ВОПРОСЫ КЛАССИФИКАЦИИ, КЛИНИЧЕСКАЯ КАРТИНА И БАЗИСНАЯ ТЕРАПИЯ ЮВЕНИЛЬНОЙ СКЛЕРОДЕРМИИ

Представлены современные сведения о классификации, клинической картине,  диагностике и лечении  склеродермии  у детей по данным литературы и собственных  исследований

Безопасность и эффективность – основа выбора ингаляционных глюкокортикостероидов в терапии бронхиальной астмы у детей

Safety and efficacy as fundamental choice of inhaled steroids for treatment of childhood asthma.Безопасность и эффективность – основа выбора ингаляционных глюкокортикостероидов в терапии бронхиальной астмы у детей

Prevention of new respiratory episodes in children with recurrent respiratory infections: An expert consensus statement

In healthy infants and young children, the development of respiratory tract infections (RTIs) is extremely common. In this paper, we present an international consensus of the available approaches for the prevention of recurrent RTIs in children, including the atopic/allergic ones as well as those with asthma. Few convincing measures for reducing the frequency and clinical relevance of recurrent respiratory episodes in RTI-prone children have been developed until now. Among the most recently suggested measures, immunotherapy is attractive, but only for OM-85 is there a sufficient number of well-conducted clinical trials confirming efficacy in RTIs prevention with an adequate safety profile. In the case of probiotics, it is not clear which bacteria can offer the best results and which dosage and schedule of administration are the most effective. The problems of dosage and the schedule of administration are not solved also for vitamin D, despite some promising efficacy results. While we wait for new knowledge, the elimination or reduction as much as possible of the environmental factors that favor RTIs, vaccination when available and/or indicated, and the systematic application of the traditional methods for infection prevention, such as hand washing, remain the best measures to prevent recurrent infections in RTI-prone children

Опыт комбинированного использования бесфреонового ультрамелкодисперсного препарата беклометазона дипропионата и формотерола в терапии среднетяжелой бронхиальной астмы у детей

Open non-comparative 3-month study of efficacy of combined therapy with beclomethasone (Beclason ECO Easy Breathe) and formoterol (Foradil) was performed in children 6 to 11 years old with moderate bronchial asthma. The study involved 35 patients (the average age was 8.64 ± 0.65 yrs), 69 % were boys. The length of the disease was 2 to 10 yrs (6.01 ± 0.83 yrs). All the patients were given Beclason ECO Easy Breathe 200 meg and Foradil 9 meg twice a day. We evaluated inhalation technique, clinical and functional dynamics, possibilities of achieving the full asthma control, need in short-acting β1-agonists, tolerability and safety of the therapy. No one patient experienced technique problems when using Beclason ECO Easy Breathe. By the 8-th week of the treatment asthma symptoms disappeared in all the patients, breathing rate and lung auscultation became normal. Significant improvement in lung function was noted by the 12-th week of the therapy. The FEV1 growth under the bronchodilating test diminished indicating more bronchial stability. Peak expiratory flow rate increased even in children with initial normal parameters. The need in short-acting β2-agonists reduced from 1,9 ± 0,4 to 0,6 ± 0,2 doses daily. The treatment was well tolerated.Thus, the combination of Beclason ECO Easy Breathe and Foradil in moderate asthma children results in achieving the full asthma control, clinical stability, elimination of the asthma signs, improvement in lung function.Нами проведено открытое несравнительное исследование эффективности комбинированной терапии беклометазоном (Беклазон ЭКО "Легкое дыхание") и формотеролом (Форадил) у детей 6-11 лет с бронхиальной астмой (БА) средней тяжести в течение 3 мес. В исследование были включены 35 пациентов (средний возраст 8,64 ± 0,65 лет), 69 % составили мальчики. Длительность заболевания варьировалась от 2 до 10 лет (в среднем — 6,01 ± 0,83 года). Всем пациентам был назначен Беклазон ЭКО "Легкое дыхание" 200 мкг дважды в день в комбинации с Форадилом 9 мкг дважды в день. На фоне этой терапии каждые 3 мес. мы оценивали технику использования ингалятора "Легкое дыхание" и Аэролайзера; динамику клинического и функционального статуса, возможности достижения полного контроля; потребность в β2-агонистах короткого действия, переносимость и безопасность терапии. Ни у кого из пациентов не возникло трудностей в использовании Беклазона ЭКО "Легкое дыхание" и Аэролайзера. К 8-й нед. терапии у всех детей исчезли клинические проявления БА, нормализовалась ЧД, отсутствовали физикальные изменения в легких. Достоверное улучшение показателей функции внешнего дыхания, по сравнению с исходными, отмечалось через 12 нед. терапии. В пробе с бронхолитиком достоверно уменьшился прирост FEV1, что свидетельствует о нормализации бронхиальной проходимости и снижении бронхолабильности. Пиковая скорость выдоха в динамике увеличивалась даже у детей, исходно имевших нормальные показатели. Потребность в короткодействующих β2-агонистах в ходе исследования снизилась с 1,9 ± 0,4 до 0,6 ± 0,2 инг./сут. Отмечена хорошая переносимость терапии.Проведенное исследование показало, что комбинация Беклазона ЭКО "Легкое дыхание" и Форадила у детей со среднетяжелой БА приводит к достижению контроля заболевания, стабилизации состояния, исчезновению симптомов БА, улучшению функции внешнего дыхания

Prevention of New Respiratory Episodes in Children with Recurrent Respiratory Infections: An Expert Consensus Statement from the World Association of Infectious Diseases and Immunological Disorders (WAidid)

In healthy infants and young children, the development of respiratory tract infections (RTIs) is extremely common. In this paper, we present an international consensus of the available approaches for the prevention of recurrent RTIs in children, including the atopic/allergic ones as well as those with asthma. Few convincing measures for reducing the frequency and clinical relevance of recurrent respiratory episodes in RTI-prone children have been developed until now. Among the most recently suggested measures, immunotherapy is attractive, but only for OM-85 is there a sufficient number of well-conducted clinical trials confirming efficacy in RTIs prevention with an adequate safety profile. In the case of probiotics, it is not clear which bacteria can offer the best results and which dosage and schedule of administration are the most effective. The problems of dosage and the schedule of administration are not solved also for vitamin D, despite some promising efficacy results. While we wait for new knowledge, the elimination or reduction as much as possible of the environmental factors that favor RTIs, vaccination when available and/or indicated, and the systematic application of the traditional methods for infection prevention, such as hand washing, remain the best measures to prevent recurrent infections in RTI-prone children

Опыт применения тиамфеникола глицинат ацетилцистеината при остром бронхите у детей

The aim of this study was to analyze clinical efficacy and safety of inhaled thiamphenicol glycinate acetylcisteinate (TGA) compared to conventional systemic antibacterial therapy in children with acute bronchitis.Methods. This was a randomized open postmarketing parallel-group trial which involved 150 children (71 boys) aged 3 to 17 years with acute bronchitis. Children were included to the trial if they did not improve in 5–6 days of a symptomatic treatment or if they had bacterial respiratory infection. The patients were randomly assigned either to nebulized inhalations of TGA or oral macrolides plus oral N-acetylcysteine for 7 days. Efficacy of therapy was assessed by clinical sign scoring and lung function measured by computed bronchophonography.Results. In 3 days of the treatment, the body temperature decreased to low-grade fever in both the groups. Clinical signs of acute bronchitis improved significantly in 84% of the TGA group patients with statistically significant difference compared to the controls; cough and sputum production were 1.7 ± 0.06 and 2.1 ± 0.02, respectively (р < 0.05); wheezing reduced in 1.5 times in the TGA group to the 3rd day. To the 7th day of the treatment, improvement was equal in both the group and clinical efficacy (recovering, improvement, or no change) did not differ between the groups. Systemic antibacterial therapy was not required in the TGA group.Conclusion. The results have shown the high clinical efficacy of inhaled TGA in children with acute bacterial bronchitis. Systemic macrolides did not improve clinical outcomes and did not shortened the length of the disease, but caused more adverse events compared to the inhaled topic antibacterial therapy.Острые инфекции верхних и нижних дыхательных путей являются самыми частыми заболеваниями в амбулаторной практике, с которыми встречаются педиатры. Однако частота применения системной антибактериальной терапии (АБТ) при этих инфекциях у детей достаточно высока.Материалы и методы. Проведено открытое пострегистрационное рандомизированное исследование в параллельных группах по оценке эффективности и безопасности применения препарата тиамфеникола глицинатацетилцистеината (ТГА) у детей (n = 150: 71 мальчик, 79 девочек; средний возраст – 9,9 ± 0,8 года) с острыми респираторными заболеваниями, протекающими с клиническими явлениями бронхита.Результаты. По результатам проведенного исследования установлена высокая клиническая эффективность ТГА при лечении острых бактериальных респираторных инфекций в режиме ингаляционной терапии. Представлен опыт применения ТГА при остром бронхите у детей в сравнении с системными антибактериальными препаратами (АБП).Заключение. Рекомендовано широкое назначение препарата ТГА в качестве безопасной альтернативы системным АБП при остром бронхите у детей, особенно при необходимости проведения муколитической АБТ

Relative body mass index as a new tool for nutritional status assessment in children and adolescents with bronchial asthma

© 2017, Nizhny Novgorod State Medical Academy. All rights reserved.The aim of the investigation was to estimate the possibilities of using relative body mass index (RBMI) for determining age- and gender-specific aspects of nutritional status in children and adolescents with bronchial asthma (BA) of different severity degrees. Materials and Methods. The study involved 887 children and adolescents with BA of different severities, aged 5–17 years (61– 215 months), of them 655 were boys. Their body mass index (BMI) was evaluated based on the Z-score criterion and nutritional status was determined as recommended by the World Health Organization (WHO). To unify nutritional status assessment in patients of different age and gender groups, there was introduced RBMI representing the ratio of the patient’s BMI to gender- and age-specific median BMI value presented in the WHO reference data. Results. Nutritional status and its relation to BA were studied in children and adolescents using two parameters: the standard nutritional status indicator based on BMI Z-scores as recommended by WHO, and a new parameter, RBMI, representing the ratio of the patient’s BMI to gender- and age-specific median BMI value recommended by WHO. No significant nutritional status differences were found in the studied sample of patients with various degrees of BA severity. There was revealed a tendency to a decrease in the proportion of children with normal body weight and an increase in the proportion of overweight children as BA severity increased, χ2=26.82; р=0.08. Conclusion. Using RBMI for assessment of BA patients makes it possible to significantly facilitate clinical data analysis and obtain new data unavailable when standard parameters are applied