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Pediatric pharmacology

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Vol 8, No 2 (2011)
View or download the full issue PDF (Russian)

NEW TECHNOLOGIES IN MEDICINE

6-13 490
Abstract
In modern conditions to provide the population with the high quality medical care it is necessary to assess the potentialities of a new technology in terms of actual practice. The article presents the historical background that determined the need for organizations to evaluate technologies in health care (HTA). Such an analysis allows us to establish specific guidelines and standards for the use of new technologies, identification of clear indications and priority groups of patients. The article presents the main functions of HTA agencies, as well as different approaches to the HTA in countries already having a similar experience. It is convincingly shown that the evaluation of new technologies before their widespread introduction into practice not only contributes to increasing the availability of the effective approaches to diagnosis and treatment of various diseases, but it is also regarded as an element of the state costs reduction to the health.
Key words: health technology assessment, agency for the evaluation of medical technologies, evidence-based medicine, clinical and economic analysis, economic evaluation.

EMERGENCY CONDITIONS IN CHILDREN

15-21 5513
Abstract
Hemophagocytic lymphohistiocytosis, or hemophagocytic syndrome — is a serious disease, which is based on the disorder of regulation of the immune response that leads to an uncontrolled activation of cytotoxic T-lymphocytes and macrophages and, consequently, to a severe inflammatory organs damage. The cause of the disease is a genetic defect of regulatory mechanisms or acquired immune system dysfunction in severe infections, autoimmune diseases and certain tumors. Hemophagocytic syndrome — is a life-threatening condition. Early diagnostics and intensive care are the key to a cure and requires intensive medical and emergency pediatrics knowledge of the principles of diagnostics and treatment of this disease. This article summarizes the current understanding of biology and clinical hemophagocytic syndrome. The authors presented their data on the genetic structure of Russian patients cohort and provide recommendations on the choice of therapy.
Key words: hemophagocytic syndrome, clinical course, diagnostics, children.

CASE REPORT

AN EDITORIAL ARTICLE

REVIEW

22-26 1022
Abstract
The second part of the article concerning Stevens–Johnson syndrome — toxic epidermal necrolysis (SJS–TEN) is devoted to the treatment of this disease. The modern approaches to the use of systemic agents — antibacterial, antiviral, analgesics and sedatives, and anticoagulants are discussed in detail. Regulations of the drugs use depending on the patient state and the etiology of SJS–TEN are marked out. The basic principles of the fluid therapy for rehydration and dehydration prevention are shown in the article. Particular attention is paid to the local therapy — treatment of mucous membranes and skin lesions.
Key words: Stevens-Johnson syndrome, toxic epidermal necrolysis, children, antibiotic therapy, topical treatment.
27-31 506
Abstract
A brief historical background of development of the assisted reproductive technologies (ART) is presented. The works of russian and foreign authors about the neonatal period, the health of babies born in result of different methods of ART (in vitro fertilization using ICSI) were analyzed. After discussion there were indicated new approaches for prevention of perinatal morbidity and ensuring harmonious development and quality of life for these children. The necessity of a national multicenter study of the status of children born in result of induced pregnancy was proved.
Key words: assisted reproductive technologies, IVF, ICSI technique, newborns, health.

ORIGINAL ARTICLES

32-39 476
Abstract
Current epidemiological studies show some correlation of prevalence and intensity of clinical manifestations of asthma, with the level of the intestinal parasites infestation in the studied population. Apparently, such a relationship of intestinal helminth invasion and allergic inflammation are formed on the basis of the «overlapping» or bipolar immunological mechanisms. In this context, there was planned and carried out the study concerning the relationship of clinical and functional parameters that characterize the intensity of inflammation in asthma and cytokine profile depending on the presence of chronic infestation Opisthorchis felineus. The study involved 212 patients (mean age 9,35 ± 0,12 years). It was established that the chronic infestation O. felineus in patients with asthma is characterized by the high levels of interleukin (IL) Th1 profile (IL 2, 10, IFN y) and low values of pro-inflammatory cytokines (IL 4, 5), which is associated with a lower degree of nonspecific airway reactivity.
Key words: Opisthorchis felineus, children, cytokines, IL 4, IL 5, IL 2, IL 10, IFN y.
40-42 449
Abstract
The article shows the effectiveness of the complex treatment (angiotensin converting enzymes inhibitors, blockers, diuretics and cardiac glycosides) in children with dilated cardiomyopathy with an early debut. The dynamic observation of changes in morphological and functional cardiac parameters was carried out and we studied the content of matrix metalloproteinases in 41 patients on the background of the therapy. The statistically significant positive effect of the combined therapy on the studied parameters after 1–1,5 years of the continuous treatment has been demonstrated.
Key words: dilated cardiomyopathy, matrix metalloproteinases, treatment, children.
43-49 525
Abstract
Results of study of antiviral immunity indicators in patients with mucoviscidosis were presented. A significant antibody deficiency against a number of antigenically unrelated viruses — acute respiratory pathogens and Мycoplasma pneumonia, significantly lower levels of specific cellular antiviral immunity, massive prolonged viremia was identified. Viruses that cause exacerbation of bronchopulmonary process in patients with mucoviscidosis often continue to be detected in blood and in remission. In patients with mucoviscidosis a perverted immune response to viral infection has been revealed.
Key words: mucoviscidosis, antiviral immunity, viremia.
50-56 611
Abstract
The article presents a generalized 2-year Russian experience in the application of monoclonal antibodies to IgE in children and adolescents with severe, resistant to standard treatment of bronchial asthma. Data on 65 patients treated with anti-IgE therapy with omalizumab within more than 6 months period in 6 centers of the Russian Federation from 2007 to 2010 were analyzed. The results of this analysis demonstrate the safety and high clinical effectiveness of anti-IgE-therapy in children and adolescents with severe uncontrolled atopic bronchial asthma. Full control of the disease or marked improvement can be achieved in 73% patients, the effect in most cases significantly increases during the first 6 months of treatment and becomes stable in the future, providing a good quality of life and normal lung function.
Key words: bronchial asthma, anti-IgE-therapy, treatment, adolescents, children, quality of life, omalizumab.
57-63 503
Abstract
Despite the fact that there are the researches testifying to activation of congenital (nonspecific) and got (adaptive, specific) immunity in Central Nervous System Perinatal Damages, interrelations between blood sera immunological indicators and clinical lines of Central Nervous System Perinatal Damages are studied now insufficiently. In our work the analysis of interrelations between a number of immunological indicators (the activity of leucocyte elastase (LE) and 1-proteinase inhibitor (α1-PI), the rates of autoantibodies (aAB) to nerve tissue proteins) and psychomotor development of children with consequences of Central Nervous System hypoxic-ischemic Perinatal Damages has been carried out. It is revealed that in this pathology activation of the congenital and got immunity takes place; the congenital immunity activation degree (on LE activity) back correlates with severity of psychomotor development disorders, activity α1-PI directly correlates with a psychomotor development point of children, i.e. its lowered activity is the adverse diagnostic factor; joining of autoimmune reactions (increased rates of aAB to nerve tissue proteins) characterizes the heaviest variants of psychomotor development retardations. It is shown also that pre-term infants have lower point of psychomotor development, and also more patients of this group have low α1-PI activity and the raised levels of aAB in comparison to full-term infants.
Key words: children, perinatal damages of central nervous system, psychomotor development, congenital immunity, leucocyte elastase, α1-proteinase inhibitor, autoimmune reactions.
64-69 442
Abstract

Identification of the early markers of the onset of atopic march in children remains important for the effective primary and secondary prevention of allergic diseases. The article contains results of the study of the expression of receptors for interleukin of Th2 profile (IL 4, IL 5) in infants with the formation of the atopic status. The obtained results indicate that expression of receptors is different in families with burden atopic anamnesis and/or in case of impact of certain perinatal factors.
Key words: newborn, atopy, interleukin receptors, CD124, CD125, immunoglobulin E.

LECTURE

For Pediatricians' Practice

94-98 1692
Abstract
The article covers the problem of current importance concerning the child bowel biocenosis species composition in different age periods of a child life. Numerous studies indicate that the species composition of the intestinal microflora is being formed during a long time. It is different in children depending on their age and is characterized by the high levels of not only the anaerobic microflora, but also allochthonous bacteria. It is known that the maturation of the immune system occurs during the newborn contacts with the bacterial and food agents, including bacteria of the normal intestinal flora, have immunomodulatory properties. Considering literature data and results of their own research, the authors provide recommendations for the optimizing use of probiotic preparations.
Key words: intestinal microflora, probiotic strains, children.

SHORT REPORT

TRAINING FOR TRAINERS — EDUCATIONAL PROGRAM FOR PARENTS

102-107 440
Abstract
The article is devoted to the most common childhood diseases — acute respiratory infections (ARI). As it is known, the unjustified drug prescriptions and polypragmazy are the most often registered just at ARI. In particular it concerns antipyretics, antibacterial and drugs «enhance immunity» for the frequent ARI treatment and prevention. At the same time, fails of one or another drug can lead to complications: severe septic course of bacterial process, convulsions etc. The authors share their experiences on the choice of tactics for a patient with ARI, as well as the prescription of therapies.
Key words: acute respiratory infections, antipyretics, antibiotics, prophylaxis, immune modulators, bacterial lysates, the children.

FROM THE UNION OF PEDIATRICIANS OF RUSSIA

Materials (WHO, EPA/UNESPA, IPA)

Page for pediatric nurse



ISSN 1727-5776 (Print)
ISSN 2500-3089 (Online)