This article is dedicated to the life of professor Vera Pavlovna Lebedeva – head of the maternity and childhood protection (MCP) department at the RSFSR People’s Commissariat of Health and one of the founders of the first State scientific maternity and childhood protection institute (SSMCPI) – a predecessor of the USSR AMS Institute of pediatrics. In the 1930s the SSMCPI was named after Lebedeva. This article gives documental archive data, Lebedeva’s scientific works, articles from pediatric magazines,  colleagues' memoirs which reflected the main milestones of her life and professional activity, theoretical-and-practical and pedagogical in particular. Thanks to V.P. Lebedeva’s initiative and activity, the virtually new state MCP system was created in the USSR and the first national scientific institution of a pediatric profile was organized.

The article provides a morbidity analysis and covers the epidemiologic process development tendencies in the Russian Federation for a range of infectious diseases, including those controlled by specific preventive measures, and the measures taken to fight them, aimed at preserving Russia’s status as a poliomyelitis-free country, eliminating endemic measles and rubella, reducing hepatitis B and HIV-infection morbidity and preventing influenza and ARVI from spreading on the territory of Russia.The article gives an analysis of how the measures aimed at maintaining sanitary-and-epidemiologic well-being in the process of preschool and school education, including measures of administrative responsibility enhancement for the official and corporate bodies for non-observance of sanitary-and-epidemiologic requirements for the rest and health improvement conditions of children, were fulfilled. An assessment of how aggressive information influences the population's health, especially that of children and adolescents, and measures taken by the Federal service on customers' rights protection and human well-being surveillance to decrease its influence is given. Main goals and activity areas on improving health protection and maintaining sanitary-and-epidemiologic well-being of the citizens.

Health technology assessment is a key component of healthcare decision making in most of the developed countries. Comparative effectiveness research as one of the elements of such assessment is becoming increasingly important in recent years. It is based on the effectiveness analysis of health technologies in real clinical practice setting. The authors have analyzed publications dedicated to these issues and showed the main methods of such study, its peculiarities, advantages and disadvantages. It has been revealed that the most frequently used designs of expert analysis are observational and pragmatic randomized studies. The main recommendations on analyzing comparative effectiveness are given in view of the literary data.

The article describes a case with a severe course of oligoarticular juvenile idiopathic arthritis with the development of contracture and destructive articular alterations. The successful use of methotrexate (15mg/m² of body surface per week, subcutaneously) in a child with early arthritis (disease duration – less than 2 years) is described: 6 months after the therapy had started, acute inflammatory articular alterations, arthralgiae, morning stiffness terminated; in 12 months the range of motions in the affected joints recovered completely. The inactive disease phase and remission were registered in 6 and 12 months, accordingly. The remission has continued for 12 months.

The course of a secondary pulmonary hypertension in a child with congenital heart disease and bronchopulmonary dysplasia in anamnesis is retraced in the article using a concrete clinical case. An assessment of echocardiographic and radiologic disease signs at a prolonged follow-up observation of a child with combined cardiorespiratory pathology was conducted. The main therapeutic approaches to this category of patients were covered.

The article is dedicated to the vaccination issues of the adult population. The authors list the main factors conditioning the problem's relevance. The given material reflects the experience of foreign colleagues and cites the authors' observations. The amount of people vaccinated at the family vaccinal prevention Center of the RAMS FSBI "SCCH" from January 2010 and July 2012 thanks to the active health communication offered by the Center's personnel is as follows: against hepatitis B - 118, against hepatitis A - 121, against chickenpox - 92 adult patients. According to the authors, this category of patients is being actively immunized against influenza and pneumococcal infection. An important role in the article is given to the cervical carcinoma prevention. 2,352 vaccinations against the human papilloma virus were made at the Center in 2007-2011. The authors analyzed the motivation of the vaccinated patients and proved the role of public awareness measures. The article discloses the role and prospects of family vaccination and shows the need for regulatory legal measures in order to change the current unregulated vaccination tendencies in the adult population.

At present, tick-borne encephalitis is registered in Siberia, Far East, Urals, Belarus and central regions of Russia. The viral infection has also been recently revealed among the population of the previously problem free regions: Penza, Yaroslavl, Magadan, Kamchatka, Moscow and Ivanovo. The disease manifests itself in various forms: febrile, meningeal, meningoencephalitic etc. The disease prognosis is favorable in case of a meningeal or febrile form, but significantly worse in case of a meningoencephalitic form – fatal outcomes take place in 25-30% of cases. Residuals in the form of convulsive hyperkinetic syndrome may remain in some patients even if the treatment started in time. Active immunization is the primary tick-borne encephalitis prevention.

Hemorrhagic conditions are associated with severe health problems and an increase in mortality rate among children. Quick and adequate reaction of a doctor who was the first to appear beside such a patient is necessary to save the child’s life; mistakes may lead to severe complications, including fatal outcome. The article formulates methodological recommendations on diagnosing and rendering help to children of the first months of age with developing hemorrhagic manifestations in the environment of neonatal and newborn centers taking into account their laboratorial and therapeutic capabilities.

This discussion article adduces a short review of clinical studies where the use of probiotics has shown the best results. The issues of whether probiotics are capable of having a protective effect on the intestinal barrier, an antagonist effect – on opportunistic microbes and a stimulatory effect – on the immune system, are discussed. The best studied production species and strains forming probiotic drugs are observed. The differences between monostrain and multispecies probiotics are given. The reasonability of using combined drugs with combinational additive or synergetic strain-specific effects is explained.

Article is dedicated to the problem of headache in children. This pathology is being found more frequently in pediatric and children’s neurologic practice. The authors examine headache pathogenesis from the position of magnesium deficiency. Analysis of results of the modern studies on magnesium deficiency and its correction in patients with headache indicates that magnesium metabolism may play an important role both in pathogenesis of different headache types and in its treatment and prevention.

Objective: The measurement of aortic pulse wave velocity (PWVao) is an accepted marker in stratifying individual cardiovascular risk in adults. There is an increasing volume of evidence concerning impaired vascular function in different diseases in paediatric populations, but, unfortunately, only a few studies are available on the measurement of normal PWVao values in children. The aim of our study was to determine the reference values of PWVao in a large healthy population using a newly developed technique. Methods: Three thousand, three hundred and seventyfour healthy individuals (1802 boys) aged 3–18 years were examined by an invasively validated, occlusive, oscillometric device. Results: The mean PWVao values increased from 5.5_0.3 to 6.5_0.3 m/s (P<0.05) in boys and from 5.6_0.3 to 6.4_0.3 m/s (P<0.05) in girls. The increase, however, was not constant, and the values exhibited a flat period between the ages of 3 and 8 years in both sexes. The first pronounced increase occurred at the age of 12.1 years in boys and 10.4 years in girls. Moreover, between the ages of 3 and 8 years, the brachial SBP and mean blood pressures increased continuously and gradually, whereas the PWVao remained unchanged. By contrast, beyond the age of 9 years, blood pressure and aortic stiffness trends basically moved together. Conclusion: Our study provides the largest database to date concerning arterial stiffness in healthy children and adolescents between the ages of 3 and 18 years, and the technology adopted proved easy to use in large paediatric populations, even at a very young age.

 

 

The article provides general information on botulinum therapy in treating spastic forms of cerebral palsy; a review of modern botulinum toxin A drugs’ injection precision control methods at spasticity and other pathologic states is given; advantages and disadvantages of each injection control method are analyzed in detail. Special attention is paid to the substantiated choice of the injection control method in pediatric practice; muscles of the highest degree of complexity for botulinum therapy at spastic forms of cerebral palsy are described. The authors’ observations and results of applying ultrasound botulinum toxin A drugs’ injection control at different spasticity patterns in children are given.

At present ca. 25% of children have sleep disorders. The main method of diagnosing sleep disorders is polysomnography. The article presents the analysis of night sleep study results in children with various pathologies. The study involved 103 children in total; 13 of them formed the control group. It is necessary to conduct a complex examination of sleep-wake cycle disorders involving a quantitative assessment of subjective complaints using a questionnaire and objective polysomnographic registration of night sleep parameters.

 

The article is dedicated to purulent renal lesion which is considered to be very rare in children. Case reports on complicated and purulent pyelonephritis forms in children are only singular. The authors present their own experience of observing 10 such clinical cases. Clinical manifestations, peculiarities of laboratory parameters’ change and also the visualization efficiency of kidney changes discovered with instrumental methods are considered in detail. Antibacterial therapy peculiarities are also shown. The authors offer the criteria, according to which a complicated urinary tract infection course may be suspected with high confidence.

 

The aim of the study is to study theoretical and practical basics of organizing specialized palliative pediatric service while taking into consideration the need for rendering complex medical-social help to children at the terminal stage of a disease and their parents. Patients and study methods. The study was conducted using the methods of theoretical literature analysis, comparison, generalization, observation, interview and polls. 252 children with severe, life-threatening diseases, and 368 parents of such children took part at the empirical stage. Results. It was proved that palliative help should start as soon as the diagnosis (presupposing untimely death risk) is set and may continue throughout the disease, in the moment of death and after it. Palliative help may most efficiently be rendered at healthcare institutions as they have all the necessary conditions. Conclusions. The following were defined as the main areas of psychological help: pedagogical and psychological work with the child to create a maximally comfortable and emotionally developing environment; psychological work with relatives to preserve their health and personal potential and prevent family breakdown.

The article deals with psychological aspects of complex medical and social rehabilitation of disabled children with cerebral palsy in detail. Residual-organic cerebral insufficiency at cerebral palsy may be a basis for development of both cognitive disorders and psychogenic reactions, pathological personality formations due to the adverse psychosocial influences caused by disorders of motor and mental functions, which is necessary to take into consideration when conducting rehabilitation measures. The authors considered actual problems of diagnosing and treating the psychological disorders at cerebral palsy and suggested a system of complex mental pathology rehabilitation for this disease, which is aimed at correcting psychoemotional, cognitive and behavioral disorders and also restoring the social adaptation of children and adolescents with cerebral palsy.

Cardiovascular diseases are the main cause of invalidism and untimely death of people in developed countries. The share of cardiovascular diseases in the mortality rate reaches 40-60%. The frequency rate of cardiovascular diseases  among children and adolescents is growing with each passing year. Increased blood pressure variability in patients with arterial hypertension in youth is a factor aggravating the arterial stiffness derangement. The aim of this study is to develop methods of early cardiovascular diseases’ diagnostics in children in order to reduce the rate of primary and repeated complications in the future. Observation showed that singular blood pressure measurements at a consultative appointment with a doctor do not give the full picture of the character of its changes in a child and may lead to incorrect diagnosis, as blood pressure has considerable individual variability. Daily blood pressure monitoring allowed revealing high arterial hypertension rate in children at night, including children with normal and low blood pressure during daytime. It is shown that the non-invasive oscillometric arteriography method allows to determine parameters characterizing arterial vessels’ remodeling with a high reproducibility. Significant difference between the obesity degree and the pulse wave aortic spread speed increase has been indentified.