[Intrauterine Pneumocystis infection]. / Vnutriutrobnaya pnevmotsistnaya infektsiya.

Pneumocystosis is well known as an opportunistic infection that is presently most frequently registered in patients with HIV infection and in those with other immunodeficiency states. Earlier, after the Second World War, Pneumocystis pneumonia was most commonly detected in debilitated and premature children; nosocomial outbreaks of pneumocystosis were studied in detail in the 1960s and 1970s. The pathogen is transmitted through the air, but a number of references indicate that it can be transmitted through the placenta. Despite the increasing number of publications on pneumocystosis in pediatrics, physicians remain unfamiliar with this disease. The paper provides evidence that Pneumocystis jiroveci can infect the fetus in utero. If unrecognized, the disease can lead to a child's death due to severe respiratory failure. The authors describe their case of generalized pneumocystosis that has developed in a child with evidence of intrauterine infection (detection of the pathogen in the autopsy material and placenta and identification of serological markers in his/her parents). The issues that are associated with intrafamilial infection and a risk for in utero transmission of P. jiroveci are discussed.

[Stroke in children and adolescents: a formation of a pediatric register]. / Insul't u detei i podrostkov: formirovanie pediatricheskogo registra.

AIM: To optimize a system of medical care, introduction of treatment and diagnostic guidelines, including secondary stroke prevention and rehabilitation measures, by implementation of pediatric stroke registry. MATERIAL AND METHODS: Fifty-seven patients, aged from 1 year to 17 years 11 months, included into the Moscow city registry of pediatric stroke were examined. Forty-two patients suffered ischemic stroke and 15 hemorrhagic stroke. RESULTS AND CONCLUSION: The diagnostic search for the causes of pediatric stroke is difficult due to the wide variety of etiologic factors and high frequency of their combinations. This confirms the necessity of multidisciplinary approach to the management of children and adolescents in the acute phase of stroke in a multiprofile hospital with the following specialized ambulatory care.

[Palivizumab: four seasons in Russia].

In 2010, the Russian Federation (RF) registered palivizumab--innovative drug, based on monoclonal antibodies for passive immunization of seasonal respiratory syncytial virus (RSV) infection in children of disease severe progress risk group, which include primarily premature infants, children with bronchopulmonary dysplasia and hemodynamically significant congenital heart disease. Currently, palivizumab is included in the list of recommended medicines and medical care standards of different countries, including Russia. In the review the results of Russian research on the progress of RSV infection, its epidemiology and immunization experience gained over the 2010-2014 period are summarized in relation to the foreign data. During the four epidemic seasons palivizumab immunization covered more than 3,200 children of severe RSV infection risk group with a progressive annual increase in the number of patients who received the drug. Geography of palivizumab immunization is also greatly expanded in our country during this time. If during the first two seasons measures of immunization were taken mainly in Moscow and St. Petersburg, at the present time, thirty one territorial entities of the Russian Federation have the experience in the drug application. Analysis of the results of RSV infection immunization (made in several regions) confirms the high clinical efficacy and palivizumab safety already demonstrated in international studies. In addition, the analysis presents the potential to improve the efficiency of the integrated RSV infection immunization programs, realizing in the establishment of high-risk child group register, adequate counseling for parents, as well as the development of the routing of patients and coordination of interaction between different health institutions during the immunization.

[Modern aspects of diabetic ketoacidosis treatment in children].

UNLABELLED: The aim of the research - the analysis of the regularities of diabetic ketoacidosis treatment in children and adolescents with type 1 diabetes mellitus, the explanation of the results obtained with the use of biological systems stability theory elements. MATHERIALS AND METHODS: The study included 90 children with type I diabetes mellitus in a state of diabetic ketoacidosis of different severity degree. With newly diagnosed type 1 diabetes mellitus - 56 children, with the "courced" diabetes - 34 children. In the evaluation of patients status was defined glucose, pH, and other indicators of acid-base status, using gas analyzer GEM Premier 3000 ("Instrumental laboratory", USA). RESULTS: All children received treatment under the Protocol, approved by the Moscow Health Department, withdrawn from the state of diabetic ketoacidosis without any complications. In the basis of this methodology is application of glucose solutions and "small" doses of insulin from the start of infusion therapy in spite of hyperglycemia. This therapy helps to prevent cerebral edema against the background of gradually reduce the blood glucose. pH recovery was explained by the existence of a common pathophysiology process. Given the qualitative description of this process on the basis of biological systems stability theory. Were determined 3 stationary state: pH = 7.4 and pH < 6,9; and one is unstable, called "the point of no return" - pH = 6.9. The conclusions of this theory substantiate the effectiveness of ketoacidosis treatment with offered method CONCLUSION: The offered technique for diabetic ketoacidosis treatment on the basis of the glucose solutions infusion throughout the treatment and "small" doses of insulin values pH and glucose in a safe range, even in patients with high risk of brain edema, which is confirmed by biological systems stability theory.

[Developmental dysphasia: assessment of the drug treatment efficacy].

To assess the efficacy of treatment with encephabol, we examined 40 children, aged from 3 to 5 years, with developmental dysphasia. All patients were randomized into two equal groups: group 1 received encephabol (suspension form, daily dosage 200-250 mg, or 12-15 mg/kg) during 2 months; group 2 did not receive this medication. In the first group, there was a significant improvement of expressive and impressive speech and speech attention; the active vocabulary and a number of phrases in colloquial speech increased by a factor of 3 versus 1.5 in the control group. After the treatment with encephabol, the parents reported the decrease in motor disturbances, psychosomatic disorders, the improvement of attention and the emotional state of the children.

[Depressive symptoms worsen cardiovascular prognosis and shorten length of life in patients with arterial hypertension and ischemic heart disease].

UNLABELLED: The KOORDINATA study (clinical epidemiological program of investigation of depression in cardiological practice in patients with arterial hypertension and ischemic heart disease) was a prospective 3 year long multicenter study of effects of depressive and anxiety states on the course and prognosis of ischemic heart disease (IHD) and arterial hypertension (AH). MATERIAL AND METHODS: Patients (n=5038, age more or equal 55 years) with verified IHD and/or AH from 37 cities were included into the study. Symptoms of anxiety and depression were assessed by the HADS scale (Hospital Anxiety And Depression Scale) validated in Russia. RESULTS: Clinically significant symptoms of anxiety ( more or equal 11 HADS) were present in 33 and 38%, of depression - in 30 and 38% of patients with IHD and AH, respectively. Presence of clinically manifested depression at initial examination increased 1.59 times combined risk of nonfatal and fatal cases (odds ratio [OR] 1.59, 95% confidence interval [CI] 1.30-1.96, p=0.0001), 1.64 times - risk of cardiovascular death (OR 1.64, 95% CI 1.20-2.24, p=0.0021), and 1.82 times - risk of death from all causes (OR 1.82, 95% CI 1.41-2.34, p=0.0001). It is known that for somatic patients crossover of anxiety and depression symptoms is typical (simultaneous presence of some symptoms of anxiety and depression). Total HADS score equal to 11 or more increased risk of all cause death (OR 1.41, 95% CI 1.08-1.84, p=0.0111), as well as fatal and nonfatal events (OR 1.33, 95% CI 1.08-1.65, p=0.0089). CONCLUSION: Taking into consideration negative effect of depressive symptoms on prognosis it is recommended to screen patients with IHD in the first place those who have had myocardial infarction and brain stroke with the aim of detection of depression and anxiety depressive symptoms and subsequent their adequate correction.

[Determination of cefixime blood plasma levels by HPLC].

For comparative study of the pharmacokinetics of Cemidexor (capsules of 100 mg) and Suprax (capsules of 400 mg), a method of HPLC with quantitative determination of cefixime (the active substance in the drugs) in the blood plasma of patients with UV detection was developed. The data teproducibility with an account of the admissibility criterion was observed within the interval of all the concentrations (0.06-10 mcg/ml). The accuracy and correctness of the method also corresponded to the admissibility criteria. The lower limit of the quantitative determimation of the cefexime blood plasma levels was 0.06 mcg/ml. The pharmacokinetics was studied with the open crossed randomized method. The results were used for calculation of the pharmacokinetic parameters required for estimation of the bioequivalence of the drugs. The statistical analysis of the pharmacokinetic parameters showed that Cemidoxor and Suprax were bioequivalent.

[RELIPH - regular treatment and prevention - the key to improvement of situation with cardiovascular diseases in Russia: results of a Russian multicenter study (part III)].

The first results of a big Russian multicenter study " RELIF - Regular treatment and prevention - the key of improvement of the situation with cardiovascular diseases in Russia " are presented. The study examines the accordance of arterial hypertension (AH) and coronary heart disease (CHD) treatment recommended by physicians to contemporary standards. Patients adherence to physicians recommendations is also studied. 512 general practitioners and 2517 patients with AH and CHD from 20 cities of Russia were included. In the present article the current situation with medical treatment of AH, isolated or in comorbidity with CHD is presented.

[Compliance to treatment of arterial hypertension and ischemic heart disease - key condition of lowering of cardiovascular mortality].

The paper contains consideration of the problem of compliance to treatment of arterial hypertension and ischemic heart disease. Various aspects of compliance to treatment related to patients, physicians, special features of diseases and character of drug and nondrug recommendations.

[Depressive symptoms worsen prognosis in patients with arterial hypertension and ischemic heart disease: first results of prospective phase of Russian multicenter study COORDINATA].

COORDINATA - Russian multicenter prospective (3 year long) study having the aim to elucidate influence of symptoms of anxiety and depression on cardiovascular (CV) prognosis in patients with arterial hypertension (AH) and ischemic heart disease (IHD). Results of 1.5 years of prospective phase of the study are presented. Material and methods. Symptoms of depression and anxiety were assessed by Hospital Anxiety and Depression Scale (HDS) in 5038 patients with AH and/or IHD aged 55 years and older. By the end of 1.5 years follow up telephonic interview was carried out with 4449 patients or their relatives in the course of which occurrence of soft and hard end points (cardiovascular complications and deaths of IHD, cardiovascular and other causes) were established. There were 142 deaths (60.6% cardiovascular), 85 strokes, and 42 dynamic disturbances of cerebral circulation. Total number of hard and soft end points was 356 (8.0%). Presence of depressive, anxious, and combined anxious-depressive symptoms in patients with AH/IHD at initial examination increased 1.5 - 2 fold risk of development of cardiovascular catastrophes and death (due to IHD, CV and all causes). Besides psychological factors clear-cut influence on prognosis exerted sex, age, level of education and income of patients, smoking (both in the past and at inclusion in the study), low level of daily physical activity, elevated levels of blood pressure and heart rate, as well as a row of social characteristics of patients.

[RELIPH -- REgularnoye Letcheniye I ProPHylaktika (Regular Treatment and Prevention) -- the key to improvement of situation with cardiovascular diseases in Russia: results of multicenter study. Part II].

The paper presents results of the conducted in Russia large scale study " REgularnoye Letcheniye I ProPHylaktika (Regular Treatment and Prevention) -- the key to improvement of situation with cardiovascular diseases in Russia -- RELIPH " on assessment of conformity of recommended by medical practitioners treatment of arterial hypertension (AH) and ischemic heart disease (IHD) to contemporary standards as well as compliance of patients to physician s recommendations. Local physicians/general practitioners (n=512) and patients (n=2517) with AH (isolated and combined with IHD) from 20 cities in Russia participated in the study. This publication contains data on assessment of compliance of patients to antihypertensive therapy and to recommendations of physicians concerning non-drug treatment, as well as analysis of large number of factors closely associated with compliance.

[RELIPH--REgularnoye Letcheniye I ProPHylaktika (regular treatment and prevention)--the key to improvement of situation with cardiovascular diseases in Russia: results of multicenter study. Part I].

The paper presents first results of the conducted in Russia large-scale study " REgularnoye Letcheniye I ProPHylaktika (Regular Treatment and Prevention)--the key to improvement of situation with cardiovascular diseases in Russia--RELIPH" on assessment of conformity of recommended by medical practitioners treatment of arterial hypertension (AH) and ischemic heart disease (IHD) to contemporary standards and compliance of patients to physician's recommendations. Local physicians/general practitioners (n=512) and their patients (n=2517) with AH and IHD from 20 cities of Russia participated in the study. The publication contains data on prevalence of risk factors in patients with AH and IHD, their knowledge, habits, skills, and amount of possessed medical information, as well as awareness of primary care physicians about actual problems of secondary prevention of cardiovascular diseases.