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Pediatric pharmacology

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Vol 14, No 5 (2017)
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EDITORIALS

AN EDITORIAL ARTICLE

341-354 3158
Abstract

The article brings up the topic not only vital and urgent for further development of modern medical science, but also affecting the interests of mankind as a whole and of every inhabitant of the Earth in particular: that is the irrational use of antibiotics and antibiotic resistance which rate is growing rapidly. We investigate the reasons for the epidemic of antibiotic resistance and discuss in detail all the necessary measures in order to cope with this problem. The shocking data on the almost universal irrational use of antibiotics by both medical workers and parents is provided. We demonstrate the microbiome changes that follow antibacterial drugs application resulting in the development of severe chronic pediatric diseases which cause severe disability or life-threatening conditions in children with long-term results in adult age. In conclusion, we summarize the evidence-based research in phytomedicine that present the phytopreparations as a serious alternative to antibiotics in a number of clinical settings.

 

ORIGINAL ARTICLES

356-365 775
Abstract

Background. Quality of life (QoL) is an important parameter that provides additional information about changes in health status. Objective. Our aim was to study the change in QoL of patients with severe persistent bronchial asthma (BA) during the treatment with genetically engineered biological preparation (GIBP) omalizumab in addition to daily background therapy. Methods. The QoL assessment was conducted using the Health Utilities Index Mark 3 and Mark 2 (HUI3, HUI2) questionnaires at two points (1st point and 2nd point — in 6 months) in 47 children with severe BA at the age of 13 (7; 17) years, 72% of them are boys. At the same points, QoL was evaluated using the PAQLQ (S) specialized pediatric questionnaire (Standardized Pediatric Asthma Quality of Life Questionnaire). Results. Depending on the duration of omalizumab therapy, all children were divided into 5 groups: 1st group — children who did not receive treatment with monoclonal antibodies at the 1st point; in 2, 3, 4, 5-th groups, the QoL assessment was performed on GIBP treatment for different time. In children of the 1st group whose QoL was evaluated before starting GIBP therapy and in 6 months, a statistically significant change in scores on the Health Utilities Index questionnaire was noted: the multi-attribute indices HUI2 and HUI3 improved, respectively, by 21.3 and 10.71% (p = 0.041 and 0.086). According to the HUI2 classification system, a significant improvement in the emotion attribute was revealed, which positively correlated with the overall indicator and the emotion indicator of the PAQLQ (S) questionnaire. In the remaining groups, the indicators of the Health Utilities Index questionnaire did not change significantly. Conclusion. The study results showed that the dynamics of the quality of life in children with severe persistent BA is an important additional criterion in a comprehensive assessment of the efficacy of targeted bioengineering therapy.

 

366-372 771
Abstract

Background. Sexual development of adolescents is one of the important indicators of the population well-being, the study of which, in the context of the world trend towards a change in the period of puberty, can contribute to the identification of public health problems. Objective. Our aim was to study the basic indicators of sexual development of adolescents and to determine the regional characteristics of this population. Methods. The evaluation of secondary sexual characteristics was carried out by specialists according to Tanner criteria. Ultrasound examination of organs of the reproductive system was carried out using a portable scanner Mindray M7. The analysis of the results was carried out taking into account the gender, living conditions, physical development. Results. We examined 7,120 adolescents aged from 13 to 16 years. The degree of axillary hair distribution by Tanner criteria was 2.4±0.7 in young men, 2.9±0.4 — in girls, pubic hair — 2.0±0.9 and 2.6±0.8, respectively. The indicator of development of mammary glands by Tanner criteria in girls was 2.6±0.8, menstrual function by Tanner criteria — 2.4±0.8. Herewith, urban adolescents had later terms of appearance of the secondary sexual characteristics in comparison with the inhabitants of rural areas. Conclusion. We registered the delayed sexual development in 8.1% of girls and 13.6% of young men. Urban youths have experienced a delay in gonadal growth. Among the female population there was an outstripping growth and development of the uterus and ovaries in comparison with rural adolescents.

 

373-379 1632
Abstract

Early detection of the connective tissue dysplasia (CTD) is hampered as the used diagnostic criteria are complex and subjective. The aim of the study is to examine the incidence and clinical profile of the adolescent CTD by means of the screening checklist. Methods. The study included the pupils at the age of 10–14 years. The questionnaire designed to reveal the 7 CTD’s signs (thin skin, skin hyperelasticity, keloid cicatrix, blue sclera, soft auricles, arachnodactylia, joints hypermobility), containing 12 illustrated questions with explanation for the parents, was performed as a screening method. The conditionally healthy group (the absence of CTD) consisted of the adolescents with below 12 points total and CTD group was presented by the adolescents with 13 and more points. The physical development was appreciated according to the centile tables, Quetelet index and Vargui index. The health status analysis was based on the out-patient medical records. Results. 1560 pupils were the participants of the study: 752 boys (48.2%) and 808 girls (51.8%). CTD signs were observed in 965 (61.9%) children. The adolescents with CTD’s signs demonstrated the following characters more often than the adolescents without CTD’s signs: soft auricles — 788 (81.7%) against 277 (46.6%), skin hyperelasticity — 685 (71%) against 93 (15.6%), joints hypermobility — 665 (68.9%) against 203 (34.1%), blue sclera — 665 (68.9%) against 184 (30.9%), arachnodactylia — 534 (55.3%) against 57 (9.6%). The disharmonious physical development because of the underweight body took place in 430 (52.3%) adolescents with CTD. Compared to the conditionally healthy group the most of the adolescents with CTD had the pathology of the musculoskeletal system (scoliosis, flatfoot), myopia, vegetative-vascular dystonia, digestive apparatus diseases. The CTD is associated with greater probability of the development of above mentioned pathologies, that can be indicative of the contribution of the anomalies of the connective tissue development into the etiopathogenesis of the these diseases. Conclusion. It is established that there is the high prevalence of the CTD signs among the adolescents (pupils) at the age of 10–14 years.

 

380-385 3202
Abstract

Background. The adolescent period is characterized by the features of growth and development of the organism when the risk of a number of diseases increases under the conditions of hormonal adjustment and under the influence of environmental factors. Objective. Our aim was to determine the reference values of the main values of peripheral blood and the prevalence of anemia in adolescents residing in the territory of the Tomsk region. Methods. We studied the results of medical examination of children aged from 13 to 16 years. To determine the main values of the general blood test (erythrocytes, hemoglobin, leukocytes, erythrocyte sedimentation rate), an automatic hematological analyzer was used. Evaluation of physical development was carried out by standard methods. The analysis of the results was carried out considering the sex, living conditions, weight, height, and body mass index. Results. We analyzed the values of peripheral blood of 7,120 adolescents. Rated values corresponded to the conventional age norms. The hemoglobin level and the number of erythrocytes are associated with the body weight, height, and body mass index of the respondents. Anemia of varying severity was recorded in 618/7,120 (8.7%) adolescents. More often anemia was verified in rural areas (OR 1.52; CI 95% 1.28–1.80) as well as in females (OR 2.62; CI 95% 2.18–3.15). Conclusion. Regional features of peripheral blood values and the prevalence of anemia in adolescents of the Tomsk region have been determined.

 

REVIEW

386-391 1154
Abstract

Bronchial asthma remains one of the most common non-infectious diseases. In children, the highest prevalence and incidence of asthma is observed in adolescence. Difficulties in achieving and maintaining control over the disease in adolescents are due to the peculiarities of their socio-psychological adaptation, low adherence to therapy, and poor doctor-patient interaction. To achieve maximum control over the disease in children and adolescents suffering from moderate bronchial asthma, according to current guidelines, combined drugs should be used. A number of conciliation documents on asthma adopted the concept of using a single inhaler from the third stage of treatment, which is used both as a basic therapy and for relieving exacerbations. A large number of studies have demonstrated successful experience with the use of such tactics, including in adolescents in real clinical practice. It is proved that this approach increases adherence to therapy, reduces the risk of exacerbations, and improves the control over the disease. However, further research is needed, because therapy with a single inhaler has age limits.

 

392-399 836
Abstract

The article discusses modern ideas about the genesis of the most common variants of functional gastrointestinal disorders (FGID) in infants, and their ability to lead to long-term negative consequences for the health of the child. The article provides data on role of intestinal microbiota in development of FGID in infants and current approaches to prevention and correction using probiotics with proven effectiveness.

 

VACCINATION

For Pediatricians' Practice

402-407 653
Abstract

Background. Despite the active development of diagnostic capabilities, the problems of diagnosis at the pre-hospital stage with abdominal pain remain unresolved. Objective. Our aim was to analyze the results of evacuation to healthcare facilities as well as treatment outcomes (conservative and surgical) of hospitalized children who applied for first aid with acute abdominal pain, in order to identify possible shortcomings in the existing diagnostic algorithm and its optimization. Methods. The results of treatment outcomes for children with acute abdominal pain at the pre-hospital stage and evacuation to healthcare facilities by visiting teams for the period 2014–2015. are presented by the example of the State Institution «Engels Emergency Medical Setting». Results. Difficulties in routing children to the necessary healthcare facilities (surgical or somatic) are due to the complexities of differential diagnosis of the disease in children with acute abdominal pain at the pre-hospital stage. Conclusion. The main task of the primary care and emergency physician at the pre-hospital stage, whose decision determines the direction of the diagnostic search, timeliness and adequacy of the subsequent treatment measures, is to give a correct assessment of abdominal pain syndrome.

 

408-410 962
Abstract

Background. Improvement of treatment methods and relapse prevention of pyelonephritis in children is relevant to pediatrics. The study of the antibacterial possibilities of herbal medicines (HM) provoke great interest for researches . The aim of the survey was to investigate the antimicrobial properties of combined phytotherapy in vitro. Methods. Two microbiological researches were performed in vitro. One of them was conducted using the microtechnique for serial dilution-antibiotic sensitivity testing of 62 cultures (genera Escherichia, Klebsiella, Proteus and Pseudomonas, Staphylococcus, Streptococcus) isolated in significantly diagnostic concentration from the urine of children in the acute phase of pyelonephritis. The antibacterial effect of RLP was detected using the microtechnique for serial dilution. To exclude the antibacterial effect of the alcohol present in the phytopreparations, a number of analogous dilutions were placed in 19.5% solution of ethyl alcohol. At the same time, the sterility of the reaction components was monitored. The second research studied the concentration changes of the microbial suspension of Escherichia coli isolated from the urine of children before the treatment onset with incubation of different concentrations of phytopreparations and at a different exposure periods. Results. Studies on the antimicrobial activity of HM in vitro demonstrated the antimicrobial effect of HM on 58% of the examined cultures. The highest drug sensitivity was revealed in the genera Klebsiella (80%), Staphylococcus (77%), and E. coli (51.5%). Studies on the concentration changes of microbial suspension of E. coli detected 100% activity of undiluted HM at a 24-hour exposure period (sample D). A significant decrease in the pathogen growth was also obtained with HM with the dilution ratio 1:1 at a 24-hour exposure period. Conclusion. The microbiological analyses demonstrated and confirmed the antibacterial characteristics of HM.

 

Page for pediatric nurse

411-414 917
Abstract

Replacement renal therapy is the only method for treating the terminal stage of chronic renal failure before kidney transplantation, if such one is possible. In recent years, the frequency of outpatient peritoneal dialysis, conducted both in a hospital and at home, has increased for this purpose in children. The efficacy of dialysis and minimization of complications, especially peritonitis, depend not only on the program chosen by a doctor but also on the correct execution of the procedure and the observance of aseptic and antiseptic rules by persons performing dialysis (nurse and mother). The article introduces the basic principles of dialysis: demonstrating the role of a nurse in the procedure, the author justifies the need to improve knowledge in the field of renal replacement therapy in order to intelligently and easily explain the essence of dialysis to a mother and teach her how to perform the procedure independently.

 

SHORT REPORT

FROM THE UNION OF PEDIATRICIANS OF RUSSIA



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