КЛИНИКО-ЭТИОЛОГИЧЕСКАЯ ХАРАКТЕРИСТИКА ОКИ У ГОСПИТАЛИЗИРОВАННЫХ ДЕТЕЙ ГОРОДА МОСКВЫ В 2015—2017 ГГ.

A retrospective analysis of the etiological structure and clinical manifestations of acute intestinal infections was conducted in 8459  children hospitalized in a specialized infectious disease department at the Children's City Clinical Hospital No.9 in Moscow,  in 2015—2017 based on the study of statistical reports of the Children's City Clinical Hospital No.9 for 2015—2017 and 2417 case histories of children aged 1 month to 18 years old.It was found that children with age 1—7 years of age (58.5%) are more likely to have acute intestinal infections and are hospitalized. The etiological interpretation of acute intestinal infections remains at a low level and is 28.6%. The leading causative agents of acute intestinal infections are viruses (83%), mainly rotaviruses (62%), less often noroviruses (18%). Topical diagnosis in the vast majority of patients with acute intestinal infections was gastroenteritis (74.7%), which leads to the development of toxicosis with exsiccosis,  especially in young children, which is the reason for hospitalization  in the hospital. The share of bacterial diarrhea is small (17%), among them salmonella  is significant, and in young children  — staphylococcal infection. In recent years, the relevance of identifying campylobacter and clostridium, these pathogens may be the cause of the development of diarrhea with hemoccolitis.Проведен ретроспективный анализ этиологической  структуры и клинических проявлений острых кишечных инфекций (ОКИ) у 8459 детей, госпитализированных в специализированное инфекционное отделение Детской городской клинической больницы №9 им. Г.Н. Сперанского ДЗ г. Москвы  (ДГКБ №9) в 2015—2017  гг. на основе изучения статистических отчетов ДГКБ №9 за 2015—2017  гг. и 2417 историй болезни детей в возрасте от 1 месяца жизни до 18 лет.Установлено, что чаще болеют ОКИ и госпитализируются дети в возрасте 1—7 лет жизни (58,5%). Этиологическая расшифровка ОКИ остается на низком уровне и составляет 28,6%. Лидирующим возбудителем ОКИ являются вирусы (83%), преимущественно ротавирусы (62%), реже — норовирусы (18%). Топическим диагнозом у подавляющего большинства больных с ОКИ оказался гастроэнтерит (74,7%), который приводит к развитию токсикоза с эксикозом, особенно у детей раннего возраста, что и служит причиной госпитализации  в стационар. Доля бактериальных диарей невелика (17%), среди них значимым остается сальмонеллез, а у детей раннего возраста — стафилококковая инфекция. В последние  годы актуальность приобретает выявление кампилобактерий и клостридий, т.к. эти возбудители  могут быть причиной развития диареи с гемоколитом

Аутохтонный висцеральный лейшманиоз в Российской Федерации и роль полимеразной цепной реакции как альтернативного метода диагностики

The aim of the work is to summarize the available literature data on cases of visceral leishmaniasis in children registered in the Russian Federation, as well as to describe our own clinical observation of autochthonous visceral leishmaniasis in a 9-year-old child, in the diagnosis of which the polymerase chain reaction (PCR) method was used.Materials and methods: a review of domestic and foreign literature over the past 20 years, including Internet resources, was carried out. We observed a 9-year-old child hospitalized in the Russian Children's Clinical Hospital. Leishmania DNA was determined in blood serum by PCR using the Amplisens – Leishmania-Fl reagent kit.Results. It was established that the infection of the patient observed by us occurred on the territory of the Russian Federation in the Crimea. The diagnosis of leishmaniasis was confirmed by morphological examination of the bone marrow and the detection of pathogen DNA in the blood serum by PCR.Conclusion. On the territory of the Russian Federation there are foci of autochthonous visceral leishmaniasis in the Crimea and the North Caucasus. Polymerase chain reaction is an alternative to bone marrow aspirate microscopy for the diagnosis of visceral leishmaniasis.В работе обобщены данные литературы о случаях висцерального лейшманиоза у детей, зарегистрированных на территории РФ, а также представлено описание собственного клинического наблюдения аутохтонного висцерального лейшманиоза у ребенка 9 лет, в диагностике которого использован метод полимеразной цепной реакции (ПЦР). Нами наблюдался ребенок 9 лет, госпитализированный в Российскую детскую клиническую больницу. ДНК лейшманий определялась в сыворотке крови методом ПЦР с использованием набора реагентов Амплисенс-Лейшманиозы-Fl. Результаты. Установлено, что заражение наблюдавшегося нами пациента произошло на территории РФ в Крыму. Диагноз лейшманиоза подтверждался при морфологическом исследовании костного мозга и обнаружении ДНК возбудителя в сыворотке крови методом ПЦР. Заключение. На территории Российской Федерации имеются очаги аутохтонного висцерального лейшманиоза в Крыму и на Северном Кавказе. Полимеразная цепная реакция представляет собой альтернативу микроскопии пунктата костного мозга для диагностики висцерального лейшманиоза

ХАРАКТЕРИСТИКА ОСТРЫХ КИШЕЧНЫХ ИНФЕКЦИЙ У ДЕТЕЙ, ГОСПИТАЛИЗИРОВАННЫХ В СТАЦИОНАР Г. МОСКВЫ

The article presents the results of the study of the etiological structure and clinical features of acute intestinal infections of viral, bacterial and mixed etiology in children hospitalized in a specialized department of Children's Clinical Hospital №9 named G. N. Speransky, city of Moscow in 2008—2016. It was found that during 9 years of follow-up, the number of hospitalized patients with acute intestinal infections does not have an obvious tendency to decrease. More than half of hos-pitalized patients are children 1—7 years old. Among the reasons for acute intestinal infections of established etiology, viral agents (rotaviruses and noroviruses) prevail. Among bacterial intestinal infections, the most urgent are salmonellosis, campylobacteriosis and staphylococcal infection.  В статье представлены результаты изучения этиологической структуры и клинических особенностей острых кишечных инфекций (ОКИ) вирусной, бактериальной и смешанной этиологии у детей, госпитализированных в специализированное отделение ДГКБ №9 им Г.Н. Сперанского г. Москвы в 2008—2016 гг. Установлено, что на протяжении 9 лет наблюдения количество госпитализированных пациентов с ОКИ не имеет очевидной тенденции к снижению. Более половины госпитализированных пациентов составляют дети в возрасте 1—7 лет. Среди причин ОКИ установленной этиологии преобладают вирусные агенты (ротавирусы и норовирусы). Среди бактериальных кишечных инфекций наибольшую актуальность представляют сальмонеллез, кампилобактериоз и стафилококковая инфекция. 

JUVENILE MYOCLONIC EPILEPSY: A FOCUS ON THE EFFICACY OF THERAPY AND THE RATE OF RELAPSES ACCORDING TO LONG-TERM FOLLOW-UP DATA

Juvenile myoclonic epilepsy (JME) is a type of adolescent-onset idiopathic generalized epilepsy with the appearance of massive myoclonic seizures and, in most cases, generalized convulsions occurring chiefly in the period after awakening. It is assumed that there is a two-locus (dominant and recessive) model of inheritance of JME; moreover, the dominant gene is located on the short arm of chromosome 6. JME is one of the most common types of epilepsy and most frequent among idiopathic generalized epilepsies. Its rate is 5 to 11 % of all types of epilepsy with some female predominance. The diagnosis of JME creates no problems in typical cases. The disease is generally manifested by a concurrence of myoclonic (usually in the hands) and generalized clonic-tonic-clonic seizures occurring during waking. Typical absences and epileptic myoclonus of the eyelid are rarer. Seizures are clearly provoked by sleep deprivation. As in other types of idiopathic epilepsy, the patients’ neurological status is normal; no intellectual disabilities are observed. This type of epilepsy is well treatable and, when initial monotherapy is correctly used, sustainable remission occurs immediately in the vast majority (75–85 %) of the patients with JME. However, the problem of these patients, unlike that of patients with many forms of idiopathic epilepsy, is that sleep pattern disturbance, missing a dose of antiepileptic drugs (AED), or therapy refusal give rise to relapse of seizures in the vast majority of patients even in long-term remission.Due to the fact that the data available in the literature on the efficacy of therapy in patients with JME and particularly on the results of its discontinuation are contradictory, the authors of the paper conducted an investigation to determine therapeutic effectiveness and the frequency of relapse of seizures in patients with JME during a long-term follow-up.The study enrolled 106 JME patients who had been regularly followed up at the Saint Luka’s Institute of Pediatric Neurology and Epilepsy for 3 to 28 years (mean 8.6 years). The authors detailed the clinical characteristics of the disease and the results of the investigation in the observed patients. The investigation showed that JME was the second common type (next to rolandic epilepsy) among all idiopathic epilepsies. Clinical remission lasting 3 years or longer was achieved in the vast majority of cases (89.6 %); however, clinical and electroencephalographic remission was in only 22 % of the patients. Treatment was not absolutely ineffective in any of the cases. Monotherapy for JME was used in most patients (79 %), duotherapy in 17 % and polytherapy (3 AEDs) in 4 %. Valproate was most commonly used as monotherapy for JME (56 %); levetiracetam and topiramate were more rarely in 13 and 8 %, respectively.Unfortunately, despite the high effect of treatment, the recurrence rate during or after discontinuation of AED therapy (which was gradually done under guidance of video-assisted electroencephalographic monitoring at least 3–4 years after remission) was very high (92 %). The recurrence risk was highest when the dose was reduced by more than 50 % and within the first year after therapy discontinuation. Multiple attempts to discontinue the treatment were made at an interval of an average of 4.3-years of remission in a number of patients. The authors identified a number of factors increasing the recurrence risk after withdrawal of an AED

CHARACTERISTICS OF ACUTE INTESTINAL INFECTIONS IN CHILDREN HOSPITALIZED IN THE CLINIC IN MOSCOW

The article presents the results of the study of the etiological structure and clinical features of acute intestinal infections of viral, bacterial and mixed etiology in children hospitalized in a specialized department of Children's Clinical Hospital №9 named G. N. Speransky, city of Moscow in 2008—2016. It was found that during 9 years of follow-up, the number of hospitalized patients with acute intestinal infections does not have an obvious tendency to decrease. More than half of hos-pitalized patients are children 1—7 years old. Among the reasons for acute intestinal infections of established etiology, viral agents (rotaviruses and noroviruses) prevail. Among bacterial intestinal infections, the most urgent are salmonellosis, campylobacteriosis and staphylococcal infection

КЛИНИКО-ЭТИОЛОГИЧЕСКАЯ ХАРАКТЕРИСТИКА ОКИ У ГОСПИТАЛИЗИРОВАННЫХ ДЕТЕЙ ГОРОДА МОСКВЫ В 2015—2017 ГГ.

A retrospective analysis of the etiological structure and clinical manifestations of acute intestinal infections was conducted in 8459  children hospitalized in a specialized infectious disease department at the Children's City Clinical Hospital No.9 in Moscow,  in 2015—2017 based on the study of statistical reports of the Children's City Clinical Hospital No.9 for 2015—2017 and 2417 case histories of children aged 1 month to 18 years old.It was found that children with age 1—7 years of age (58.5%) are more likely to have acute intestinal infections and are hospitalized. The etiological interpretation of acute intestinal infections remains at a low level and is 28.6%. The leading causative agents of acute intestinal infections are viruses (83%), mainly rotaviruses (62%), less often noroviruses (18%). Topical diagnosis in the vast majority of patients with acute intestinal infections was gastroenteritis (74.7%), which leads to the development of toxicosis with exsiccosis,  especially in young children, which is the reason for hospitalization  in the hospital. The share of bacterial diarrhea is small (17%), among them salmonella  is significant, and in young children  — staphylococcal infection. In recent years, the relevance of identifying campylobacter and clostridium, these pathogens may be the cause of the development of diarrhea with hemoccolitis.Проведен ретроспективный анализ этиологической  структуры и клинических проявлений острых кишечных инфекций (ОКИ) у 8459 детей, госпитализированных в специализированное инфекционное отделение Детской городской клинической больницы №9 им. Г.Н. Сперанского ДЗ г. Москвы  (ДГКБ №9) в 2015—2017  гг. на основе изучения статистических отчетов ДГКБ №9 за 2015—2017  гг. и 2417 историй болезни детей в возрасте от 1 месяца жизни до 18 лет.Установлено, что чаще болеют ОКИ и госпитализируются дети в возрасте 1—7 лет жизни (58,5%). Этиологическая расшифровка ОКИ остается на низком уровне и составляет 28,6%. Лидирующим возбудителем ОКИ являются вирусы (83%), преимущественно ротавирусы (62%), реже — норовирусы (18%). Топическим диагнозом у подавляющего большинства больных с ОКИ оказался гастроэнтерит (74,7%), который приводит к развитию токсикоза с эксикозом, особенно у детей раннего возраста, что и служит причиной госпитализации  в стационар. Доля бактериальных диарей невелика (17%), среди них значимым остается сальмонеллез, а у детей раннего возраста — стафилококковая инфекция. В последние  годы актуальность приобретает выявление кампилобактерий и клостридий, т.к. эти возбудители  могут быть причиной развития диареи с гемоколитом.</p