Vol 8, No 4 (2011)
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AN EDITORIAL ARTICLE
6-28 418
Abstract
Concepts of disease severity, activity, control and responsiveness to treatment are linked but different. Severity refers to the loss of function of the organs induced by the disease process or to the occurrence of severe acute exacerbations. Severity may vary over time and needs regular follow up. Control is the degree to which therapy goals are currently met. These concepts have evolved over time for asthma in guidelines, task forces or consensus meetings. The aim of this paper is to generalize the approach of the uniform definition of severe asthma presented to WHO for chronic allergic and associated diseases (rhinitis, chronic rhinosinusitis, chronic urticaria, atopic dermatitis) in order to have a uniform definition of severity, control and risk, usable in most situations. It is based on the appropriate diagnosis, availability and accessibility of treatments, treatment responsiveness and associated factors such as co-morbidities and risk factors. This uniform definition will allow a better definition of the phenotypes of severe allergic (and related) diseases for clinical practice, research (including epidemiology), public health purposes, education and the discovery of novel therapies.
Key words: IgE, allergy, severity, control, risk, asthma, rhinitis, rhinosinusitis, urticaria, atopic dermatitis.
Key words: IgE, allergy, severity, control, risk, asthma, rhinitis, rhinosinusitis, urticaria, atopic dermatitis.
NEW TECHNOLOGIES IN MEDICINE
30-35 594
Abstract
The article describes the basic approaches to evaluating innovativeness of pharmaceuticals, Russian and foreign experience is represented. The authors pay particular attention to the state involvement in the promotion of new products and create regulatory systems for quality control. The issues of creating a unified system of evaluation of pharmaceuticals innovativeness, which is associated with the need to develop a total innovativeness of pharmaceuticals «scale».
Key words: innovations, innovativeness, therapeutic innovativeness.
Key words: innovations, innovativeness, therapeutic innovativeness.
PHARMACOECONOMICS IN PEDIATRICS
48-54 421
Abstract
The purpose of the study: selection of the supporting anti-asthma therapy (SAAT) of the moderate asthma in school children, residents of the village with the lowest ratio of price and efficiency. The maximum frequency of achieving control of asthma was 64%. The spectrum of asthma medicines (drugs) used in outpatient phase is represented. For 7 years, the proportion of the inhaled corticosteroid (ICS) therapy in children with asthma has increased moderately by 5.5 times and was 66%, of which 2/3 was the combination of inhaled glucocorticosteroids. When using the combined drug salmeterol/fluticasone propionate (50/100 mkg) during 3 months, after that fluticasone proionat during next 3 months as a level-controlled asthma the SAAT controlling BA increased 2 times. The cost of drugs accounted for 86% of direct medical costs (DMC), the cost of hospitalization decreased from 80 to 56% (DMC savings — 24%). The results of the analysis of «cost–effectiveness» SAAT allow to review the financial resources for health in favor of providing children with mild asthma inhaled high-performance combination that will improve the quality of medical care for children, residents of the rural regions.
Key words: asthma, children, inhaled glucocorticosteriods, combined therapies, pharmacoeconomic analysis.
Key words: asthma, children, inhaled glucocorticosteriods, combined therapies, pharmacoeconomic analysis.
55-58 488
Abstract
Therapy of chronic uveitis refractory to the basic treatment, in juvenile idiopathic arthritis (JIA) is a very complex problem in pediatrics. Substantial progress in this area resulted after the implementation in practice of inhibitors of tumor necrosis factor (TNF), as the most effective in such clinical situation drugs adalimumab and infliximab are considered (although infliximab was not officially approved in JIA). Objective. To estimate the cost effectiveness of TNF inhibitors — adalimumab, and infliximab in chronic uveitis, refractory to the basic therapy (including associated with juvenile rheumatoid arthritis). Methods. A modeling on the basis of a comparative prospective cohort clinical study was carried out. The analysis was performed by the method «cost–effectiveness» from a position of health and social accounting perspective. Results. It was shown that the frequency and time of remission did not differ when treatment with infliximab (5 mg/kg at 0–2–6 weeks and further once in 6–8 weeks) and adalimumab (24 mg/m2 once in 2 weeks). Adalimumab provides a long-term maintenance of remission (no recurrence in 60% of patients within 40 months of observation), whereas 1 year after the treatment with infliximab the frequency of exacerbations was returned to that observed before therapy. The proportion of patients without relapse in the treatment with infliximab for 40 months was 18.8%. Similar results were obtained in a subset of patients with chronic uveitis associated with JIA (with follow-up of 20 months of in a group of infliximab number patients without relapse was 11.1%, with adalimumab therapy — 63.6%). In the general population of patients with refractory chronic uveitis the factor «cost–effectiveness» calculated for a patient with the maintenance of remission for 3 years with adalimumab therapy was in 2,1–2,8 times less than in the treatment with infliximab. In chronic uveitis associated with JIA, the coefficient of difference «cost–effectiveness» calculated for a patient with the maintenance of remission for 20 months was even more pronounced and was 3,9–5,1 times in favor of adalimumab. Conclusions. The realized pharmacoeconomic analysis suggests the feasibility of adalimumab treatment of chronic uveitis refractory to routine therapy. At the same time be aware that the results of the study are preliminary in nature, as they are based on data from a cohort study, which included a small number of patients.
Key words: chronic uveitis, juvenile idiopathic arthritis, infliximab, adalimumab, cost-effectiveness analysis.
Key words: chronic uveitis, juvenile idiopathic arthritis, infliximab, adalimumab, cost-effectiveness analysis.
CASE REPORT
140-145 942
Abstract
Often under the guise of «ordinary» Rickets are more severe kidney diseases, developing as a result of inherited or acquired, primary or secondary defects in the renal tubules. Incorrect diagnosis leads to an inadequate therapy, rapid progression of disease and renal failure. The article describes the main approaches to the diagnosis and treatment of disorders of tubular rachitis similar syndrome, presents a number of clinical cases in author's practice.
Key words: tubulopathy, acidosis, electrolyte disorders, rickets, rickets-like syndrome, diagnostics, treatment, children.
Key words: tubulopathy, acidosis, electrolyte disorders, rickets, rickets-like syndrome, diagnostics, treatment, children.
VACCINATION
60-63 431
Abstract
The paper presents the experience of childhood immunization with the various manifestations of tuberculosis infection inanimate (ADC-M, Pneumo 23) and live vaccines (domestic divaccine «measles–parotitis», combined vaccine Priorix). The safety and efficacy of vaccination in this group of children with positive clinical and laboratory dynamics of tuberculosis on the background of a specific treatment have been demonstrated, as well as the vaccination tactics of children registered at the TB clinic based on the results of the study have been elaborated.
Key words: various manifestations of tuberculosis infection, vaccination tactics, safety, efficiency, children.
Key words: various manifestations of tuberculosis infection, vaccination tactics, safety, efficiency, children.
76-81 472
Abstract
An open clinical observation over a period of post-vaccination in 184 children (ages 3 to 18 months), vaccinated and re-vaccinated with the combined vaccine against diphtheria, pertussis, tetanus, polio and Haemophilus influenzae type b using the standard procedure. Period of observation was 2009–2010, age of children — 3–4.5–6–18 months. All vaccinated children were divided into 3 groups: I — healthy, II — with allergic diseases, III — with CNS pathology. The features of post-vaccination period in each group have been determined. The general and local vaccination reactions, as in various manifestations and on terms have been evaluated. A combined vaccine demonstrated a good tolerance in healthy children included in the study, as well as in children of a risk group.
Key words: diphtheria, pertussis, tetanus, polio, Haemophilus influenzae type b, immunization, combined vaccine, post-vaccination period, post-vaccination reactions, children.
Key words: diphtheria, pertussis, tetanus, polio, Haemophilus influenzae type b, immunization, combined vaccine, post-vaccination period, post-vaccination reactions, children.
82-86 470
Abstract
The problem of diagnosis, prevention and treatment of diseases caused by human papilloma virus (HPV), in recent years has become more urgent, not only for physicians, scientists, but also for patients. This is due to the high contagiousness of HPV, its prevalence and, of course, proved oncogenicity. Creation and introduction of preventive vaccines against the most common HPV types played a definite role in the global health, and, of course, raised the attention of doctors and the public to human papillomavirus infection and associated diseases. At the same time propaganda against vaccination blocks the widespread adoption of this disease prevention in our country. In this paper, we introduce the American experience of monitoring vaccination adverse events.
Key words: human papillomavirus infection, prevention, vaccination, adverse events, monitoring, children.
Key words: human papillomavirus infection, prevention, vaccination, adverse events, monitoring, children.
EMERGENCY CONDITIONS IN CHILDREN
69-75 978
Abstract
Hyponatremia is the most common electrolyte disorder in patients at the hospital stage of treatment. Symptomatic hyponatremia is associated with severe neurological disorders. The degree of dysfunction varies from mild behavioral disturbances to convulsions, coma, or death, depending on the duration and depth of hyponatremia. Neurological disorders are caused, on one hand by edema and swelling of the brain on the background of hyponatremia, on the other — by the development of the osmotic demyelination syndrome in its rapid correction. Symptomatic hyponatremia is a threatening complication and is associated with a significant increase in mortality in children with a wide range of diseases. The article deals with the modern approaches to the pathophysiology, diagnosis and treatment of hyponatremia.
Key words: hyponatremia, osmotic demyelination syndrome, children.
Key words: hyponatremia, osmotic demyelination syndrome, children.
REVIEW
87-91 435
Abstract
Effective and safe anesthesia is the especially important problem in pediatric anesthesiology. The authors present data on the relatively new drug — xenon. Results of the investigations of both foreign and Russian scientists are cited. The mechanism of action of xenon and its effect on systemic and cerebral circulation and central nervous system, hemostasis, and other systems are demonstrated. The authors pay special attention to the factors responsible for the restricted use of the gas in general practice, indicate the peculiarities of its use in pediatric practice.
Key words: xenon, the mechanism of action, anesthesia, advantages, disadvantages, impact on the body, children.
Key words: xenon, the mechanism of action, anesthesia, advantages, disadvantages, impact on the body, children.
ORIGINAL ARTICLES
92-100 430
Abstract
To a risk group of a heavy course of the respiratory syncytial viral (RSV) infection could be ascribed preterm infants, born before the 35th week of gestation inclusive, as well as children under 2 years old with the bronchopulmonary dysplasia or hemodynamically significant congenital heart defects. World experience shows that the seasonal immunoprophylaxis against RSV-infection with palivizumab in these patients enables to reduce the frequency of hospitalization and resuscitation measures, as well as to decrease the number of deaths. The article presents authors’ clinical and laboratory data and instrumental evaluation of the efficacy and safety of palivizumab on specific clinical examples.
Key words: respiratory syncytial virus, acute respiratory viral infection, prematurity, bronchopulmonary dysplasia, congenital heart defects, palivizumab.
Key words: respiratory syncytial virus, acute respiratory viral infection, prematurity, bronchopulmonary dysplasia, congenital heart defects, palivizumab.
I.N. Zakharova,
M.I. Pykov,
Z.V. Kaloeva,
L.A. Kataeva,
S.V. Shishkina,
I.V. Berezhnaya,
E.V. Reznichenko,
N.V. Molotkova
101-104 568
Abstract
Gilbert’s syndrome is a benign indirect hyperbilirubinemia of the hereditary nature, caused by deficiency of the enzyme uridindiphosphatglucuronitransferase. UGT1A1 gene is localized on chromosome 2q37. The most common is a defect in the promoter region of the gene pairs in the thymine-adenin. 200 children aged 8 to 16 years with clinical and laboratory manifestations of Gilbert syndrome have been examined. All children undergone to a genetic study. It was calculated that the external signs, the shown complaints and laboratory manifestations are not enough sensitive and specific. This suggests that these symptoms can not be used as criteria for diagnosis of the Gilbert syndrome. The obtained results allow to recommend that all children with hyperbilirubinemia and Gilbert’s syndrome suspected should undergo to a genetic research as a priority.
Key words: liver, hyperbilirubinemia, Gilbert syndrome, gene UGT1A1, diagnosis, children.
Key words: liver, hyperbilirubinemia, Gilbert syndrome, gene UGT1A1, diagnosis, children.
106-111 475
Abstract
The article presents an interim statistical analysis of the open multicenter randomized clinical trial, whose goal was to evaluate the efficiency and safety of immunomodulatory therapy of acute intestinal infections of viral etiology in children. Patients and methods: at this stage 28 children aged 6 months to 6 years with a clinically diagnosed viral diarrhea were included in the study. Children were randomly assigned to two groups: basic, where for the treatment was used the suppository preparation of recombinant human interferon alpha-2b in combination with taurine, and a control group, where the patients admitted the drug as the recombinant human interferon alpha-2b in combination with a complex immunoglobulin preparation. The dynamics of the relief of individual viral diarrhea symptoms was assessed within 5 days after the patient was included in the study. Results: the analysis of the data revealed no significant differences in the efficiency of the investigated drugs, this fact suggests the equivalence of the produced therapeutic effect. The use of the preparation containing recombinant human interferon alpha-2b in combination with taurine, reduces the level of a drug load on the child’s organism without loss of the treatment efficiency.
Key words: recombinant human interferon alpha-2b, taurine, an acute intestinal infection of viral etiology, treatment, children.
Key words: recombinant human interferon alpha-2b, taurine, an acute intestinal infection of viral etiology, treatment, children.
RARE DISEASES
112-116 443
Abstract
The authors are citing the literature data and share their own experiences of observation of two patients with cardiomyopathy associated with restrictive phenotype caused by mutations in defined genes encoding the synthesis of cardiac troponin I and desmin gene. Particular attention of the authors is paid to the importance of family anamnesis, which could allow to suppose hereditary disease character and the diagnostic value of genetic testing. The complex of the correct and timely executed diagnostic algorithm will favour optimization of the therapeutic tactics and possibly extend the life of the patient.
Key words: cardiomyopathy, restrictive phenotype, cardiac troponin I desmin, gene mutations, diagnostics, treatment.
Key words: cardiomyopathy, restrictive phenotype, cardiac troponin I desmin, gene mutations, diagnostics, treatment.
CLINICAL RECOMMENDATIONS
For Pediatricians' Practice
122-124 406
Abstract
One of the main conditions for normal growth and development of the child is a full-grown digestion. In this paper, the authors emphasize the importance of the intestinal microbiota condition for adequate digestion, and they are citing the main causes of disaccharidase deficiency, which contributes to the violations of the microbiota and exacerbates the intestine damage. Scientists share their experience of the correction of biocenosis and functional intestines disorders in infants.
Key words: digestion, intestinal microbiota, biologics, intestine biocenosis violations, correction, children.
Key words: digestion, intestinal microbiota, biologics, intestine biocenosis violations, correction, children.
125-129 589
Abstract
Dramatic rising prevalence of type 2 diabetes among children and adolescent required from health care providers to develop a new strategies for screening, treatment and prevention of diabetes at this age. Many medications have been developed for treatment of type 2 diabetes in adult. Despite on this, therapeutic modalities in children and adolescent remain extremely limited. This review discussed modern data about pathogenesis diabetes type 2 and main risk-factors. Author presents an update on management of type 2 diabetes in young patients.
Key words: diabetes type 2, prevalence, causes treatment, metformin, children.
Key words: diabetes type 2, prevalence, causes treatment, metformin, children.
130-134 409
Abstract
Living in the industrialized countries is characterized by an increased number of respiratory infections among children, especially in recent years. In this case there is a group of children in which the frequency of such cases per year exceeds that of their coevals, so this contingent is referred to the group of sickly children. The paper presents the influence of the ribosomal-proteoglycan complex on the child’s immune system to increase the resistance to the most common respiratory pathogens.
Key words: frequently sick children, respiratory infections, immunomodulator, treatment, ribosamal-proteoglycan complex
Key words: frequently sick children, respiratory infections, immunomodulator, treatment, ribosamal-proteoglycan complex
TRAINING FOR TRAINERS — EDUCATIONAL PROGRAM FOR PARENTS
135-138 531
Abstract
Vitamins and minerals play a unique role in the human health maintaining. Children’s organisms are particularly sensitive to the deficiency of vitamins. Typically, the child receives all the necessary vitamins and minerals as a part of nutrition. But in a period of an intensive growth, in climatic conditions changing, increased physical and mental stress, during stress conditions or infectious diseases, as well as during the recovery period the child should receive vitamins, minerals in the mineral and vitamin complexes.
Key words: vitamins, minerals, avitaminosis, hypovitaminosis, treatment, prevention, children.
Key words: vitamins, minerals, avitaminosis, hypovitaminosis, treatment, prevention, children.
Materials (WHO, EPA/UNESPA, IPA)
ISSN 1727-5776 (Print)
ISSN 2500-3089 (Online)
ISSN 2500-3089 (Online)
