СНИЖЕНИЕ ЧАСТОТЫ ОСЛОЖНЕНИЙ ПРИ ИСПОЛЬЗОВАНИИ ТУННЕЛИРОВАННЫХ КАТЕТЕРОВ У ДЕТЕЙ С СИНДРОМОМ КОРОТКОЙ КИШКИ, НАХОДЯЩИХСЯ НА ДОМАШНЕМ ПАРЕНТЕРАЛЬНОМ ПИТАНИИ

The number of patients with chronic intestinal failure including «short bowel syndrome» (SBS) who require long-term parenteral nutrition (PN) is growing now. 10-year experience of authors in providing home parenteral nutrition (HPN) in Russia shows that HPN is cost-saving method that improves prognosis of patients. The effect of skin-tunneled catheters and venous port-systems in hospital and home PN was analyzed in the open prospective study. 23 PN periods in 20 children were studied. The incidence of catheter-associated infections was 2.58 for 1000 catheter-days for tunneled catheter or port. It was shown that skin-tunneled central venous catheters (CVC) and port-systems reduce the incidence of all infectious complications by 10 cases (p=0.033) per 1000 catheter-days in average, the incidence of catheter-related system infections by 9 cases (p=0.004), the incidence of technical complications by 5 cases (p=0.005) per 1000 catheter-days if compared with standard CVC. Our results make it possible to recommend the use of skin-tunneled CVC and port-systems as a method of choice for patients requiring long-term PN.В настоящее время увеличивается количество пациентов с хронической кишечной недостаточностью, в частности с синдромом короткой кишки (СКК), нуждающихся в длительном, в том числе пожизненном, парентеральном питании (ПП). На протяжении 10 лет авторы внедряют методику домашнего ПП, которое снижает затраты на лечение и улучшает прогноз у пациентов с СКК. В данной работе проанализирован эффект использования туннелированных катетеров и подкожных портов для венозного доступа в условиях стационара и домашнего ПП. Изучены 23 периода ПП у 20 детей с хронической кишечной недостаточностью. Частота катетер-ассоциированых инфекций при использовании специализированных устройств составила 2,58 случаев на 1000 катетеро-дней. Использование туннелированных ЦВК и порт-систем снижает общую частоту инфекционных осложнений в среднем на 10 случаев (р=0,033), катетер-ассоциированных системных инфекций - на 9 случаев (р=0,004), частоту технических осложнений - на 5 случаев (р=0,005) на 1000 катетеро-дней. Полученные результаты позволяют рекомендовать использование туннелированных ЦВК и порт-систем в качестве методики выбора венозного доступа у детей, нуждающихся в длительном ПП

Modern aspects of rendu-osler-weber disease

Rendu-Osler-Weber disease (hereditary hemorrhagic telangiectasia) is a rare hereditary disease that develops in childhood, characterized by vascular dysplasias, multiple telangiectasias of the skin and mucous membranes, and hemorrhagic syndrome of different localization. One of the first and most noticeable signs of the disease is spider veins on the skin and nasal mucous membranes. With lesions of nasal mucosa and gastrointestinal tract, the disease proceeds with frequently recurring bleeding. In chronic blood loss, iron deficiency anemia develops, and in acute cases, a fatal outcome is possible. The article provides a brief historical summary of Rendu-Osler-Weber disease description, etiopathogenetic mechanisms of the disease development, clinical picture with the most typical manifestations, as well as modern diagnostic and treatment criteria. Particular attention is paid to the early diagnosis of the disease. In conclusion, the authors cite their own observation of an 11-year-old patient with Rendu-Osler-Weber disease. © 2019, Pediatria Ltd. All right reserved

Iron deficiencies: focus on teenage girls

T.M.&nbsp;Vasil’eva1,2, I.N. Zakharova1, A.L. Zaplatnikov1,3, N.G. Sugyan1,2, E.V. Shirdanina2, E.A. Doroshina1, L.S. Serikova1, I.D. Maykova3, O.A. Kuznetsova3, A.S.&nbsp;Vorob’eva3, E.R. Radchenko3, L.V. Goncharova3, N.V. Gavelya3 1Russian Medical Academy of Continuous Professional Education, Moscow, &nbsp;Russian Federation 2City Children Outpatient Department No. 133, Moscow, Russian Federation 3Z.A. Bashlyaeva City Children Clinical Hospital, Moscow, Russian Federation Aim: to improve the efficacy of iron deficiency treatment in teenage girls by their early diagnosis and rational treatment. Patients and Methods: complete blood count was performed in 2,303 teenage schoolgirls aged 14–17 years (mean age 16.3±0.6 years) who underwent routine annual medical examination. Whole capillary blood was tested. Reduced hemoglobin concentration (less than 120 g/l) was anemia diagnostic criterion in teenage girls. Hypochromic anemia was verified in color index less than 0.85 and mean corpuscular hemoglobin (MCH) less than 26 pg. In some girls (n=133) with verified isolated hypochromic red blood cells but in the lack of anemia and microcytosis, serum iron, total iron-binding capacity, serum ferritin, and transferrin saturation were measured. Results: hypochromic anemia was diagnosed in 8.3% of teenage girls. In 96.8% of them, anemia was mild. In 133 teenage girls with verified hypochromic red blood cells but no anemia, latent iron deficiency was diagnosed in 20.3% of cases. Preliminary results of mild iron-deficiency anemia treatment in 19 teenage girls (mean age 14.7±0.5 years) using Tardyferon demonstrate its good tolerability and high clinical laboratory efficacy. After 4 weeks of the treatment, hemoglobin concentration has increased by 10.7±0.3 g/l (р&lt;0.05). No adverse side effects were reported. Conclusions: our findings demonstrate that the algorithm described in this paper should be followed to improve the diagnosis of iron deficiencies. Keywords: anemia, hypochromic RBCs, teenage, iron deficiencies, iron-deficiency anemia, latent iron deficiency, iron preparations, Tardyferon. For citation: Vasil’eva T.M., Zakharova I.N., Zaplatnikov A.L. et al. Iron deficiencies: focus on teenage girls. Russian Journal of Woman and Child Health. 2019;2(3):206–212. <br