Modern pediatrics. Ukraine
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2021 ◽  
pp. 73-80
Author(s):  
Yu.V. Marushko ◽  
◽  
S.I. Esipova ◽  
T.V. Gishchak ◽  
◽  
...  

The review article provides data from modern studies confirming the multifaceted effect of vitamin D in the human body. Vitamin D3 receptors (VDRs) have been shown to be present in most organs and tissues of the body. This confirms the importance of vitamin D not only in the formation of the skeletal system, but also in many of its extraosseous effects. Calcitriol affects the modulation of cell growth, neuromuscular conduction, inflammation processes, and is also an important stimulator of innate immunity due to the synthesis of antimicrobial peptides that provide protection against bacteria and viruses. In recent years, the relationship between the concentration of vitamin D in the blood and the incidence of respiratory infections in children has been actively studied. Many studies have shown that low vitamin D status is characteristic of most children with respiratory infections, and an adequate level of 25(OH)D in serum has a positive effect on the frequency of these infections and the severity of their course. Most authors demonstrate the benefits of vitamin D supplementation in the prevention of respiratory diseases in children, but there is no consensus regarding the frequency and dosage of vitamin D. The authors declare that they have no conflicts of interest. Key words: vitamin D, children, deficiency, respiratory diseases, prevention.


2021 ◽  
pp. 63-71
Author(s):  
S.O. Kramarov ◽  
◽  
V.V. Yevtushenko ◽  

Acute respiratory infections are the leading cause of morbidity and mortality in childhood. Antibacterial therapy for acute respiratory infections should be prescribed carefully and under strict indications. This review analyzes the etiological structure of diseases of the upper and lower respiratory tract, identifies modern views on the rational use of antibacterial agents in diseases such as acute tonsillopharyngitis, rhinosinusitis, bronchitis and pneumonia. Among the variety of antibacterial agents, macrolide drugs, in particular azithromycin, are most often used in pediatric practice. The pharmacological properties of azithromycin, mechanisms of its antimicrobial and immunomodulatory activity, indications for use in acute respiratory infections in children are considered in the article. No conflict of interest was declared by the authors. Key words: antibiotics, acute respiratory infection, macrolides, azithromycin, children.


2021 ◽  
pp. 19-24
Author(s):  
S.I. Ilchenko ◽  
◽  
T.V. Mozheiko ◽  
А.О. Fialkovska ◽  
N.V. Mishina ◽  
...  

Regurgitation syndrome in infants is one of the manifestations of gastroesophageal reflux disease (GER), which can be both an age-related physiological condition and pathological one with the risk of gastroesophageal reflux disease (GERD) developing. Differential diagnosis of GERD in infants and young children is difficult due to invasiveness and low availability of the recommended diagnostic methods, in particular esophageal pH3metry. Today, the search for new non-invasive and simple, but sensitive and specific, methods for diagnosing GERD in pediatric practice is relevant and promising. Purpose — to determine the dynamic patterns of the salivary pepsin level in young children within the framework of daily monitoring and depending on the clinical manifestations of regurgitation. Materials and methods. 55 children from 3 to 18 months were examined, among them was 38 children with visible regurgitation syndrome and 17 healthy children without clinical manifestations of the regurgitation syndrome. The intensity of regurgitation was assessed using a five-point scale «ESPGHAN». A reflux questionnaire was used for screening diagnostics of pathological GER in children. Salivary pepsin level was determined three times a day by enzyme-linked immunosorbent assay (ELISA pepsin). Statistical processing was performed using «Statistica v.6.1» software package. Results. Regurgitation syndrome was registered in all children of the main group according to their current complaints. The results of reflux questionnaire showed the following data: half of the children (52.6%) had no signs of GER, possible reflux was revealed in 31.6% of children, and probable reflux was revealed in 15.8% of children. The results of daily monitoring of salivary pepsin level in infants showed that it was significantly higher in children with regurgitation than in control group, both in terms of average daily values and intermediate values. It was found that the maximum pepsin activity in children was immediately after regurgitation. There were no significant differences between the three saliva samples and the average daily pepsin index in the children of the main group, which may indicate the presence of latent episodes of reflux during the day. Сhildren with a high risk of GERD according to the reflux questionnaire had significantly higher values of salivary pepsin on an empty stomach and its average daily level, which has sufficient specificity and predictive value according to the ROC analysis results. Conclusions. Determination of salivary pepsin levels in infants can be included in screening noninvasive tests for the GER diagnosis. The use of these tests to predict the risk of extraesophageal damage requires further study. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: regurgitation, GER, GERD, pepsin, children.


2021 ◽  
pp. 6-13
Author(s):  
R.V. Marushko ◽  
◽  
D.O. Bakhtiiarova ◽  
S.R. Klai ◽  
D.M. Zahorodniuk ◽  
...  

Continuing medical education (CME) or continuing professional development (CPD), which is currently being implemented in Ukraine, is an education throughout a professional career, which allows medical healthcare providers effectively perform their professional duties with the best results. This is achieved thanks to the coherent cooperation of accreditation bodies, providers or organizers of CPD and medical specialists, as well as by introducing an effective model of accreditation, which ensures that providers are provided medical workers with the proper education. Purpose — to describe the basic principles of educational activity within the framework of CPD, based on the provider accreditation model which is currently generally recognized and most effective in the world. Recommendations provided in the article can be used by the CME/CPD participants or stakeholders who are aimed at active participation in the implementation of a new accreditation system. Key words: continuing professional development, continuing medical education, accreditation, provider, medical specialists, education activities.


2021 ◽  
pp. 34-39
Author(s):  
A.G. Hasanov ◽  
◽  
I.E. Huseinova ◽  

Purpose — to determine and compare vitamin D levels in children diagnosed with COVID-19-associated pneumonia and healthy children. Materials and methods. The study involved 90 children. The main group consisted of 75 inpatient children with a diagnosis of COVID-19-associated pneumonia (positive PCR — polymerase chain reaction with reverse transcription). Patients in the main group were divided into 2 subgroups: subgroup I consisted of 49 patients with a pneumonia of moderate course, and subgroup II — 26 patients with a pneumonia of severe course. The control group consisted of 15 practically healthy children. The scheme of examination of sick children included anamnestic data, the use of clinical, instrumental and laboratory, immunological examination methods. The concentration of vitamin D in the blood serum of sick and healthy children was determined by the method of enzyme3linked immunosorbent assay (ELISA). The indicators were measured on a Stat Fax 4700 device using a Pishqaman reactive kit (made in Germany). Results. The concentration of vitamin D in blood serum was 1.8 times lower in subgroup I and 2.0 times in subgroup II, compared with the control group. The average values of vitamin D in blood serum compared with the control group were <1.1 times lower in the age group <1 year, 1.1 times lower in the age group 1–3 years, and 2.3 times lower in the age group >3 years. Conclusions. Based on our research, it can be concluded that there is a relationship between vitamin D deficiency and COVID-19. Thus, the average level of vitamin D was lower in children with COVID-19-associated pneumonia, and varied depending on the severity of the disease (more pronounced changes were observed in severe pneumonia). There are also differences in vitamin D levels in the age groups of children with COVID-19-associated pneumonia: in children from age groups under 1 year and 1–3 years old the decrease in serum vitamin D level is less pronounced than in the age group over 3 years old. The main mechanisms of vitamin D involvement in the immune modulation process in COVID-19 require further study. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: children, COVID-19, vitamin D.


2021 ◽  
pp. 14-18
Author(s):  
T.P. Borysova ◽  
◽  
O.Yu. Obolonska ◽  
Т.К. Мavropulo ◽  
L.P. Badogina ◽  
...  

Hemodynamically significant patent ductus arteriosus (HSPDA) in premature infants leads to renal hypoperfusion due to the phenomenon of «stealing» of the systemic circulation, which can contribute to the development of acute kidney injury (AKI). The use of ultrasound Doppler sonography of the renal vessels can be effective in assessing renal blood flow and in the early diagnosis of acute renal failure. Purpose — to assess the prognostic significance of the state of renal blood flow in the first day of life in premature infants with HSPDA in the early diagnosis of AKI. Materials and methods. We examined 40 preterm infants (gestational age 29–36 weeks) with HSPDA. Distribution of the examined patients: the group with AKI — 23 children, the group without AKI — 17 children. The observation period was 10 days. The patients underwent echocardiography with Doppler analysis using a broadband microconvex probe with a frequency of 5–8 MHz (TOSHIBA Nemso XG) at 5–11 hours of life. Color Doppler ultrasound scanning of renal vessels was performed on the first, third and tenth days of life. The parameters of blood flow in the main renal and interlobar renal arteries were studied: peak systolic velocity (PSV) and end diastolic velocity (EDV) of blood flow, resistance index (RI). Diagnosis and stratification of AKI severity met the KDIGO neonatal modification criteria. Results. On the third to fifth day of life, AKI was diagnosed in 23 (57.5%) children, but already in the first day of life, compared with patients without AKI, a significant decrease in PSV parameters of blood flow in the main renal artery was noted (20.6±5.87 cm/sec versus 25.4±6.17 cm/sec in children without AKI, p<0.02). In addition, the main changes in the first day of life in patients with AKI were revealed at the level of the interlobar renal artery, namely: a decrease in PSV blood flow (11.10±3.329 cm/sec versus 18.48±3.014 cm/sec in children without AKI, p<0.001) and EDV of blood flow (2.83±2.063 cm/sec versus 6.16±2.447 cm/sec in children without AKI, p<0.001), increased RI (0.758±0.137 versus 0.666±0.1216 in children without AKI, p<0.02). On the third day of life at AKI, there was a disorder in the parameters of blood flow in the interlobaric renal artery, the value of which on the tenth day of life did not differ from the parameters of children without AKI. Conclusions. In premature infants with HSPDA, who were diagnosed with AKI on the third to fifth day of life, in the first day of life, there is a decrease in PSV blood flow parameters in the main renal artery, changes in blood flow in the interlobar renal artery, namely: a decrease in PSV and EDV blood flow, an increase in RI. Thus, the assessment of the state of blood flow in the interlobar renal artery on the first day of life in premature infants with HSPDA is of diagnostic value for the timely determination of the risk group for AKI. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of all participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: premature infants, patent ductus arteriosus, renal blood flow, acute kidney injury.


2021 ◽  
pp. 55-61
Author(s):  
О.B. Synoverska ◽  
◽  
Yu.I. Alekseeva ◽  
N.M. Fomenko ◽  
M.Y. Rеitmаier ◽  
...  

The article provides basic information about the syndrome of prolonged QT interval, which is a rare pathology of the cardiovascular system and can cause sudden death. The mutations in the genes responsible for dysfunction of ion channels are the key in the pathogenesis of this disease. Jerwell and Lange—Nielsen, Romano—Ward, Andersen—Tavil and Timothy syndromes are described as the main hereditary variants of this syndrome. A own case of the disease in a patient was given. The peculiarity of this case was on the acute, atypical onset of the disease, which started with convulsions and sudden cardiac death. The clinical picture of this case, features of a current are described, indicators of the basic methods of research are resulted. Information on the treatment of this clinical case at the local level and in the department of surgical treatment of arrhythmias, where the patient underwent implantation of endocardial bicameral cardioverter-defibrillator, іs presented. Data on further observation and treatment of the child at the place of residence are given. The research was carried out in accordance with the principles of the Helsinki declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: syndrome, QT interval, etiology, pathogenesis, clinical picture, diagnosis, examination, treatment.


2021 ◽  
pp. 46-50
Author(s):  
O.V. Dutchuk ◽  
◽  
Z.R. Kocherha ◽  
V.M. Voloshynovych ◽  
Yu.I. Alekseeva ◽  
...  

Currently, the problem of diagnosing pleuropulmonary blastoma in children remains relevant, because this pathology often runs under the guise of other nosologies, including pneumonia, and is extremely difficult to diagnose. Currently there are no pathognomonic clinical symptoms, specific diagnostic criteria for this disease, almost 60% of patients have nonspecific symptoms. This article presents a rare clinical case of biphasic pulmonary blastoma in a child who was examined and treated at the Ivano-Frankivsk Regional Children's Clinikal Hospital Ivano-Frankivsk Regional Council. The main clinical manifestations, diagnosis and treatment of biphasic blastoma of the lungs in a child based on the observation of a 5-year-old girl who was hospitalized for acute abdominal pain, chest pain and cough. After clinical — laboratory and instrumental methods of examination, right-sided pneumonia and exudative pleurisy were diagnosed. The set of treatment measures did not give the expected positive effect, improving the patient's condition. Additional testing is required for suspected breast cancer. It has been established that the best method for verifying the diagnosis of pulmonary blastoma is multislice computed tomography with intravenous bolus contrast and immunohistochemical examination of the biopsy. The methods of treatment used in this case, including anti-inflammatory and polychemotherapy according to the scheme, the use of radical treatment at the National Cancer Institute in Kyiv — surgery right pneumonectomy with pericardial resection. The child is currently in stable remission for 4.5 years. The described clinical case demonstrates the difficulty of diagnosing lung blastoma in children due to the lack of typical clinical manifestations. The research was carried out in accordance with the principles of the Helsinki declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: children, pneumonia, blastoma, pulmonology, diagnosis, treatment.


2021 ◽  
pp. 25-33
Author(s):  
N.V. Vorobiova ◽  

Purpose — to determine the role of the lactase gene MCM6 allelic polymorphism 13910 C/T and the concomitant food allergy (FA) and atopic dermatitis (AD) on the formation of carbohydrate malabsorption syndrome manifestations in early-aged children with rotavirus infection (RVI). Materials and methods. 60 children aged 1–24 months with RVI were examined. The determination of single nucleotide polymorphism 13910 C/T of the MCM6 gene was performed by real-time polymerase chain reaction and the content of total Ig E in serum was determined by enzyme immunoassay for all children on the day of hospitalization. Total amount of carbohydrates in feces (Benedict's test) and the level of lactose in feces (Malfatti's test) were also determined in the dynamics of the disease (on the 3rd, 5th, 7th, 10th day). The analysis of the carbohydrate malabsorption syndrome clinical and laboratory signs was carried out in subgroups depending on the genotype 13910 C/T of the MCM6 gene and concomitant allergic pathology. Results. No significant differences were found in the maximum daily frequency of diarrhea, its duration and the frequency of intestinal colic and flatulence registration in children with genotypes C/C, C/T and T/T -13910 of the MCM6 gene (p>0.05). There was no statistically significant difference in the total level of carbohydrates and lactose in feces at all stages of the disease (p>0.05 on the 3rd, 5th, 7th, 10th). Children with concomitant FA and AD had 1.3 and 2 times higher daily frequency of liquid bowel movements during the height of the disease (p<0.05 on the 5th and 7th days, respectively), 1.3 times longer diarrhea (p<0.05), 1.6 and 1.8 times higher incidence of flatulence and intestinal colic (p<0.05). These children had 3 and 3.3 times higher Benedict's test values (p<0.01), as well as 3 and 2.5 times higher Malfatti's test values (p<0.01; p<0.05, respectively) on the 3rd and 5th days of RVI, respectively, than in patients without allergies, with a gradual decrease in this difference during the period of convalescence (p>0.05 on the 10th day). Conclusions. The allelic polymorphism 13910 C/T of the MCM6 gene does not affect the degree of oligosaccharide metabolism disorders in the intestines in early-aged children with RVI. Against the background of concomitant food allergy and atopic dermatitis in children with RVI, there are more pronounced laboratory signs of carbohydrate malabsorption, and, as a consequence, diarrhea more pronounced during the height of the disease with a higher incidence of flatulence and intestinal colic. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the author. Key words: rotavirus infection, early-aged children, carbohydrate malabsorption syndrome, lactase gene polymorphism, food allergy, atopic dermatitis.


2021 ◽  
pp. 51-54
Author(s):  
Ye.Ye. Pohorila ◽  

The clinical course, features of diagnostic examinations and difficulties in verification of the new nosology of multisystem inflammatory syndrome associated with SARS-CoV-2 in 15-year-old girls are described. The girl was taken to the Kyiv Regional Children's Hospital No. 2 with complaints of fever, intoxication syndrome, general weakness, dizziness, vertigo, lack of urine during the day. The child was examined by a consilium of doctors, examined in the laboratory and instrumentally, after a carefully collected epidemiological history revealed possible contact with a patient with coronavirus infection at the place of study and identified a probable case of multisystem inflammatory syndrome associated with SARS-CoV-2. According to the results of our own observations during the pandemic, this nosology was found in patients who relapsed into coronavirus infection in clinical or subclinical form and for the period of hospitalization had a clinical symptom complex of Kawasaki with similar symptoms. This disease is new today, has a variety of clinical manifestations and pathological features that are a problem for clinicians. After all, at present there are no unified protocols for the diagnosis and treatment of MIS-C (multisystem inflammatory syndrome) and each doctor relies on their own experience and previously described cases. This case of multisystem inflammatory syndrome will help practicing clinicians in the early stages to diagnose the disease and provide qualified care to patients. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of all participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the author. Key words: multisystem used for setting fire syndrome, 15-year-old girl, kawasaky-like symptoms, SARS-CoV-2, intravenous immunoprotein, acetophene, glucocorticosteroids.


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