Опыт вакцинации 13-валентной конъюгированной пневмококковой вакциной пациентки с ювенильным идиопатическим артритом с частыми респираторными инфекциями на фоне терапии метотрексатом

The article presents the experience of vaccination with a pneumococcal 13-valent conjugate vaccine (PCV13) of a patient aged 5 years with oligoarticular juvenile idiopathic arthritis (JIA) receiving methotrexate at a dose of 15 mg/m2 per week subcutaneously. Treatment with methotrexate provided a remission of JIA, but was accompanied by frequent respiratory infections — up to 8 times a year. During infection progression, methotrexate injections were omitted. Gaps in the treatment with methotrexate were accompanied by an exacerbation of the underlying condition. Vaccination of the patient with PCV13 reduced the frequency of respiratory infections to 2 times a year, which was accompanied by the development of persistent remission of the disease. Adverse events and exacerbation of JIA in a child after vaccination with PCV13 were not registered.Представлен опыт вакцинации 13-валентной конъюгированной пневмококковой вакциной (13ПКВ) пациентки в возрасте 5 лет с олигоартикулярным ювенильным идиопатическим артритом (ЮИА), получавшей метотрексат в дозе 15 мг/м2 в неделю подкожно. Лечение метотрексатом обеспечило ремиссию ЮИА, но сопровождалось частыми респираторными инфекциями — до 8 раз в год. При развитии инфекций инъекции метотрексата пропускались. Перерывы в лечении метотрексатом сопровождались обострением основного заболевания. Вакцинация пациентки 13ПКВ обеспечила снижение частоты респираторных инфекций до 2 раз в год, что сопровождалось развитием стойкой ремиссии заболевания. Нежелательных явлений и обострения ЮИА у ребенка на фоне вакцинации 13ПКВ не зарегистрировано

Первые результаты оценки качества медицинской помощи на догоспитальном и госпитальном этапах детям с острой аллергической патологией

Background. Differential diagnosis of exacerbations of allergic diseases in children at pre-hospital and hospital stages of rendering emergency medical care (EMC) remains a relevant issue. One of the reasons is that medical care does not always comply with current clinical guidelines.Objective. Our aim was to analyze the quality of emergency medical care for children with acute allergic pathology.Methods. A retrospective study with a retrospective analysis and extraction of data from medical records (in 2 stages) was conducted.Results. The study analyzed the data of 595 children with acute allergic pathology who applied for emergency medical care (girls — 215; 36.13%). The average age of patients was 43.12 ± 41.09 months, 455 (76.47%) were under 5 years of age. 513 (86.22%) children applied for medical care for the first time, 24 (4.03%) children — for the second time; in 58 (9.75%) emergency team call records, this column was not filled. Based on the complaints and diagnoses indicated in the medical documentation, the children were divided into 3 groups: Croup, Cutaneous Manifestations of Allergy, and Bronchopulmonary Manifestations. We analyzed the reliability and validity of final diagnoses made at pre-hospital and hospital stages and assessed the adequacy of the carried out pharmacotherapy.Conclusion. According to our study, the quality of medical care at pre-hospital and hospital stages does not always correspond to current standards, algorithms, and available clinical guidelines.Дифференциальная диагностика обострений аллергических заболеваний у детей на догоспитальном и госпитальном этапах оказания скорой медицинской помощи (СМП) остается актуальной проблемой. Одна из причин в том, что медицинская помощь не всегда проводится в соответствии с современными клиническими рекомендациями.Цель исследования — проанализировать качество оказания скорой и неотложной медицинской помощи детям с острой аллергической патологией.Методы. Проведено ретроспективное исследование с ретроспективным анализом и выкопировкой данных из медицинской документации (в 2 этапа).Результаты. В исследовании проанализированы данные 595 детей с острой аллергической патологией, обратившихся за скорой медицинской помощью (девочек — 215; 36,13%). Средний возраст пациентов — 43,12±41,09 мес, из них 455 (76,47%) — в возрасте до 5 лет. Первично за медицинской помощью обратились 513 (86,22%) детей, повторно — 24 (4,03%); в 58 (9,75%) картах вызова бригады СМП заполнение данной графы отсутствовало. На основании указанных в медицинской документации жалоб и выставленных диагнозов дети разделены на 3 группы: «Круп», «Кожные проявления аллергии» и «Бронхолегочные проявления». Проанализированы достоверность и обоснованность уточненных диагнозов, выставленных на догоспитальном и госпитальном этапах, оценена адекватность проведенной фармакотерапии.Заключение. По данным нашего исследования, оказание медицинской помощи на догоспитальном и госпитальном этапах не всегда соответствует современным стандартам, алгоритмам и имеющимся клиническим рекомендациям.Конфликт интересовЛ.С. Намазова-Баранова — получение исследовательских грантов от фармацевтических компаний Пьер Фабр, Genzyme Europe B. V., ООО «Астра зенека Фармасьютикалз», Gilead/PRA «Фармасьютикал Рисерч Ассошиэйтс СиАйЭс», «Bionorica», Teva Branded Pharmaceutical products R&D, Inc/ООО «ППД Девелопмент (Смоленск)», «Сталлержен С. А.»/«Квинтайлс ГезмбХ» (Австрия)

American College of Rheumatology Provisional Criteria for Clinically Relevant Improvement in Children and Adolescents With Childhood-Onset Systemic Lupus Erythematosus

10.1002/acr.23834ARTHRITIS CARE & RESEARCH715579-59

Vitamins А, С and D — Essential Trio for Infants

Administration of essential vitamins A, C and D in vitamin-mineral complex in common dosage is efficient for immunity formation, harmonious physical and neuropsychic development, rickets prevention. Dosage of components at the physiological daily maintenance in basic vitamin complexes for infants is integral for nursing mother supplementation and fortification of the food used for infant weaning. If necessary, and specifically in immature infants, the basic vitamin complex (vitamins A, C and D) can be extended with other required micronutrients (vitamin D, for example, can be extended up to 1000 ME). It depends on feeding type, intake of vitamin-mineral complexes for nursing mothers, seasonal prevalence, region and many other factors

Structural Reasons for the Nonlinear Optical Properties of KTP Family Single Crystals

A brief review focuses on studies into the structural reasons for the nonlinear optical properties of crystals of the potassium titanyl phosphate family, performed at the Shubnikov Institute of Crystallography. Accurate X-ray diffraction data are discussed, providing evidence that the optical susceptibility of crystals is related not only to the alternation of long and short Ti–O bonds in the chains of TiO6 octahedra, but to the geometry of tetrahedral anions and the alkaline cation arrangement in the structure channels, as well. The contribution of each of the three structural components depends on the crystal composition

Growth and Structure of Rare-Earth Molybdate Crystals Na_0.65La_4.35Mo₃O_15.81±δF_0.07±ε

Rare-earth sodium- and fluorine-substituted molybdates with the Na0.65La4.35Mo3O15.81±δF0.07±ε composition were synthesized for the first time as single crystals. An accurate X-ray diffraction analysis of three samples at room temperature showed that the obtained crystals are isostructural to undoped cubic compounds of the Ln5Mo3O16+δ family (space group Pn3¯n). Sodium cations partially occupy one of the two lanthanum positions and center the more distorted LaO8 polyhedra, while fluorine anions occupy over-stoichiometric oxygen positions in the vast interstices (cavities) of the structure. The partial substitution of fluorine atoms for oxygen ones affects the transport characteristics of compounds by activating the oxygen atoms in the anionic subsystem due to the effect of supplementary electrostatic repulsion between anions of different types

Genetic Polymorphisms Associated with Rheumatoid Arthritis Development and Antirheumatic Therapy Response

Rheumatoid arthritis (RA) is the most common inflammatory arthropathy worldwide. Possible manifestations of RA can be represented by a wide variability of symptoms, clinical forms, and course options. This multifactorial disease is triggered by a genetic predisposition and environmental factors. Both clinical and genealogical studies have demonstrated disease case accumulation in families. Revealing the impact of candidate gene missense variants on the disease course elucidates understanding of RA molecular pathogenesis. A multivariate genomewide association study (GWAS) based analysis identified the genes and signalling pathways involved in the pathogenesis of the disease. However, these identified RA candidate gene variants only explain 30% of familial disease cases. The genetic causes for a significant proportion of familial RA have not been determined until now. Therefore, it is important to identify RA risk groups in different populations, as well as the possible prognostic value of some genetic variants for disease development, progression, and treatment. Our review has two purposes. First, to summarise the data on RA candidate genes and the increased disease risk associated with these alleles in various populations. Second, to describe how the genetic variants can be used in the selection of drugs for the treatment of RA

On the Development and Application of Multiple Cases for Accreditation of Health Care Professionals

The sequence for the development of the multiple case methodology (training technology) for accreditation of health care professionals has been presented. The multidimensionality of cases allows to cover all functions of professional standards. To improve the technique reliability, the multiple-choice tests have been offered. The requirement of local independence of tasks has been implemented. The results of approbation of cases with participation of 114 graduates (6th year) of 5 medical universities have been analysed. The interpretation of the analysis results and their use for assessing the professional readiness of health care professionals have been offered

Pneumococcal Vaccine in Patients with Systemic Juvenile Idiopathic Arthritis Receiving Biologic Therapy: International Practice Review

International practice of immunization against pneumococcus in patients with systemic juvenile idiopathic arthritis (SJIA) receiving biological therapy is generalized in this review. High efficiency and safety of pneumococcal vaccines in children with SJIA is presented. Numerous researches show the adequate immune response after vaccination as well as alongside with genetically engineered biologic drugs therapy. Prevention of pneumococcal disease in patients with SJIA reduces the risk of development of pneumococcal diseases severe complications

Experience of Vaccination of a Patient with Systemic Juvenile Idiopathic Arthritis (sJIA) with a 13-Valent Pneumococcal Conjugate Vaccine, prior to the Appointment of Therapy with Tocilizumab, an Anti-IL-6-Receptor Monoclonal Antibody

Background. Infections are the main cause of death for patients with autoimmune rheumatic diseases. In adult patients with rheumatoid arthritis (RA), mortality caused by respiratory infections is 2–5 times higher than in the population. One of the frequent infectious complications in the course of treatment with tocilizumab, the first-choice drug for treating systemic juvenile idiopathic arthritis (sJIA), is pneumonia characterized by a poor clinical picture, normal values of laboratory indices of the disease activity (ESR, C-reactive protein) with pronounced changes in the lungs revealed by computed tomography. In case of acute respiratory infection in children with systemic JIA, immunosuppressants and genetically engineered biological preparations (GEBP) are discontinued. This often leads to an exacerbation of the underlying disease and the progression of a pathological process. At present, vaccination against pneumococcal infection in Russia is not included in the standard for managing patients with rheumatic diseases. Studies of the safety and efficacy of vaccination with 13-valent pneumococcal conjugate vaccine (PCV) in patients with sJIA receiving genetically engineered biological preparations were not conducted. Clinical Case Description. The article shares the experience of vaccination of a girl aged 9 years with a 13-valent PCV that was conducted in the course of a scientific investigation, which studied the efficacy and safety of vaccination of children with systemic JIA prior to prescription of GEBP tocilizumab. Vaccination did not cause a deterioration in the course of the main disease (1 month), led to a reduction in the incidence of acute respiratory infections (from 4 to 1 time within 6 months before and after vaccination), and discontinuation of antibacterial drugs within 6 months after vaccination. Conclusion. The safety of a 13-valent PCV in a child with sJIA and a decrease of the incidence of respiratory diseases after vaccination, their complications, and the use of antibacterial drugs have been shown