No 2 (2020)


Second malignant tumors in pediatric cancer survivors

Pavlova T.Y., Valiev T.T.


The development of a second malignancy is one of the most serious late effect for children who have been cured from the first malignancy. Chemoradiotherapy is a carcinogenic factor of the developing of the second malignancy. Organs and tissues of the child's body, taking into account the degree of maturity, microenvironment, age and life factors, are differently susceptible to the carcinogenic effects of chemo- and radiation therapy. Given the increase in the number of patients cured from the first malignancy, improving therapy is aimed at reducing the risk of developing a second malignancy as the child's body grows and develops. Determining the risk factors for secondary malignancy and developing measures aimed at reducing the frequency of secondary tumors in pediatric cancer survivors is an important task of modern oncopediatry. This paper presents the most common childhood tumors, after treatment of which the development of the second malignancy occurs. Risk factors and timing of secondary tumors are highlighted. Special attention is paid to recommendations for monitoring people who have been cured of malignancy in childhood.
Pediatrics. Consilium Medicum. 2020;(2):12-16
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From simple symptoms to complex diagnosis

Zaytseva O.V., Besedina M.V., Striga E.V., Tolstova E.M., Lokshina E.E., Zaytseva N.S., Beliaeva T.Y.


The pediatrician is often the first doctor to deal with the onset of various diseases. Deep and constantly updated knowledge are very important in the daily practice. Often observed, the most common symptoms, for example, fever, rash, feeding disorders, are the primary signs of a serious diseases. In such cases, when careful anamnesis and microsymptomatics may suspect a disease, pediatrician could competently examine the patient and refer him to experts. In this article, we present three clinical cases when, despite all the observed manifestations, due to the joint work of specialists, histiocytosis and specific infectious diseases were detected in a timely manner, which makes it possible to start adequate therapy in a positive time frame.
Pediatrics. Consilium Medicum. 2020;(2):17-20
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Payr's syndrome as the cause of chronic abdominal pain in children

Kamilova A.T., Ergashev N.S., Nurmatova N.S., Geller S.I.


Payr's disease occurs with stenosis of the colon due to its excess in the zone of splenic curvature. This symptom complex is characterized by paroxysmal abdominal pain, a feeling of pressure or fullness in the upper left quadrant of the abdomen, pressure or burning pain in the region of the heart, palpitations, shortness of breath, chest or pre-cardiac pain with a sense of fear, one- or two-sided shoulder pain with radiation to the arm, pain between the shoulder blades. The article describes the clinical case of a patient with Payr's disease. All available publications devoted to this topic are analyzed.
Pediatrics. Consilium Medicum. 2020;(2):21-24
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Eyes vs COVID-19 infection: the gates of infection or one of the target organs?

Mishustin A.V., Melnicova M.B., Ponomareva N.I., Kononova N.A., Delyagin V.M.


The bulk of publications devoted to coronavirus infection (COVID-19) is devoted to lung damage, less often to neurological and gastroabdominal disorders. Significantly less attention is paid to eye damage. Conjunctivitis is usually described. Considering the pathogenesis of COVID-19, the eye is defined as the entrance gate to infection. However, the anatomical and immunological characteristics of the eye allow us to talk about the essential role of the eye in the spread of infection throughout the body and damage to the eye as a target organ. COVID-19 has a tropism for eye tissue. The eye has a large surface in contact with virus-containing microaerosols in the air and contaminated hands. Attachment of the virus occurs on the conjunctiva, cornea, retina due to angiotensin converting enzyme 2 (ACE2) receptors and some other receptors, lipophilic periocular skin and superficial tear film. From there, through the tear-nasal duct, the virus enters the nose under the lower nasal concha, from where it is transferred through the nasopharynx and oropharynx to the lungs and intestines. Simultaneously with the transfer of the virus, a specific inflammatory process in the form of conjunctivitis and lacrimation is also played out. The hematogenous introduction of the virus into the retina is manifested by microthrombosis of its vessels, edema. In children, the density of the receptors that ensure the fixation of the virus is significantly lower than in adults. COVID-19 eye damage may be the debut of systemic manifestation. Therefore, ophthalmologists who are in close contact with patients with conjunctivitis, initially perceived as adenoviral, are most at occupational risk. Given the adhesive, transmissible and pathogenetic significance of the eye in the development of COVID-19, it is necessary to evaluate the importance of aerosols reaching the eyes and drops (ACE2 receptor blockers, zinc, azithromycin, etc.) for the prevention and treatment of COVID-19.
Pediatrics. Consilium Medicum. 2020;(2):26-28
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Influence of vitamin D on the immune response of the organism

Zakharova I.N., Maltsev S.V., Zaplatnikov A.L., Klimov L.Y., Pampura A.N., Kuryaninova V.A., Berezhnaya I.V., Zhdakaeva E.D., Simakova M.A., Tsutsaeva A.N., Dolbnya S.V., Verisokina N.E., Krushelnitsky A.A., Makhaeva A.V., Sychev D.A.


A literature review is devoted to the effect of vitamin D on the body's immune response. Studies show that vitamin D is able to inhibit the synthesis of pro-inflammatory cytokines, and, as a result, play an important role in the formation of immune tolerance, which is important in infectious, autoimmune diseases and in patients after organ transplantation. Vitamin D can be used both as a prophylaxis and for therapeutic purposes for infectious diseases, in oncohematology, allergology, gastroenterology, and can also affect the intrauterine development of the fetus and the immune response of the newborn, reducing the risk of pregnancy pathology, risks of premature birth and placenta pathology, as well as reducing the frequency, severity and risk of adverse outcome in newborns with congenital and acquired infectious diseases. In the postnatal period, normal provision with vitamin D not only reduces the frequency, but also prevents the formation of severe forms of autoimmune, allergic diseases in children and adolescents.
Pediatrics. Consilium Medicum. 2020;(2):29-37
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Maintenance of remission and prevention of disease flares in children with atopic dermatitis. Position paper of the Association of Children's Allergists and Immunologists of Russia

Smolkin Y.S., Migacheva N.B., Smolkina O.Y.


Since atopic dermatitis is a chronic disease with recurrent course having a significant negative effect on the quality of life of patients and their families the important attention in clinical practice should be given to measures aimed to maintaining of disease remission and flares prevention. Key measures are: systematic rational skin care, exclusion of the impact of allergenic and non-allergenic triggers, timely use of topical anti-inflammatory drugs at first sign of an exacerbation. The goal achievement is possible only through close interaction with parents of children suffering from atopic dermatitis, patient’s therapeutic education and their active involvement into disease control process.
Pediatrics. Consilium Medicum. 2020;(2):38-45
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Hypersensitivity reactions of insect genesis in children

Mil'dzikhova D.R., Niewozinskaya Z.A., Korsunskaya I.M.


Insects make up 1/2 of the living organisms on the planet. Insect bites are a common phenomenon that usually does not require seeking specialized treatment. It is almost impossible to establish a reliable frequency of allergic reactions to insect bites. Most often, a specialist is consulted about severe skin manifestations in children due to bites of mosquitoes, bees, bugs, lice and fleas. The peak of calls occurs in the summer period, so, according to some reports, insect bites are the cause of calls for help in 44% of cases. Skin manifestations of allergies are often caused not by the bite itself, but by various enzymes in the saliva of the insect. Insect bites can occur in the form of hives or delayed reactions with papules, ulcers or blisters that persist for several weeks. The main problem with insect bites is intense itching, which can cause the attachment of a bacterial infection. In view of this, the treatment of insect allergies is primarily aimed at stopping itching. In children in different age groups, regardless of the localization of bites, a gel containing dimetindene maleate can be used, which is highly effective in allergic dermatoses.
Pediatrics. Consilium Medicum. 2020;(2):46-49
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Irrigation therapy in the treatment and prevention of pathology of the nasal cavity in young children

Subbotina M.V.


The article describes the main protective mechanisms of the mucous membrane of the respiratory tract (epithelial barrier, mucociliary clearance, antimicrobial peptides, immunoglobulin A, microbiota), which prevent the penetration of respiratory infections. Mucociliary transport slows down the low humidity of the inhaled air and mucous membrane, as well as drugs such as benzalkonium chloride, naphazoline, oil drops, astringents. Carbocysteine, macrolides, salbutamol, saline solutions accelerate the work of the ciliary epithelium. Features of infants are underdevelopment of cavernous tissue in the nasal cavity, inability to breathe through the mouth with nasal congestion, and the presence of various, including intestinal, microflora in rhinitis. A feature of the course of rhinitis in young children is often the absence of a fluid secretion in the nose, and noisy labored breathing is caused by dry crusts of accumulated secretion in the posterior nasal cavity, which are practically not removed by aspiration. These features determine the low effectiveness of decongestants in the treatment of rhinitis, which can also lead to undesirable side effects, such as tachycardia, lethargy, and coma. Maintaining normal protective factors for the nasal cavity plays an important role in preventing acute respiratory viral infection in young children. This is facilitated by environmental humidity, which can be ensured by the use of special air humidifiers, as well as by irrigation of the nasal cavity of young children with saline solutions. The article describes the objectives, indications and methods of irrigation therapy for the prevention and treatment of rhinitis in infants.
Pediatrics. Consilium Medicum. 2020;(2):50-55
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Characteristics of congenital and hereditary factors and their role in the genesis of vegeto-vascular dysfunction by hypotensive type

Melnikova I.Y., Buryak V.N.


Materials and methods. We examined 89 adolescents aged 11 to 14 years suffering from vegetative-vascular dysfunction (VVD) by the antihypertensive type, among them 36 adolescents in whom VVD was combined with grade I thyroid hyperplasia, and 53 teenagers with VVD a history of indications of perinatal damage to the central nervous system (PDCNS). The control group consisted of 69 healthy adolescents of a similar age. All subjects were typed with 15 antigens of group A and 24 antigens of group B of the main histocompatibility complex HLA. Results. When determining the association strength of typed antigens with VVD with the enlargement of the thyroid gland of the first degree (VVDTG), the most pronounced relationship was found for B44 antigen, to a lesser extent B15 and B5 antigens, as well as antigen A1. Association with PDCNS was most pronounced for antigens B44 and A29. The association with B13 antigen disease was strong enough. To a slightly lesser extent, it was determined for antigens A25 and A19. Significantly more frequent occurrence in adolescents with VVD of B44 antigen, both with concomitant hyperplasia of the thyroid gland, and in the presence of anamnestic indications of damage to the central nervous system transferred in the perinatal period, indicate a similar mechanism of inheritance and development of VVD in adolescents. The presence of the B44 antigen in a child makes it possible to predict with a high degree of probability the possibility of developing VVD.
Pediatrics. Consilium Medicum. 2020;(2):56-61
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Evaluation of the clinical effectiveness of various anti-relapse therapy regimens in children with pyelonephritis

Eremeeva A.V.


Relevance. Currently, pyelonephritis (PN) remains one of the most common bacterial infections in children. Treatment of chronic PN (CP) should be based on the principles of staging, continuity and continuity. Purpose. Evaluation of the advisability of prescribing anti-relapse therapy, its tolerability and the effectiveness of various regimens to prevent relapse in children with acute and CP. Materials and methods. The study involved 167 children from 2 to 12 years old, including 139 (83.2%) girls and 28 boys (16.8%). Children were divided into the following groups: 1A (n=32) with the onset of acute PN, received cephalosporins (CS) of the third generation for 10-14 days; 1B (n=35) - with the onset of acute PN, received third-generation CS for 10-14 days, then for 1 month - a combination of standardized extracts of BNO 1040; group 2A (n=32) with recurrent CP received third generation CS for 10-14 days, then furazidine for 14 days; group 2B (n=34) with recurrent CP received third generation CS for 10-14 days, then furazidin for 14 days, then a combination of standardized extracts of BNO 1040 for 1 month; group 2B (n=34) with recurrent CP received third-generation CS for 10-14 days, then a combination of standardized extracts of BNO 1040 for 3 months. Results. During anti-relapse therapy, all patients in group 1B showed no recurrence of the disease in the first 6 months after the end of antibiotic therapy, as well as a tendency to increase the duration of the remission period when compared with group 1A. Among patients with CP, the least effective treatment regimen was used for group 2A; it was statistically significantly (p<0.05) inferior in anti-relapse effect to groups 2B and 2C. No significant differences were found between group 2B and group 2C. Conclusion. The use of anti-relapse therapy in children with acute PN reduces the likelihood of relapse in the first 2 years from the onset of the disease. Among patients with CP, the optimal results for an increase in the remission period were obtained with a combination therapy furazidine + a combination of standardized extracts BNO 1040 or long-term herbal therapy with a combination of standardized extracts BNO 1040.
Pediatrics. Consilium Medicum. 2020;(2):62-66
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Experience in the effective long-term use of adalimumab in the treatment of a patient with an early debut of juvenile idiopathic arthritis and uveitis

Galstyan L.A., Zholobova E.S., Suchkova D.V., Chebysheva S.N., Meleshkina A.V.


A case of early debut of juvenile idiopathic arthritis in a 2-year-old patient associated with uveitis, refractory to methotrexate therapy, non-steroidal anti-inflammatory drugs, and topical glucocorticoids, is presented. The given clinical example demonstrates the high therapeutic efficacy of adalimumab. The duration of remission of the articular syndrome and uveitis was 5 years.
Pediatrics. Consilium Medicum. 2020;(2):67-71
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Osteotropic micronutrients and their effect on bone remodeling in adolescents

Zakharova I.N., Tvorogova T.M., Vasil'eva S.V., Vorob'eva A.S., Stepurina L.L., Kuznetsova O.A.


The formation of bone mineral density and its maximum peak mass is associated with the provision of the body with osteogenic micronutrients - vitamin D, calcium, magnesium and trace elements involved in the synthesis of bone matrix and its mineralization. Aim. To study the provision of adolescents with vitamin D, micro- and macroelements (calcium, magnesium, zinc, copper, manganese, boron) with an assessment of the state of metabolism and bone mineralization. Methods An open prospective study was carried out with the participation of adolescents aged 10-17 years of the 1-2 health group. The concentration of 25(OH)D, calcium, magnesium and zinc in the blood serum, the content of magnesium, zinc, boron, copper, manganese in the hair, calcium excretion in the urine, the level of osteocalcin, C-terminal telopeptides of type I collagen (beta-cross laps) in blood. A densitometric study of the lumbar spine was carried out. The effect of a combined preparation containing vitamin D, micro- and macroelements on the level of 25(OH)D, microelements and bone mineral density was analyzed. Results. In the autumn-winter period, 100 teenagers were included in the study. Vitamin D deficiency was found in 96 out of 100 adolescents, inadequate provision - in 4 people. The normal content of all studied trace elements was observed only in 4 out of 100 adolescents. Urinary calcium excretion was decreased in all adolescents. A low level of osteocalcin was found in 46 (48%) of 96 adolescents, an increased content of beta-cross lars - in 17 (18%). 46 out of 100 adolescents are diagnosed with osteopenia. Against the background of corrective therapy (n=73), there was a positive dynamics of the supply of vitamin D, micro-and macroelements, as well as bone mineralization. Conclusion. In adolescents, a high prevalence of vitamin D deficiency, diselementosis, combined with disturbances in the processes of bone tissue remodeling, was revealed.
Pediatrics. Consilium Medicum. 2020;(2):72-79
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Iron deficiency syndromes are the basis of a personalized approach to the treatment of anemia in pediatric practice

Demikhov V.G., Lebedev V.V., Demikhova E.V., Abalenikhina Y.V., Dmitriev A.V.


The erythron’s physiological function is possible only with the normal bone marrow, adequate renal production of erythropoietin and sufficient supply of substrate (iron, protein) to erythroid bone marrow progenitor cells. Any defects of these factors can lead to the development of anemia. Iron deficiency is one of the most common causes of anemia in children. The causes of iron-deficiency erythropoiesis and anemia are different and are called iron-deficiency syndromes (IDS). Allocate absolute iron deficiency, a functional deficiency of iron, iron sequestration and hereditary IDS. Absolute iron deficiency leads to iron deficiency anemia (IDA), iron sequestration to anemia of inflammation, and individual mutations of genes encoding iron metabolism lead to hereditary forms of IDA. In clinical practice, the cause of anemia can be either one iron deficiency syndrome, or a combination of several IDS at once. Complex disorders of erythropoiesis and iron metabolism in patients with anemia can be the cause of resistance to oral iron. Differential diagnosis of the main IDS in individual case allows to choose the more optimal available therapeutic options.
Pediatrics. Consilium Medicum. 2020;(2):80-84
pages 80-84 views

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