rehabilitation of chronic focal points of infections, hardening, physical therapy and sports, spa recreation. At the same time all treatments and preventive measures must be comprehensive and their implementation to be systematic and consistent.
Key words: acute respiratory infections, children, prevention, bacterial immunomodulator.
Shevchuk Yu. V.
Experience of the use of «Broncho-Vaxom» in the complex threatment of the frequently ill children.
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Purpose: To study the state of frequently and chronically ill children and the evaluation of the «Broncho-Vaxom» preparation in their treatment.
Patients and methods. In the ENT-department the 39 children aged from 2 to 12 years were under observation. The chronic pathology or morphofunctional features of rhino- and oropharynx, nasal cavity was diagnosed in most of patients; all the children had the signs of pharynx inflammation of different degrees, in most of the children were diagnosed adenoid vegetation, acute or chronic adenoiditis. During the previous year of observation children underwent an average 6, 54 ± 1,8 episode of acute infections accompanied by application of systemic antibiotic therapy from 2 to 5 times. In the complex treatment of diseases for the patients of the main group (20 (52%) of the children) «Broncho-Vaxom» preparation was ordered by 1 tablet on an empty stomach during 10 days. Then the application of the preparation was repeated twice at intervals 20 days (during three months by 10-days course). The control group included 19 (48%) of children who had received standard treatment.
Results. After the end of the rehabilitation course after 3 months the results of the pharyngeal swab examination showed more expressive dynamics in the group of children who had received «Broncho-Vaxom» and marked a decrease of the number of white blood cells and the detection rate of coccal flora in 2 times. The inclusion of the «Broncho-Vaxom»preparation to the scheme of rehabilitation at frequently ill children increased treatment efficiency and accelerate the process of rehabilitation of the upper respiratory tract. Positive changes in the pharyngeal microflora are persisted after the end of treatment. Conclusions. Usability, no side effects, therapeutic efficacy and availability of the «Broncho-Vaxom» preparation allow recommending it for widespread use in the complex treatment of frequent and prolonged ill children.
Key words: Broncho-Vaxom, acute respiratory diseases, immunomodulator, frequently ill children.
Kosakovskyi A. L., Yurochko F. B.
Modern management during the acute otitis media in children.
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Summary. A classification and current principles of diagnosis and treatment of otitis media in children are presented.
Ovcharenko L. S., Vertegel A. A., Andrienko T. G., Zhikhareva N. V., Samokhin I. V.
Therapy of hepatotoxic level manifestations during the use of ceftriaxone in children with respiratory tract pathologies.
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Purpose: To determine the efficacy and safety of the use of ursodeoxycholic acid (UDCA) in children with disorders of the hepatobiliary system developed in the setting of the treatment with the use of ceftriaxone.
Patients and methods. A total of 50 children treated with ceftriaxone for acute bacterial inflammation of the respiratory system (bronchitis, community-acquired pneumonia), who had developed disorders of the hepatobiliary system were under observation. Depending on the method of treatment of the found disorders patients were randomly assigned into two groups of observation: the children of the 1st group had received UDCA «Ukrliv» preparation during 20 days in the form of a suspension, the children of the 2nd group had received only symptomatic therapy (antispasmodics, sorbents). For the control of hepatotoxic level of ceftriaxone all children underwent ultrasonography of the hepatobiliary system, biochemical blood examination. Results. Use of the «Ukrliv» preparation had shown high clinical and laboratory efficiency — within the first 10 days of the use the preparation significantly reduced both subjective and objective clinical symptoms of hepatotoxic level — and good tolerance of this method of therapy. Its use does not have a negative impact on the course of acute infectious diseases therefore children had got antibiotic preparation. Monotherapy by «Ukrliv» suspension was more effective than symptomatic application of multiple preparations by this way had a pharmaco-economic and medical importance that allow reducing medical burden on the child.
Conclusions. UDCA «Ukrliv» preparation had shown high clinical and laboratory efficacy and tolerability in children with hepatobiliary system disorders developed on the setting of the treatment with ceftriaxone.
Key words: children, ceftriaxone, hepatotoxic level, hepatic, ursodeoxycholic acid.
Smulska N. O., Gorovenko N. G., Zozulia I. S., Rossokha Z. I., Pichcur N. O.
Ischemic stroke in childhood: risk factors and possible reasons.
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This paper analyses reasons about development ischemic stroke in childhood and detail studies thrombophilia as a one condition or risk factor of ischemic stroke. We demonstrate clinical case of ischemic stroke in adolescence and show a role of genetics factors, especially typical for thrombophilia genes polymorphism and family history. We gave a recommendation about planning of a further life for patient.
Keys words: ischemic stroke in childhood, risk factors, thrombophilia.
Berezhnoi V. V., Marushko T. V.
Concentration of methotrexate in blood serum in children with juvenile rheumatoid arthritis at oral and subcutaneous administration way of preparation
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Purpose: To study the serum concentrations of methotrexate (MTT) at 1 hour after administration in children with juvenile rheumatoid arthritis (JRA), it oral and subcutaneous administration way.
Patients and methods. A total of 15 children with JRA, aged 9–12 years were under observation. In all children at presence of arthritis 5 or more joints during the first 6 months of disease the arthritis is diagnosed. All the children received a dose of 15 MTT mg/m2/week together with folic acid at a dose of 5 mg/week, 24 hours after administration of MTT. Seven (47.6%) children received the drug orally, eight (52.4%) — by the way of subcutaneous administration.
Results. In children with JRA, who has subcutaneous administration way of MTT in comparison with children, who are used oral MTT the significantly higher concentration of the preparation in the serum one hour after application is observed. In 42,9±18,7% of patients, who are used the oral administration way of MTT one hour after its reception was no such concentration of preparation in the blood serum, which is associated with its clinical efficacy. At the same time the subcutaneous administration of the preparation is reached it concentration and associated with its clinical efficacy in (100%) patients.
Conclusions. Methotrexate is the «gold standard» of disease- modifying therapy for patients with JRA. The subcutaneous administration way of preparation allow achieving its high concentrations in the blood serum of patients in comparison with oral administration way, which is associated with greater effectiveness of therapy and less frequent side effects.
Key words: juvenile rheumatoid arthritis, methotrexate, subcutaneous administration way.
Vorobiova G., Fedevych O., Stupina A., Yemets I.
Hypoxic alterations of myocardial structure in neonates with transposition of the great arteries, according to timing of arterial switch operation.
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In the case of prenatal diagnoses of transposition of the great arteries (TGA), we propose to perform arterial switch operation (ASO) at the first hours of patient's life. Immunological and histological investigations of the myocardial hypoxia according to timing of ASO are presented in this paper.
Material and Methods. Seventeen consecutive newborns with TGA and different timing of surgery were allocated into two groups for investigation of hypoxia development: I group (n=8) with prenatally diagnoses and ASO at the first hours of life; II group (n=9) with postnatal diagnoses, balloon atrioseptostomy and delayed ASO (conventional approach). Levels of hypoxia-inducible factor-1α (HIF-1α) were measured in peripheral blood just before ASO, at the 1st, 3rd and 7th days postoperatively. During the surgical procedure, before cardiopulmonary bypass a biopsy from the right atrium was taken for light and electron microscopy.
Results. The groups were similar in diagnoses, birth weight, cardiopulmonary bypass protocol and surgery technique. The mean age at operation in the I group was 3.8±1.1 hrs vs 183±46 hrs in II group. Levels of HIF-1α were elevated in patients of II group and decreased postoperatively. Muscular contractures, sarcoplasmic vacuolation were typical for myocardium of newborns of the second group as opposed to the first one.
Conclusion. Delayed ASO is associated with elevated levels of HIF-1α and signs of hypoxic injury of myocardial structure in neonates with TGA before surgery.
Key words: transposition of the great arteries, hypoxic injury of myocardial structure, electron microscopy.
Gentle V. V., Marushko T. V.
Feachers of treatment of systemic forms of juvenile idiopathic arthritis.
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Summary. The data of randomized examination of tocilizumab application in patients with systemic juvenile idiopathic arthritis are presented. The efficiency of the drug is shown.
Key words: juvenile idiopathic arthritis, systemic form, treatment, tocilizumab.
Denisova M. F., Chernega N. V., Muzyka N. N., Dyba M. B., Zadorozhna T. D., Archakova T. N.
Clinical peculiarities and efficacy of the pathogenetic therapy of pediatric patients with Crohn's disease.
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The article presents results of the analysis of anamnestic data, clinical manifestations, parameters of the instrumental and laboratory investigations in pediatric patients with Crohn's disease. The schemes of differential treatment have been presented depending on the disease forms, as well as the immediate and Long-term results of therapy, and possible reasons for the disease relapses.
Key word: children, Crohn's disease, diagnostics, treatment.
Netrebenko O. K.
Metabolic programming in the antenatal period.
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The first 1000 days of human existence determine a child's health, lifetime, and of these 1000 days the first 270 (period of pregnancy) play an important, often decisive role. Disturbances of intrauterine growth increase the incidence of development of obesity, ischaemic heart disease, insulin resistance and a number of other diseases later in adulthood. Tendencies to development of these diseases results from disorders of intrauterine environment/nutrition, which often is associated with delay of intrauterine growth. The influence of adverse factors at early critical stages of development of the fetus on the state of the structure of tissues, organs and their functioning is called intrauterine programming. As has been shown, insufficient or excessive nutrition of a pregnant woman and also deficit of particular nutrients programme changes.
Key words: intrauterine programming, nutrients, nutrition programming.
Kozakevych V. K., Kozakevych E. B.
Optimization of early infant nutrition.
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Purpose: To study the clinical effectiveness of milk formula «Malyutka premium 3 with prebiotics and nucleotides» for infant food from 12 months.
Patients and methods. A milk formula «Malyutka premium 3 with prebiotics and nucleotides» is managed to 37 children aged from 1 to 3 years (18 girls and 19 boys). The 12 children of which were apparently healthy and the rest of them had anemia, hypotrophy, functional disorders of the gastrointestinal waste and atopic dermatitis. Follow-up was during the 3 months. A general clinical blood tests, urine tests, coprogram and feces analyses on dysbacteriosis presents before and after the examination is carried out to all children.
Results. The good tolerability of the product as to the apparently healthy children so to children with special dietary needs is marked. The normalization of bowel movements, optimizing the nature of feces is noted clinically. In the microbiological study of children's feces which was conducted before the introduction of the milk formula «Malyutka premium-3 with prebiotics and nucleotides» and after a month of it application the increase in the activity of normal intestinal flora and reduction of pathogenic flora are conclusively established.
Conclusions. Milk formula application to children after 12 months is the best in the prevention or treatment of minimal gastrointestinal dysfunctions.
Key words: infants, cow's milk, infant milk formulas, prebiotics, nucleotides.
Nyankovskyi S. L., Sadova O. R., Ivantsiv V. A., Yatsula M. S., Vozniak A. V., Pasechnyuk I. V., Yuschik L. V.
Approaches to the diagnosis and treatment of functional disorders of the digestive system in pupils.
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Purpose: introduction of new approaches to diagnosis and treatment of functional disorders of the digestive system and gastroduodenal diseases in pupils; efficacy and safety of outpatient administration of prokinetic «Domrid» in children with gastroduodenal pathology.
Patients and methods. A screening survey of about 25,000 pupils of 4 districts of Lviv region is conducted. The questionnaire contained 50 questions which are determined the nature of the main complaints of pupils, their nutrition and physical activity, medical and social characteristics. On the base of obtained data was formed risk group of gastroduodenal pathology development for the further evaluation, monitoring and treatment. After thorough examinations were selected 100 children aged 14-18 years who had symptoms of alleged gastroduodenal pathology confirmed by available objective signs. To all children was carried out the estimation of quality of life, were given recommendations on nutrition and daily routine, appointed 2–3-week course of prokinetic Domrid. Reexamination of children was conducted after 4 weeks from the beginning of the course of treatment. The dynamics of complaints and physical examination data, the quality of life of pupil were estimated.
Results. According to the results of survey most pupils considered themselves healthy, but the screening questionnaire is found complaints and symptoms that may indicate the presence of a functional disorder and organic disease, which is in further confirmed by the data of additional examinations. The use of prokinetic Domrid in children with typical complaints of dysmotility of the upper digestive system during 3 weeks in the setting of food correction and the way of life in the most of cases resulted to the normalization of health, reduction of the main complaints, the quality of life of pupils.
Conclusions. It is found a significant number of functional gastroduodenal disorders among children of school age. High efficiency, good tolerability and safety of outpatient prokinetic Domrid is proved.
Key words: children, pupils, functional disorders of the digestive system, prokinetic Domrid.
Korneva V. V., Kozhara Yu. A., Kozachuk V. G., Boyarskaya E. A., Kapichina M. A.
Modern approaches in the theatment of chronic constipation in children.
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Objective: optimization of chronic constipation therapy in children; study and compilation of the data of clinical efficacy of the «Biosporin-Biopharma» preparation at present disease.
Patients and methods. A total of 60 children aged from 1 to 15 years were under observation. Combined therapy of all patients with chronic constipation included: Diet-, physio-and vitamin therapy, lactulose and trimebutine and local therapy. Biosporin-Biopharma additionally was prescribed for the patients of the (main) 1st group. During the chronic constipation in children preparation was appointed interior 1 dose 2 times a day during 10–15 days. The patients of the 2nd (comparison) group had received other preparations with the probiotic effect. If it necessary the treatment of the underlying disease is conducted.
Results. Clinical efficacy of the treatment was marked in 100% of children of the 1st group and 76.69% of children of the 2nd group. Reducing of symptoms of the chronic constipation in children in the 1st group occurred after 5 days of the therapy in 50% of cases, and after 15th day of the treatment the constipation relief was observed in 93.3% of patients, in the 2nd group — in 33% and 76.69%, respectively. During the therapy and after the course of treatment by Biosporin Biopharma preparation the tendency of intestinal microbial landscape improvement- normalization of protective flora, elimination or significant reduction of pathogenic microorganisms were marked, in the 2nd group is noted more slow improvement of microbiota. Analysis of the follow-up observations is shown that 90% of children had one of the manifestations of chronic constipation and associated with it clinical symptoms and deficiency anemia. In 62.5% of children of the 2nd group were manifestations of chronic constipation.
Conclusions. The use of Bisporin Biopharma preparation can prevent or reduce the appearance of dysbiosis which is characteristic for the period of exacerbation during the chronic constipation that makes it rational in use at present pathology.
Key words: chronic constipation, children, comprehensive treatment, dysbiosis, preparation with probiotic activity.
Marushko Y.
Current data on the duration of therapy antisecretory drugs acid diseases in children (review of literature).
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The analysis of the literature on treatment of acid disorders in children with the use of the drug from the group of proton pump inhibitors — omeprazole. Omeprazole is used in the world for children from 1 year shows high efficiency and safety in the treatment of erosive and inflammatory diseases of the esophagus, stomach and duodenal ulcers, gastroesophageal reflux disease, in the therapy of H. pylori. The drug can be used for a long time as a maintenance therapy.
Key words: gastro-duodenal pathology, children, Helicobacter pylori, omeprazole.
Bodnar G. B.
The features of pain syndrome during the associated gastroduodenal pathology in children with congenital anomalies of colon.
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Purpose: To study the features of pain in children with congenital abnormalities of the colon (CAC) with associated gastroduodenal pathology.
Patients and methods. A total of 72 children aged 7–17 years with congenital abnormalities of the colon (dolichosigmoid, dolichocolon, Hirschsprung's disease, Payr's disease) with symptoms of gastric and duodenal ulcers during the hospital treatment were examined. Conventional clinical and laboratory and instrumental examinations were ordered for all patients.
Results. During the detailed examination of children with CAC in 42 of patients (58.34%) were revealed the presence of a complex of symptoms (disturbance of appetite, heartburn, flatulence, pain of pit of the stomach, the feeling of heaviness after eating, nausea, vomiting) of gastroduodenal lesions. Endoscopic examination of the upper gastrointestinal tract (esophagus, stomach, duodenum) had found associated pathology and also violation of motor'evacuation function of the upper gastrointestinal tract. The main subjective symptom of gastroduodenal lesion in children with LGS fleece was a pain in the abdomen.
Conclusions. In children with congenital abnormalities of the colon prevails combined inflammation of the stomach and duodenum. Pain syndrome in children with this pathology is characterized by a presence paroxysmal, brief pain in the right groin, which is not typical for the classical clinical picture of gastroduodenal inflammation in children.
Key words: children, congenital abnormality of the colon, gastroduodenal pathology, pain syndrome.
Hnateyko О. Z., Lychkovska O. L., Kulachkovska I. Ju., Semen W. D., Bohatyryova Kh. V.
Family risk-factors and resistance-factors in the formation of gastroduodenal pathology in children.
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Summary. Present study is dedicated to determination of psychosocial factors of predisposition and resistance to the formation of upper gastrointestinal pathology in children. There was revealed that among family risk-factors of the formation of gastroduodenal pathology in children are the dominant mother's position; passive and shun father's behaviour; protracted conflicts; hidden hostility between the parents; low levels of the support, of the emotional warmth, of the unity in the family; available external control of the family. Described family constellation can promote basic conflict in patients with gastroduodenal pathology by F.Alexander. Among family protective factors of the formation of gastroduodenal pathology in children there are following: warm, supportive relationships in the family, harmonious partnership of the parents, lack of external control over the family.
Key words: gastroduodenal pathology in children, psychosocial (family) risk-factors and resistance-factors.
Abaturov A. E., Stepanova Yu. Yu., Krivusha O. L., Gerasimenko O. M.
Approaches to the threatment of rotavirus infection in children.
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Purpose: To study the clinical effectiveness of substitutive enzymotherapy using the enzyme lactase in the treatment of rotavirus infection in infants.
Patients and methods. A total of 44 children aged from 3 to 18 months with acute intestinal infection of rotavirus etiology were under observation. For verification of the diagnosis data were collected the data of medical history, physical examination, general clinical laboratory test, bacteriological examination of feces with the aim of identification of possible bacterial acute intestinal infection agent. For the rotavirus antigen detection was used CITO TEST ROTA test system. Basic therapy in the hospital included the conduct of rehydration and detoxication therapy (oral and / or infusion), antiviral therapy and the use of probiotics. 23 children of the main group from the first day of hospital treatment received dietary supplement «Mamalak» during the feeding. 21 children of the control group continued breastfeeding in the ordinary course.
Results. Inclusion of the dietary supplement «Mamalak» to the treatment of diseases contributed to an acceleration of positive dynamics by reducing the manifestations of secondary lactase deficiency and reducing of diarrhea syndrome duration. Improving of overall condition allowed improving the effectiveness of oral rehydration and detoxification therapy. In the setting of a substitutive therapy were a rapid rehabilitation of digestion and absorption processes in children of the main group especially the data of carbohydrate and fat metabolism.
Conclusions. Substitutive enzymotherapy with the use of dietary supplement «Mamalak» promotes quick recovery and breastfeeding preservation during the illness.
Key words: infants, breastfeeding, intestinal infection, lactase deficiency, substitutive enzymotherapy.
Usachova E. V., Paholchuk T. M., Silina E. A., Matveeva T. B., Shulga O. V., Pechugina V. V., Berestovaya I. V., Shtibler A. V., Turlyun V. A.
Features of rotavirus infection course in infants with cytomegalovirus and the way of pathogenic therapy.
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Purpose: To study the features of rotavirus infection course in infants in the setting of persistent CMV infection and rationale of the treatment of pathogenic form of this disease with recombinant interferon alpha-2b (Lipoferon).
Patients and methods. A total of 95 infants with rotavirus infection (RVI) were under observation, the 65 of them children, who are in the setting of persistent CMV infection (main group); 30 of them a children from the control group, who are not infected with CMV. Physical and laboratory examination is carried out for all children: clinical and biochemical blood tests, general urinalysis, fecal (coprocytogram, bacteriological studies of feces, proteolytic activity). According to orders is carried out ultrasound of the abdomen cavity organs and neurosonography. Children of the main group with RVI in the setting of CMV were divided into two groups. In the 1st were included 35 of patients, who had received the «Lipoferon» orally 5–7 days. 30 patients of the 2nd group received only standard therapy.
Results. Against the Lipoferon application the rapid elimination of the common manifestations of systemic inflammation, normalization of bowel movements and the cessation of vomiting were marked, it is also succeed to prevent the fluctuating course of disease involving the mucous membranes of the tracheobronchial tree. At follow-up examination of the feces on rotavirus antigen the result was negative in 91.4% of patients from the first group and the five (16.6%) from the second group had re-allocated rotavirus.
Conclusions. In infants with CMV infection of RVI the long term course is peculiar for accession on the 5-8 day catarrhal symptoms of the tracheobronchial tree and liver damage. The inclusion of Lipoferon preparation to the complex therapy of RVI in children with persistent cytomegalovirus promotes more rapid relief of main clinical manifestations of the disease and speed recovery. Lipoferon is a safe preparation for the treatment of rotavirus infection in infants.
Key words: rotavirus infection, cytomegalovirus infection, infants, diagnosis, clinic, treatment, Lipoferon.
Rymarenko N. V., Usova S. V., Chvetko S. T., Romanenko S. P., Soboleva E. M.
The features of clinical nutrition in infants with rotavirus infection on the inpatient stage.
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The aim of the study was to increase the effectiveness of the treatment of rotavirus infection (RI) in young children with the use of the lowlactose medical mixture Humana HN.
Patients and methods. A total of 107 children aged from 6 months to 3 years with the acute form of rotavirus infection were examined. All patients had clinical and laboratory examination which is included monitoring of the dynamics of the main pathological syndromes, routine investigations (blood and urine
analyses, coprogram, control of acetone in the urine), bacteriological examination of feces by standard methods. All children underwent a comprehensive medical therapy including rehydration (oral and parenteral), antiviral, enzyme replacement therapy. Antibiotics of cephalosporin and an aminoglycoside were administrated to the 96.0% of patients in the first days of treatment, the rest of them had got- nitrofurans (nifuroxazide). Since hospitalization and all acute phase of disease the 45 (42.0%) of infants, and the 23 (21.5%) of patients aged 1-3 years had received lowlactose mixture Humana HN as a basic nutrition.
Results. The exsicosis of the II degree is marked in all children with rotavirus infection. Isolated rotavirus infection was established in 94% of patients, in 6% was determined the mixed infection. In the setting of Humana HN application the early cessation of vomiting, reduction of multiplicity and character more rapid normalization of bowel movements, decreased appetite, bloating and improved are marked in comparison with the patient who had received routine infant formula.
Conclusions. The positive influence of application of the treatment mixture Humana HN to nutrition of the children with rotavirus infection is marked by a shortening of gastroenteritic syndrome, conduction of rehydration therapy (by parenteral method) and also by the duration of hospital stay.
Key words: infants, rotavirus infection, clinical nutrition, Humana HN.
Kaladze N. N., Slobodyan E. I.
Immunorehabilitation of children with chronic pyelonephritis in the resort conditions.
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Objective: to optimize the rehabilitation of children with chronic pyelonephritis (CP), in the resort conditions with the use of immunomodulating phytopreparation «Imupret.»
Patients and methods. A total of 45 children with chronic pyelonephritis aged from 6 to 17 years were examined. The 38 (86.3%) of patients were suffered from obstructive pyelonephritis, the 7 (13.7%) of them from non-obstructive. A set of laboratory studies in addition to the traditionally accepted in nephro-urology includes the determination of hormonal status, state of the T-cell and humoral components of immune system; X ray urological and ultrasound examination. Children of the main group (n = 23) had received standard treatment which included sanatorium-resort treatment, diet number 5, remedial gymnastics, climatotherapy on I-II regime, sanitation of the focuses of chronic infection, pelotherapy and preparation «Imupret.» Experimental group is consisted form 22 children who had received only basic rehabilitation therapy. The control group is consisted from 15 apparently healthy children of similar age.
Results. Focuses of chronic infection were detected in 34 (75.5%) of children while 14 (31.1%) of patients had 2 or more focuses. Parents of 16 (35.5%) of children raised complaints of frequent and prolonged seasonal ARI, 22% associated with acute chronic pyelonephritis. Under the influence of the therapy occurred unidirectional changes of immunological parameters in both groups, but only in patients with frequent exacerbations of chronic pyelonephritis, ARI, with not clear focuses of infection and only those indicators that have significant deviations abnormalities. Results of follow-up examination during the year had shown a statistically significant reduction of hospitalization for the reason of aggravation of chronic pyelonephritis — 30.4% in the 1st group and 11.1% in the 2nd group.
Conclusions. As a result of long-term antigenic effect on the child body stress-realizing and immune system of children with chronic pyelonephritis is characterized by tensions response process, a violation of intercellular cooperation and lack of spare capacity. Complex of sanatorium-resort therapy with the use of the Imupret preparation has effective influence at secondary pathogenetic mechanism of chronic pyelonephritis progression — on the immune homeostasis state.
Key words: chronic pyelonephritis, rehabilitation, combined immunotherapy Imupret.
Taradiy N. N., Bagdasarova I. V., Mandzyuk Ya. P., Bagdasarova R. V.,
Tereschenko V. S., Raspopa Ya. M.
Apoptosis markers during the chronic pyelonephritis in children.
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Purpose: To study apoptosis marker status in the circulating immune competent cells in children with chronic pyelonephritis.
Patients and methods. In 23 patients with chronic pyelonephritis, and 25 healthy children the expression of intracellular receptors to INFγ and TNFα, inducible nitrogen oxide synthase (iNOs), Fas/Apo, proapoptotic protein Bax – and anti:apoptotic protein Bcl-2 , annexing V (AnnV) is examined through the use of confocal laser scanning microscopy in the circulating immune competent cells (ICC), subpopulations of T lymphocytes CD4 and CD8.
Results. It is fund that TNF, Fas /Apo, iNOs AnnV much more activated in the ICC against the high expression of protein Bcl-2 in their composition. A high expression of differentiation markers of T lymphocytes with a predominance of CD8 CD4 is marked. In CD4 lymphocytes within the control INFα, TNFγ, iNOs and AnnV were expressed while Fas/Apo, Bax and Bcl-2 has reduced expression. In the CD8 lymphocytes significant activation of iNOs, Fas / Apo and AnnV expression during the normal level of TNFα and Bcl-2 expression and Bax and INFγ decreased expression was established. It is assumed that the main elimination function is performed by cytotoxic T lymphocytes (CD8) during the activating apoptosis by nitrogen oxide (NO) — and Fas-mediated way.
Conclusions. In chronic pyelonephritis in children the role of studied markers of apoptosis on the one hand is defined by participation in the compensatory reactions of the immune system during the kidney tissue infection, on the other hand- explains the possibility of chronic process due to enhancing of expression the Vcl-2 gene expression in the mononuclear of circulating blood and decreased expression of the Bax gene in both T- subpopulations CD4 and CD8.
Key words: chronic pyelonephritis, markers of apoptosis and differentiation, immune cells.
Mamenko M. E., Bugaenko O. A., Budnik T. V.
Serotonergic system state in children with diffuse nontoxic goiter and its influence on formation of functional gastrointestinal disorders.
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Purpose: To study the significance of violations of serotonin production in the emergence of functional gastrointestinal disorders in children with diffuse non-toxic goiter.
Patients and methods. Overall 695 children by the age of 5-11 years (total sample) were under observation. Determination of levels of TSH, free T4 and serotonin are held to 88 children with goiter, taken during a screening study on the base of junior classes of the secondary schools. The control group is included 39 children of similar age and sex without signs of thyroid pathology, acute and chronic infectious and somatic diseases. Determination of the size of thyroid gland and it structure was performed with the help of ultrasonography (AlokaSSD-1400 apparatus with linear transducer and frequency of 7.5 MHz). The results were compared with normative data of World Health Organization for the periods 2001 and 2007yy. Functional state of gastrointestinal disorders was assessed by the level of hormones: TSH and free T4. The study was carried out by the method of solid-phase competitive chemiluminescent enzyme multiplied immunoassay with the use of standard test kits «Immulite 1000 RapidTSN», «Immulite 1000» on the automatic analyzer «DiagnostikProductsCorporation». The results were compared with the current standard of medical care for children with the endocrine system diseases. For verification of gastroenterological diseases additionally were performed such tests as ultrasound of the abdomen, fibroesophagogastroduodenoscopy, coprogram, ergography by standard methods. For estimation of the serotonergic system status was carried out quantitative determination of serotonin in the blood serum by the method of solid-phase competitive chemiluminescent enzyme multiplied immunoassay with the help of diagnostic test systems Serotonin ELISA («IBLHamburg», Germany).
Results. It is found that most children with goiter has decreased signs of functional activity of the thyroid gland on the level of minimum thyroid dysfunction (42,0 ± 5, 3%) and subclinical hypothyroidism (10, 2 ± 3, 2%). Decreasing of functional activity of the thyroid in children with goiter increases the risk of functional gastrointestinal disorders development mainly due to hypokinetic conditions and reduces the low concentration of serotonin with a minimum level of the transmitter in children with subclinical hypothyroidism (2,84 ± 0,71 ng / ml) and for the presents of irritable bowel syndrome with constipation (3,78 ± 0,06 ng / ml).
Conclusions. Impaired production of serotonin is one of the possible mechanisms for the development of functional gastrointestinal disorders in children with thyroid cancer.
Key words: goiter, pituitary-thyroid system, functional gastrointestinal disorders, serotonin, children.
Belykh N. A.
Micronutrient deficiency (iodine and iron) in infants.
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The aim of the study was to assess the availability of iodine and iron in infants and to identify the factors which are contributing to the formation of this micronutrient deficiency.
Patients and methods. The analysis of the medical records and the results of neonatal screening on congenital hypothyroidism of 948 children the 456 (48.1%) of them boys and 492 (51.9%) of girls are conducted. The concentration of blood hemoglobin was measured in all children at the age of 9 months. The concentration of iodine in the urine taking into account the median is measured in 138 infants (median age 3 5,2 ± 1,1 months., 73 boys, 65 girls), the 61 of them were exclusively at breastfeeding, 77 of them received adapted milk formulas enriched with iodine (60–100 mg / L), and 81of them nursing mothers (median age 26,2 ± 2,2 years). The function of the pituitary-thyroid system of children (n = 138) was evaluated by the level of thyreotrophin and free thyroxine by the method of immunohemilyuminestsentnym with the use of standard «Immulite 1000» test kits. The transport fund body was evaluated in 60 infants by the level of serum iron, total iron binding capacity of serum and calculation of transferrin saturation. A state of iron repository was determined by the level of serum ferritin by chemiluminescence method using «FER Іmmulite 2000» test system. The Concentration of iron in the breast milk is measured by the photometric method using a set of reagents by «Pliva» (Czech Republic), iodine 3 ceriumarsenite method after samples conditioning (protein precipitation with a solution of 1% trifluoroacetic acid followed by centrifugation).
Results. It is found that on the second half of life most children diagnosed latent iron deficiency (52.6%), and one in three children have iron deficiency anemia (34.9%). Children who are exclusively at breastfeeding do not get enough iodine (median of ioduria 3 82.9 mg / l). It is demonstrated that the factors which contribute the development of iron deficiency in the first year of life are prematurity, complicated pregnancy, poor nutrition of nursing mother. Formation of iodine deficiency is caused by insufficient intake of iodine during the breastfeeding (median iodine concentration in the breast milk 3 68.0 mg / l).
Conclusions. Along with the activities of antenatal care it is necessary raise awareness of breastfeeding mothers on nutrition and the negative impact of iodine deficiency and iron on children's health and timely use of prevention measures.
Key words: feeding, iron deficiency state, iodine deficiency, infants, breastfeeding.
History of pediatric dentistry.
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