Characteristics of blood pressure level in children with different body weight

BACKGROUND: Essential arterial hypertension (AH) develops more often in children with accompanying risk factors — obesity, overweight, positive heredity and genetic predisposition.AIM: Study of peculiarities of arterial hypertension clinical course in adolescents with normal body weight, overweight and obesity.MATERIALS AND METHODS: The study was conducted on children with arterial hypertension who received treatment in two hospitals in Voronezh in 2016–2020. A retrospective analysis of the children’s case histories was carried out taking into account the anamnesis, clinical laboratory and instrumental examination data and the pharmacotherapy. Some children underwent polymerase chain reaction genetic testing to determine pathological alleles of genes regulating blood pressure (BP).RESULTS: 96 patients aged 9 to 17 took part in the study. The group with normal body weight included 38 children (39.6%), median age 16.4 (aged 10.7; 17.9), with overweight — 33 people (34.4%), median age 15.2 (aged 12.0; 17.9), with obesity — 25 children (26.0%), median age 14.5 (aged 9.2; 17.9). Obese children developed arterial hypertension at earlier age (p = 0.023). According to blood pressure daily monitoring (BPDM), pathological values of systolic blood pressure (SBP) during the day (above the 95th percentile) among children with normal body weight were observed in 17 patients (44.7%), with excess body weight — in 14 people (42.4%), with obesity — in 16 people (64%), p = 0.031. Accurate difference values between the groups were obtained in terms of time index (TI) of SBP at night (p = 0.006). Time index of diastolic BP during the day > 50% was observed only in the obese children group — 4 people (16%) (p = 0.042). Pathological alleles of the angiotensinogen gene (AGT: 704 T>C), aldosterone synthase gene (CYP11B2: -344 C>T) and endothelial nitrogen synthase type 3 (NOS3: -786 T> C) were identified most frequently during genetic testing in some patients.CONCLUSION: Children with obesity developed earlier arterial hypertension compared to the same-age children with normal body weight and more often had unfavorable type of arterial hypertension according to BPDM. These results can be used to choose individual therapy and to develop special attention as regards certain target organs damage

Role of portocaval shunts in development of complications after liver transplantation

Rationale. Portal blood flow is a key component in the viability of the liver transplant. Portocaval shunts formed on the background of the liver cirrhosis before transplantation can cause portal vein steal syndrome, with subsequent development of ischemic necrosis of the graft. To date, the tactics of treating patients with portal vein steal syndrome during liver transplantation has not been sufficiently developed. This paper presents a literature review and our own experience on this important, but little-studied issue. Purpose. The purpose of this research is to study the role of portocaval shunts in the development of complications after liver transplantation, based on a retrospective analysis of clinical cases. Conclusions. In liver transplantation, portocaval shunts can cause the development of portal vein steal syndrome with subsequent development of liver failure. For the diagnosis of portal vein steal syndrome, it is important to use the data obtained at all stages of liver transplantation. Surgical correction of portal vein steal syndrome can be performed during liver transplantation and in the early postoperative period. © 2022 by the authors

КЛИНИКО-ЛАБОРАТОРНАЯ ОЦЕНКА СИНДРОМА ИНТОКСИКАЦИИ ПРИ ОСТРЫХ РЕСПИРАТОРНЫХ ВИРУСНЫХ ИНФЕКЦИЯХ У ДЕТЕЙ

There was performed a comparative analysis of clinical and laboratory indicators of intoxication syndrome in 70 children aged from 1 month to 16 years with acute respiratory viral infection (АRVI) of different etiology. To make an objective appraisal of the intoxication syndrome intensity the spectral characteristics of low and median molecular weight substances (LMMWS) in plasma and red blood cells with the calculation of their balance was studied, the level of exogenous pathogens was defined. The intensity of clinical symptoms was evaluated in points (from 0 to 3). It was established that total clinical manifestation of intoxication syndrome was from 3,4 ± 0,6 points in the case of respiratory syncytial viral infection to 6,2 ± 0,8 points in the case of influenza depending on the etiology. The increased level of LMMWS in red blood cells and exogenous pathogens was noticed to compare with the control values in all the groups regardless of the etiology. In the case of influenza the increase of LMMWS in plasma to 11,5 ± 0,5 c.u., and of the level of exogenous pathogens to 0,25 ± 0,04 c.u. was noted. The most expressed changes of indicators were revealed in the case of mixed viral infection when LMMWS in plasma was increased to 14,0 ± 1,6 c.u., LMMWS in red blood cells — to 27,0 ± 1,2 c.u., and exogenous pathogens amount — to 0,4 ± 0,09 c.u. A direct correlation of the average force between clinical and laboratory criteria of intoxication was revealed (r = 0,3; p < 0,05). Проведен сравнительный анализ клинико-лабораторных показателей синдрома интоксикации у 70 детей в возрасте от 1 месяца до 16 лет с острой респираторной вирусной инфекцией (ОРВИ) разной этиологии. Для объективной оценки выраженности интоксикации исследовали спектральную характеристику веществ низкой и средней молекулярной массы (ВНСММ) плазмы и эритроцитов с расчетом их соотношения, определяли уровень экзогенных патогенов. Выраженность клинических симптомов оценивалась в баллах (от 0 до 3). Установлено, что суммарная клиническая выраженность синдрома интоксикации в зависимости от этиологии составляла от 3,4 ± 0,6 баллов при респираторно-синцитиальной вирусной инфекции до 6,2 ± 0,8 баллов при гриппе (p < 0,05). Отмечено повышение уровня ВНСММ эритроцитов и экзогенных патогенов в сравнении с контрольными значениями во всех группах вне зависимости от этиологии. При гриппе отмечалось увеличение концентрации веществ низкой и средней молекулярной массы плазмы до 11,5 ± 0,5 у.е., уровня экзогенных патогенов до 0,25 ± 0,04 у.е. Наиболее выраженные изменения показателей отмечены при смешанной вирусной инфекции, при которой уровень ВНСММ плазмы повышался до 14,0 ± 1,6 у.е., ВНСММ эритроцитов до 27,0 ± 1,2 у.е., экзогенных патогенов до 0,4 ± 0,09 у.е. Выявлена прямая корреляционная связь средней силы между клиническими и лабораторными критериями интоксикации (r = 0,3; p < 0,05).

Diagnostic and Prognostic Value of Hyperammonemia in Patients with Liver Cirrhosis, Hepatic Encephalopathy, and Sarcopenia (Experts’ Agreement)

Introduction. In cirrhotic patients, hyperammonemia develops due to impaired ammonia detoxification and portosystemic blood shunting and is most commonly associated with hepatic encephalopathy and sarcopenia. Currently, there are questions regarding the diagnosis of hyperammonemia and the effect of ammonia-lowering therapy on disease outcomes.Materials and methods. The Russian Scientific Liver Society selected a panel of seven experts in liver cirrhosis research and management of patients with this disease to make reasoned statements and recommendations on the issue of diagnostic and prognostic value of hyperammonemia in patients with liver cirrhosis, hepatic encephalopathy and sarcopenia.Results. The Delphi panel identified the most relevant topics, in the form of PICO questions (patient or population, intervention, comparison, outcome). The Delphi panel made six questions relevant to clinical practice and gave reasoned answers, framed as ‘clinical practice recommendations and statements’ with evidence-based comments. The questions and statements were based on the search and critical analysis of medical literature by keywords in Englishand Russian-language databases. The formulated questions could be combined into four categories: hepatic encephalopathy, sarcopenia, hyperammonemia, and ammonia-lowering therapy.Conclusions. The results of the experts' work are directly relevant to the quality management of patients with liver cirrhosis, and their recommendations and statements can be used in clinical practice

ОПЫТ СОЗДАНИЯ ЛИСТА ОЖИДАНИЯ ТРАНСПЛАНТАЦИИ ПЕЧЕНИ В ЕКАТЕРИНБУРГЕ

Gaining the experience of liver transplantation waiting list formation is the important condition of transplant cen- ter successful work. In the era of transplant organ shortage careful medical examination of the patient before the operation and detection of unfavorable facts and transplantation contraindications are of paramount importance. At the same time evaluation of the structure of potential liver transplant recipients category allows to develop maximal effective management of waiting list patients and prevention of fatal complications before operation. Приобретение опыта формирования листа ожидания трансплантации печени является важным условием успеха работы трансплантационного центра. Тщательное обследование больного до операции позволяет своевременно выявить неблагоприятные факторы и противопоказания для трансплантации, что является особенно важным в условиях дефицита донорских органов. Вместе с тем изучение структуры категории больных, имеющих показания для пересадки печени, позволяет отработать максимально эффективную методику ведения их в листе ожидания и предупреждать развитие фатальных осложнений до операции.

Efficacy and safety of the first domestic pegilated interferon alpha-2b «Pegaltevir» at chronic hepatitis C: pilot data of phase III clinical study

Aim of investigation. Comparative assessment of efficacy and safety of Pegaltevir and PegIntron in within pattern of combined antiviral therapy in previously untreated patients with chronic hepatitis C.Material and methods. Overall 140 patients with chronic hepatitis C, who received no antiviral therapy previously were included in original study. Patients were randomized in 4 groups. Groups differed in relation to received drug and hepatitis C virus genotype. All patients received 1,5 mkg per 1 kg body weight per week of Pegaltevir or PegIntron and 800–1400 mg of ribavirin per day. Preliminary estimation of drug efficacy was based on rates of rapid and early virologic response (RVR and EVR) achievement, dynamics of biochemical tests, dynamics of blood level of peginterferon alpha and neopterin. Safety features were estimated as well.Results. Comparative analysis has demonstrated absence of statistically significant distinctions of RVR and РВО rates at application of two peginterferon alpha-2b drugs. There were no differences in frequency of achievement of serologic response, as well as safety in Pegaltevir and PegIntron groups. Dynamics of blood concentration of peginterferon alpha correlated to neopterin concentration both in Pegaltevir group and in PegIntron group.Conclusions. Study results have shown high rates of RVR and РВО achievement, and acceptable safety profile of Pegaltevir, comparable with that of PegIntron at chronic hepatitis C in previously untreated patients

ОЦЕНКА ЭФФЕКТИВНОСТИ ЖЕЛАТИНА ТАННАТА ПРИ ОСТРЫХ ИНФЕКЦИОННЫХ ДИАРЕЯХ У ДЕТЕЙ

Specific features of the course of acute intestinal infections of viral and bacterial etiology in children are described, features of the syndrome of endogenous intoxication in children carrying infectious diarrhea are characterized. As a result of the study, the efficacy and safety of gelatin tannate (LLC «YADRAN», Croatia) with intestinal infections of bacterial and viral etiology in children has been confirmed. Установлены особенности течения острых кишечных инфекций вирусной и бактериальной этиологии у детей, охарактеризованы особенности синдрома эндогенной интоксикции у детей, переносящих инфекционные диареи. В результате проведенного исследования подтвержена эффективность и безопасность желатина танната (ООО «ЯДРАН», Хорватия) при кишечных инфекциях бактериальной и вирусной этиологии у детей.

ЗНАЧЕНИЕ ГЕМАТОЛОГИЧЕСКИХ ПОКАЗАТЕЛЕЙ ПРИ ОСТРЫХ РЕСПИРАТОРНЫХ ВИРУСНЫХ ИНФЕКЦИЯХ У ДЕТЕЙ

Hematological studies are basic and mandatory in diagnostics and laboratory monitoring of infectious diseases, which led to their inclusion in the modern standards of laboratory examinations of children. Assessment of hematological parameters used for the provisional differential diagnosis of viral or bacterial nature of the disease. For research currently being used increasingly Hematology analyzers, which allows to facilitate and standardize the results. In this paper a comparison and differences hematological parameters practically healthy children and children with respiratory infections. Identified some changes in indicators of haemogram depending on the etiology and character of the clinical course of the disease. On the basis of the leukocyte formula defined leukocyte indices of intoxication and illustrates their importance in assessing the severity of the infection process.Гематологические исследования являются основными и обязательными в диагностике и лабораторном мониторинге инфекционных заболеваний, что обусловило их включение в современные стандарты лабораторного обследования детей. Оценку гематологических показателей используют для предварительной дифференциальной диагностики вирусной или бактериальной природы заболевания. Для проведения исследований в настоящее время все чаще применяют гематологические анализаторы, что позволяет ускорить и стандартизировать получение результатов. В настоящей работе проведено сопоставление и показаны отличия гематологических показателей практически здоровых детей и детей с респираторными инфекциями. Выявлены изменения показателей гемограммы в зависимости от этиологии и характера течения заболевания. На основании лейкоцитарной формулы определены лейкоцитарные индексы интоксикации и показана их значимость в оценке тяжести инфекционного процесса

Safety and efficacy of telaprevir in treatment of a chronic hepatitis C in patients of the Russian population included in early access program study

Aim of investigation. HEP3002 is the international early access program of efficacy and safety estimation of telaprevir in combination to peginterferon alpha and ribavirin for patients with severe fibrosis or liver cirrhosis caused by hepatitis C virus (HCV) genotype 1. Efficacy and safety of this therapeutic mode were evaluated in intermediate analysis on 16-th week of treatment in 153 patients from Russia who have already reached the 16-th week of treatment or potentially can do so.Material and methods. The study has prospectively included 153 HCV infected patients (genotype 1), with bridging fibrosis or compensated liver cirrhosis who received treatment by telaprevir in combination to peginterferon-alpha and ribavirin for 12 wks with subsequent 12-or 36-week rate of antiviral therapy (AVT) by peginterferon alpha and ribavirin in relation to virologic response and fibrosis severity. Analysis has been carried out for intention to treat (ITT) populations with application of 16-th week AVT data.Results. Total of 153 patients have completed 12-week course of triple therapy and 4-week course of peginterferon-alpha and ribavirin treatment (48% cirrhotic patients, 97% – HCV-1b). The level of HCV RNA was undetectable both at the 4-th week, and at the 12-th week (extended rapid virologic response) in 42 (75%) of 56 previously untreated patients, in 34 (89%) of 38 with relapses after previous treatment, in 4 (57%) of 7 with previous incomplete response, in 22 (52%) of 42 with the previous zero response and in 7 (70%) of 10 with previous virologic breakthrough. Sustained virologic response was achieved in 73 (80%) of patients available for analysis (n=91). Most frequent adverse events of the 2-4 degrees, related to telaprevir, were anemia (63 patients, 41%), thrombocytopenia (15 patients, 10%) and skin rash (7 patients, 5%). For anemia treatment in 50 (33%) patients the doze of ribavirin has been reduced, erythropoietin was prescribed to 12 (8%) to patients and no blood transfusion was required; 10 (7%) patients have ahead of schedule stopped course of treatment by telaprevir in connection with development of anemia (6), thrombocytopenia (2) and occurrence of skin rash (2).Conclusion. In 153 patients with severe liver fibrosis caused by hepatitis C virus (genotype 1), on background of triple AVT with telaprevir high level of immediate virologic response and low level of the preterm treatment discontinuation was marked

Параметры субъективно-объективного показателя здоровья среди женщин открытой городской популяции

Highlights. The subjective and objective indicator of health is the most important parameter characterizing the motivation of the population to preserve public health. In Russian and foreign epidemiological studies, differences in attitude to one`s health are dependent upon social and economic status, gender differences, ecology, and marital status. For the first time, the parameters of the subjective and objective indicator of health were determined among women in the population of a medium-sized urban city in Western Siberia. It must be mentioned that women remain to be the most vulnerable category of the population in terms of psychological stress. The data obtained using Tyumen`s population will assist in the prediction of the population`s response to preventive programs, estimation of the amount of preventive care needed, taking into account the expenses, and analysis of the effectiveness of possible intervention.Aim. To determine some parameters of the subjective and objective indicator of health (health attitudes and health self-assessment) among women in urban population.Methods. The epidemiological study included a representative sample of women of working age (25–64 years old) residing in the Central Administrative District of Tyumen, stratified by age (1 000 women, response rate 70.3%). The attitude of the population towards health was assessed using the standard WHO MONICA-psychosocial questionnaire “Awareness and Attitude towards Health”.Results. The obtained data revealed low responsibility for health among working age women (36.5–46.7%), and predominantly negative self-assessment of health (70.0%). The results showed a low responsibility for cardiovascular health in the female population (a fifth of the population trusted only their own feelings, and more than half of the population would not seek medical help for mild pain in the chest). A trend towards increasing negative self-assessment of health and increasing trust in the examination of a physician without additional examination was noted in the participants in young to middle age range.Conclusion. The subjective and objective indicator of population`s health requires further studies and can be used as a basis for the development and implementation of comprehensive preventive programs that take into account gender and age-dependent features and risks.Основные положения. Субъективно-объективный показатель здоровья – наиболее важный параметр, характеризующий особенности мотивации популяции к сохранению общественного здоровья. В российских и зарубежных эпидемиологических исследованиях установлены различия в отношении к своему здоровью в зависимости от индикаторов социального, экономического положения, гендерных различий, демоэкологического фактора, брачного статуса. На открытой популяции среднеурбанизированного города Западной Сибири среди женщин, являющихся наиболее уязвимой категорией населения в отношении психологической нагрузки, впервые определены параметры субъективно-объективного показателя здоровья. Полученные на модели г. Тюмень данные позволят прогнозировать отклик населения на проведение профилактических программ, оценить предварительные объемы необходимой профилактической помощи, учесть материальные затраты, которых потребуют превентивные мероприятия, а также проанализировать эффективность возможного вмешательства.Цель. Определение некоторых параметров субъективно-объективного показателя здоровья (отношения к здоровью и его самооценки) среди женщин открытой городской популяции.Материалы и методы. Одномоментное эпидемиологическое исследование открытой популяции выполнено  на  репрезентативной  выборке  среди  женщин  трудоспособного возраста (25–64 лет) Центрального административного округа Тюмени, стратифицированной по возрасту (1 000 женщин, отклик 70,3%). Отношение населения к своему здоровью установлено при использовании жестко стандартизованной анкеты ВОЗ «Знание и отношение к своему здоровью» программы «МОНИКА-психосоциальная».Результаты. Данные одномоментного эпидемиологического исследования показали низкую ответственность за свое здоровье среди работающих женщин (36,5–46,7%), преимущественно негативную самооценку здоровья (70,0%), а также низкую ответственность в отношении сердечно-сосудистого здоровья в женской популяции (пятая часть популяции доверялась только своему самочувствию, а более половины популяции не обратилось бы за медицинской помощью при слабо выраженной боли в области сердца). В диапазоне от молодого к среднему возрасту отмечена тенденция роста негативной самооценки здоровья, а также повышения доверия общему осмотру врача без дополнительных исследований.Заключение. Субъективно-объективный показатель здоровья населения требует активного изучения в популяциях и может служить научной основой для разработки и внедрения комплексных профилактических программ с учетом гендерных и возрастных особенностей и рисков