No 4 (2020)
Articles
Dear colleagues and friends!
Abstract
We see off this difficult year, which has brought so many worries and difficulties. He demanded a lot of effort and courage from doctors, which helped the vast majority of patients to recover. The new coronavirus infection, which has shaken up the usual order of life in all countries of the world without exception, which has affected almost every person, has created enormous risks and difficulties, but has also taught us a lot. The need to combine efforts, mutual assistance, humanity and kindness became even more obvious.
11-11
Active specific immunoprophylaxis of influenza in the context of the COVID-19 pandemic and the beginning of vaccination against coronavirus infection caused by the SARS-CoV-2 virus
Abstract
A literature review based on the analysis of data published in the open press or available in electronic form on the official websites of international and national professional medical communities, as well as government regulatory bodies, is devoted to the issues of influenza immunization in the context of the COVID-19 pandemic and the start of vaccination against coronavirus infection caused by the SARS-CoV-2 virus. It is emphasized that influenza vaccinations significantly reduce the incidence and frequency of severe forms of influenza infection, which is accompanied by a decrease in the burden on the healthcare system and the preservation of reserves to combat the COVID-19 pandemic. Preliminary data are presented on the positive impact of influenza immunization on the incidence, severity and outcome of COVID-19, especially in people over the age of 65. Changes were noted in the National Immunization Schedule aimed at increasing coverage with influenza vaccinations, as well as at the start of vaccination against coronavirus infection caused by the SARS-CoV-2 virus, with the allocation of priority populations for priority immunization.
12-16
Influence of the media and social media on public opinion about vaccination
Abstract
The history of the creation of the first vaccine that saved the world from the deadly disease of smallpox is more than 200 years old. Most modern vaccines are safe and effective in preventing disease. Throughout history, there have been supporters and opponents of vaccination, despite overwhelming evidence that the procedure saves a huge number of lives. The article provides a historical overview of the creation of vaccines and the formation of public opinion about vaccination. Examples of refusal to vaccinate on the basis of irresponsible anti-vaccination propaganda, which resulted in outbreaks of socially significant infectious diseases, are given. The reasons for refusing vaccinations are fear of reaction to vaccinations and complications after the procedure, religious motives and other factors. In modern society, the formation of public attitudes towards vaccination is greatly influenced by the media and social networks. Vaccine misinformation can be politically and economically ordered. In the context of the COVID-19 pandemic, vaccination will be the most effective preventive measure. Achieving widespread vaccination coverage requires education at all levels, including the media and social media. It is necessary to educate the public about the risks and benefits of vaccination, which should promote immunity to fears about vaccine safety and unfounded rumors, as well as prevent their spread. The need to increase adherence to vaccination was reflected in the Strategy for the Development of Immunoprophylaxis of Infectious Diseases for the Period until 2035.
17-24
On the issue of symptomatic treatment of respiratory infections in children during the COVID-19 season
Abstract
The current epidemic season is characterized by a high incidence of acute respiratory viral infections and a new coronavirus infection among children. A significant part of children suffer from respiratory infections in mild and moderately severe forms, and only need symptomatic therapy, which includes antipyretic therapy. Both with a banal respiratory infection, and with COVID-19, ibuprofen and paracetamol can be used.
25-30
Novel coronavirus infection in childhood: literature review and clinical observation
Abstract
The article presents a review of the literature and a clinical observation of a case of a severe form of the new coronavirus infection COVID-19 in an 8-year-old child, which was complicated by a bacterial infection. The relevance of this clinical case is associated with the novelty of the disease itself, the relative rarity of a severe form of a new coronavirus infection in childhood, the complexity of its treatment, and a combination of viral and bacterial inflammation of the lower respiratory tract.
31-37
Possibilities of using topical (intranasal) solution of framycetin in the treatment of inflammatory pathology of the nasal cavity and nasopharynx in children 3–9 years old
Abstract
Relevance. Topical antimicrobial agents (TAAs) have been used for many years to treat infections of various organs and systems, acting directly at the site of inflammation and providing a high local concentration in the absence of side/undesirable effects often associated with the use of systemic antibacterial agents. TAAs are included in the clinical guidelines of professional medical communities not only in combination with systemic antibacterial agents, but also as an alternative method of treatment (especially in otorhinolaryngology).
Aim. To evaluate the clinical efficacy of a solution for intranasal use based on framycetin of Russian (Tramicent®) and foreign (Isofra®) production in the complex therapy of patients with rhinopharyngitis and rhinosinusitis.
Materials and methods. The study included children aged 3 to 9 years who applied for an outpatient appointment with an otorhinolaryngologist for nasal congestion and/or discharge and did not require hospitalization for the underlying disease. All patients were prescribed treatment: sea water solutions for irrigation of the nasal mucosa in combination with intranasal TAA framycetin: Russian-made framycetin was used in children of group 1 (Tramicent®), in children of group 2 – foreign production (Isofra®). 7 days after the initial examination, the state of nasal breathing, rhinoscopic picture, dynamics of disease symptoms and satisfaction with the treatment of parents/legal representatives were assessed.
Results. The study included 61 patients aged 3 to 9 years (31 boys and 30 girls) with diagnoses of rhinopharyngitis (68%) and rhinosinusitis (32%). Comparison of the evaluated symptoms in patients on day 0 and day 7 showed that both drugs had a positive therapeutic effect: a statistically significant difference was noted in both groups for all studied symptoms on day 0 versus day 7 (p<0.05). Patients and/or their parents/legal representatives subjectively assessed the effectiveness of treatment with both drugs as “satisfied” and “very (very) satisfied”, no statistically significant difference was found (p=0.1987).
Discussion. The use of a Russian drug based on framycetin, in comparison with its foreign analogue, showed comparable clinical efficacy for all indicators evaluated in this study, with the exception of the symptom «nasal cavity edema». Subjective assessment of the treatment performed by parents/legal representatives of children also did not reveal a statistically significant difference in the use of framycetin produced in Russia and abroad (p=0.1987).
Conclusion. A Russian-made drug based on framycetin is not inferior in clinical efficacy to a foreign analogue, it is safe and can be used in treatment regimens for infectious and inflammatory pathologies of the nasal cavity and nasopharynx in children aged 3 to 9 years.
38-43
Herpes infections and allergic diseases in children
Abstract
The frequency of allergic pathology increases significantly every year. Herpetic infection is a constant companion of a person. Given the high percentage of herpes viruses infected, as well as their almost lifelong persistence in patients, the Association of herpes infections and allergic diseases is particularly relevant. Most often, herpes infections complicate the course of atopic dermatitis in children, often leading to the development of both acute and recurrent herpetic eczema. Chickenpox in children with atopic dermatitis is more severe, often complicated by the addition of a secondary bacterial infection. It is proved that herpes infections worsen the course of bronchial asthma, and can also trigger the development of acute and chronic urticaria. From the point of view of treatment of atopic diseases associated with herpes infections, in addition to standard treatment, it is necessary to conduct pathogenetic antiviral therapy when planning therapy.
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Component changes of body composition in children with obesity and the development of the left ventricle hypertrophy
Abstract
We analyzed the changes in LVMI depending on the BMI and the body composition of the body in children 10–17 years of age.
Materials and methods. 112 children were examined: 60 obese children, 26 with overweight and 26 patients in the control group. All the children underwent anthropometry with the calculation of BMI, evaluation of the body composition of the body according to bioimpedance analysis, echocardiography with calculation of LVM and LVMI and detection of arterial hypertension according to the data of daily monitoring of arterial pressure.
Results. Children with obesity had large sizes of LV, LVM and LVMI. Arterial hypertension was noted in 60.2% of cases among patients with excess body weight, but significant differences in LVMI in children with and without arterial hypertension were not received. In children with increasing body weight there is an increase in all body components, especially fat mass. With an increase in body weight, the increase in LVM occurs to a greater extent than the increase in active cell mass (reflects the development of LV hypertrophy in obesity). When analyzing the proportions between the LVM and the body components, it is seen that with the development of obesity, LVM in relation to the active cell mass, extracellular and intracellular water sectors increases, but in relation to fat mass significantly decreases.
Conclusion. The outstripping growth of LVM in relation to the active cell mass and intra- and extracellular water sectors and the «deficit» of LVM in relation to the fat mass were revealed. In children with obesity, there is no evidence of water retention and the development of left ventricular hypertrophy is not associated with an increase in volume loading, but is apparently due to non-hemodynamic factors.
52-56
Child with transplanted kidney – difficult patient: peculiarities of medical observation, interaction with family
Abstract
Relevance. Terminal chronic renal failure (CRF) in children is growing worldwide and is an important medical, social and economic problem. The fatality in early and distant terms in transplantation, is 13–15%. Kidney transplantation (Moscow, Samara) has been carried out in the territory of the Samara region since 2005. Kidney transplantation was carried out for 21 children, fatality was 9.5%.
Aim. Study the results of kidney transplantation in children with CRF, peculiarities of medical observation, commitment to treatment, interaction with the patient ‘s family.
Materials and methods. 21 children and a teenager with terminal CRF with kidney transplantation between the ages of 6 and 18.
Results. The main causes of terminal CRF formation in children with kidney transplantation were congenital (CAKUT syndrome) and hereditary diseases. The maximum survival time of the graft was 15 years. The main feature of medical support of patients with transplanted kidney was observation of immunosuppression and its correction. Most children get tacrolimus. Transplant rejection occurred in 1 child in case of disorder of drug administration. Another patient had acute transplant rejection, and the teenager died. After the kidney transplant, the patient’s life and surroundings change in a positive direction. 8 adult patients work after receiving higher education.
Conclusions. Kidney transplantation occupies a major place in the treatment of CRF in children. The necessary condition for transplant survival is long-term rehabilitation of the patient, commitment to observation and treatment, constant interaction with the child ‘s family.
57-61
Guided growth for leg length discrepancies, angular deformities and fixed knee flexion deformities treatment
Abstract
Materials and methods. The data of 4 groups with patients from 4 to 14 years old were studied. Group 1: 22 patients (34 knees), with angular deformities about the knee. Group 2: 38 patients (38 knees) with leg length discrepancies. Group 3: 15 patients (27 knees) with knee flexion contracture and cerebral palsy. Patients of 1–3 groups were operated by guided growth. The reference group (40 patients, 60 knees) was formed to determine the normal knee extension values in children according to X-ray and goniometry data.
Results. The mean angle of deformity before and after surgical treatment in group 1 were: 15.3 and 1.6º; in group 3: 160 and 4º recurrence, respectively, (p<0.05). The mean leg length discrepancy before and after surgery in group 2 were: 30 and 8 mm (p<0.05). The mean correction rate in group 1 was 0.6º per month, in group 2 – 0.9 mm per month, in group 3 – 2.9º per month. The mean score on the Gillette FAQ in group 3 increased after surgical treatment from 3.63 to 4.13. In reference group the mean angle of passive extension was 5º recurrence with goniometry lying on back, and 15º recurrence on X-ray. The mean active extension in a standing position was 4º recurrence. Smaller values of the tibiofemoral angle with goniometry in the standing position and passive extension with X-ray and goniometry can serve as clinical and radiological criteria for knee flexion contracture.
Conclusion. Guided growth is an effective technique for correcting leg length discrepancy and angular deformities about the knee in children. Close outpatient observation allows to not only timely identify orthopedic pathology, but also to effectively correct it without major reconstructive operation.
62-69
Comparative analysis of the effectiveness of bone-plastic and soft-tissue reconstructive operations in children with cerebral palsy in equino-plano-valgus deformity of the foot
Abstract
Aim. To carry out a comparative analysis of approaches to the surgical correction of equinoplonal valgus deformity of the feet in children with infantile cerebral palsy.
Materials and methods. A retrospective clinical and radiological analysis of the results of surgical treatment of 109 patients (194 feet) with equinoplovalgus deformity of the feet was performed. The patients are divided into four groups according to the method of surgical correction and age periods. Tendon-muscle plastics: in study group 1a, 21 children 4–7 years old and 23 children 8–11 years old in group 1b. Osteoplastic surgery: 28 children 4–7 years old in study group 2a and 34 children in group 2b. The average age of the patients was 8.2±2.8 years. According to the neurological status, patients of I – III levels of motor development (according to the Gross Motor Function Classification System – GMFCS) with hemiparesis, diplegia and tetraparesis were examined. Comparative analysis was carried out with a reference group consisting of 40 children (71 feet) with exostotic chondrodysplasia or injury to the ligamentous apparatus of one foot at the age of 4–11 years without neurological pathology and foot deformities.
Results. A significant improvement in clinical and radiological parameters was determined in all study groups 14±2 months after surgical treatment in comparison with preoperative parameters. Most of the values approached the established reference intervals. Assessment 34±3 months after surgical treatment in study groups 1a and 1b showed a decrease in the studied clinical and radiological parameters. The results after 34±3 months in study groups 2a and 2b with performed osteoplastic interventions did not reveal significant differences from the parameters after 14±2 months. Such results indicate the preservation of early results of surgical treatment when using osteoplastic methods for correcting foot deformities in children 4–11 years old. The results obtained with the use of soft tissue surgical techniques in children 8–11 years old indicate a high recurrence rate in the long term.
Conclusion. The study of functional status parameters according to the Gillette Functional Assessment Questionnaire 22±4 months after surgery revealed an increase in functional status in 42.85% of children in group 1a and 71.43% in group 2a. In group 1b, an increase in functional status was noted in 30.45% of children, in group 2b – in 67.65% of children. In 4.33% of children of the primary school group, tendon-muscle plastic showed negative dynamics in the functional status. The data obtained in general indicate that there are great prospects for long-term correction of foot deformity by means of osteoplastic operations in comparison with surgery of soft tissue structures.
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