Differentiated approach to correcting low vitamin D status in adolescent girls in Moscow

Introduction. The work is devoted to the study of vitamin D status in adolescent girls and the selection of adequate doses for its correction.Study objective. To study the dynamics of calcidiol concentration in the blood serum against vitamin D3 intake and evaluate the effectiveness of correcting doses of vitamin in adolescent girls from Moscow.Study design. A double-blind, placebo-controlled, prospective, randomized clinical study.Materials and methods. The study involved adolescent girls aged from 11 to 17 years (n = 218) from I-II health groups, with determined serum level of 25(OH)D. Participants were randomly assigned to the main and control groups. The adolescent girls in the study group received vitamin D3 tablets, and the control group received a placebo. Study duration was 6 months. The dose of vitamin D3 was dependent on baseline serum caLcidioL levels and ranged from 800 IU to 2000 IU. Vitamin D status was redetermined in the girls who completed the treatment (n = 192).Results. Initially, 96.4% of girls had a low vitamin D status, while vitamin D insufficiency was observed in 26.6%, deficiency in 57.8%, deep deficiency in 12%. The median level of 25(OH)D in the main group before taking the vitamin was 16.25 ng/ml, after taking - 24.1            ng/ml, in the control group - 17.9 and 11.4 ng/ml, respectively (p < 0.001). In the main group, an increase in the content of the metabolite was observed in 94.9% of the subjects, the initially identified pronounced deficit was completely absent.Conclusions. A differentiated approach to prescribing different doses of cholecalciferon, depending on the baseline level of 25(OH)D, BMI and age, is an effective method for replenishing vitamin D deficiency in adolescents. The high probability of normalization of vitamin D status in certain age groups, mainly with the appointment of low corrective doses of cholecalciferol justifies the possibility of their use for 6 months or more in adolescents during puberty period

Особенности суточного профиля артериального давления у здоровых детей в ходе адаптации к обучению в учебных учреждениях разного типа

Arterial hypertension in children is a serious socially important problem, because it holds a position within the top of cardiovascular diseases, beginning from the adolescent age. A timely start of preventive measures based on appropriate forecast assessment in children from risk groups will make it possible to reduce the disease burden in elder age groups. Research purpose. Based on comprehensive assessment of clinic-anamnestic, genealogic, psychologic data, peculiarities of daily profile of arterial tension in the course of adaptation to education in educational institutions, to characterize the markers and single out the factors associated with AT increase in children that are considered relatively healthy.Patients. On a voluntary basis, 199 children of 1–2 health groups were included in the research at the age of 10–12 years (11.3 ± 0.02 years) who had just started their education at a cadet educational institution or middle school. The children did not have any complaints by the time of the research, nor did they have the necessity of taking medicines which could have an effect on the cardiovascular system and acute infectious diseases during the previous month.Methods. The research was carried out during the period from September 2013 until May 2014 in 2 successive stages corresponding to the first and second academic terms. The examination included clinic-anamnestic and genealogic methods, anthropometry, three-fold measuring of arterial pressure by Korotkoff’s method, 24-hour ECG and AP monitoring, monitoring of motion activity volume, study of general and school levels of anxiety and psychic tension, assessment of the vegetative nervous system condition, nature of exercise tolerance and volume of additional sports load, volume of additional academic load.Results. The most important predictors of AH development and elevated AP persistence in children aged 10–12 years of 1 and 2 health groups are: values of SAP and/or DAP 90 and 95 percentile taking into account sex, age and height at one-shot measurements, the presence of AH in relatives within the immediate family, excessive (over 75 percent for this age and height) body weight and high (over 96 bpm) values of average day-time heart rate following results of HM. The previous data concerning a quick enough adaptation of children to increased daily loads was confirmed, including an authentic increase of motion activity volume within educational programs of cadet educational institutions.Актуальность. Артериальная гипертензия (АГ) является серьезной социально значимой проблемой, в том числе у детей, так как занимает одно из ведущих мест в структуре сердечно-сосудистой заболеваемости уже с подросткового возраста. Своевременное начало профилактики, основанное на адекватной оценке прогноза у детей из групп риска, позволит снизить заболеваемость у них в старшем возрасте.Цель исследования: охарактеризовать маркеры и выделить факторы, ассоциируемые с повышением АД у условно здоровых детей с учетом комплексной оценки клинико-анамнестических, генеалогических, психологических данных, особенностей суточного профиля артериального давления (АД) в ходе адаптации к обучению в учебных учреждениях кадетского и общеобразовательного типа.Пациенты и методы. В исследование на добровольной основе включены 199 детей 1–2-й групп здоровья в возрасте от 10 до 12 (11,3 ± 0,02) лет, впервые приступивших к обучению в учреждении кадетского образования или среднем звене общеобразовательной школы, не имеющих на момент исследования жалоб, необходимости приема лекарственных препаратов, влияющих на сердечно-сосудистую систему, а также острых инфекционных заболеваний в течение прошедшего месяца. Исследование проведено в период с сентября 2013 по май 2014 г. в два последовательных этапа, соответствующих первому и второму учебному полугодию. Обследование включало клинико-анамнестический и генеалогический методы, антропометрию, трехкратное измерение АД по методу Короткова, 24-часовое мониторирование электрокардиограммы и АД, регистрацию объема двигательной активности, исследование уровней общей и школьной тревожности и психического напряжения, оценку состояния вегетативной нервной системы, переносимости физической нагрузки, характера и объема дополнительной спортивной нагрузки, объема дополнительной учебной нагрузки.Результаты. Наиболее значимыми предикторами развития АГ и устойчивости повышенного АД у детей в возрасте 10–12 лет 1–2-й групп здоровья являются значения систолического и/или диастолического АД 90-го и 95-го перцентиля с учетом пола, возраста и роста при одномоментных измерениях; наличие АГ у родственников 1-й степени родства; избыточная масса тела (> 75-го перцентиля для данного возраста и роста) и высокие (> 96 уд/мин) значения средней дневной частоты сердечных сокращений по результатам холтеровского мониторирования. Подтверждены полученные ранее данные о достаточно быстрой адаптации детей к повышенным ежедневным нагрузкам, включая достоверное повышение объема двигательной активности, в пределах программ обучения учреждений кадетского образования

Недостаточность витамина D у подростков: результаты круглогодичного скрининга в Москве

Goal. Study of vitamin D sufficiency in children of puberty and pre-puberty age in Moscow. Methods. We examined children aged from 10 to 17 years living in Moscow. In order to appraise seasonal changes in the blood vitamin D status, we determined the average level of the main vitamin D metabolite — 25(OH)D — in different months of the year. The criteria for involving children into a laboratory examination were age (11–17 years), absence of organic or genetic pathology, permanent residence in Moscow, no intake of calcium and active vitamin D metabolite preparations at the time of examination. Results. The study involved 360 children (i. e. 30 children were examined every month) aged from 10 to 17 years. Analysis of the obtained data demonstrated differences in vitamin D sufficiency in the examined children in winter, spring, summer and autumn months. The serum concentration of vitamin D was significantly higher in summer months than in winter months. We did not reveal sex-related differences in vitamin D sufficiency among Moscow adolescents. Diet evaluation demonstrated that children extremely rarely consume fish as the main food source of vitamin D. Conclusions. Special attention should be given to the development of effective methods of correction of low vitamin D status and prevention thereof. Maintenance of the optimal vitamin D status in winter is infeasible due to insufficient exposure to sunlight, short duration of children’s walking during the schoolyear and absence of cholecalciferol sources in children’s diets. Special attention should be given to vitamin D intake by means of prescribing enriched food additives. Цель: изучить обеспеченность детей препубертатного и пубертатного возраста г. Москвы витамином D*. Методы. Нами обследованы дети в возрасте от 10 до 17 лет, проживающие в Москве. Для оценки сезонного изменения статуса витамина D в крови определяли среднее содержание основного метаболита витамина D — 25(OH)D — в течение разных месяцев года. Критериями включения детей для проведения лабораторного обследования стали возраст (от 11 до 17 лет), отсутствие органической и генетической патологии, постоянное проживание в Москве, отсутствие приема на момент обследования препаратов кальция и активных метаболитов витамина D. Результаты. В исследование включено 360 детей (то есть ежемесячно проходили обследование по 30 детей) в возрасте от 10 до 17 лет. Анализ полученных данных продемонстрировал различия в обеспеченности витамином D обследованных детей в зимние, весенние, летние и осенние месяцы. Сывороточная концентрация витамина D оказалась достоверно выше в летние месяцы по сравнению с зимним периодом. Не выявлено половых различий в обеспеченности витамином D среди московских подростков. Оценка рациона показала, что частота потребления детьми рыбы как основного пищевого источника витамина D крайне низка. Выводы. Необходимо уделить особое внимание разработке эффективных методов коррекции низкого статуса витамина D и его профилактике. В зимний период невозможно поддерживать статус витамина D на оптимальном уровне вследствие недостаточной солнечной инсоляции, краткой продолжительности прогулок детей в течение учебного года, а также из-за отсутствия в пищевом рационе детей источников холекальциферола. Особое внимание необходимо уделить поступлению витамина D путем назначения обогащенных пищевых добавок.

Special Features of a 24-hour Arterial Blood Pressure Profile in Healthy Children During the Period of Adaptation to Studying at Different School Types

Arterial hypertension in children is a serious socially important problem, because it holds a position within the top of cardiovascular diseases, beginning from the adolescent age. A timely start of preventive measures based on appropriate forecast assessment in children from risk groups will make it possible to reduce the disease burden in elder age groups. Research purpose. Based on comprehensive assessment of clinic-anamnestic, genealogic, psychologic data, peculiarities of daily profile of arterial tension in the course of adaptation to education in educational institutions, to characterize the markers and single out the factors associated with AT increase in children that are considered relatively healthy.Patients. On a voluntary basis, 199 children of 1–2 health groups were included in the research at the age of 10–12 years (11.3 ± 0.02 years) who had just started their education at a cadet educational institution or middle school. The children did not have any complaints by the time of the research, nor did they have the necessity of taking medicines which could have an effect on the cardiovascular system and acute infectious diseases during the previous month.Methods. The research was carried out during the period from September 2013 until May 2014 in 2 successive stages corresponding to the first and second academic terms. The examination included clinic-anamnestic and genealogic methods, anthropometry, three-fold measuring of arterial pressure by Korotkoff’s method, 24-hour ECG and AP monitoring, monitoring of motion activity volume, study of general and school levels of anxiety and psychic tension, assessment of the vegetative nervous system condition, nature of exercise tolerance and volume of additional sports load, volume of additional academic load.Results. The most important predictors of AH development and elevated AP persistence in children aged 10–12 years of 1 and 2 health groups are: values of SAP and/or DAP 90 and 95 percentile taking into account sex, age and height at one-shot measurements, the presence of AH in relatives within the immediate family, excessive (over 75 percent for this age and height) body weight and high (over 96 bpm) values of average day-time heart rate following results of HM. The previous data concerning a quick enough adaptation of children to increased daily loads was confirmed, including an authentic increase of motion activity volume within educational programs of cadet educational institutions

CURRENT GUIDELINES FOR DIAGNOSIS AND TREATMENT OF VEGETATIVE DYSTONIA IN CHILDREN AND ADOLESCENTS

Disorders of the autonomic nervous system represent a relevant problem in the modern pediatric and adolescent health care due to high prevalence, polymorphism of clinical manifestations, and a negative impact on the quality of life of children and adolescents.It is now believed that autonomic dysfunction underlies many chronic non-communicable diseases which, according to WHO, cause death of tens of millions of people every year: coronary artery disease, hypotension and hypertension, cardiac arrhythmia and cardiac conduction defects, gastric ulcer, asthma, etc. The trigger of the pathological process, followed by damage to the target organ, is the change in nervous regulation

The role of magnesium deficiency in the formation of functional constipation in children and adolescents

Pediatricians face a problem of functional constipation in children and adolescents in one-third of cases of observation. Functional disorders of the gastrointestinal tract are based on disregulatory processes of the cortical-vegetative-endocrine complex. Magnesium deficiency is one of the factors influencing the formation of functional constipation in children, and an important link in the pathogenesis of the disease. Correction of magnesium level by means of magnesium-containing mineral water is one of the safe, effective and complex factors influencing a number of pathogenetic mechanisms of formation of functional constipation in children and teenagers

ADAPTATION OF CHILDREN TO STUDYING IN VARIOUS INSTITUTIONS: THE INFLUENCE OF VEGETATIVE HOMEOSTASIS AND PERSONAL ADAPTIVE RESOURCES

In order to study the peculiarities of children’s adaptation to the impact of moderate chronic stress we examined 177 healthy children from 10 to 12 years, who began to study in various institutions. We studied the volume of the educational load, academic performance, parameters of vegetative homeostasis, personal characteristics and the style of adaptive behavior. The cardiovascular system was evaluated by daily ECG monitoring and blood pressure. The duration of follow-up was 2.5 years. Adaptation of children, regardless of the type of educational institution, was accompanied by a tension of the vegetative regulation mechanisms. The children with formed adaptive personal resources and a balanced state of the autonomic nervous system adapted most successfully. At the beginning of adaptation we observed increase in blood pressure in 25.4% of children, and arterial hypertension in 3.3% of children. In 24 months there was found sinus bradycardia in 8.5% of children. Regardless of the type of institution, the depletion of adaptive capacity was associated with abnormalities in the state of the children’s health, low training effectiveness and poor tolerance of educational load. Thus, we believe that personal characteristics, styles of adaptive behavior and the state of vegetative regulation mechanisms should be taken into account when preparing recommendations for the training and organization of medical and psychological-pedagogical support for students

CAROTID ARTERY STENTING IN A PATIENT WITH SINUS BRADYCARDIA: CLINICAL CASE

Syndrome of hemodynamic depression is a frequent complication of the carotid artery endovascular intervention and, as a rule, is transient in nature. This article presents a clinical case of carotid artery stenting in a 63-year-old patient. The specific feature of this patient was the initial sinoatrial node dysfunction as a permanent sinus bradycardia. The examination verified multisite atherosclerosis, including coronary artery stenosis, manifested by the presence of stable angina, without history of myocardial infarction. Therefore, coronary endovascular treatment was firstly performed. Reexamination after coronary blood flow restoration revealed stable sinus bradycardia persistence without any positive or negative changes. According to anamnesis, examination and instrumental diagnostic results, indications for permanent cardiac pacing were not identified. Carotid artery stenting after the necessary preventive measures was successful. The article also considers possible risk factors of significant perioperative bradycardia during carotid angioplasty with stenting and measures preventing cardiac conduction perioperative worsening

ASTHENIC SYNDROME IN THE PEDIATRICIAN PRACTICE

Asthenia (from Greek σθένεια impotence) is a pathological condition characterized by weakness, fatigability, emotional lability, hyperesthesia, sleep disorders. Fatigue can accompany a variety of diseases (somatic, neurological, infectious, mental ones) and develop in healthy children in certain circumstances. Unlike usual fatigue usually occuring as a result of intense mobilization of the body and which is a physiological condition, the fatigue does not disappear after rest and require provision of patient medical care