Ways of increasing the efficacy of antibiotic therapy in young children with severe forms of acute pneumonia]

Examination of 136 children with the severe form of acute pneumonia treated in a resuscitation unit revealed a marked suppression of the immunity and lowered antibiotic sensitivity of the bacterial microflora isolated from the respiratory tracts. The patients were previously treated with antibiotics of 2 to 5 families. Auto-blood irradiated with X-rays without the host was transfused to 72 children (group 1) with immunomodulating purposes. 64 children (group 2) were treated with the same purposes with eleuterococcus, pentoxyl and methyluracil. After transfusion of the auto-blood irradiated with x-rays without the host there was an increase in the antibiotic sensitivity of the bacterial flora along with a marked and rapid improvement of the immunity status. The severe state was alleviated earlier in the patients of group 1. The inflammatory lesions in the lungs of the group 1 patients were arrested sooner and the patients were discharged from the hospital 11 days earlier than the children treated with the routine immunomodulators.     

Radioimmunologic tests in children with pruritus and with a combination of pruritus and allergic respiratory disease

Radioimmunological tests were carried out in 180 children with pruritus and 167 children with pruritus and allergic respiratory diseases. Difference between these groups was statistically insignificant in case of food allergy. Results of RAST were more often positive in case of respiratory allergy in the patients with pruritus and coexisting allergic respiratory diseases than in patients with skin involvement only. Reaction was more intense and allergy polyvalence measured with RAST was higher. All differences were statistically significant (p less than 0.001 or 0.01). Mean IgE levels was higher in children of all age groups in case of pruritus coexisting with allergic respiratory diseases.     

Treatment of dysentery in children with a combination of monomycin and Eleutherococcus]

An acute dysentery process was studied in 100 children at the age of 1 to 14 years treated with monomycin; 54 patients (the 1st group) were treated with monomycin in combination with eleuterococcus and 46 patients (the 2nd group) were treated with monomycin alone. The dysentery process in the both groups was close. However, the increase in the levels of gamma-globulin, antidysentery antibodies and the phases of changes in the index of phagocytosis completeness during the disease were more pronounced in the patients of the 2nd group than those in the children of the 1st group. Recovery of the patients of the 1st group was registered earlier. It was concluded that eleuterococcus as an adaptagen provided recovery of the patients at lower efforts of the protection mechanisms. Wide use of eleuterococcus in combination with monomycin for the treatment of children with dysentery is recommended.     

Value of determining the spectrum of blood serum fatty acids in evaluating increasing the effectiveness of antibiotic therapy of dysentery in children with prodigiozan and ephedrine

One hundred and ninety one children with acute Sonne and Flexner dysentery were observed with respect to the disease process, immunity indices and blood serum fatty acid spectrum. 104 children were treated with monomycin alone and 87 children were treated with the antibiotic in combination with prodigiozan and ephedrine as immunostimulators. It was shown that the recovery terms in the patients treated with the use of the immunostimulators decreased as compared to the patients treated with the antibiotic alone. The fatty acid spectrum in the children treated with the use of the immunostimulators differed from that in the children treated without them by low levels of fatty acids of the C12:0 to C18:1 composition.     

Cellular aspects of pathogenesis of hypertrophic cardiomyopathy: Role of cardiomyocyte polyploidy and activation of nuclear antigen of the proliferating cell in myocardium

For a comparative analysis of cytomorphological characteristics of hypertrophied interventricular septum (IVS), both patients different ages with severe courses of obstructive hypertrophic cardiomyopathy (OHCMP) were examined, including children, and patients with essential arterial hypertension (EAH). The course of OHCMP in children as compared with adults was found to be characterized by considerable IVS hypertrophy that was accompanied by an acceleration of cardiomyocyte polyploidization. The mean ploidy level of cardiomyocytes in children with OHCMP was higher than in adult patients. The mean ploidy level of nuclei, the number of prolipherative cell nuclear antigen (PCNA)-positive nuclei, and the number of polyploid cardiomyocyte nuclei in adult patients with OHCMP were significantly higher statistically than in patients with EAH. The PCNA-positive labels in stromal cells were revealed only in patients with OHCMP. The obtained data indicate an important role of cardiomyocyte polyploidy and of activation of the proliferating cell nuclear antigen in development of myocardial hypertrophy in patients with OHCMP.     

自闭症儿童口腔正畸治疗中系统性心理预防与干预的作用

目的:评估系统性心理预防及干预在自闭症儿童口腔疾病治疗中的作用。方法:将在我医院进行正畸治疗的40例12~16岁自闭症患者按着随机分配分为对照组与实验组,每组各20例。在正畸治疗过程中,对照组实施常规心理行为预防及干预,包括:治疗前的基础准备、治疗过程中注意事项、治疗后康复方案及辅助治疗等。而对于实验组,除了实施常规的行为预防及干预外,还进行系统性心理行为预防及干预,包括:语言疏导、健康教育、辅助矫正、生命体征监测、肢体语言演示等。结果:实验组和控制组的孩子们能够完成正畸治疗,自闭症儿童治疗配合的的程度,听话依从性,显著高于对照组(P0.01),两组之间蛀牙数和牙龈指数存在差异(P0.05)。结论:系统性行为预防及干预能够提高自闭症儿童的配合合作的程度及医嘱依从性,值得在口腔正畸科门诊自闭症儿童患者中推广。     

白癜风患儿抗核抗体、免疫球蛋白及补体检测的临床分析

目的:探讨白癜风患儿中抗核抗体(ANA)、免疫球蛋白(IgG、IgA、IgM)以及补体(C3、C4)的表达及临床意义。方法:收集2014年10月至2016年5月我院收治的30例白癜风患儿为病例组,并于同期随机选取30例健康体检儿童为对照组,患儿的血清ANA、12种自身抗体谱分别采用间接免疫荧光法及免疫印迹法进行检测,IgG、IgA、IgM,C3、C4水平采用免疫透射比浊法进行检测。结果:病例组中ANA阳性率为13.33%(4/30),与对照组的3.33%(1/30)比较,差异无统计学意义(P0.05)。12种自身抗体谱中,分别有1例(3.33%)患儿dsDNA、SmDNA、SS-A/Ro60KD、SS-B/La、CENP-B阳性,与对照组比较,差异均无统计学意义(P0.05)。病例组患儿血清IgG、IgA、C4水平低于对照组,差异有统计学意义(P0.05)。ANA阳性患儿血清IgG、IgA、IgM水平高于ANA阴性患儿,而补体C3、C4水平低于ANA阴性患儿,差异有统计学意义(P0.05)。结论:白癜风患儿ANA阳性表达与健康儿童无明显区别,体液免疫功能有明显异常,临床有重要的参考价值。     

Evaluation of varicella vaccine in childhood leukemia. Observation over 6 years

Since 1977, we have used a live attenuated varicella vaccine to immunize 10 children with acute leukemia. 8 patients had no adverse clinical reaction but 2 patients developed mild fever and papulovesicular rash after vaccination. All 9 tested children became seropositive after the vaccination. Also in all 3 children who were observed for more than 4 years, persistence of neutralizing antibody was detected. Most of the recipients were prevented from developing symptoms of varicella in spite of contact exposure. Two patients developed varicella when they were in severe immunosuppressive states but their symptoms were mild. None of the children developed herpes-zoster during the 6 year follow-up period. The results suggest that the varicella vaccine is effective in children with acute leukemia, and that long-term effectiveness can be expected.     

Glomerular basement membrane thinning in children: a morphometric assessment

OBJECTIVE: To develop our own procedures, allowing for a quick evaluation of glomerular basement membrane (GBM) thickness and to present a statistical classification of thin basement membrane disease (TBMD), minimal change disease (MCD), and IgA nephropathy (IgAN) cases. STUDY DESIGN: Measurements were carried out with the aid of the original software for semiautomatic image analysis on biopsies from 31 children with TBMD, 51 with MCD, and 10 with IgAN. RESULTS: The strongest statistically significant dependence between GBM thickness and age was observed in children with MCD below 5 years of age. There was no significant dependence between GBM thickness and age among patients with TBMD. The values of all analyzed parameters characterizing GBM thickness distribution in children with TBMD were significantly lower than those in patients with MCD and IgAN. A slight, statistically significant increase of some parameters was noted in children with IgAN in contrast to patients with MCD. The multivariate logistic regression model with three independent variables--quartile 1, quartile 3, and percentile 30--proved to be the most appropriate in differentiating between patients with TBMD and children with MCD or IgAN. The model allowed for correctly classifying 96.8% of patients with TBMD (30 of 31 children) and 98.4% patients from the MCD and IgAN groups (60 of 61 children). We failed to construct a similarly appropriate model for differentiating between patients with MCD and IgAN. CONCLUSION: The introduction of morphometric and statistical methods to routine nephropathologic diagnostics represents true progress in very precise and quick assessment of GBM thickness.     

Comparative morphological analysis of the articular cartilage, epiphyseal plate, spongy bone, and synovial membrane of the knee joint in children treated and not treated with ciprofloxacin]

Comparative data on he postmortem morphological examination of the knee joint in children treated and not treated with ciprofloxacin while alive are presented. Nine children were ill with mucoviscidosis and 8 children were ill with aplastic anemia. The patients were ill with mucoviscidosis and 8 children were ill with aplastic anemia. The patients were treated with ciprofloxacin in a daily dose of 20 to 40 mg/kg body weight at the average for 148 days. The condition of the articular cartilage, growth area, spongy bone and synovial membrane of the knee joint was examined visually, histologically and morphologically. It was revealed that ciprofloxacin had no chondrotoxic effect. The structure affected in some cases by the ciprofloxacin treatment was the synovial membrane which developed subacute synovitis not clinically manifested (latent) in life. The phenomenon is explained.     

Oro-maxillofacial development in patients with GH deficiency and in normal short children

Detailed oro-maxillofacial studies using dental cast, pantomogram and cephalogram were performed in 43 patients with GH deficiency aged 7-17 years and compared statistically to the results from 62 short children with normal GH secretion. The dental age was retarded as compared to the chronological age in patients with GH deficiency by a mean of 2.0 +/- 1.3 years. This value did not differ statistically from that observed in normal short children (1.7 +/- 0.8 years). However the bone age was significantly retarded in patients with GH deficiency (3.2 +/- 1.7 yrs vs 1.5 +/- 1.1 yrs, p less than 0.001). There was no difference between tooth size or cephalogram analysis results in the children in the two groups. The coronal arch length, basal arch width and basal arch length were shorter in patients with GH deficiency. These data indicate underdevelopment of the maxilla in patients with GH deficiency.     

A study of sister-chromatid exchange in peripheral lymphocytes of hepatitis B patients with HBsAg positive and their children

Previous studies of sister-chromatid exchange (SCE) in patients with hepatitis B have been reported. But as far as we know, no such work has been done in children born to parents with hepatitis B, either one or both of whom are infected. In the present study, frequencies of SCE in the peripheral lymphocytes of 30 hepatitis B parents with hepatitis B surface antigen (HBsAg) positive and 40 of their children were observed. SCE frequencies of 20 normal adults and 3 normal children were analysed for comparison with the patients and their children. The results obtained from all of the samples were as follows: The hepatitis B patients with HBsAg positive had a significantly higher SCE frequency than the normal adults (P less than 0.01); the children born after their parents contracted hepatitis B had a significantly higher SCE frequency than normal children (P less than 0.01); there was no significant difference in SCE (P greater than 0.05) between children born after their parents contracted hepatitis B, children born after their mothers acquired it and children born after their fathers acquired it. The above results indicate that hepatitis B patients with HBsAg positive and their children born after they contracted hepatitis B had significantly higher frequencies of SCE; these data might throw new light on the study of genetic factors acting on the mechanism of hepatitis B.     

13例SCN2A 基因突变相关儿童神经系统疾病表型分析

摘要 目的：总结并分析SCN2A基因突变引起的儿童神经系统疾病相关表型谱特点。方法：采用回顾性研究,收集2018年6月至2021年6月在上海交通大学医学院附属上海儿童医学中心神经内科诊治的患儿,并经二代基因测序检测,纳入SCN2A基因突变者,研究并总结患儿神经系统临床表型特点。结果：共纳入13例SCN2A突变患儿,包括新生突变9例和遗传性突变4例。其中11例患儿伴有癫痫发作,发作年龄为1日龄~1岁11月龄,4例在新生儿期起病 （36%）,1~3 月龄起病2例（18%）,4~12月龄起病2例（18%）,1岁后起病3例（27%）;发作类型中强直阵挛发作、痉挛发作、局灶性发作均各有4例（36%）,阵挛发作1例（9%）。另有2例无癫痫发作的患儿,1例表现为全面性发育迟缓,另一例表现为发育迟缓合并孤独症谱系疾病。11例癫痫患儿中,丛集性发作患儿10例。遗传性突变4例患儿中2例智力、运动发育正常;9例新生突变的患儿中8例伴有运动、智力发育落后,1例发育正常。11例癫痫患儿表型中良性家族性新生儿癫痫1例,新生儿惊厥2例,婴儿痉挛症2例,不能分类的早发性癫痫性脑病3例,儿童期起病的癫痫性脑病2例,热厥附加症1例。结论：SCN2A基因突变引起的儿童神经系统疾病以癫痫表现居多、癫痫表型谱广,少数表现为不伴癫痫发作的发育迟缓和孤独症谱系疾病。     

The provocation test in children with cow-milk protein and gluten intolerance: evaluation of the clinical response and lesions in the mucous membrane of the small intestine

Provocation test (re-introduction of the noxious protein) was carried out in two groups of patients: (a) with intolerance to the cow-milk proteins (41 children) treated with milk-free diet for 6-24 months, and (b) with gluten intolerance (26 children) treated with gluten-free diet for 6-36 months. The following parameters were compared: type and frequency of the clinical symptoms seen in these patients prior to the introduction of allergen-free diet. Moreover, the type of observed morphological changes in the small intestine mucosa following provocation test were analysed in the groups of 7 patients. A two-year elimination of milk from the diet produces milk tolerance in about 61% patients; clinical symptoms in the remaining children are diversified. Re-introduction of gluten with the diet (provocation test) produces recurrence of gluten intolerance in 96% of children treated with gluten-free diet for 2-3 years. Recurrence of the disease was accompanied by the atrophy of the intestinal villi.     

Contents of antibodies to Bordetella pertussis antigens in patients with rheumatic diseases

Study of presence of antibodies against pertussis in 72 rheumatic patients (with uvenile rheumatoid arthritis, systemic lupus erythematosus, etc.) aged 1-18 year old without history of pertussis was performed. Mean age of the patients was 10.6 +/- 0.48 year old, duration of illness--51.2 +/- 4.42 months. Immunosupressive therapy at the time of the study was conducted in 68 (94.4%) children. Using ELISA method, IgG to pertussis toxin (PT) and to antigens of acellular pertussis vaccine (aPV) were detected in 98.6% and 100% of children. High titers of antibodies were detected more frequently in 7-18 year old age group, which can indicate recent pertussis disease or infection. Vaccination history was studied in 131 children with rheumatic diseases. Incidence of pertussis in 43 unvaccinated children was 116.3 per 1000, and in 16 children with incomplete vaccination--62.5 per 1000. Out of 75 patients, who received vaccination series and revaccination, clinically distinct pertussis was not diagnosed.     

Development of articulation before delayed hard-palate closure in children with cleft palate: a cross-sectional study

The development of articulation before surgical closure of the hard palate was compared in 75 preschool children with cleft lip and palate and 40 preschool children born without clefts. The children were aged 2 years to 5 years 11 months. The patients had significantly poorer articulation skills than the controls at each age level. Substitutions were the most frequent error, and they did not decrease with age in the patients. Fistula size and a history of speech therapy were significant factors in the articulation error scores only in 5-year-olds. No advantage in articulation proficiency was found for those who had worn a prosthesis to occlude the hard-palate defect.     

Use of tablet forms of monomycin in children with acute dysentery]

The clinical picture of acute dysentery caused mainly by Shigella sonnei was studied in 160 children: 50 children were treated with monomycin tablets and for the treatment of 110 children monomycin in the form of amorphous powder in bottles was used. The treatment was carried out in accordance with the official instructions. Coincidence of the recovery time in the both groups was registered. When the patients were treated with monomycin tablets, 5 and 15-34 per cent of the antibiotic a daily dose was excreted with the urine and excrements respectively. It was concluded that monomycin in the from of tablets was more convenient in the treatment of children.     

How can natural products serve as a viable source of lead compounds for the development of new/novel anti-malarials?

Background

Change of Kenyan treatment policy for uncomplicated malaria from sulphadoxine-pyrimethamine to artemether-lumefantrine (AL) was accompanied by revised recommendations promoting presumptive malaria diagnosis in young children and, wherever possible, parasitological diagnosis and adherence to test results in older children and adults. Three years after the policy implementation, health workers' adherence to malaria diagnosis and treatment recommendations was evaluated.

Methods

A national cross-sectional, cluster sample survey was undertaken at public health facilities. Data were collected using quality-of-care assessment methods. Analysis was restricted to facilities with AL in stock. Main outcomes were diagnosis and treatment practices for febrile outpatients stratified by age, availability of diagnostics, use of malaria diagnostic tests, and test result.

Results

The analysis included 1,096 febrile patients (567 aged <5 years and 529 aged ≥5 years) at 88 facilities with malaria diagnostics, and 880 febrile patients (407 aged <5 years and 473 aged ≥5 years) at 71 facilities without malaria diagnostic capacity. At all facilities, 19.8% of young children and 28.7% of patients aged ≥5 years were tested, while at facilities with diagnostics, 33.5% and 53.7% were respectively tested in each age group. Overall, AL was prescribed for 63.6% of children aged <5 years and for 65.0% of patients aged ≥5 years, while amodiaquine or sulphadoxine-pyrimethamine monotherapies were prescribed for only 2.0% of children and 3.9% of older children and adults. In children aged <5 years, AL was prescribed for 74.7% of test positive, 40.4% of test negative and 60.7% of patients without test performed. In patients aged ≥5 years, AL was prescribed for 86.7% of test positive, 32.8% of test negative and 58.0% of patients without test performed. At least one anti-malarial treatment was prescribed for 56.6% of children and 50.4% of patients aged ≥5 years with a negative test result.

Conclusions

Overall, malaria testing rates were low and, despite different age-specific recommendations, only moderate differences in testing rates between the two age groups were observed at facilities with available diagnostics. In both age groups, AL use prevailed, and prior ineffective anti-malarial treatments were nearly non-existent. The large majority of test positive patients were treated with recommended AL; however, anti-malarial treatments for test negative patients were widespread, with AL being the dominant choice. Recent change of diagnostic policy to universal testing in Kenya is an opportunity to improve upon the quality of malaria case management. This will be, however, dependent upon the delivery of a comprehensive case management package including large scale deployment of diagnostics, good quality of training, post-training follow-up, structured supervisory visits, and more intense monitoring.     

General practice observed. Child abuse and general practice.

In a general practice of 9250 patients with 1841 children under 10 there were 12 cases of actual abuse during 1973-6. In March 1976 30 children were at risk. A preventive scheme was set up and the short-term outcome was good. There were no cases of serious abuse among the children at risk.