Пластический бронхит, ассоциированный с корригированным пороком сердца у ребенка

Plastic bronchitis (PB) is a rare disease that causes airway obstruction with large «rubber» bronchial casts in adults and children, mainly due to concomitant cardiac or pulmonary pathology. It involves the organization of exudate or transudate, which takes the form of the respiratory tract. Mortality with PB reaches 50%. Exact epidemiological data are not known. In most patients, PB occurs in the context of major diseases, which can be conditionally divided into two groups: heart and vascular disease and secondary complication of pulmonary diseases. Usually PB manifests with episodes of dyspnea, tachycardia, hypoxia, fever and cough associated with airway obstruction. Sometimes the symptoms resemble asthma or obstructive bronchitis, accompanied by wheezing and the symptoms of respiratory failure, decreasing of saturation (of what?), the development of pneumothorax. All existing methods of treatment are symptomatic. Promising methods of therapy are the use of inhaled unfractionated heparin and a recombinant tissue plasminogen activator (TAP). The article presents a clinical case of PB in a girl of 5 years with the background of corrected cardiac anomaly.Пластический бронхит (ПБ) – редкое заболевание, вызывающее обструкцию дыхательных путей крупными «резиновыми» слепками бронхов у взрослых и детей, преимущественно в связи с сопутствующей сердечной или легочной патологией. Это связано с организацией экссудата, или транссудата, который принимает форму дыхательных путей. Смертность при ПБ достигает 50%. Точные эпидемиологические данные неизвестны. У большинства пациентов ПБ возникает в контексте основных заболеваний, которые условно можно разделить на две группы: болезни сердца и сосудов и вторичное осложнение легочных заболеваний. Клинические проявления ПБ проявляются эпизодами одышки, тахикардии, гипоксии, лихорадки и кашля, связанного с обструкцией дыхательных путей. Иногда симптомы напоминают астму или обструктивный бронхит, сопровождаются разнообразными хрипами и симптомами дыхательной недостаточности, снижением сатурации, развитием пневмоторакса. Все существующие методы лечения являются симптоматическими. Перспективными методами терапии являются ингаляционное использование нефракционированного гепарина и рекомбинантного тканевого активатора плазминогена (ТАП). В статье приводится клинический случай развития и течения ПБ у девочки 5 лет после гемодинамической коррекции функционально единственного желудочка сердца.

Половое развитие подростков в Томской области

Background. Sexual development of adolescents is one of the important indicators of the population well-being, the study of which, in the context of the world trend towards a change in the period of puberty, can contribute to the identification of public health problems. Objective. Our aim was to study the basic indicators of sexual development of adolescents and to determine the regional characteristics of this population. Methods. The evaluation of secondary sexual characteristics was carried out by specialists according to Tanner criteria. Ultrasound examination of organs of the reproductive system was carried out using a portable scanner Mindray M7. The analysis of the results was carried out taking into account the gender, living conditions, physical development. Results. We examined 7,120 adolescents aged from 13 to 16 years. The degree of axillary hair distribution by Tanner criteria was 2.4±0.7 in young men, 2.9±0.4 — in girls, pubic hair — 2.0±0.9 and 2.6±0.8, respectively. The indicator of development of mammary glands by Tanner criteria in girls was 2.6±0.8, menstrual function by Tanner criteria — 2.4±0.8. Herewith, urban adolescents had later terms of appearance of the secondary sexual characteristics in comparison with the inhabitants of rural areas. Conclusion. We registered the delayed sexual development in 8.1% of girls and 13.6% of young men. Urban youths have experienced a delay in gonadal growth. Among the female population there was an outstripping growth and development of the uterus and ovaries in comparison with rural adolescents. Половое развитие подростков — один из важных показателей благополучия населения, изучение которого в условиях мировой тенденции к изменению сроков наступления пубертатного периода может способствовать выявлению проблем общественного здравоохранения. Цель исследования — изучить основные показатели полового развития подростков и определить региональные особенности данной популяции. Методы. Оценка вторичных половых признаков проводилась врачами-специалистами по критериям Tanner. Ультразвуковое исследование органов репродуктивной системы осуществлялось при помощи переносного сканера Mindray M7. Анализ результатов проводили с учетом пола, условий проживания, физического развития. Результаты. Обследовано 7120 подростков в возрасте от 13 до 16 лет. Степень оволосения подмышечной впадины по критериям Tanner составила у юношей 2,4±0,7, у девушек — 2,9±0,4, степень лобкового оволосения — 2,0±0,9 и 2,6±0,8 соответственно. Показатель развития молочных желез по критериям Tanner у девушек составил 2,6±0,8, менструальная функция по критериям Tanner — 2,4±0,8. При этом у городских подростков выявлены более поздние сроки появления вторичных половых признаков в сравнении с жителями сельских районов. Заключение. У 8,1% девушек и 13,6% юношей зарегистрирована задержка полового развития. У городских юношей выявлена задержка роста гонад; среди женского населения наблюдалось опережение роста и развития матки и яичников в сравнении с сельскими подростками.

Plastic bronchitis associated with corrected cardiac anomaly in a child

Plastic bronchitis (PB) is a rare disease that causes airway obstruction with large «rubber» bronchial casts in adults and children, mainly due to concomitant cardiac or pulmonary pathology. It involves the organization of exudate or transudate, which takes the form of the respiratory tract. Mortality with PB reaches 50%. Exact epidemiological data are not known. In most patients, PB occurs in the context of major diseases, which can be conditionally divided into two groups: heart and vascular disease and secondary complication of pulmonary diseases. Usually PB manifests with episodes of dyspnea, tachycardia, hypoxia, fever and cough associated with airway obstruction. Sometimes the symptoms resemble asthma or obstructive bronchitis, accompanied by wheezing and the symptoms of respiratory failure, decreasing of saturation (of what?), the development of pneumothorax. All existing methods of treatment are symptomatic. Promising methods of therapy are the use of inhaled unfractionated heparin and a recombinant tissue plasminogen activator (TAP). The article presents a clinical case of PB in a girl of 5 years with the background of corrected cardiac anomaly

Diagnosis of Bronchial Asthma in Children 3–6 Years Old by Using Serum Periostin and Surrogate Markers of Eosinophilic Inflammation (Blood Eosinophils and Total IgE): a Cross-Sectional Study

Background. It is difficult to diagnose bronchial asthma (BA) in children under the age of 6 due to the limited ability to study respiratory function. Therefore, it is relevant to search for such diagnostic markers of BA that do not require the active participation of a child.Objective. Our aim was to assess the diagnostic value of serum periostin levels in comparison with surrogate markers of eosinophilic inflammation (total IgE and blood eosinophils) for the diagnosis of BA in preschool children.Methods. A cross-sectional study included children 3–6 years of age with BA and healthy peers. The levels of serum periostin (ELISA), total IgE (chemiluminescent method), blood eosinophils (counted on a hematological analyzer) were determined. To study the diagnostic value of peripheral blood parameters ROC-analysis was used.Results. Children with BA (n = 56) compared with the healthy group (n = 29) showed higher levels of serum periostin (median and quartile) — 5.7 (3.4, 8.0) and 2.7 (1, 7; 3.6) ng/ml (p < 0.001), total IgE — 180 (122; 622) and 55 (45; 87) IU/ml (p < 0.001), blood eosinophils — 6.1% (3.8; 8.0) and 3.6% (2.7; 4.1) (p < 0.001). The area under the ROC curve (AUC) for serum periostin was 0.81 (95% CI 0.73–0.89), for total IgE — 0.86 (95% CI 0.77–0.92), for blood eosinophils — 0.77 (95% CI 0.67–0.86). Independent predictors of serum periostin were total IgE and the number of exacerbations of BA over the past 12 months > 2 (R2 = 0.527).Conclusion. The level of serum periostin in preschool children with BA is higher than in their healthy peers. The diagnostic value of serum periostin in BA is in the range from moderate to good and is comparable to that for the levels of blood eosinophils and total IgE

ALLERGIC RHINITIS IN PRE-SCHOOL CHILDREN LIVING IN URBAN SETTINGS OF THE ALTAI REGION: A POPULATION-BASED CROSS-SECTIONAL STUDY

Background. It is necessary to study the prevalence and risk factors of allergic rhinitis (AR) among pre-school children in order to develop a disease prevention strategy.Objective. Our aim was to study the prevalence, clinical and allergological features, and risk factors for AR in pre-school children living in urban settings of the Altai Region.Methods. At the screening stage, the study enrolled children aged 3–6 years attending pre-school educational institutions in 5 cities of the Altai Region. AR symptoms were determined using the ISAAC questionnaire. The AR was diagnosed if ≥ 2 symptoms (rhinorrhea, nasal breathing difficulty, itching in the nasal cavity, repetitive sneezing) lasted ≥ 1 h with a positive prick test and/or a blood level of specific IgE > 0.35 kU/L to at least one allergen (total 11).Results. The prevalence of AR in urban children aged 3–6 years (n = 3,205) was 10.6%; 48% of them were previously diagnosed with AR. 85% of children had a persistent course of the disease; 69% had mild AR. Most often, there was established sensitization to house dust mites (61.6%), birch pollen (40.9%), and cat fur (19.4%). The risk factors for AR were family history of allergies [odds ratio (OR) 4.2; 95% confidence interval (CI) 3.5–5.9], masculine (OR 2.8, 95% CI 1.9–4.0), smoking parents (OR 1.8, 95% CI 1.2–2.9), nonadherence to a regimen/dosage of vitamin D3 intake in infancy (OR 1.8, 95% CI 1.2–2.8), presence of asthma-like symptoms (OR 10.2, 95% CI 7.2–14.5), and manifestations of atopic dermatitis (OR 6.0, 95% CI 4.2–8.5).Conclusion. AR occurs in every tenth pre-school child (mainly of mild severity and persistent course), every second disease among them was diagnosed for the first time. Sensitization occurs to typical for childhood allergens. The risk factors for AR are family history of allergies, masculine, passive smoking, ignoring the recommendations of taking vitamin D3 in infancy, the presence of atopic dermatitis, and asthma-like symptoms

PREVALENCE FOR THE ATOPIC DERMATITIS DEVELOPMENT AT PRE-SCHOOL CHILDREN OF ALTAI KRAI

Aim of research: to evaluate the prevalence of atopic dermatitis at 3–6-year-old children by applying russified version of ISAAC questionnaire (International Study of Asthma and Allergies in Childhood) and to determine risk factors.Materials and Methods. Cross-section research was carried out in five places of Altai Territory (2015–2016). The prevalence of AD was determined with the help of the russified ISAAC Manual filled in by parents of the 3–5-year-old children. The ISAAC definition for current atopic dermatitis (cAD) was used in studies. Patient considered suffering from cAD if respondents’ parents pointed «YES»  on three questions: «Have you ever had an itchy rash which was coming and going for at least six months?», «Have you had this itchy rash at any time in the last 12 months?», «Has this itchy rash at any time affected any of the following places: the folds of the elbows, behind the knees, under the buttocks, or around the neck, ears or eyes?».Results. The research covered 3205 children of 3–6-year-old age. The prevalence of cAD was 12.3 % (n = 393). Medically confirmed diagnosis of AD was stated only at 7.9 % (n = 254) from 393 children. It was established in logistic-regression analysis that burdened familial allergologic history increases 4,6 times the risk of the cAD development at preschool age (OR = 4.62; 95 % CI = 3.69–5.77; p < 0,01). Little duration of breastfeeding (less than six months) increases the risk of cAD development 1,6 times (OR = 1.62; 95 % CI = 1.26–2.09; p < 0.05. The prematurity, tobacco smoking at parents or the contact with pets on the first year age were not found to enhance the risk of cAD development at preschool children.Conclusion. The cAD prevalence markedly exceeds the rates of the medically confirmed diagnoses. The burdened familial history of allergic diseases and little duration of breastfeeding enhance the risk of cAD development at preschool age

Muckle–Wells Syndrome in a Child With Recurrent Urticaria

Cryopyrin associated periodic syndromes (CAPS) are rare monogenic autoinflammatory diseases from the group of hereditary periodic syndromes caused by a regulation defect of inflammatory cytokines, in particular interleukin 1β. They include familial cold autoinflammatory syndrome (FCAS), Muckle–Wells syndrome (MWS), and neonatal-onset multisystem inflammatory disease (CINCA/NOMID). Previously, Muckle–Wells syndrome was considered as a triad of symptoms — urticaria, deafness, and reactive amyloidosis. Today, the spectrum of symptoms is constantly expanding: it includes fever, fatigue, conjunctivitis, arthralgia, arthritis, myalgia, irritability, headache, abdominal pain, mouth ulcers, pericarditis, which involves doctors of different specialties in the diagnostic and treatment process, who are not always familiar with this disease. In Russia, single observations of this disease have been described. We present the clinical case of Muckle–Wells syndrome in a 5-year-old child, whose first symptoms appeared at the age of 2 months. This observation underscores the complexity of diagnosing the syndrome in children

Sexual Development of Adolescents in the Tomsk Region

Background. Sexual development of adolescents is one of the important indicators of the population well-being, the study of which, in the context of the world trend towards a change in the period of puberty, can contribute to the identification of public health problems. Objective. Our aim was to study the basic indicators of sexual development of adolescents and to determine the regional characteristics of this population. Methods. The evaluation of secondary sexual characteristics was carried out by specialists according to Tanner criteria. Ultrasound examination of organs of the reproductive system was carried out using a portable scanner Mindray M7. The analysis of the results was carried out taking into account the gender, living conditions, physical development. Results. We examined 7,120 adolescents aged from 13 to 16 years. The degree of axillary hair distribution by Tanner criteria was 2.4±0.7 in young men, 2.9±0.4 — in girls, pubic hair — 2.0±0.9 and 2.6±0.8, respectively. The indicator of development of mammary glands by Tanner criteria in girls was 2.6±0.8, menstrual function by Tanner criteria — 2.4±0.8. Herewith, urban adolescents had later terms of appearance of the secondary sexual characteristics in comparison with the inhabitants of rural areas. Conclusion. We registered the delayed sexual development in 8.1% of girls and 13.6% of young men. Urban youths have experienced a delay in gonadal growth. Among the female population there was an outstripping growth and development of the uterus and ovaries in comparison with rural adolescents

Amino acid formulas in patients with food allergy

The article presents modern approaches to the use of balanced formulas for nutrition and diet correction in children with various forms of food allergies. The guidelines are based on all available up to date evidence on the efficacy, safety and utility of using such innovative medical technology as specialized amino acid formulas. This formula is the targeted medical intervention for food allergies and confirmed cow's milk protein allergy, and particularly for patients with reduced physical growth and development (growth rates included). The material is based on methodological guidelines on the amino acid formulas usage previously developed by specialist experts of the Union of pediatricians of Russia in 2020

Amino Acid Formulas in Patients with Gastrointestinal Diseases

Modern approaches for the management of children with gastrointestinal pathologies include optimal nutritional support that makes it possible to replete energy failure and restore essential nutrients balance. The article presents key information on gastrointestinal diseases in which modern amino acid formulas can be used to regulate nutritional status. The authors have conducted the extensive analysis of all available for now evidence on the efficacy, safety and utility of using such innovative medical technology as special elemental formula in gastrointestinal tract pathological conditions. This material is the basis for guidlines on the use of amino acid formulas developed by expert specialists of the Union of Pediatricians of Russia in 2020