Индексы антиоксидантной системы при ювенильном идиопатическом артрите

Mother and Child Health Protection Scientific Research Institute, Department of Paediatrics, Nicolae Testemitanu State Medical and Pharmaceutical UniversityThe pathogenesis of juvenile idiopathic arthritis (JIA) is complex, in a permanent study. Oxidative stress has shown to play an important role in the perpetuating inflammation. The antioxidant barrier is a complicated system of enzymes, elements and substances that are formed to protect the aerobic organisms against high concentrations of oxygen. 150 children with JIA and 20 real healthy children were included in a randomized study. The authors examined the indices of the antioxidant system (total antioxidant activity (AAT), superoxiddismutase (SOD), catalase, glutathione-peroxidase, glutathionereductase and ceruloplasmin) of 90 patients with JIA and 20 healthy children. A low endogenous antioxidant capacity was found in the patients with JIA and the functional parameters of SOD, catalase, glutathione-peroxidase and glutathione-reductase were found to be much lower for the patients with JIA, compared with the control group. The values of the antioxidant indices were significantly lower in the systemic form, while glutathione-peroxidase, glutathione-reductase and ceruloplasmin were noted as having practically the same values in all evolutionary variants.Патогенез ювенильного идиопатического артрита (ЮИА) достаточно сложный процесс. Важную роль в сохранении воспалительного процесса имеет окислительный стресс. Антиоксидантный барьер является сложной системой антиоксидантных ферментов, элементов и веществ, которые образуются для защиты аэробных организмов против концентрации кислорода. В данное исследование были включены 150 детей с ЮИА и 20 здоровых детей. У 90 больных с ЮИА и 20 здоровых детей была оценена антиоксидантная система (общая антиоксидантная активность (ОAA), супероксиддисмутаза (СОД), каталаза, глутатион-пероксидаза, глутатион-редуктаза и церулоплазмин). Таким образом, у детей с ЮИА был зарегистрирован низкий уровень СОД, каталазы, глутатион-пероксидазы и глутатион-редуктазы в сравнении с контрольной группой. Показатели антиоксидантной системы имели более низкие показатели при системном варианте, тогда как глутатион-пероксидаза, глутатион-редуктаза и церулоплазмин имели практически одинаковые значения во всех вариантах ЮИА

Determining of N-acetyl-β-glucozaminidase in urine of patients with acute glomerulonephritis

Departamentul Pediatrie, USMF ”Nicolae Testemiţanu”Summary: Determining of activity of NFG-β in urine is marker of diagnosis whieh reflects the activity of inflammatory process in kidneys, and allow to make prognosis of sequelae as well as topography of lesions in kidneys tissue.Obiective: Determinarea activităţii N-acetil-β-glucozaminidazei (NAG-β) în urină la copii cu glomerulonefrită acută (GNA). Material şi metode: Studiul dat este axat pe un lot de 46 copii cu GNA sindrom nefrotic, inclusiv 32 copii cu GNA sindrom nefrotic steroidsensibil şi 14 copii cu GNA sindrom nefrotic steroidrezistent. Copiii au fost examinaţi la etapele clinico-evolutive ale maladiei, în stadiul funcţional compensator al maladiei. Diagnosticul GNA sindrom nefrotic a fost bazat pe datele anamnestice, clinico-paraclinice, pe explorări biochimice. Sindromul nefrotic a fost diagnosticat în prezenţa edemelor, proteinuriei masive (>40 mg/m²/h sau a raportului proteină/creatinină în urină > 2,0 mg/mg) şi hipoalbuminemie (<2,5 mg/dl). Vârsta medie a debutului maladiei a constituit 7,76±0,60 ani. Activitatea NAG-β în urină a fost calculată după metoda Pugh D. Grupul de control l-au constituit 20 copii practic sănătoşi. Rezultate: La copiii cu GNA sindrom nefrotic steroidsensibil în perioada manifestărilor clinice activitatea NAG-β în urină a sporit de 4,5 ori (11,10±1,85 nM/s, mM creatinină) comparativ cu grupul de control (2,43±0,47 nM/s, mM creatinină). În perioada remisiunii activitatea NAG-β în urină s-a redus practic până la nivelul grupului de control (2,20±0,04 nM/s, mM creatinină). În lotul copiilor cu GNA sindrom nefrotic steroidrezistent în perioada manifestărilor clinice s-a semnalat o creştere de 4,0 ori (9,61±2,24 nM/s, mM creatinină) a activităţii NAG-β în urină comparativ cu grupul de control. În perioada remisiunii activitatea NAG-β în urină continuă să rămână sporită (10,53±1,42 nM/s, mM creatinină) comparativ cu grupul de control. Concluzii: Determinarea activităţii NAG-β în urină reprezintă un marcher diagnostic care reflectă intensitatea procesului inflamator renal, permite prognozarea complicaţiilor precum şi topografi a lezării ţesutului renal

Внебольничная пневмония, ассоциированная с герпетической инфекцией у детей

USMF “Nicolae Testemiţanu”, Departamentul PediatrieBackground: Respiratory system diseases have high levels incidence in children (up to 70%), pneumonia being the most acute clinical form amongst all of them, having also a high incidence (20 – 40 %) and the presence of comorbidities is associated with herpes infection. Community-acquired pneumonia is an actual problem and the main reason for infant-mortaliry worldwide (WHO 2010). Association of acute respiratory dizeases with herpes infection markedly increases the mortality risk, especially amongst children of young age. Aim: Evaluation of clinical and immunological peculiarities in children under 5 years of age with acute pneumonia associated with pesistent herpes infection. Objectives: 1. Estimation of the anamnestic, clinical and laboratory data in acute respiratory infections associated with herpes infection. 2. Cellular and humoral immunity study. 3. Examination of anti-herpes and anti-cytomegalovirus antibodies in serum and urine, and virus DNA identifi cation in patients with suggestive history for Herpes simplex or Cytomegalovirus infection. Materials and methods: The study group included 47 children under 5 years of age with community-acquired pneumonia, associated with Herpes infection. Diagnosis of Herpes infection was confi rmed by PCR and IFM. Results: Immunological disorders were observed in 2/3 of cases (decreased levels of CD4, CD8, CD20 and serum IgA and IgG levels). The presence of HSV and/or CMV in parents was confi rmed by PCR in 79% of cases, by ELISA method - 11%. Viruses coinfections (ARD, HSV, CMV) determines immunological disorder and severity of clinical manifestations. Conclusions: Prenatal and postnatal risk factors in association with history of herpes infections determine acute manifestations of the commutity-acquired pneumonia. In 2/3 of cases IgG levels are three fold higher than the normal once, that indicates the presence of persistent herpes infection. Cellular and humoral immunological disorders contribute to a more sever and complex evolution of pneumonia in patients if associated with latent and persistent herpes infection.Актуальность: Внебольничная пневмония является актуальной проблемой и главной причиной детской смертности в мире (ВОЗ, 2010). Ассоциация острых респираторных заболеваний с герпетической инфекцией (ГИ) создает огромный риск смертности, особенно среди детей младшего возраста. Цель работы: Исследование клинико-иммунологических особенностей острых респираторных инфекций у детей в возрасте до 5 лет, протекающих в виде острых пневмоний, ассоциированных с устойчивой герпетической инфекцией (ГИ). Задачи: 1. Оценка анамнестических, клинических и параклинических данных при острых респираторных инфекциях, ассоциированных с ГИ. 2. Изучение клеточного и гуморального иммунитета. 3. Серологическое исследование на присутствие анти-герпетических антител 1-го, 2-го типа, антицитомегаловирусных антител в сыворотке крови и моче обследуемых детей, а также определение ДНК в сыворотке крови и моче у пациентов с положительным семейным анамнезом в отношение вируса герпеса и/или цитомегаловирвируса. Материалы и методы: В исследование были включены 48 детей в возрасте до 5 лет с острой внебольничной пневмонией, ассоциированной с герпетической инфекцией и положительным семейнымй анамнезом (наличие герпеса-инфекций). Диагноз герпетической инфекции был подтвержден методом ПЦР (Полимеразная Циклическая Реакция) и ИФР (Иммунофлюоресцентная Реакция). Результаты и дискуссии: Иммунный дисбаланс присутствовал в 2/3 случаев (уменьшение уровня CD8, CD4, CD20 и плазменных иммуноглобулинов IgA и IgG). Присутствие герпетической инфекции (HSV 1, 2 типа) и/ или цитомегаловиротической инфекции (CMV) у родителей было подтверждено методом ПЦР в 79% случаев и ИФР в 11% случаев. Семейный анамнез подтверждает высокую заболеваемость HSV в исследовании (94%), а у 16% обследованных присутством CMV. У 14% детей из группы исследования была диагностирована гирпетическая инфекция. ДНК-CMV была выявлена в плазме у 25,9% детей, а ДНК-HSV 1-го, 2-го, 6-го типов – в 27,6% случаев. Выводы: 1. Пренатальные и постнатальные факторы риска совместно с положительным герпетическим семейным анамнезом определяют тяжелое течение внебольничной пневмонии у детей до 5 лет. 2. У 2/3 детей уровень IgG был увеличен в 3 раза по сравнению с нормой, что подтверждает присутствие устойчивой герпетической инфекции. 3. Ассоциация респираторной инфекции с HSV 1-го, 2-го типа и CMV регистрировалось у 1/3 детей. 4. Выявились иммунологические нарушения, как клеточного, так и гуморального иммунитета, что объясняет тяжесть течения и сложность терапии латентной, устойчивой инфекции с дыхательной системы, такой как пневмония

Difficulties in diagnosis and treatment of acute bones and joints infections in newborn

Catedra de chirurgie, ortopedie şi anesteziologie pediatrică, USMF ,,Nicolae Testemiţanu”, Secţia chirurgia nou-născuţi, Centrul Naţional Ştiinţifico-Practic de Chirurgie Pediatrică "Natalia Gheorghiu”, Institutul Mamei şi Copilului, Chişinău, Republica Moldova, Al XII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova cu participare internațională 23-25 septembrie 2015Introducere: Procesul inflamator la nivelul sistemului osteo-articular reprezintă o urgenţă chirurgicală a perioadei neonatale. Incidenţa sechelelor la nou-născuţi variază între 6% şi 50% şi conduc la apariţia tulburărilor în creşterea osului, discrepanţa lungimii extremităţilor, artrite, fracturi patologice. Scopul: De a ameliora rezultatele tratamentului medico-chirurgical al nou-născuţilor cu infecţii osteo-articulare prin aprecierea unei strategii de diagnostic şi tratament adecvat la debutul bolii. Material şi metode: Pe parcursul anului 2010-2014 au fost spitalizaţi şi trataţi 44 nou-născuţi cu osteomielită hematogenă acută. În procesul inflamator au fost antrenate humerusul – la 16 nou-născuţi, oasele antebraţului – la 3, femurul cu articulația coxo-femurală – 22, tibia – 2 şi osul mandibular la un nou-născut. Au fost analizate datele clinice, imagistice, condițiile favorizante de apariție a procesului, factorii de pronostic. La 90% din pacienţi au fost depistate comorbidităţi (pneumonie, infecţie respiratorie, omfalită, enterocolită, encefalopatie perinatală, ş.a.). Rezultate: Tratamentul conservator a fost utilizat în 3 cazuri, în cazul unui diagnostic precoce, în primele 24 ore de la debut. În 41 cazuri managementul medico-chirurgical a inclus trei elemente de bază: evacuarea puroiului, antibioticoterapia şi imobilizarea articulaţiei. Concluzii: Infecțiile osteoarticulare la nou-născut reprezintă o afecțiune septico-purulentă al cărui tratament standard este cel chirurgical. Modificările distructive ale cartilajului derulează rapid, devenind ireversibile peste 3-4 zile de la debutul bolii, fapt ce impune o tactică terapeutică şi chirurgicală cât mai precoce. Lipsa semnelor clinice şi paraclinice la nou-născut cauzează diagnosticul tardiv şi tratamentul neadecvat.Introduction: The inflammatory process in the osteo-articular system is a surgical emergency in neonatal period. The incidence of sequelae in infants between 6% and 50% and give rise to disturbances in bone growth, extremity length discrepancy, arthritis, pathologic fractures. Purpose: To improve the results of medical and surgical treatment of newborns with osteo-articular infection by assessing a strategy of diagnosis and treatment. Material and methods: During 2010-2014, 44 infants with acute hematogenous osteomyelitis were hospitalized and treated. The inflammatory process involved humerus in 16 newborns, forearm bones – in 3, femur with coxo-femoral joint – in 22, tibia –in 2 and mandibula in 1 newborn. Patients were examined clinically, imagistic, with determination of predisposing conditions for the development of the process and prognostic factors. In 90% of patients comorbidities (pneumonia, respiratory infection, enterocolitis, perinatal encephalopathy, etc.) were identified Results: Conservative treatment was used in 3 cases, in case of early diagnosis, within 24 hours of onset. In 41 cases, medical and surgical management included three basic elements: drainage of pus, antibiotic therapy and immobilization of the joint. Conclusions: Musculoskeletal infections in new-born is a septico-purulent disease of which standard treatment is surgical. Destructive changes of the cartilage develop quickly and becoming irreversible on 3-4 days from the onset of illness, fact which requires therapeutic and surgical approach as early as possible. The absence of clinical and paraclinical signs in a new-born can result in delay of diagnosis and non-adequate treatment

Surgical tactics in congenital pathology of small intestine in newborns

Catedra de chirurgie, ortopedie şi anesteziologie pediatrică, USMF ,,Nicolae Testemiţanu”, Secţia chirurgia nounăscuţi, Centrul Naţional Ştiinţifico-Practic de Chirurgie Pediatrică ,,Natalia Gheorghiu”, Institutul Mamei şi Copilului, Chişinău, Republica Moldova, Al XII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova cu participare internațională 23-25 septembrie 2015Introducere: Ocluzia intestinală congenitală este o patologie frecvent întâlnită la nou-născut – 1:3000, cu o letalitate de 16,5- 64%. Diagnosticul anomaliilor asociate, tratamentul chirurgical adecvat şi conduita postoperatorie rămân dificile. Scopul: De a ameliora rezultatele tratamentului chirurgical al nou-născuţilor cu patologie congenitală a intestinului prin alegerea metodei optime de refacere a continuităţii tractului intestinal. Material şi metode: Am analizat 214 nou-născuți pentru patologie congenitală a intestinului subţire într-un interval de 6 ani (01.01.2009-31.05.2015). S-au studiat caracteristicele epidemiologice, clinice, de diagnostic imagistic, histologice, tehnicele de corecţie chirurgicală, factorii de pronostic. Rezultate: Procedeele chirurgicale au înregistrat: membrana duodenului – 15, atrezia duodenului – 12, anomalii de rotaţie şi fixare a intestinului mediu – 93, pancreas inelar – 6, membrana intestinului subţire – 6, atrezia intestinului subţire – 22, sindromul Ledd – 22, torsia intestinului subțire – 11, diverticul Meckel – 13, dedublarea intestinului – 4, ileus meconial – 8, disganglionoza intestinului subţire – 2. S-au efectuat: adezioliza cu refacerea anatomică a topografiei intestinale – 93, detorsia, adezioliza – 27, duodenotomie, rezecţia membranei – 15, duodenoduodenoanastomoză latero-laterală – 9 şi tehnica Kimur – 5, duodeno-jejunoanastomoză – 4, enterotomie, rezecţie de membrană – 6, rezecţie segmentară, enterostomă terminală – 15, sau în două ţevi – 3 cu anastomoză la a II-a etapă, rezecţie segmentară, enteroenteroanastomoză termino-terminală – 2, laterolaterală – 23, T-anastomoză – 3, enterostomie – 9. Concluzii: Patologiile congenitale ale intestinului la nou-născut sunt stări clinice de urgenţă, necesită un diagnostic precoce și tratament individual de la caz la caz, pentru a reduce complicațiile și mortalitatea. Entero-enteroanastomoza primară se aplică în lipsa peritonitei, a modificărilor inflamatorii şi circulatorii ale intestinului.Introduction: Congenital intestinal obstruction is the pathology found at newborn - 1:3000 with a lethality of 16.5-64%. The diagnosis of associated abnormalities, the surgical treatment and postoperative conduct remain difficult. Purpose: To improve the results of surgical treatment of newborns with congenital bowel pathology by choosing the optimal method for the restoration of the intestinal tract continuity. Material and methods: We analyzed 214 newborns for congenital bowel pathology within 6 years (01.01.2009-31.05.2015). We studied the epidemiological characteristics, clinical, diagnostic radiology, histology, surgical correction techniques, prognostic factors. Results: Surgical procedures have been the following: membrane of duodenum – 15, duodenal atresia – 12, abnormal bowel rotation and fixing average – 93, annular pancreas – 6, membrane of the small intestine – 6, bowel atresia – 22, syndrome Ledd - 22, torsion of small bowel – 11, diverticulum Meckel – 13, duplication of the intestine – 4, meconium ileus – 8, disganglionozis of small intestine – 2. Were performed: intestinal adhesions dissection with restoration of anatomical intestinal topography – 93, detorsia, intestinal adhesions dissection – 27, duodenotomy, membrane resection – 15, duodenoduodenoanastomosis side-toside – 9 and method Kimur – 5, duodeno-jejunoanastomosis – 4, enterotomy, membrane resection – 6, segmental resection, terminal enterostoma – 15 or biluminal enterostomy – 3, with stage II – anastomosis, segmental resection, enteroenteroanastomosis end-to-end – 2, side-to-side – 23, T-anastomosis – 3, enterostomy – 9. Conclusions: Congenital bowel pathologies in the newborn are emergency medical conditions which require early diagnosis and individual treatment of the case in order to reduce complications and mortality. Primary enteroenteroanastomosis is applied in the absence of peritonitis, inflammatory and circulatory changes of the intestine

Cicatricial complications of necrotizing enterocolitis in newborns

Catedra de chirurgie, ortopedie şi anesteziologie pediatrică, USMF ,,Nicolae Testemiţanu”, Secţia chirurgia nounăscuţi, Centrul Naţional Ştiinţifico-Practic de Chirurgie Pediatrică "Natalia Gheorghiu”, Institutul Mamei şi Copilului, Chişinău, Republica Moldova, Al XII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova cu participare internațională 23-25 septembrie 2015Introducere: Enterocolita ulceronecrotică fiind o patologie severă, frecvent necesită tratament chirurgical, în special la prematuri. În funcţie de etapa clinico-evolutivă şi terapia conservativă efectuată în 15-48% se pot dezvolta stenoze cicatriciale intestinale, ca rezultat al modificărilor structurale anatomice. Scopul: De a ameliora rezultatele tratamentului chirurgical al nou-născuţilor cu enterocolită ulceronecrotică. Material şi metode: În perioada 2010-2014, au fost trataţi 72 nou-născuţi cu enterocolită ulceronecrotică. În 29 cazuri greutatea la naştere a constituit 1000-1600 gr, termenul de gestaţie 29-32 săptămâni; la 38 – greutatea era 2000-2600 gr, termenul de gestaţie 32-41 săptămâni. Infecţia intrauterină a fost prezentă la 48 nou-născuţi. La 16 – diagnosticate malformaţii congenitale cardiace; la 19 – omfalită, la 57 – diverse afecţiuni în sarcină. Rezultate: Tratamentul conservator a fost efectuat la 25 nou-născuţi, la 42 – tratament chirurgical. Tehnicile chirurgicale: rezecţia segmentară de intestin afectat cu anastomoză primară – 5, rezecţie segmentară de intestin cu aplicarea stomei şi refacerea amânată a continuităţii intestinale – 30, lavajul şi drenarea cavităţii abdominale – 7. La 5 pacienţi s-a dezvoltat stenoza cicatricială a intestinului după tratamentul conservativ, complicată cu ocluzie intestinală mecanică. Examenul histopatologic al intestinului afectat a stabilit atrofia mucoasei, hiperplazia foliculilor plicelor Peyer, tunica musculară cu dismaturitatea structurilor ganglioneuronale, pe alocuri cu disganglionoză se gmentară. Concluzii. Enterocolita ulceronecrotică în stadiul II şi III necesită tratament chirurgical – rezecţia segmentară a intestinului afectat, deoarece modificările morfopatologice ale intestinului devin ireversibile, cauzând ocluzie intestinală mecanică la distanţă. Pacienţii cu enterocolită ulceronecrotică cu peritonită sau perforaţie pot avea un pronostic rezervat pentru viaţă.Introduction: Necrotizing enterocolitis is a severe pathology, frequently require surgical treatment, especially in preterm infants. Depending on the clinical stage and performed conservative therapy in 15-48% of cases the cicatricial intestinal stenosis may develop, resulting in anatomical structural changes. Purpose: To improve the results of surgical treatment of newborns with necrotizing enterocolitis. Material and methods: In the period 2010-2014 72 newborns with necrotizing enterocolitis were treated. In 29 cases weight at birth constituted from 1000 to 1600 g, gestational age 29-32 weeks; in 38 cases weight was 2000-2600 g, gestational age 32-41 weeks. Intrauterine infection was present at 48 newborns. In 16 cases the cardiac malformations were diagnosed; in 19 – omfalytis and in 57 – different disorders in pregnancy. Results: Conservative treatment was performed at 25 neonates; at 42 was performed surgical treatment. Surgical techniques: segmental resection with primary anastomosis – 5, segmental bowel resection and stoma application with delayed restoration of intestinal continuity – 30, lavage and drainage of the abdominal cavity – 7. At 5 patients cicatricial bowel stenosis developed after conservative treatment, complicated with mechanical intestinal obstruction. Histopathologic examination of affected bowel demonstrates mucosal atrophy, hyperplasia of Peyer follicles, muscular layer with immaturity of ganglioneuronale structures, sometimes with segmental disgangliosys. Conclusions: Necrotizing enterocolitis in stage II and III requires surgery – resection of affected bowels, because changes of diseased intestine become irreversible causing intestinal mechanical occlusion. Patients with enterocolitis complicated with peritonitis and perforation have a reserved prognosis for life

Факторы риска и особенности клинического течения и диагностики инфекций мочевыводящих путей у детей первого года жизни

USMF „Nicolae Testemiţanu“, Departamentul PediatrieBackground. Urinary tract infection (UTI) is one of the most common bacterial infections in children; the diagnosis is difficult particularly in young children and infants, because in this age group the clinical presentation of urine infection is often with non-specific clinical signs. UTI among other infant diseases have a special place because of the increased risk for sequels and renal scarring. Aim: To estimate risk factors for urinary tract infections in children and to evaluate clinical and diagnosis features of these in infants. Material and methods. The retrospective study included 44 children under 1 year of age diagnosed with UTI, who were hospitalized to the Nephrology Department of the Institute of Maternal and Child Healthcare in the period December 2007 to 2010. The studied children were 25 females and 19 males. The following methods were used for the examination of patients and experimental data processing: clinical – history, onset and clinical symptoms; laboratory – urinalysis and examination of the urine by Necipurenko method; instrumental – renal ultrasound and scintigraphy; statistical processing of results. Results. This paper highlights the contributory factors for the development of ITU in children under 1 year of age. Of a great importance is the mother’s health, especially during the antenatal period when certain risk factors may affect the child: heredity, chronic pyelonephritis (50%), gestosis (95,2%), nephropathies (45,3%), risk of abortion (36,3%). In the postnatal period risk factors include background conditions (52,3%), infectious inflammatory processes (40,9%), acute respiratory viral infections (22,7%). Conclusions: Becomes obvious the need to estimate the contribution of risk factors in the development of UTI in infants in order to attribute the child to a “risk group” and also to bring real improvements to early diagnosis, treatment outcomes and prevention of this disease.Введение. Инфекция мочевыводящих путей (ИМП) является одной из самых распространенных бактериальных инфекций у детей. Диагностика этих сотсояний часто затруднена, особенно у маленьких детей и младенцев, так как в этой возрастной группе клинические проявления часто характеризуются неспецифическими признаками. Среди других заболеваний детского возраста ИМП занимают особое место в связи с повышенным риском развития рубцовых осложнений. Цель: оценить факторы риска развития инфекции мочевыводящих путей у детей на первом году жизни, а также оценить особенности клинического течения и диагноза у детей грудного возраста. Материалы и методы. Ретроспективное исследование включило 44 ребенка (25 девочек и 19 мальчиков) в возрасте до 1 года с диагнозом ИМП, которые были госпитализированы в отделение нефрологии Института Матери и Ребенка в период с декабря 2007 по 2010 год. Следующие методы были использованы для обследования пациентов и обработки экспериментальных данных: клинические – анамнез, развитие заболевания и клинические проявления; лабораторные методы – анализ мочи и исследование мочи по методу Нечипуренко; инструментальные методы – УЗИ почек и сцинтиграфия; статистическая обработка результатов. Результаты. Данное исследование раскрывает факторы, способствующие развитию ИМП у детей грудного возраста. Большое значение имеет здоровье матери, особенно в дородовой период, когда определенные факторы риска могут негативно влиять на развитие плода: наследственность, хронический пиелонефрит (50%), гестоз (95,2%), нефропатии (45,3%), риск преждевременных родов (36,3%). В послеродовом периоде факторы риска включают преморбидные состояния (52,3%), инфекционные воспалительные процессы (40,9%), острые респираторные вирусные инфекции (22,7%). Выводы: Становится очевидной необходимость оценки вклада факторов риска в развитии инфекции мочевыводящих путей у детей раннего возраста с целью выявления групп высокого риска, а также улучшения ранней диагностики, результатов лечения и профилактики данных заболеваний

Прогностические показатели развития ювенильного идиопатического артрита

Department of Pediatrics, Nicolae Testemitanu State Medical and Pharmaceutical University, Congresul III al Medicilor de Familie din Republica Moldova, 17–18 mai, 2012, Chişinău, Republica Moldova, Conferinţa Naţională „Maladii bronhoobstructive la copii”, consacrată profesorului universitar, doctor habilitat Victor Gheţeul, 27 aprilie, Chişinău, Republica MoldovaJuvenile idiopathic arthritis (JIA) is a highly disabling disease that leads to functional and physical compromise by osteo-articulars lesions and premature mortality in systemic diseases, impacting medical, social and economic well-being. To determine the prognosis of development indices JIA, discriminant function (F) was used and clinical examination was performed which included studying the patient’s age at disease onset, disease duration, number of joints and laboratory tests included studying the radiological stage after Steinbrocker. The discriminant function was performed in a group of 51 patients diagnosed with JIA. Factors that influenced the favorable evolution of JIA were high patient age at the onset of disease, low disease duration, a low number of joints and radiological stages I-II after Steinbrocker. The presence of these factors allowed us to predict 72.4% of cases with a favorable outcome. On the other hand, young age at onset, long disease duration, a high number of joints and radiological stages III-IV after Steinbrocker were unfavorable prognostic factors. The presence of these indices allowed the estimation of adverse developments in 77.3% of cases.Ювенильный идиопатический артрит (ЮИА) является хроническим заболеванием, которое приводит к функциональной и физической недостаточности, костно-суставным повреждениям преждевременной смертности (при системном варианте), имеет медицинское, социальное и экономическое значение. Для определения прогнозирующих факторов развития ЮИА была использована математическая дискриминантная функция (F) с проведением клинического обследования, которое включало изучение возраста пациента в начале заболевания, длительность заболевания, количество болезненных суставов, а лабораторные исследования включали изучение радиологических стадий по Штейнброкеру. Дискриминантная функция была определена у 51 пациентов с ЮИА. Таким образом, факторы, влияющие на благоприятную эволюцию ЮИА, были: возраст старше 10 лет в начале заболевания, короткая длительность заболевания, малое число болезненных суставов и радиологические стадии I-II по Штейнброкеру. Наличие этих факторов позволило в 72,4% случаев прогнозировать благоприятный исход ЮИА. С другой стороны, малый возраст пациента в начале заболевания, большая длительность заболевания, большое количество болезненных суставов и радиологические стадии III-IV по Штейнброкеру были неблагоприятными прогностическими факторами. Присутствие этих показателей позволило прогнозировать неблагоприятный исход в 77,3% случаев

Cystoadaptometry in children with nephrolithiasis

In view of studying the function of the urinary bladder, at thirty nine children with ages between four and fifteen years old, diagnosed with urotiliasis, 39 (thirty nine) cystoadaptomerys were performed and in about 60% (sixty percent) of the cases bladder hypotony was found. In order to improve the treatment of the bladder hypotony, stimulant drugs of the urinary tract peristalsis, such as Neostigmina, Cerucal, Neiromedina, were added to the treatment, which showed satisfying results

Disfuncția vezicii urinare în obstrucțiile tractului urinar pelvin. Stenoza congenitală uretrală posterioară la băieţi. Partea I

Stenoza congenitală a uretrei posterioare se întâlnește frecvent și duce la tulburarea întregului tract urinar - uretra suprastenotică, colul vezicii urinare, vezica urinară, ureterohidronefroză, mai frecvent bilateral. Având origine congenitală, această malformație rezultă din dezvoltarea incompletă a membranei urogenitale - limita pasajului uretral posterior și anterior și spasmul muscular al tractului urinar pelvin. Diagnosticul include ultrasonografie, urografie, cistouretrografie micțională, renoscintigrafie dinamică, cistometrie, urofluometrie radionuclidică, uretroscopie, calibrarea uretrei cu buj cu olivă, examen neurologic, miografie musculară perineală. A fost elaboratăt clasificarea clinico-radiologică a acestui tip de stenoze, fiind descrise diferite grade, care necesită un tratament diferențiat în funcție de fazele clinic-radiologice. Stenoza neurogenă se dezvoltă la copiii mai mici cu un tablou clinic mai sever comparativ cel forma congenitală. Rezecția transuretrală a peretelui anterior al uretrei stenotice este metoda de elecție în tratamentul stenozei uretrale.Congenital posterior urethral stenosis is common and leads to disorder of the entire urinary tract - suprastenotic urethra, bladder neck, bladder, ureterohydronephrosis, more often bilaterally. It can be congenital as a result of incomplete development of the urogenital membrane - the limit of the posterior and anterior urethral passage and the muscular spasm of the pelvic urinary tract. Diagnosis includes ultrasound, urography, micturating cystourethrography, dynamic renoscintigraphy, cystometry, radionuclide uroflowmetry, urethroscopy, calibration of the urethra with olivary bougies, neurological examination, perineal muscle myography. The clinical-radiological classification of stenosis was developed, which is more didactic. There are different degrees of stenosis as suprastenotic resonance that requires a differentiated treatment depending on the clinical radiological phases. Neurogenic stenosis develops in younger children with a more severe clinical picture than the congenital one. Transurethral resection of the anterior wall of the stenotic urethra is the method of choice in the treatment of stenosis