ОБЩЕЕ МОТОРНОЕ РАЗВИТИЕ И ФОРМИРОВАНИЕ ФУНКЦИИ РУК У ПАЦИЕНТОВ СО СПАСТИЧЕСКИМИ ФОРМАМИ ДЕТСКОГО ЦЕРЕБРАЛЬНОГО ПАРАЛИЧА НА ФОНЕ БОТУЛИНОТЕРАПИИ И КОМПЛЕКСНОЙ РЕАБИЛИТАЦИИ

Aim: to investigate the dynamic of general motor function and manual abilities in children with spastic forms of cerebral palsy (CP) after complex rehabilitation combined with single and repeated injections of botulinum toxin A (BTA). Patients and methods: the article presents 18 month follow-up of 52 patients with mono- and bilateral spastic forms of CP after single and multiple injections of botulinum toxin A and complex rehabilitation/ Patients received totally 74 injection sessions: 17 (32,7%) children — twice, 5 (9,6%) children — three times. Motor development assessment was done according to the GMFCS and GMFMS-88 scales and centile curves of normal motor development connected with these scales, hand function was classified according to the MACS scale. For the first time results of botulinum toxin therapy and rehabilitation were compared with the natural motor development of patients with different levels of motor disturbances according to centile tables. Results: patients with bilateral cerebral palsy improved slowly than hemiparetic and changes lasted for longer period. Level according to the MACS scale didn’t depend on the gestational age of the patients, was higher in children with hemiparesis and changed for 1 level in 4 (7,7%) patients after the first botulinum toxin A injections. Цель исследования: изучить динамику формирования общих моторных функций и функции рук у пациентов со спастическими формами детского церебрального паралича (ДЦП) на фоне комплексной реабилитации, дополненной однократными и повторными инъекциями ботулинического токсина типа А (БТА). Пациенты и методы: в течение 18 месяцев проведено проспективное наблюдение 52 пациентов с одно- и двусторонними спастическими формами детского церебрального паралича на фоне однократных и повторных инъекций БТА и комплексной реабилитации.  Всего проведено 74 инъекционные сессии. 17 (32,7%) детей получили двукратные инъекции, 5 (9,6%) — трехкратные. Результаты моторного развития детей оценены с использованием международных шкал GMFCS, GMFMS-88 и центильных таблиц моторного развития, соотнесенных с этими шкалами. Функция рук оценена с применением шкалы MACS. Впервые проведено сопоставление результатов реабилитации с применением ботулотоксина типа А и показателей естественного моторного развития пациентов с различными классами двигательных нарушений при детском церебральном параличе. Результаты: в группе пациентов с двусторонними формами ДЦП улучшения показателей моторного развития происходили медленнее и сохранялись длительнее, по сравнению с пациентами с гемипарезом. Функциональный класс моторики рук по шкале MACS не зависел от гестационного возраста пациентов, был выше у детей с гемипарезом и клинически значимо изменился в 4 (7,7%) случаях после первого курса ботулинотерапии

ОПЫТ МНОГОУРОВНЕВЫХ ПОВТОРНЫХ ИНЪЕКЦИЙ БОТУЛИНИЧЕСКОГО ТОКСИНА ТИПА А (ABOBOTULINUM TOXIN A) ПРИ СПАСТИЧЕСКИХ ФОРМАХ ДЕТСКОГО ЦЕРЕБРАЛЬНОГО ПАРАЛИЧА

Objective: Our aim was to analyze the dosages of Abobotulinum toxin A used for each muscle in the clinically effective and safe repeated multilevel injections in CP children, and the intervals between injections. Methods: Retrospective analysis of 229 injection sessions into 359 muscles of the upper and 361 muscles of the lower extremities in 133 children (2–18 years) with spastic CP. Analysis included only patients who were injected for the first time and demonstrated decrease of spasticity in injected muscles according to modified Ashworth and/or Tardieu scales without significant side effects 2–4 weeks after injections. Motor deficit according to GMFCS was: GMFCS I — 16 (12%) children, GMFCS II — 26 (19.6%), GMFCS III — 43 (32.3%), GMFCS IV — 30 (22.6%), GMFCS V — 18 (13.5%). Repeated injections (up to 5 sessions) were done in 59 children. Maximum follow-up perion was 22 months. 40 patients (30.1%) had one-sided injections, 93 (69.9%) — two-sided, 125 (94%) — multilevel injections. Results: We presented minimal and maximal dosages, interquartile ranges for each injected muscle, also «off-label» and our proposition of per-segment calculation of dosages in multilevel injections in CP. We also demonstrated the stability of intervals between repeated injections and dosages per kg in a patient. These results are compared with the official Russian and international recommendations of BTX-A treatment for children. Conclusion: We presented our experience of BTX-A dosages calculation for the spastic CP treatment which could be used as a recommendation and guide for the multilevel injections treatment according to the aims of rehabilitation, spasticity level, muscle size and motor deficit of a concrete patient. Цель исследования: произвести анализ доз препарата Abobotulinum toxin A, применявшегося при клинически эффективных повторных многоуровневых инъекциях у детей со спастическими формами ДЦП, оценить стабильность используемых доз и интервалов между инъекциями. Методы: выполнен ретроспективный анализ 229 инъекционных сессий в 359 мышц верхних и 361 мышцу нижних конечностей у 133 детей со спастическими формами ДЦП в возрасте от 2 до 18 лет, впервые проходивших ботулинотерапию с последующей комплексной реабилитацией и продемонстрировавших снижение тонуса и спастичности по модифицированной шкале Эшворта и/или по шкале Тардье без утраты функции и иных нежелательных явлений через 2–4 нед после инъекции. Распределение детей по уровням моторного развития: GMFCS I — 16 (12%), GMFCS II — 26 (19,6%), GMFCS III — 43 (32,3%), GMFCS IV — 30 (22,6%), GMFCS V — 18 (13,5%) человек. Повторные инъекции (до 5) БТА проведены у 59 детей, максимальный срок наблюдения — 1 год 10 мес. Односторонние инъекции получили 40 (30,1%) пациентов с одно- и двусторонними формами ДЦП, двусторонние инъекции — 93 (69,9%) пациента, многоуровневые инъекции — 125 (94%) детей. Результаты: рассчитаны минимальные и максимальные использованные дозы, интерквартильные диапазоны доз БТА для каждой мышцы, в т.ч. по «off-label» показаниям. Обоснован посегментный подход при расчете многоуровневых инъекций БТА при ДЦП. Показана стабильность интервалов между повторными инъекциями и относительное постоянство доз Abobotulinum toxin A в расчете на килограмм массы тела для конкретного пациента. Полученные результаты сопоставлены с существующими официальными инструкциями, отечественными и международными рекомендациями по применению препаратов БТА у детей. Выводы: указанные дозы носят рекомендательный характер и могут быть использованы в качестве ориентира при планировании многоуровневой ботулинотерапии у пациентов с ДЦП с учетом целей лечения, уровня спастичности, размеров мышц и степени функциональных нарушений.

ARIA 2016: Care pathways implementing emerging technologies for predictive medicine in rhinitis and asthma across the life cycle

The Allergic Rhinitis and its Impact on Asthma (ARIA) initiative commenced during a World Health Organization workshop in 1999. The initial goals were (1) to propose a new allergic rhinitis classification, (2) to promote the concept of multi-morbidity in asthma a

ENIGMA and global neuroscience: A decade of large-scale studies of the brain in health and disease across more than 40 countries

This review summarizes the last decade of work by the ENIGMA (Enhancing NeuroImaging Genetics through Meta Analysis) Consortium, a global alliance of over 1400 scientists across 43 countries, studying the human brain in health and disease. Building on large-scale genetic studies that discovered the first robustly replicated genetic loci associated with brain metrics, ENIGMA has diversified into over 50 working groups (WGs), pooling worldwide data and expertise to answer fundamental questions in neuroscience, psychiatry, neurology, and genetics. Most ENIGMA WGs focus on specific psychiatric and neurological conditions, other WGs study normal variation due to sex and gender differences, or development and aging; still other WGs develop methodological pipelines and tools to facilitate harmonized analyses of "big data" (i.e., genetic and epigenetic data, multimodal MRI, and electroencephalography data). These international efforts have yielded the largest neuroimaging studies to date in schizophrenia, bipolar disorder, major depressive disorder, post-traumatic stress disorder, substance use disorders, obsessive-compulsive disorder, attention-deficit/hyperactivity disorder, autism spectrum disorders, epilepsy, and 22q11.2 deletion syndrome. More recent ENIGMA WGs have formed to study anxiety disorders, suicidal thoughts and behavior, sleep and insomnia, eating disorders, irritability, brain injury, antisocial personality and conduct disorder, and dissociative identity disorder. Here, we summarize the first decade of ENIGMA's activities and ongoing projects, and describe the successes and challenges encountered along the way. We highlight the advantages of collaborative large-scale coordinated data analyses for testing reproducibility and robustness of findings, offering the opportunity to identify brain systems involved in clinical syndromes across diverse samples and associated genetic, environmental, demographic, cognitive, and psychosocial factors

The immunological plasmodium falciparum malaria characteristics of children in Tajikistan Republic

The epidemiological situation in Tajikistan Republic deteriorated in the 1990s, when an influx of refugees from Afghanistan resulted in mass importation of Plasmodium vivax and Plasmodium falciparum malaria to Khatlon region. The National Programme of Malaria Control was successful and malaria transmission was interrupted in 2009. Background. The aim of this study was to investigate the mechanisms of immunological response in Tajik children with tropical Plasmodium falciparum malaria. Materials and Methods. We examined 124 patients with P. falciparum malaria at the age of 6 months up to 14 years that were hospitalized in Clinical Infectious Diseases Hospital in Dushanbe city and in Regional hospital of Khatlon region in the period 2000-2007. In most cases, they were school-age children (56%). The peak incidence was recorded in July-October. Verification of the diagnosis was based on clinical, epidemiological data, and the results of blood microscopy. In all patients, along with the standard, clinical, and laboratory tests, a number of indicators of the immune status were performed that include the T-immunity, the content of serum immunoglobulins of three main classes, the level of circulating immune complexes (CIC), C3 complement, and the concentration of key serum cytokines that have been studied in the dynamics of infectious process. Finding. The study of cellular and humoral immunity in patients with Plasmodium falciparum malaria is an obvious additional criterion in assessing the severity of infection. The imbalance of cytokine profile is an important pathogenic factor in the development of severe and recurrent forms of the disease, since the formation of a defective immune response to parasitic antigens contributes to adverse outcomes. Conclusions. Plasmodium falciparum malaria was characterized by depression of cellular and humoral immunity, the degree of which depended on the severity of the pathological process. © 2019 Nighina M. Khodzhaeva et al

Epidemiological and clinical aspects of diagnosis, treatment and prophylaxis of imported malaria cases in Russian federation

Actually one of the main tasks of health workers in the field of the tropical diseases prevention (malaria) is early detection of malaria imported cases and efficacious treatment. In order to prevent the re-establishment of local malaria transmission by Anopheles mosquitoes from imported malaria cases, and fatal cases of disease there is develop and implement the Case Management Protocol of malaria diagnosis and treatment (2014, 2019) based on long-term experience of epidemiologists and clinicians, taking into account recommendations of WHO (2013, 2015). In this article the main principles of diagnosis and treatment of different malaria species Plasmodium falciparum- and Plasmodium vivax-malaria, prophylaxis measures of autochthonous cases from imported cases of the word endemic region are discussed. © 2020 Consilium Medikum. All rights reserved