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Pediatric pharmacology

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Vol 8, No 6 (2011)
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NEW TECHNOLOGIES IN MEDICINE

6-10 489
Abstract

Retracted.

The reimbursement system for drugs and medical devices is a significant factor that defines their accessibility and affordability. Due to increasing prices in healthcare worldwide, the last decades are characterized by the infusion of innovative approaches to cost-containment in healthcare and by the restriction of the ineffective or insufficiently effective technologies utilization. The requirements for including new drugs and medical devices into reimbursement lists have increased. Evidence of cost-effectiveness and budget impact of new technologies is more and more often required when dossier for health technology assessment (HTA) is submitted. The history of approaches and requirements to clinical and economical analysis from the regulatory authorities’ point of view are considered in the article.
Key words: reimbursement system for drugs and medical devices, restrictive lists, effectiveness of medical technologies, appraisal of new technologies, budget impact analysis, HTA dossier.
(Pediatric pharmacology. — 2011; 8 (6): 6–10).

CASE REPORT

119-124 436
Abstract
The article presents the observation of early debut and the severe course of the juvenile polyarthritis involving the eyes, refractory to treatment by classical immunosuppressants. Successful use of the genetically engineered biological drug — adalimumab is described:  by the 4th week of therapy the acute inflammatory changes in affected joints were stopped, range of motion in them fully recovered; to the 8th week uveitis remission was registered, laboratory values of the disease activity were normalized: erythrocyte sedimentation rate, serum concentration of C-reactive protein.
Key words: children, juvenile rheumatoid arthritis, rheumatoid uveitis, adalimumab.
(Pediatric pharmacology. — 2011; 8 (6): 119–124).

VACCINATION

12-16 451
Abstract
Outbreaks of varicella in children’s groups raises a number of public health and economic problems. The aim of this study was to investigate the epidemiological and clinical features of the development and course of chickenpox in children of different ages from high-risk groups, as well as to analyze the estimated cost of the disease and the potential cost-effectiveness of vaccination. The analysis of the incidence of varicella and its complications in children raised in specialized children’s home (in 2009) and treated at the social rehabilitation center for minors in Smolensk (in 2010). Infections and hospitalizations cases were accounted on the basis of the stories of children medical histories (f. 112, f. 26). We performed the calculation of the illness cost and possible cost-effectiveness of prevention of infection by a double Varilriks vaccination. It is shown that the incidence of chickenpox in closed team (orphanage)  was 40,8% (64 out of 157 children previously not suffered from chickenpox), in an open team (rehabilitation center) — 71,4% (30 out of 42 children). All sick children from the orphanage and 25 of the 30 infected from the rehabilitation center were hospitalized. Cost of illness (direct medical costs associated with inpatient and ambulatory settings) was 939 821 and 633 986 rub., respectively,  which was 3,0 (314 000 rub.) and 7,5 times (84 000 rub.) more expensive than vaccinations. Thus, the savings could amount to 625 821 (-66,6%) and 549 986 rubles. (-86,8%), respectively.
Key words: children, chickenpox, morbidity, hospitalization, complications, cost of illness, vaccination.
(Pediatric pharmacology. — 2011; 8 (6): 12–16).
18-22 970
Abstract
Varicella — is a common viral infection that can cause complications and adverse outcome not only in children at risk, but also in healthy children and adults. Socio-economic burden of disease due to both-direct health care, costs — to seek medical care and treatment,  and indirect — social. The introduction of immunization after the development of live attenuated vaccine has shown impressive results provided high coverage of morbidity and mortality associated with chickenpox declined sharply. However, the development of infection in vaccinated patients — a breakthrough varicella may be related with the deterioration of post-vaccinal immunity with time,  and the primary tolerance and inability to induce an effective immune response. Despite the undeniable progress in the prevention of chicken pox since the early 2000s. the world’s a discussion about the need to move to the two-dose vaccination scheme in national immunization programs has been started.
Key words: vaccination, children, chickenpox, varicella, breakout.
(Pediatric pharmacology. — 2011; 8 (6): 18–22).

URGENT ISSUES OF A TREATMENT OF EAR, NOSE, THROAT DISEASES

25-29 583
Abstract
Paper is devoted to a common pathology in pediatric otorinolaryngology — nose furuncle. The authors present their own data on the occurrence of the nose furuncle in children, as well as share their own experience in treating this disease. The clinical efficacy of local therapy in treatment of an abscessed nose furuncle in children and bacteriological efficacy in the treatment of nasal carriage of St. aureus recurrence in children with nasal furuncle has been studied. Good tolerability and high efficacy of this drug in the treatment of the nose furuncle in children when applied topically was marked.
Key words: nose furuncle, Staphylococcus aureus, treatment, children.
(Pediatric pharmacology. — 2011; 8 (6): 25–29).

REVIEW

30-35 481
Abstract
Paper is devoted to violations of bone mineral density, in particular to osteoporosis. The authors emphasize the importance of the disease, stating that it is included in the list of 5 the most important human diseases. Markers of bone formation and resorption,  a number of electrolytes and trace elements involved in the metabolism of bone tissue are represented. The article describes the basic mechanisms of formation, clinical, diagnostic and therapeutic aspects of osteoporosis in children. The authors describe the bone lesion in juvenile osteoporosis and rare hereditary syndromes. The principles of osteoporosis therapy in children are covered.
Key words: bone mineral density, bone quality, osteoporosis, juvenile osteoporosis, osteogenesis markers, markers of bone resorption, bone metabolism, treatment, children.
(Pediatric pharmacology. — 2011; 8 (6): 30–35).
36-39 467
Abstract
At present time few subpopulations T lymphocytes responsible for the implementation of various immune functions including regulatory have been described:Th1, Th2, Th17, Th3, Tr и Treg. As for the regulatory T lymphocytes (Treg), then the most convincingly established fact is their suppressing activity only for a single molecule — the transcription factor FOXP3+. The basis of representation of Treg participation in allergic processes — the presence of allergic manifestations in carriers of gene mutations FOXP3 — children with IPEX-syndrome. Elevated levels of CD4+CD25+-cells was also revealed in atopic dermatitis, contact dermatitis, and exacerbation of atopic form of bronchial asthma in children allergic to cow’s milk lactalbumin. There is strong evidence of functional Treg impairment in allergies in children and restoration of their activity correlated with a positive effect of treatment. Approaches to the restoration of Treg function in allergic diseases in children are now actively being developed in the applied immunology.
Key words: regulatory T lymphocyte subpopulations, immunopathogenesis, allergies, children.
(Pediatric pharmacology. — 2011; 8 (6): 36–39)

LECTURE

40-48 819
Abstract
Article is devoted to the treatment of bronchial asthma in children according to age, form and severity of the disease. An analysis of published randomized trials for the treatment of severe asthma in young children has been carried out, the complexity of the treatment of patients at this age has been demonstrated. Particular attention is focused on the authors evaluate the effectiveness and safety of inhaled corticosteroids that are used as monotherapy or in combination with other groups of drugs in children of different age groups depending on the severity of asthma. The conditions for improving adherence to therapy are discussed.
Key words: asthma, treatment, inhaled corticosteroids, the efficacy, safety, adherence to therapy, dry powder inhaler, metered dose aerosol inhaler, children.
(Pediatric pharmacology. — 2011; 8 (6): 40–48).
50-56 1262
Abstract
The article is devoted to the neonats adequate pharmacotherapy, including use of medications off-label. The authors emphasize the characteristics of a newborn child organism (as a full-term and preterm) that define the distinct processes of pharmacokinetics and pharmacodynamics in the older children. This paper discusses the problem of the optimal route of administration choice, provides basic information about medications used in the most common pathological conditions in newborns.
Key words: drug therapy, drugs, newborns, premature infants.
(Pediatric pharmacology. — 2011; 8 (6): 50–56).

ORIGINAL ARTICLES

61-66 503
Abstract
The epidemiologic data on RSV infection prevalence in the Russian Federation and its impact on respiratory morbidity in the pediatric population are limited. This article provides the analysis of results of a prospective, multicenter, observational cohort study. The study was conducted in 9 centers in the Russian Federation — in Moscow, St. Petersburg, and Tomsk. Children less than 2 years of age were included. It was found that during the season of high RSV morbidity RSV is found in 38 % of children hospitalized for lower respiratory tract infections; mean hospitalisation duration in children with severe RSV infection was over 1 week. Usually the duration of hospitalization was associated with disease severity and requirements for healthcare resources and oxygen supplementation. Moreover, in the Russian Federation the hospital length of stay in patients with RSV infection depended on the type of medical insurance. It was demonstrated that RSV infection caused severe respiratory failure in some infants less than 1 year of age and, therefore, was a substantial burden for the system of hospital medical care in the Russian Federation. Prophylaxis of severe RSV infection in high-risk groups of children during the might reduce the need for hospitalization.
Key words: respiratory syncytial virus infection, bronchiolitis, risk factors, prophylaxis, epidemiology, children.
(Pediatric pharmacology. — 2011; 8 (6): 61–66).
68-73 430
Abstract
Difficulties in the timely effective prevention of the atopic process development are related to the lack of unified well-founded programs of primary and secondary prevention of allergy. The paper presents results of studies demonstrating the important role of food antigens in the early formation of the atopic status of the child. A modern algorithm for clinical and immunological diagnosis of atopy, identifying cause-significant allergens in infants has been worked out.
Key words: infants, children of the first year of life, atopy, allergy, prevention, food antigens, IgE.
(Pediatric pharmacology. — 2011; 8 (6): 68–73).
74-76 407
Abstract
The paper presents the results of a study of the life quality of children with chronic kidney diseases using a questionnaire Pediatric Quality of Life Inventory, which allows us to estimate the physical, emotional, social and role functioning. The authors included in the analysis the least studied in pediatric nephrology cohort of patients — children with intact renal function. According to the patients responses, regardless of the age, compared with healthy children, physical, emotional and social aspects were the lowest. In accordance with the parents responses the quality of children life have been reduced, mainly due to the physical component. The children of preschool age (5–7 years) showed the most marked reduction of all parameters of life quality.
Key words: quality of life, chronic kidney disease, children.
(Pediatric pharmacology. — 2011; 8 (6): 74–76).
77-81 510
Abstract
Xenon have been used as an anesthetic in the Russian Federation for 11 years in anesthesia in adult patients. In April 2010, the permission of the Ministry of Health and Social Development for the clinical studies evaluating the efficacy and safety of medical xenon anesthesia in children based on the Institute of Emergency Children’s Surgery and Traumatology had been received. Xenon in pediatric anesthesiology is of a special interest because it has properties equivalent to an «ideal anesthetic». To assess its effectiveness in anesthesia in children 42 patients aged 1 to 18 years were included in the study. A comparative assessment of the adequacy of anesthesia with xenon and sevoflurane has been conducted. At different stages of the research in addition to clinical parameters the level of growth hormone and cortisol were measured. The study showed that anesthesia with xenon was different from sevoflurane by hemodynamic stability, and both have a high level of anesthetic anti-stress activity.
Key words: anesthesia with xenon, stress hormones, anesthesia in children.
(Pediatric pharmacology. — 2011; 8 (6): 77–81).

СOGNITIVE HEALTH AND IDENTITY OF THE CHILD

83-87 494
Abstract
The paper is devoted to neuropsychology — the science that studies dysfunction, degree of formation of the higher mental functions, allows not only to describe symptoms of their disorders, but also to identify mechanisms, to develop adequate tactics of the patient treatment. The authors emphasize that in recent years the interest of psychologists, teachers, and pathopsychologists to this area due to the increasing number of children with difficulties in adaptation, underachieving in education. The character of neuropsychological examination of a child, which must be structurally dynamic is described. Refinement of the individual characteristics of the child, the necessary motivation formed by physician permits the effective correctional work.
Key words: neuropsychology, the founders, the higher mental functions, neuropsychological investigation, correctional work, children.
(Pediatric pharmacology. — 2011; 8 (6): 83–87).

For Pediatricians' Practice

88-92 443
Abstract
Over the past few decades significant advances in the treatment of children with oncological diseases have been obtained. In this regard an issue of the life quality of patients after treatment, the problem of diagnosis and therapy of long-term complications of chemotherapy is particularly actual. Purpose of the work — to develop the audiologic examination scheme of children treated with platinum drugs (carboplatin, cysplatin). We examined 46 children aged from 3 months to 18 years. As an audiological methods we used different classes of otoacoustic emissions, tympanometry, tonal threshold audiometry. In 15,2% of children with normal hearing thresholds at speech frequencies we revealed a high frequency hearing loss, and in 8,7% — a sensoneural hearing loss and in 6,5% — conductive hearing loss. During the dynamic examination the progressed deafness took place in 7 (12) children. On the base of the obtained results we determined the most optimal scheme of audiologic examination.
Key words: ototoxicity, platinum drugs, otoacoustic emission hearing screening.
(Pediatric pharmacology. — 2011; 8 (6): 88–92).
93-95 367
Abstract
This paper presents an analysis of the results of medical and social study of boys with congenital malformations and diseases of the genital organs and their families. The main studied group included 588 boys who were under the supervision of City Children’s Polyclinic № 130, Moscow, 135 other boys were included into control group. Using high-tech methods of surgical treatment of this disease in combination with medical and social adjustment for the outpatient phase increased the efficiency of the health recovery in the maingroup of boys.
Key words: boys with diseases of the reproductive organs, medical, social, and surgical correction of health.
(Pediatric pharmacology. — 2011; 8 (6): 93–95).
96-102 468
Abstract
Increasing effectiveness of topical exposure in atopic dermatitis in children, as well as search for new safe external facilities is one of the urgent problems of modern dermatology. Data concerning the need for inclusion of topical calciumneurin inhibitors in the scheme of topical treatment of atopic dermatitis as for the relief of acute and for long term monitoring of the further course of the disease are proved. Authors evaluated and showed the high clinical efficacy, safety and tolerability of tacrolimus ointment 0.03% in the external treatment of 40 children with atopic dermatitis of moderate and severe degrees in children aged from 2 to 15 years.
Key words: atopic eczema, topical therapy, long-term control, tacrolimus ointment, children.
(Pediatric pharmacology. — 2011; 8 (6): 96–102).
103-107 563
Abstract
The most important component in the treatment of children with infectious and inflammatory diseases is antibiotics. However, widespread, and sometimes not enough justified use of antibiotics often leads to complications, among which a violation of the gastrointestinal tract microecology i. e. an antibiotic-associated diarrhea occupies a special place. Currently, the most promising avenue for the prevention and complex treatment of antibiotic-associated diarrhea in children is the use of probiotics. The article presents data of domestic probiotic preparation in the complex treatment of antibiotic-associated diarrhea in children.
Key words: antibiotic-associated diarrhea, probiotics, antibiotics, intestines dysbiosis.
(Pediatric pharmacology. — 2011; 8 (6): 103–107).
108-113 598
Abstract
The article is devoted to one of the most «problematic» aspects of Pediatrics — use of immune-response modulating drugs. Complexity is due as to the abundance of similar agents on the pharmacological market also to the evident absence of the proved efficacy and safety of most of them. The authors focused their attention on the category of patients, to whom these drugs were most commonly prescribed — i. e. children with recurrent acute respiratory infections. Along with the classification the characteristics of the different groups of immune-response modulating drugs are presented.
Key words: children with recurrent acute respiratory infections, acute respiratory infections, immune-response modulating therapy, ribosomal-proteoglican complex.
(Pediatric pharmacology. — 2011; 8 (6): 108–113).

RARE DISEASES

114-118 464
Abstract

In recent years in expanding diagnostic capabilities and improved knowledge level diseases that were previously considered rare become increasingly identified. Along with the achievements of the pharmaceutical industry, timely diagnosis and adequate therapy appointment can often save the life of the child and delay the progression of the disease. This article focuses on a rare, genetically determined, pathology of lysosomal diseases group, inherited autosomal recessively — NPD type C. Different versions of the clinical course and diagnostic methods are showed in details. Take account of the existing in our country hypo diagnostics of this disease, the authors propose to put into practice a diagnostic algorithm «index of suspicion of the disease NP-C» in order to improve detection and timely initiation of pathogenetic therapy.
Key words: rare diseases, storage diseases, lysosomal diseases, Niemann-Pick disease type C, diagnostics, clinical course, treatment, children.

(Pediatric pharmacology. — 2011; 8 (6): 114–118).

JUBILEE

136-140 813
Abstract

This article presents reflections on the contribution of the great Russian scientist, one of the most prominent world science stars Mikhail Lomonosov (8/19.11.1711–4/15.04.1765) in connection with the 300th anniversary of his birth celebrated in 2011. Particular attention is paid to his role as an advocate for the development of domestic education and science, and his views on medicine. In the same year we are celebrating the 250 years anniversary since M. Lomonosov’s writing the letter to I.I. Shuvalov, «On the saving and reproduction of the Russian People» (1761), which contained an extensive program of increasing the country's population,  which included a range of legal, social and medical measures to help increase fertility and reduce child mortality.
Key words: M. V. Lomonosov, I. I. Shuvalov, Moscow University, «On the saving and reproduction of the Russian people».
(Pediatric pharmacology. — 2011; 8 (6): 136–140).

TRAINING FOR TRAINERS — EDUCATIONAL PROGRAM FOR PARENTS

127-131 670
Abstract

The introduction of mass immunization programs in public health care separated in time the period of infectious diseases in pre-and post-vaccination era. To date, it is clear that there is no more effective preventive programs in medicine, than vaccination. Unfortunately,  at present, the number of unjustified refusals of vaccinations increased that are associated with anti-vaccination parents mood. This article is intended for pediatricians, who often face in their practice with the questions of parents about vaccination and its pros and cons. We’ll try to answer the most pressing of them and dispel some misconceptions and myths related to infectious diseasesprevention.
Key words: vaccination, childhood infections, mandatory vaccinations, complications, the immune system.
(Pediatric pharmacology. — 2011; 8 (6): 128–131).

FROM THE UNION OF PEDIATRICIANS OF RUSSIA

Materials (WHO, EPA/UNESPA, IPA)

DEBATABLE ISSUES OF PHARMACOTHERAPY

57-60 13507
Abstract

Article assesses the impact of adverse factors on intrauterine development of the child, first of all, drugs. The author stresses that the importance of drug safety (D) is due to the large number of unintended pregnancies worldwide. A list of the D, providing proven teratogenic effects on a child organism is presenting. It is shown that the D teratogenic effect in humans can not be assessed on the basis of experimental data obtained in animals due to the difference between metabolic and detoxification processes in a different mammals and individuals.
Key words: drugs, safety, teratogenic effects, fetal development, the unborn child.
(Pediatric pharmacology. — 2011; 8 (6): 57–60).



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