СИНДРОМ ОБСТРУКТИВНОГО АПНОЭ СНА У ДЕТЕЙ КАК РИСК РАЗВИТИЯ СЕРДЕЧНО-СОСУДИСТОЙ ПАТОЛОГИИ

Objective: Our aim was to examine the predictors of cardiovascular disorders in children affected by obstructive sleep apnea syndrome (OSAS) based on the results of polysomnography and continuous monitoring of blood glycose. Мethods: Before the examination, parents filled in questionnaires concerning their children sleep quality. The procedure was followed by the study of the sleep by means of polysomnography (Embla s 7000, USA). A system of continuous monitoring of blood glucose was applied (Guardianreal-time, Medtronicminimed, USA) by means of which a glycemic profile tissue fluid was studied. Results: A night sleep research of 120 children aged 3–16 y.o. is presented. There were 4 groups depending on the pathology: diseases of the nervous system (n =31), ENT-pathology (n =18), bronchial asthma (n =24) and overweight and obesity (n =34). The comparison group consisted of 13 apparently healthy children. The study has shown that the parents of every second child with sleep disorders did not know about the fact. The 60 % of the patients with high body mass index (BMI) had a snore, which was significantly higher the in children with normal body mass index — 35% (р =0.012). The index of apnea-hypopnea (AHI) was higher in the patients with ENT-pathology 17 times (p 0.001) and the patients with obesity 7 times (p 0.001) in comparison to the comparison group. In the analysis of the overall sample (n =120) was obtained significant negative correlation with heart rate variability and heart rate (r = 0.405; p 0.001). It is also shown that among 14 investigated children with OSAS only 8 had episodes of hypoglycemia (less than 3.3 mmol/l) during night sleep. All of them were with a high body mass index and with above average stature (1sd). Conclusion: Children with ENT-pathology and with high high body mass index have high risk of cardio-vascular diseases. Children with above average stature and with increased body mass index affected by OSAS have additional backgrounds for cardiovascular diseases development as a result of the latent periods of hypoglycemia at night. Цель исследования: выявить предикторы сердечно-сосудистых нарушений у детей на фоне  синдрома обструктивного апноэ сна (СОАС) по результатам полисомнографии и непрерывного мониторирования глюкозы. Методы: перед обследованием родители заполняли анкету-вопросник по качеству сна, исследование сна проведено методом полисомнографии (Embla S7000,США). Системой непрерывного мониторирования глюкозы (Guardian Real-Time, Medtronic MiniMed, США) исследовали гликемический профиль в тканевой жидкости. Результаты: обследовано 120 детей в возрасте 3–16 лет. Детей распределяли по группам патологий: 31 — с болезнями нервной системы, 18 — с патологией ЛОР-органов, 24 — с бронхиальной астмой и 34 — с избыточным весом и ожирением (ИвиО); 13 практически здоровых детей составили группу сравнения. Родители каждого второго ребенка не знали о нарушениях дыхания во время сна у своих детей. Храп в общей выборке при повышенном ИМТ обнаружен у 60% детей, что значимо чаще, чем у детей с нормальным ИМТ (35%; р =0,012). Индекс апноэ / гипопноэ (ИАГ) был выше при патологии ЛОР-органов в 17 раз (p 0,001) и в группе с ИВиО — в 7 раз (p 0,001) по отношению к группе сравнения. В этих же группах оказалась повышенной частота сердечных сокращений (ЧСС) по сравнению с группой сравнения (р =0,002). При анализе в общей выборке (n =120) была получена значимая отрицательная связь между вариабельностью ритма сердца и частотой сердечных сокращений (r= -0,405; p 0,001). Показано, что из 14 обследованных только у детей с повышенным ИМТ и ростом выше среднего (1SD; n =8) были зарегистрированы эпизоды ночной гипогликемии (3,3 ммоль/л). Заключение: дети с патологией ЛОР-органов и повышенным ИМТ на фоне СОАС подвержены риску развития сердечно-сосудистой патологии. Дети с ростом выше среднего и повышенным ИМТ на фоне СОАС имеют дополнительные предпосылки для развития сердечно-сосудистых заболеваний в виде скрытых периодов гипогликемии в ночной период. 

THE INVOLVEMENT OF ENDOTHELIAL DYSFUNCTION MARKERS IN THE PATHOGENESIS OF CHRONIC GLOMERULONEPHRITIS

Chronic glomerulonephritis remains the leading cause of formation of chronic renal insufficiency, which creates the necessity of looking for new ways of the progress impediment. In the last few years considerable interest was aroused in the study of the endothelium state, especially taking into account a wide spectrum of its physiologically important functions. The term «endothelial dysfunction» came into existence, its decisive importance in the pathogenesis of the development and progressing of the atherob sclerotic process, arterial hypertension was proven. Extensive studies are underway to establish the role of the endothelial dysfunction in case of chronic inflammatory diseases, including chronic glomerulonephritis. This article summarizes the modern views on the involvement of endothelial dysfunction markers (nitric oxide, endothelinb1, molecules of vascular cytoadherenceb1, von willebrand factor, inhibitor of plasminogenb1 activator) in the pathogenesis of chronic glomerulonephritis.Key words: endothelial dysfunction, nitric oxide, endothelin, molecule of vascular cytoadherence-1, von willebrand factor, inhibitor of plasminogen-1 activator

ACUTE RESPIRATORY INFECTIONS IN CHILDREN — A TACTICS CHOICE

The article is devoted to the most common childhood diseases — acute respiratory infections (ARI). As it is known, the unjustified drug prescriptions and polypragmazy are the most often registered just at ARI. In particular it concerns antipyretics, antibacterial and drugs «enhance immunity» for the frequent ARI treatment and prevention. At the same time, fails of one or another drug can lead to complications: severe septic course of bacterial process, convulsions etc. The authors share their experiences on the choice of tactics for a patient with ARI, as well as the prescription of therapies.Key words: acute respiratory infections, antipyretics, antibiotics, prophylaxis, immune modulators, bacterial lysates, the children

ACUTE RESPIRATORY INFECTIONS IN CHILDREN — A TACTICS CHOICE

The article is devoted to the most common childhood diseases — acute respiratory infections (ARI). As it is known, the unjustified drug prescriptions and polypragmazy are the most often registered just at ARI. In particular it concerns antipyretics, antibacterial and drugs «enhance immunity» for the frequent ARI treatment and prevention. At the same time, fails of one or another drug can lead to complications: severe septic course of bacterial process, convulsions etc. The authors share their experiences on the choice of tactics for a patient with ARI, as well as the prescription of therapies.Key words: acute respiratory infections, antipyretics, antibiotics, prophylaxis, immune modulators, bacterial lysates, the children

ANEMIA IN CHILDREN WITH CHRONIC KIDNEY DISEASE

Anemia is one of the most important issues in the chronic kidney disease treatment. As a rule, anemia is associated with a deficit of erythropoietin syntheses in the kidney. Recent studies have shown also the importance of iron deficiency — a relative or absolute. The authors demonstrate that the frequency and degree of anemia increases with progression of kidney disease i. e. losing of renal function. The iron metabolism investigation and the analysis of the therapy incomes lead the recommendations for optimization the treatment in consideration the potential causes of the therapy resistance.Key words: anemia, chronic kidney disease, classification, iron methabolizm, transferrin, ferritin, children

ANEMIA IN CHILDREN WITH CHRONIC KIDNEY DISEASE

Anemia is one of the most important issues in the chronic kidney disease treatment. As a rule, anemia is associated with a deficit of erythropoietin syntheses in the kidney. Recent studies have shown also the importance of iron deficiency — a relative or absolute. The authors demonstrate that the frequency and degree of anemia increases with progression of kidney disease i. e. losing of renal function. The iron metabolism investigation and the analysis of the therapy incomes lead the recommendations for optimization the treatment in consideration the potential causes of the therapy resistance.Key words: anemia, chronic kidney disease, classification, iron methabolizm, transferrin, ferritin, children

ACUTE RESPIRATORY INFECTIONS: QUESTIONS FROM PARENTS AND ANSWERS FROM PEDIATRICIANS

(Pediatric Pharmacology. – 2010; 7(4):113-116

ACUTE RESPIRATORY INFECTIONS: QUESTIONS FROM PARENTS AND ANSWERS FROM PEDIATRICIANS

(Pediatric Pharmacology. – 2010; 7(4):113-116

IMMUNE-RESPONSE MODULATING THERAPY IN CHILDREN WITH RECURRENT RESPIRATORY INFECTIONS

The article is devoted to one of the most «problematic» aspects of Pediatrics — use of immune-response modulating drugs. Complexity is due as to the abundance of similar agents on the pharmacological market also to the evident absence of the proved efficacy and safety of most of them. The authors focused their attention on the category of patients, to whom these drugs were most commonly prescribed — i. e. children with recurrent acute respiratory infections. Along with the classification the characteristics of the different groups of immune-response modulating drugs are presented. Key words: children with recurrent acute respiratory infections, acute respiratory infections, immune-response modulating therapy, ribosomal-proteoglican complex. (Pediatric pharmacology. — 2011; 8 (6): 108–113)

IMMUNE-RESPONSE MODULATING THERAPY IN CHILDREN WITH RECURRENT RESPIRATORY INFECTIONS

The article is devoted to one of the most «problematic» aspects of Pediatrics — use of immune-response modulating drugs. Complexity is due as to the abundance of similar agents on the pharmacological market also to the evident absence of the proved efficacy and safety of most of them. The authors focused their attention on the category of patients, to whom these drugs were most commonly prescribed — i. e. children with recurrent acute respiratory infections. Along with the classification the characteristics of the different groups of immune-response modulating drugs are presented. Key words: children with recurrent acute respiratory infections, acute respiratory infections, immune-response modulating therapy, ribosomal-proteoglican complex. (Pediatric pharmacology. — 2011; 8 (6): 108–113)