No 42 (2015)

ARTICLES

THE RELEVANCE OF METABOLIC PHENOTYPES OF OBESITY IN CHILDHOOD AND ADOLESCENCE

Malyavskaya S.I., Lebedev A.V.

Abstract

Rationale: The study  on  specifics of metabolic phenotypes of obesity in children and adolescents seems be highly relevant for a comprehensive assessment  of causal and  pathophysiological  roles of obesity in the  atherogenesis. Aim: To identify particulars of metabolic  phenotypes of obesity in the  population of the  school children in the  city of Arkhangelsk. Materials and methods: We examined 102 patients aged from 10 to 15 years with obesity, abdominal type (boys, 44.6%, girls, 55.4%). According to the results of a comprehensive clinical and laboratory assessments, the patients  were divided  into  the  group  of metabolically  healthy obese   (children  and  adolescents  with  obesity, but without any metabolic abnormalities) and the group of metabolically unhealthy obese (having at least 1 metabolic abnormality). The list of metabolic abnormalities  included  high triglyceride levels, low levels of high density lipoprotein  cholesterol (HDL-C), high blood pressure, impaired fasting glucose, increased  C-reactive protein  levels. Results: The  group  comparison   showed  that  the  mean levels  of  all studied   parameters  of  pro-atherogenic  metabolic  abnormalities  were significantly higher  in the  patients  with  metabolically  active obesity (the mean triglyceride levels in the groups of metabolically active and metabolically healthy obesity were 1.31 vs 0.74 mmol/L, glucose levels, 4.92  vs 4.54  mmol/L,  C-reactive protein,  3.15  vs 2.30 mg/mL, systolic and diastolic blood pressure, 118.97 vs 110.23 mmHg and 72.90 vs 68.58 mmHg, respectively; p < 0.001), with the  exclusion of the   mean level of anti-atherogenic HDL-C, which was lower (1.27 vs 1.49 mmol/L; p < 0.001). Also, in addition to abdominal obesity, 21.43% of school children with metabolically active obesity had ≥ 2 atherogenic factors, as well as some pro-inflammatory abnormalities (C-reactive protein levels were higher in one third of children and adolescents of this group, with a borderline  significance level). Sixty percent  of children and adolescents with obesity and metabolic abnormalities had abnormal lipid parameters. Pro-atherogenic metabolic abnormalities  were  found  in all children  and  adolescents with increased C-reactive protein levels. Conclusion:  Distinctly different  phenotypes  of obesity with various degrees  of metabolic  abnormalities were  found  in the  pediatric  population. Formation of combination of atherogenic clinical and metabolic abnormalities  (dyslipidemia, impaired glucose  tolerance,  high blood  pressure)  is possible already in children and adolescents with metabolically active obesity. They can be associated with chronic inflammation, and as such could be the first stage of development of atherosclerosis, metabolic  syndrome  and  cardiovascular  disease.
Almanac of Clinical Medicine. 2015;(42):38-45
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MORPHOLOGICAL AND FUNCTIONAL STATUS OF UPPER GASTROINTESTINAL TRACT IN CHILDREN WITH METABOLIC SYNDROME

Bokova T.A., Koshurnikova A.S., Tereshchenko S.G.

Abstract

Background: Existence of clinical and pathophysiological relationship between gastrointestinal disorders and components of the metabolic  syndrome  in adults has been  proved. Aim: To study morphological  and functional status of upper gastrointestinal tract  and  the  degree  of its contamination with Helicobacter pylori in children with metabolic   syndrome.  Materials  and  methods: We examined 274 children aged from 9 to 16 years. Group 1 included 144 children with metabolic syndrome, group 2, 80 patients  with obesity without metabolic  syndrome,  group  3, 50 normal weight children  with  various  gastrointestinal disorders. The assessments included esophagogastroduodenoscopy  with biopsy for morphological  and bacteriological  investigations. Results: The children from the groups 1 and 2 had significantly less complaints of pain in epigastric and pyloro-duodenal area than  those  from the group  3 (15.2, 26.8 and54% of patients, respectively; р for comparison  of group  1 vs group  3 and group  2 vs group  3 were all < 0.05). Functional and structural abnormalities of upper gastrointestinal tract were found in 90.3,86.3 and 96% of children, esophagitis, in 19.4, 17.5 and  12%, respectively. Gastritis was significantly more frequent  in groups  1 and 2 than in group  3 (31.9, 37.5 and 14%, respectively, р for comparison of group 1 vs group 3 and group 2 vs group 3 were all < 0.05), whereas  in group  3 there  were  more cases of gastroduodenitis (37.5, 42.5 and 78%) and duodenal ulcers  (1.4, 2.5  and  8%,  respectively). Antral gastritis was diagnosed in 55.5, 45 and 40% of patients, stomach  erosions, in 5.6, 7.5 and 4%, duodenitis, in 44.4, 50 and 86%, bulbar erosions, in 2.8, 1.3 and 2%, active ulcers, in 1.4, 2.5 and 8%, cardia insufficiency in 33.3, 22.5 and 28%, duodeno-gastric  reflux, in 27.8, 26.3 and  24% patients from the  groups  1, 2 and  3, respectively. Gastric mucosal biopsies of most patients, irrespective of the groups (83.3, 87.5 and 77.3%), showed signs of active  chronic  gastritis. Various degrees  of contamination  with Н. pylori was found  in 61.5, 58.3 and 46.2% of children from the groups 1, 2 and  3, respectively. Conclusion: The rates of inflammatory abnormalities  in upper  gastrointestinal tract in all patient groups are similar (93–95%) and does not  depend on  bodyweight. Motor  and  evacuation  abnormalities  are  more  frequent  in obese children  than  in those  with normal  bodyweight, and do not depend on the  metabolic  syndrome. Children with metabolic  syndrome  are characterized by moderate degree  active chronic gastritis associated   with  Н. pylori,  with  minimal  clinical signs and  symptoms  and  predominance of focal rather than wide-spread inflammation.
Almanac of Clinical Medicine. 2015;(42):46-50
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THE EFFECTS OF DIET THERAPY ON CLINICAL AND BIOCHEMICAL PARAMETERS AND BODY COMPOSITION IN OVERWEIGHT

Pavlovskaya E.V., Strokova T.V., Surkov A.G., Bagaeva M.E., Pavlyuchkova M.S.

Abstract

Background:   Only  medical   nutrition   therapy and physical activity can be used for treatment of the group  2 (p > 0.05). The fat mass in children of the group  1 decreased from 44.4% [39.1; 48.3] to Department of Pediatric Gastroenterology, Hepatology, and Nutrition1; Assistant, Chair of Dietetics and2obesity in children. In many cases, it is reasonable to  start  treatment in a hospital. Aim: To assess changes  of clinical and  biochemical  parameters and body composition with diet therapy in overweight  and  obese  children  in an  in-patient department. Materials and methods: We examined 537 children with obesity aged 13 years [11;  14] (group  1) and  104  overweight   children aged  13 [12; 14] years (group  2). Anthropometric parameters,   body   composition    by   means   ofbioimpedance  measurement,  clinical  chemistry 43.1% [37.9; 47.7] (p < 0.001), in group 2, from 33.8% [31.1; 38.5] to 32.6% [30; 36.7] (p = 0.017). The lean mass  decreased in 86.2 and  93.7% of patients, respectively.  There  were  significant  reductions on  the   levels  of  serum   total   cholesterol,  low density lipoproteins, triglycerides, high density lipoproteins  and  increase  in uric acid, compared to  their  respective  baseline  values. Conclusion: During  the  in-hospital  treatment period  obese children  show  improvements  of nutritive  status, Nutrition, Postgraduate Training FacultyPavlyuchkova Mariya S. – PhD, Dietologist1parameters of lipid and carbohydrate metabolism significant   reduction   of   fat   body   mass   with                were  assessed   at  baseline   and  at  the   end   of treatment. Duration of hospital stay was 14 days. The  children   were  on  a  diet  with  a  reduced caloric,  fat  and  carbohydrate  content.  Results: The bodymass  decreased by 5.7% [4.5; 6.9] from baseline  in the  group  1 and  by 5.3% [3.8; 7.5] in concomitant decrease  of lean mass due to a rapidbodyweight reduction.
Almanac of Clinical Medicine. 2015;(42):51-57
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THE CAUSES AND THE COURSE OF CHRONIC KIDNEY DISEASE IN CHILDREN OF PRESCHOOL AGE

Abaseeva T.Y., Pankratenko T.E., Burov A.A., Emirova K.M., Muzurov A.L.

Abstract

Background: Data on etiology and clinical course of CKD stage  3 to 5 in children of preschool  age could help obstetricians, pediatricians, and nephrologists with proper diagnostics and management of this condition and prediction of outcomes. Aim: To study causes and clinical features of CKD stage 3 to 5 in preschool  children. Materials and methods: The causes and clinical features of CKD stage 3 to 5 were investigated in 55 preschool children aged from 7 months  to 8 years. Twenty four had  CKD stage  3 to 4 and  31 children with endstage  CKD  were  on  peritoneal  dialysis. Results:96% of CKD stage 3 to 5 in preschool children were due  to  congenital/genetic kidney abnormalities. Predictors  of renal  replacement therapy  beginning in the first 5 years of life were as follows: antenatal detection of congenital  abnormalities  of the kidney and urinary tract, oligohydroamnion, high neonatal  BUN levels.  Anemia, hyperparathyroidism, arterial hypertension were more prevalent  in children on the dialysis stage of CKD, and myocardial hypertrophy and/or of the left ventricle dilatation were found in 26% of them. Forty two percent of children had growth retardation, and 40% had delayed  speech  development. Conclusion: The course CKD in preschool  children is characterized by a combination of typical metabolic  disorders with the growth  retardation (often dramatic) and delayed mental development that significantly limits the possibilities of the social adaptation of these children and social activities of their parents. Participation  of  neuropsychiatrists,  clinical psychologists, and teachers, rather than pediatricians and  nephrologists only, is desirable  in management of preschool children with CKD stage 3 to 5.
Almanac of Clinical Medicine. 2015;(42):58-65
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CORRECTION OF DYSBIOTIC ABNORMALITIES IN CHILDREN WITH ACUTE RESPIRATORY DISORDERS

Tselipanova E.E., Rusanova E.V.

Abstract

Background:  A  special  attention  in  the treatment  of  acute   respiratory  disorders  (ARD) in  children   should   be   paid   to   correction   of defense mechanisms  of the body, including elimination    of    dysbiotic    abnormalities.    The use  of  probiotics,  whose  mechanism   of  action is directed  to restoration  of qualitative and quantitative composition  of normal microbiota, is considered  to be perspective  in the combination therapy  of ARD  patients. Aim: to  assess  clinical and  laboratory  efficacy of probiotic  Florin forte in children  with  ARD.  Materials and  methods: One  hundred  and   eleven   children  aged   from3 months  to 14 years with ARD were included into the study. In 81.1% of cases they had concomitant obstruction of upper  respiratory  ways. From day1 after admission to the hospital, 81 patients  (the main  group)  were  administered probiotic  Florin forte  as a part  of combination  therapy  for 5 to7 days, and  30 children  (the  comparator group) were  administered  the  standard   treatment without  probiotics. Parameters  of oropharyngeal and  mucosal  microflora, immune  parameters of anti-infectious resistance (phagocytic activity, phagocytic index, neutrophilic index of digestion), as  well  as  secretory   immunoglobulin  A levels in  saliva  were  measured  during  the  course  of the  illness. Results: In the  patients  of the  main group   under   the   combination  therapy,  there was   a   significantly   more    rapid    elimination of    respiratory     symptoms     and     intoxication (p < 0.05), with shorter  duration  of hospitalization (4.43 ± 0.19  days vs 6.03 ± 0.25  in the  comparator group, p < 0.001). The acute  phase  of the  disease in both  groups  of patients  was characterized  by dysbiotic   abnormalities   in  oropharyngeal   and gut  microbiota, with  a decrease  in non-specific host    resistance    parameters.   After   treatment, there was a significantly higher number  of indigenous   microbial  associations   in  the   main group, compared to that in the comparator group (43.4% vs 16.7%, p < 0.01), and  a higher  growth of enterobacteria  (16.9% vs 33.3%,  respectively, p < 0.1). In the patients  taking the probiotic, there was a trend towards restoration  of qualitative and quantitative  composition   of the  gut  microflora: in the main group, there was an increase in proportions of children  with a normal  counts  of bifidobacteria  (from 26.4% in the  acute  phase  to45.3%  after  treatment,  p < 0.05)  and  lactobacilli (from 7.5% to  16.9%, respectively,  p < 0.05), and a decrease of proportion of children with hemolytic Escherichia coli (in 32.1% before  treatment and in22.6%  after  treatment,  p > 0.05).  Improvements of immune parameters of the anti-infectious resistance  system  were  found  only in the  main group: the phagocytic  index at 120 minutes  after incubation  of neutrophils  was 4.26 ± 0.04  before treatment and 3.94 ± 0.09 after treatment (р < 0.05); the  neutrophil   digestion   index,  5.70 ± 0.71  and10.83 ± 0.94   (р < 0.01),  and   secretory   IgA   level in  saliva,  0.05 ± 0.03   and   0.125 ± 0.03   mcg/mL, respectively  (р < 0.05).  Conclusion:  Inclusion  of probiotic  Florin forte  into  combination  therapy of ARD patients  promoted more rapid clinical recovery, improvement of biocenotic  parameters in oropharyngeal and gut mucosa and an increase in anti-infectious resistance of the host.
Almanac of Clinical Medicine. 2015;(42):66-71
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THE METABOLIC ACTIVITY OF THE MICROFLORA OF THE OROPHARYNX IN CHILDREN WITH BRONCHITIS AND COMMUNITY-ACQUIRED PNEUMONIA

Medvedeva E.A., Meskina E.R.

Abstract

Background: Given a steady increase in the number of children with recurrent  respiratory tract infections, to develop methods of their rehabilitation, it is necessary to evaluate  factors of nonspecific resistance. Aim: To study metabolic activity of oropharyngeal microflora in children  with recurrent bronchitis and community-acquired pneumonia, based on determination of spectrum  of shortchain fatty acids (SCFA). Materials and methods: This prospective  study included  60 children with recurrent  respiratory  tract  infections  aged  from 3 to 7 years, hospitalized  for inpatient  treatment of bronchitis  (n = 30) and pneumonia (n = 30). The oropharyngeal microflora was assessed by classical bacteriological  method (in mucosal smears); SCFA levels in non-stimulated saliva were measured by gas liquid chromatography. Results: There was no significant difference  in qualitative  and  quantitative composition  of the oropharyngeal microflora between children  with  bronchitis  and  pneumonia. However, assessment of metabolic  functions showed some significant differences. Children with   bronchitis  showed  signs of microflora hyperactivation  with total  SCFA production up  to  118.4% (mean) from that of the reference range, with predominant activation of aerobic bacteria (anaerobic index 66.8%). In children with pneumonia, microflora was suppressed (68.13% of the normal range, the difference with the bronchitis group being significant, p < 0.05), with predominance of strictly anaerobic  bacteria (anaerobic index 110.35% from the normal range, p < 0.05). Children with recurrent respiratory tract infections had the following common characteristics: prevalence  of bacterial proteolysis (70% of patients) and butyric acid deficiency (63% from the normal level in bronchitis and 33%, in pneumonia, p > 0.05). Conclusion: The data obtained could be used to make a decision on the necessity of antibacterial therapy.
Almanac of Clinical Medicine. 2015;(42):72-78
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CARBOHYDRATE MALABSORPTION SYNDROME IN CHILDREN WITH VIRAL GASTROENTERITIS

Meskina E.R.

Abstract

Background: Enteric viruses (mainly rotaviruses) are the most common cause of infectious diarrhea in infants. One  of the  pathophysiologic mechanisms in rotaviral gastroenteritis is the  reduction of the  surface  activity of enterocyte disaccharidases  and  osmotic  diarrhea. Aim: To determine the clinical significance of metabolic activity of intestinal microbiota in the formation of the osmotic component of viral diarrhea in children of various ages. Materials and methods: The study involved 139 children aged  from 1 month  to 14 years admitted to the hospital in the first 24 to 72 hours of moderate-degree  viral gastroenteritis.  Rotaviral infection was the most prevalent  (90%). Viral etiology was confirmed  by the  reaction  of indirect hemagglutination and multiplex real-time PCR (in feces). Total carbohydrate content in the feces was measured and fecal microflora was investigated by two methods: bacteriological and gas liquid chromatography with the determination of short-chain fatty acids. Results: The mean carbohydrate content in the feces of children below 1.5 years of age was higher than  that  in older children (p = 0.014). There was an inverse correlation between the concentration of rotaviral antigens  and carbohydrate   contents (r = -0,43, p < 0.05) and the production of acetic and propionic acids (R = -0,35, p < 0.01). The carbohydrate content in acute stage of the disease was linearly associated with time to normalization of the stool (r = +0,47, p < 0.01). Previous acute  respiratory or intestinal  infections within 2 months (odds ratio [OR], 14.10; 95% confidence interval [CI] 3.86–51.53), previous  hospitalizations  (OR = 14.17; 95% CI 2.74–74.32) and  past  history of intestinal dysfunction (OR 5.68; 95% CI 1.67–19.76) were predictive of severe  carbohydrate malabsorption in children below 1.5 years of age. Conclusion: The lack of microbiota functional activity (assessed by production of short-chain  fatty acids) determines the  development of osmotic  phenotype of diarrhea, that marks the total carbohydrate contents in the feces. Its predisposing factors should be taken into account  when making a decision to hospitalize.
Almanac of Clinical Medicine. 2015;(42):79-86
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THE RATIONALE FOR ALPHA-INTERFERON IMMUNOTHERAPY IN INFANTS WITH FUNCTIONAL GASTROINTESTINAL DISORDERS AND ACUTE INVASIVE INTESTINAL INFECTION

Meskina E.R., Rusanova E.V.

Abstract

Background: Acute intestinal  infections  in children are a considerable  medical and social problem  worldwide. Immune therapy  could  help  to reduce the frequency of post-infectious functional intestinal dysfunction  in patients  with comorbidities. Aim: To evaluate  the  efficacy of human  recombinant interferon  alpha-2b, administered at acute  phase  of an acute  invasive intestinal  infection to infants in the first months  of age, suffering from functional  bowel  disorders. Materials and methods: This  was  an  open-label,  randomized (envelope method), prospective  study in two parallel groups. The study included  59 infants of the  first months  of life, who were breastfed, had a history of intestinal  dysfunction  and were hospitalized  to  an  infectious  department. We studied  efficacy of recombinant interferon  alpha-2b administered in rectal suppositories  at a dose  of   chromatography with measurement of short-chain fatty acids. Results: Standard treatment was ineffective in 63.3% (95% CI 43.9–80.0%) of patients. Administration   of  interferon   alpha-2b   reduced the rate of treatment failure by day 14 to 32% (95% CI 9–56%) and  the  risk of persistent  diarrhea  for more than  one month  to 29% (95% CI 5–53%). In those patients  who were administered interferon, inflammation at days 25 to 55 was less severe and the levels of i-forms of short-chain fatty acids were lower. Conclusion: Immunotherapy with recombinant interferon alpha-2b seems to be a promising way to improve  combination treatment of acute invasive intestinal infections in infants with a history of intestinal dysfunction, as it reduces the risk of post-infectious intestinal disorders.
Almanac of Clinical Medicine. 2015;(42):87-95
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MEASUREMENT OF PROCALCITONIN IN THE CEREBROSPINAL FLUID FOR DIFFERENTIAL DIAGNOSTICS IN CHILDREN WITH MENINGITIS

Mazankova L.N., Guseva G.D., Moiseenkova D.A., Molotilova T.N., Aleshina N.I.

Abstract

Background: High production of pro-inflammatory cytokines associated with procalcitonin synthesis  and  its increased  blood  levels play an important role in the pathophysiology of systemic inflammation  in generalized  bacterial  infections. Aim: To assess diagnostic  value of procalcitonin measurement as a marker of bacterial  inflammation in cerebrospinal  fluid for differential diagnostics of bacterial  and  viral meningitis. Materials and methods: Procalcitonin  levels in blood  and cerebrospinal  fluid were measured by immunoenzyme analysis in 88 children aged from 3 months to 14 years who had been admitted to the hospital. Forty five percent  (45.4%) of them had acute bacterial meningitis, 27.3%, viral meningitis and 27.3% had the meningitis-like syndrome (control group). Results:  There  was a high  procalcitonin  level in   cerebrospinal  fluid in patients with bacterial purulent meningitis  (0,14 [0.0; 0.34] ng/mL (р < 0.006), with  the  normal  range  in the  control  group  of 0.07 [0.0; 0.07] ng/mL. This parameter correlated with blood procalcitonin level (9.8 [2.05; 13.19] ng/mL)  and  severity  of  meningitis.  In  patients with viral meningitis, the procalcitonin levels were below the normal range  (0.02 [0.01; 0.07] ng/mL). Conclusion: Measurement of procalcitonin  levels in cerebrospinal  fluid could be recommended for inclusion into the differential diagnostic algorithm of meningitis of various etiologies in children.
Almanac of Clinical Medicine. 2015;(42):96-102
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NON-INVASIVE METHODS OF THE WORK-UP FOR ASSESSMENT OF MORPHOLOGIC AND FUNCTIONAL STATE OF THE SIGMOID WALL

Mashkov A.E., Rogatkin D.A., Rusanova E.V., Filyushkin Y.N., Kulikov D.A., Sigachev A.V.

Abstract

Background: Prolonged colonic congestion in children with chronic constipation and dolichosigma are characterized  by a permanent imbalance of gut microflora, secondary inflammation and degeneration of the sigmoid wall. There is plenty of research papers on the optic non-invasive diagnostics in medicine, based on spectrophotometry and laser spectral analysis. Aim: To study morphologic and functional state  of the sigmoid wall for detection of inflammation  and  degeneration in the  sigmoid  wall and  optimization  of treatment of children with dolichosigma  and long-standing constipation. Materials and methods: From 2009 to 2014, 30 children with dolichosigma  were seen in the Department of Pediatric surgery of MONIKI. All patients  were  hospitalized  after unsuccessful conservative  treatment in in-patient  clinics of the Moscow Region. The children underwent a set of investigations  for objective assessment of degree of the secondary  inflammatory and degenerative abnormalities  in the sigmoid wall, such as microbiological assessment, cytological assessment and fluorescent  diagnostics.  Results:  There  was  no   caused  by dolichosigma. It maintains  chronic inflammation  and  may play an indirect  role in abnormalities  of gut  motor  function. Inflammatory and  degenerative abnormalities  were  confirmed by a cytological investigation  of wall-adjacent biopsy of the  sigma. The results of the  complex assessment showed  moderate inflammation  and degeneration in the  sigmoid wall in 20 children; subsequent conservative treatment of chronic colostasis was effective. Ten children had advanced secondary inflammatory and degenerative abnormalities of the  sigmoid  wall, with high  levels of elastin and collagen in the colon wall. Surgery was performed in 6 children with the highest degree of fibrous transformation of the sigma. Conclusion: Complex assessment of the sigmoid wall, including  fluorescent  diagnostics  and  microbiological and  cytological  investigations, allows for detection  and  description  of secondary  inflammatory and  degenerative abnormalities  and  subsequent choice of individualized treatment.
Almanac of Clinical Medicine. 2015;(42):103-107
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THE INFLUENCE OF COMBINATION NON-MEDICAL TREATMENT INCLUDING FUNCTIONAL PROGRAMMED ELECTRICAL STIMULATION ON THE CLINICAL AND INSTRUMENTAL PARAMETERS IN PATIENTS WITH CEREBRAL PALSY WITH SPASTIC DIPLEGIA

Eliseev V.V.

Abstract

Background: Cerebral palsy is the leading cause of physical disability in pediatric  age. The search for new methods and improvement of old rehabil- itation techniques is ongoing, due to low efficacy of the latter. Aim: To assess the efficacy of a func- tional programmed electrical muscle stimulation as a part  of combination treatment of patients with cerebral palsy in the form of spastic diplegia. Materials and methods: We analyzed the results of treatment of 71 children with cerebral palsy and spastic diplegia, who had  been  randomized  into two groups  depending on the type of treatment. In  the  first group,  the  patients  (n = 38) received a course of functional programmed electric stim- ulation  in combination with  other  non-medical treatment  methods.  The  second   group   (n = 33) underwent a usual  course  of electrical  stimula- tion in combination with non-medical  treatment, similar to that  in the first group. The third group (control)   included   41   children   without    cere- bral palsy. Clinical and  instrumental parameters were  assessed  in all study  participants. Results: After the course of combination treatment in the group  1, the  tonus  of m. gastrocnemius was de- creased significantly by 41%, that of the posterior group  of femur muscles by 43%, adductor group of femur muscles by 36%. In the group  2, the re- spective parameters decreased by 24, 21 and 21%. Muscle power  endurance was  increased  signifi- cantly in patients of both groups: that of long back extensors by 12.5 and 6.2 sec, of m. rectus abdomi- nis by 10.6 sec and 5.2 sec, of gluteal muscles by 9.3 and 4.6 sec, of m. quadriceps  by 19.8 and 7.2 sec, of m. anterior  tibialis by 12.1 and 4.6 sec, respec- tively. After the  treatment, the  active movement volume in the large joints of lower extremities  in the group 1 patients  improved as follows: by 15.6° in hip joints, by 11.1° in knee joints and by 10.6° in ankle joints. In the second group the correspond- ing values were 7.4° in hip joints, 5.1° in knee joints and 4.8° in ankle joints. The differences for all pa- rameters were statistically significant (p < 0.05), be- ing significantly better in the group 1. Conclusion: The course of the functional programmed electri- cal muscle  stimulation  at  walking,  compared to the usual electrical stimulation in spastic diplegia patients is significantly more effective in reduction of the spastic muscle tonus  of the lower extremi- ties. It improves power endurance of the weak legs and trunk muscles, increases the volume of active movements in big joints of the lower extremities.
Almanac of Clinical Medicine. 2015;(42):108-113
pages 108-113 views

A RARE CASE OF DECOMPENSATED PYLORIC STENOSIS IN A 4-YEAR-OLD GIRL

Pykhteev D.A., Sokolov Y.Y., Mashkov A.E., Slesarev V.V., Sigachev A.V., Gatsutsyn V.V.

Abstract

A rare clinical case of decompensated acquired  pyloric stenosis  in a 4-year-old girl is presented. We demonstrated the feasibility of a laparoscopic gastric resection in this young age patient. There were no early and late post-operative complications. Excellent functional and cosmetic results of the surgery were achieved.
Almanac of Clinical Medicine. 2015;(42):114-116
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REVIEW ARTICLE

MULTICHANNEL INTRALUMINAL IMPEDANCE-PH MEASUREMENT AND ITS OPPORTUNITIES IN CHILDREN WITH GASTROESOPHAGEAL REFLUX DISEASE

Erdes S.I., Polishchuk A.R., Topolskova I.A.

Abstract

Aim: To review data from clinical studies on a multichannel intraluminal impedance-pH measurement in children with gastroesophageal reflux disease (GERD). Key points: Esophageal pH measurement is considered a golden standard of GERD diagnostics   in  children.  However,  this  method can identify only the  acid reflux. Recently, multichannel  intraluminal impedance measurement of esophagus has been  introduced into the work-up of such children. This method gives the opportunity to diagnose  liquid, gas or mixed types of reflux and to determine whether it is acid, weakly acid or basic, as well as to obtain  data  on localization of the bolus in the esophagus, its length  and direction of movement (antegrade or retrograde). We present  the information on normal parameters of multichannel  intraluminal impedance and its use for assessment of infants,  as well as on changes in its parameters in children  with apnoe  and  on clinical value of non-acid reflux. The significance of multichannel intraluminal impedance in detection of esophageal disorders in patients  with otolaryngologic  symptoms   and  other  extra-esophageal signs  is discussed. Аn association  between the results  of this method and  endoscopic  and  histological abnormalities  found in GERD patients  is being actively studied. The authors  of the review focus their attention on the  data  on changes  of multichannel  intraluminal impedance parameters during  treatment of GERD  children  with  proton pump  inhibitors. Conclusion: Multichannel intraluminal impedance is a new modern  method with wide spectrum of diagnostic opportunities.
Almanac of Clinical Medicine. 2015;(42):12-22
pages 12-22 views

THE SIGNIFICANCE OF BREASTFEEDING FOR THE INFANT GROWTH AND DEVELOPMENT: A REVIEW

Ursova N.I.

Abstract

Based on the literature, the review shows the real value of breast milk as the most optimal type of postnatal feeding of infants. We describe biological mechanisms that are supposed to mediate  the influence of breastfeeding on maturation of  immune response, regulation of intestinal functions, trophic effect on small and large intestinal  mucosa, its microflora and somatic growth of an  infant. In infancy, the protective properties of  breast milk against intestinal infections are largely related to its prebiotic effect. According to the  results of the studies on the structure of the milk  fat mycella envelope, their protein not only participate in bacterial adhesion, but also exert substantial anti-microbial activity due to presence of  antimicrobial components. We discuss the role  of protective nutrients, such as zinc, iron, iodine,  selenium and vitamin A and review the results of studies performed in various countries and aimed at evaluation of an association between the type of feeding of an infant in the 1  year of life and the risk of development of somatic abnormalities. A strong influence of micronutrient deficiencies in the pregnant and breastfeeding woman on delay of in utero development has been shown, as well as its contribution to formation of congenital ab- st normalities of any organ or system, connective  tissue dysplasia, initiation and development of alimentary-related conditions in infants.
Almanac of Clinical Medicine. 2015;(42):23-37
pages 23-37 views

ЭПИДЕМИОЛОГИЯ И МЕДИЦИНСКАЯ СТАТИСТИКА

THE ANALYSIS OF MORBIDITY, HOSPITALIZATIONS, LETHALITY AND MORTALITY AMONG PEDIATRIC POPULATION OF THE MOSCOW REGION IN 2014 AND UPGRADING OF THE SYSTEM OF MEDICAL CARE FOR CHILDREN

Ursova N.I., Gurov A.N.

Abstract

Aim: To assess the rates and changes  in morbidity, hospitalizations, lethality and mortality of pediatric population in the Moscow Region in 2014, compared to 2013, and similar data for the Russian Federation  (RF). Materials and methods: We calculated  and  analyzed  morbidity  (based  on referrals),  hospitalizations, lethality  and  mortality  of the pediatric population aged  from 0 to 17 years in the  Moscow Region. The information  was taken from the Federal Statistical Surveillance report forms No 12 and No 14, as well as the Rosstat data for the Moscow Region. Results: In 2014, total pediatric morbidity (age 0–14) in the Moscow Region was 2290.2 per 1000 pediatric  population, being 10% higher, than that in 2013, but lower than the Russian Federation  average  for 2014  (2332.9‰) and lower than that in the Central Federal District (2333.5‰).  Total  morbidity  among   adolescents of 15 to 17 years of age in 2014 increased non-significantly by 1.6% and achieved  2104.7‰. This is lower than Russian Federation and Central Federal District  average   values   (2267.8  and   2188.5‰,   respectively). In 2014, pediatric lethality (age 0–17) in in-patient  department of the  Moscow Region was 0.1% (in infants, 0.13%) and was mainly related to neoplasms  (0.32%), blood and lymphatic disorders  (0.33%), congenital  abnormalities  and  birth defects  (2.61%). In 2014, infant  mortality  in the Moscow Region was 6.8‰ (in 2013, 7.0‰) versus 7.4‰ in Russian Federation  in general. In the first 6 months  of the  year 2015, this parameter in the Moscow Region continues  to  be  lower than  the average  values in Russian Federation  and Central Federal District (5.1, 6.6 and 6.2‰). With this infant mortality, the  Moscow Region ranks 13th   among Russian  Federation   administrative   subjects  and 5th  in Central Federal District. Conclusion: Despite positive trends in many parameters in the Moscow Region, it is necessary to further improve the system of pediatric medical care at all its levels.
Almanac of Clinical Medicine. 2015;(42):6-11
pages 6-11 views

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