No 3 (2020)


Probiotics as prevention for gastro-intestinal disorders in pediatrics

Perceval C., Pletincx M., Vandenplas Y.


The gastro-intestinal microbiome is a hot topic in clinical research. Beneficial effects of selected probiotics in the prevention of gastrointestinal disorders are mainly limited to acute gastroenteritis, antibiotic-associated diarrhea, infantile colic and necrotizing enterocolitis. However, there is no broad consensus to recommend the use of probiotics in the prevention of these conditions, mainly because of the different design of the multiple studies, resulting in a limited evidence for specific strains and dosages and indications. More well-designed studies are needed before recommendations can be proposed. At this stage, there is insufficient evidence to recommend the routine use of probiotics in infants and children for the prevention of gastro-intestinal disorders.
Pediatrics. Consilium Medicum. 2020;(3):12-19
pages 12-19 views

Diet of a nursing mother: what a pediatrician should and can recommend Online educational seminar overview

Zakharova I.N., Kuchina A.E.
Pediatrics. Consilium Medicum. 2020;(3):20-27
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Erythroderma in newborns and infants: differential diagnosis and therapeutic tactics

Dmitrieva J.A., Zakharova I.N., Tamrazova O.B., Bukin S.S.


Erythroderma observed in the first year of a child's life are rare pathological conditions that require special attention from a neonatologist and pediatrician. Neonatal erythroderma can both be a manifestation of physiological and transitional states in newborns, and be a symptom of a number of infectious, metabolic, immune-mediated conditions, some of which have an unfavorable outcome in case of delayed diagnosis. The article presents a clinical observation of a child with neonatal erythroderma, the peculiarities of the course of which determined the need for a differential diagnosis with physiological and transitional states, atopic dermatitis, Leiner-Mousse and Netterton syndromes. Molecular genetic research revealed a mutation in the GJB2 gene, which is responsible for the development of a rare syndromic form of erythroderma described in the structure of Keratitis-Ichtyosis-Deafness syndrome (KID-syndrome). The authors analyzed the features of the clinical picture in correlation with the data of genetic research, and presented possible approaches to therapy. The child's parents agreed to publish the medical history data and display photographs.
Pediatrics. Consilium Medicum. 2020;(3):29-34
pages 29-34 views

Analysis of vitamin D sufficiency of young children in the south of Russia and in Saudi Arabia

Klimov L.Y., Dolbnya S.V., Al'himidi A.A., Kur'yaninova V.A., Tsutsaeva A.N., Dyatlova A.A., Kipkeev S.O., Zakharova I.N.


Aim. The purpose of this work was to analyze the vitamin D sufficiency in children of the first three years of life, living in southern Russia and in the north-west of the Kingdom of Saudi Arabia during the period of minimal insolation. Materials and methods. In the period from October to March, 132 children from the Tabuk city of the Kingdom of Saudi Arabia (28°23'50 " N 36°34'44" E) and 262 patients living in Stavropol of Russian Federation (45°02' N 41°58' E) were examined. The assessment of vitamin D availability was based on the determination of serum calcidiol [25(OH)D] by competitive chemiluminescent immunoassay. Results. The level of calcidiol [Me (Q25-Q75)] of children in Tabuk was 28.0 (21.9-35.9) ng/ml, in Stavropol - 23.7 (16.2-32.7) ng/ml (p=0.0003). Vitamin D deficiency was detected in 26 (19.7%) children from Saudi Arabia and 97 (37.0%) from Stavropol (p<0.02), insufficiency (from 21 to 29 ng/ml) in 42 (31.8%) and in 87 (33.2%) cases, and normal provision in 64 (48.5%) and 78 (29.8%) children, respectively (p<0,0005). The availability of cholecalciferol in children from 1 to 5 months was 24.2 (18.7-31.9) ng/ml in Tabuk and 25.3 (14.8-34.1) ng/ml in Stavropol, patients from 6 to 12 months - 34.3 (27.4-37.8) ng/ml and 31.9 (22.1-39.9) ng/ml, children from 12 to 24 months - 31.7 (25.1-41.6) ng/ml and 22.9 (15.8-28.8) ng/ml (p=0.0002), patients from 2 to 3 years old -24.1 (19.5-30.3) ng/ml and 18.2 (14.2-24.8) ng/ml in Tabuk and Stavropol, respectively (p=0.0003). The availability of cholecalciferol in children not receiving vitamin D preparations in Tabuk was 27.8 (21.0-34.6) ng/ml, in Stavropol 19.4 (12.7-25.5) ng/ml (p=0.0003). Against the background of prophylactic intake of vitamin D preparations, the level of calcidiol in children in Tabuk was 32.9 (26.1-34.3) ng/ml, and without taking - 27.8 (21.0-34.6) ng/ml (p=0.05); in Stavropol - 29.0 (21.6-39.4) ng/ml against the background of taking and 19.4 (12.7-25.6) ng/ml without it (p=0.000000001). Vitamin D deficiency was detected in 13 (24.1%) patients of Tabuk without taking, and against the background of pharmacological prophylaxis there was not a single child with a level of 25(OH)D below 20 ng/ml. Stavropol children without taking cholecalciferol preparations had a vitamin D deficiency in 70 (52.6%) cases and in 27 (20.9%) against a background of taking it (p<0.0005). Conclusion. Vitamin D provision for children in the first three years of life living in the south of the Russian Federation was significantly worse than in a similar age cohort of children from the north-west of the Kingdom of Saudi Arabia. The age trends in vitamin D provision were the same for Saudi and Russian children; in the first year of life, a large proportion of patients in southern Russia maintain vitamin D status commensurate with Arabian, in the second and third years of life, vitamin D availability decreases in both countries, but in Russia Vitamin D deficiency is more common. The level of natural insolation in Tabuk allows maintaining the number of children with vitamin D deficiency at about 20%, while in the south of Russia, without drugs prophylaxis of hypovitaminosis D, more than half of children have vitamin D deficiency.
Pediatrics. Consilium Medicum. 2020;(3):35-42
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Relationship between atopic dermatitis and food allergy

Smolkina O.l., Dvoriankova E.V., Nevozinskaia Z.A., Korsunskaia I.M.


Atopic dermatitis (AD) is often associated with food allergies. The development of food allergies can worsen the course of AD. The increase in the incidence of AD and food intolerance may be associated with changes in the epigenome under the influence of the environment. There are also many prenatal and perinatal factors that can increase the risk of developing food allergies and/or AD: changes in the intestinal microbiota of the mother during pregnancy, caesarean section, the season of childbirth, etc. In the postnatal period, changes in the composition of the microbiome become important risk factors for the development of these diseases. exposure to food allergens. As shown by our own observations, depending on the age group, the set of food allergens may change and play a lesser role in exacerbation of AD. In cases where an allergic component acts as a provoking factor for AD, an antihistamine must be included in the therapy. Our experience shows the effectiveness of the use of desloratadine in pediatric practice together with topical glucocorticosteroids and moisturizers.
Pediatrics. Consilium Medicum. 2020;(3):43-46
pages 43-46 views

Prevention of influenza and acute respiratory viral infections during the period of seasonal rise in morbidity

Kholodova I.N.


In the article, the author provides data on the features of the course of the new COVID-19 infection and its relationship with the course of various acute respiratory viral infections (ARVI). Emphasis is placed on the need for timely prevention of ARVI in connection with the proven fact that a previous illness with influenza or ARVI can significantly increase the risk of developing COVID-19. It has been shown that at present, specific prophylaxis is carried out only for influenza, while it does not always allow achieving good results, and in relation to other viruses (adenoviruses, parainfluenza viruses, rhinoviruses, etc.) it is not carried out at all. In this regard, it is of particular importance to carry out the so-called non-specific prophylaxis. As the latter, it is proposed to use homeopathic medicines with proven efficacy. One of them is Oscillococcinum. The data of experimental and clinical justification (randomized placebo-controlled trials) of the use of this drug in ARVI prevention programs are presented. Its effectiveness and safety in both adults and children are underlined.
Pediatrics. Consilium Medicum. 2020;(3):47-51
pages 47-51 views

Bacterial lysates as immunostimulants for respiratory infection in children: mechanism of action, efficacy and safety

Shevyakov M.A.


The relevance of the use of immunostimulants in the complex treatment of acute and recurrent respiratory infections is beyond doubt. At the same time, a number of factors: unexplored mechanism of action, lack of evidence of efficacy, unexplored safety - inhibit the widespread use of many immunostimulants. In contrast to bacterial lysates, in particular the drug OM-85 (Broncho-Munal®), on the contrary, there are reliable data on good efficacy against both acute and recurrent respiratory infections, evidence of safety and scientific information on the mechanism of action.
Pediatrics. Consilium Medicum. 2020;(3):52-58
pages 52-58 views

Outpatient practice for the treatment of patients over 4 years old with monthly respiratory diseases and herpesvirus infection

Melekhina E.V., Muzyka A.D., Ponezheva Z.B., Gorelov A.V.


Relevance. In connection with the overdiagnosis of active forms of herpes viral infections and, as a consequence, polypharmacy and the appointment of im-munotropic drugs for a long time and off-label, the problem of the need and sufficiency of therapy for children with recurrent diseases of the respiratory tract, occurring against the background of reactivation of herpes viral infections, is urgent. Clinical studies have shown that children with monthly acute respiratory in-fections (ARI) and active forms of herpesvirus infections (Epstein-Barr virus, cytomegalovirus) are characterized by lower levels of immunoglobulin A, interfe-ron-α and γ. Aim. Analysis of the effectiveness of therapy with the inclusion of meglumine acridone acetate in children with monthly infections of the respiratory tract in outpatient practice. Materials and methods. The study included 75 patients over the age of 4 years who came to an outpatient clinic with complaints of monthly ARI within the last 6 months and had markers of herpes viral infections. Results. It has been demonstrated that the use of meglumine acridone acetate in children with monthly respiratory infections leads to a statistically significant increase in complete clinical recovery (67.3% in the main group versus 8.7% in the comparison group) and the transition of herpes viruses into a latent state (53.8 and 13% respectively). Prescribing meglumine acridone acetate significantly reduced the proportion of patients with active human herpesvirus-6A / B and Epstein-Barr virus infections. In addition, the appointment of meglumine therapy with acridone acetate has a positive effect on the level of neutrophils after tre-atment, which is significantly higher in the main group than in the comparison group (3.52×109 and 2.09×109 cells, respectively). Conclusion. The drug meglumine acridone acetate (Cycloferon®) can be recommended for patients over 4 years of age as an etiotropic therapy for herpes vi-ral infections in children with monthly ARI.
Pediatrics. Consilium Medicum. 2020;(3):59-64
pages 59-64 views

The course of plastic bronchitis in children

Malakhov A.B., Yablokova E.A., Tkachev M.I., Kovalenko I.V., Sokolina I.A.


Plastic bronchitis (PB) is a rare disease that occurs at any age patients with cardiovascular or pulmonary pathology. The pathogenesis of bronchial casts formation is not completely clear. Dense casts obturate the lumen of the bronchi, causing the formation of atelectasis. The extremely high heterogeneity of the clinical manifestations of plastic bronchitis makes timely diagnosis a difficult problem. Recommendations for the management of such patients have not been developed, the most effective and universal interventions are sanitation bronchoscopy and physical methods to restore the patency of the respiratory tract. The composition of inhalation nebulizer therapy is different, its use allows you to avoid relapses of the disease. The article provides a detailed review of modern descriptions of PB in children, a clinical case of PB in a 3-year-old child.
Pediatrics. Consilium Medicum. 2020;(3):65-72
pages 65-72 views

Differential diagnosis between postinfectious bronchiolitis obliterans and hypersensitive pneumonitis

Spichak T.V., Kustova O.V.


The article draws the attention of pediatricians to two rare forms of bronchopulmonary pathology in children: post-infectious obliterating bronchiolitis and hypersensitive pneumonitis, for which crepitant or moist small bubbling rales are typical persistent or appearing in the same areas of the lungs. The characteristics of each of these forms of pathology, including etiology, features of morphological changes in lung tissue, clinical and functional manifestations of the disease, treatment characteristics, course and prognosis, as well as accepted diagnostic criteria, are given. On a specific clinical example, the complexity of the diagnosis of the lobar variant of post-infectious obliterating bronchiolitis, due to the inconstancy of respiratory complaints, and differential diagnosis with hypersensitive pneumonitis, especially in young children, is shown. Dynamic monitoring of the patient with the implementation of a set of necessary research methods and monitoring the dynamics of the process allows avoiding errors in diagnosis and treatment with systemic steroids in the absence of signs of disease progression.
Pediatrics. Consilium Medicum. 2020;(3):73-79
pages 73-79 views

Visceral leishmaniasis in children (own results and literature analysis)

Volkova G.I., Smirnova M.I., Delyagin W.M.


Leishmaniasis is a tropical parasitic infection with a preferred lesion in children. Leishmaniasis, perceived as an infection in hot and humid regions, is not always taken into account in the differential diagnostic search in febrile children with splenomegaly, the degree of which prevails over hepatic anemia. The geographical factor is not taken into account. In our observations, the period from the first symptoms to the diagnosis ranged from 0.5 to 17 months. The diagnosis is confirmed by the results of bone marrow puncture, immunological tests. Treatment is based on the use of antimony drugs. Often, adverse reactions are recorded in the form of an increase in hepatic enzymes, bilirubinemia, anemia. Prevention is the avoiding of mosquito bites.
Pediatrics. Consilium Medicum. 2020;(3):80-83
pages 80-83 views

Reference values of the heart rate and the heart rate coefficient of variation in infants during different sleep phases

Kelmanson I.A.


Reference values of the heart rate and of the heart rate coefficient of variation during different sleep phases based on the polysomnographic findings in 2073 infants are presented. Reference values were constructed using conventional LMS (lambda-mu-sigma) smoothing algorithm aimed at maximal approximation of the calculated values to the real ones. Reference centile curves and tables for infants aged 1 through 52 weeks at different sleep phases as a function of infant age and sex are provided. The reference values presented in this work are compared with known published data.
Pediatrics. Consilium Medicum. 2020;(3):84-91
pages 84-91 views

Syncope during sleep in a child with hereditary long QT syndrome (case report)

Pshenichnikova I.I., Tvorogova T.M., Zakharova I.N.


Genetically determined long QT syndrome is characterized by attacks of loss of consciousness against the background of episodes of malignant ventricular arrhythmias. Due to the high risk of sudden cardiac death, timely diagnosis of this pathology is of great importance. In the given clinical observation, the manifestation of the syndrome of an extended QT interval in a 5-year-old boy is described. The manifestations of the disease were short-term episodes of loss of consciousness, which developed during sleep in the morning during the transition of sleep phases: "sleep - wakefulness". Clinically, this was expressed by crying, straining, pallor of the skin, followed by a complete loss of muscle tone and involuntary urination. Examination on a standard electrocardiogram revealed a significant lengthening of the absolute and corrected QT interval. During the daily monitoring of the electrocardiogram, pre-morning paroxysm of frequent ventricular extrasystole was revealed, against which a burst of tachycardia "pirouette" was recorded with a heart rate of 138 beats / min, lasting 8 seconds. The patient was prescribed antiarrhythmic therapy, against the background of which a positive effect was obtained in the form of the disappearance of clinical symptoms, a reduction in the duration of the QT interval (absolute and corrected), the absence of bursts of ventricular tachycardia "pirouette" with repeated daily recordings of the electrocardiogram. Clinical observation demonstrates the need for timely in-depth cardiological examination of patients with syncope.
Pediatrics. Consilium Medicum. 2020;(3):92-94
pages 92-94 views

Interferon clinical use: modern view on efficacy and safety. Literature review

Valiev T.T.


Interferons (IFN) were find about 65 years ago and during this time it was studied structure, types, cells producing this cytokines and genes coding of IFN. It was paid a great attention to IFN functions and biologic role in anti-viral and anti-tumor immunity, and in systemic inflammatory and autoimmune reactions. By biologic effects, which arise in organism by IFN, administrations for IFN clinical use were formed: viral infections and malignancies therapy. Currently, proposed clinical IFN use are scale down, because of not only new (including targeted) drugs, but also increased reports about long-term side effects, caused by IFN. One of the most serious side effects are autoimmune disorders, which make us reconsider IFN therapy to more safety drugs.
Pediatrics. Consilium Medicum. 2020;(3):95-104
pages 95-104 views

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