No 42 (2015)

Rationale: The study  on  specifics of metabolic phenotypes of obesity in children and adolescents seems be highly relevant for a comprehensive assessment  of causal and  pathophysiological  roles of obesity in the  atherogenesis. Aim: To identify particulars of metabolic  phenotypes of obesity in the  population of the  school children in the  city of Arkhangelsk. Materials and methods: We examined 102 patients aged from 10 to 15 years with obesity, abdominal type (boys, 44.6%, girls, 55.4%). According to the results of a comprehensive clinical and laboratory assessments, the patients  were divided  into  the  group  of metabolically  healthy obese   (children  and  adolescents  with  obesity, but without any metabolic abnormalities) and the group of metabolically unhealthy obese (having at least 1 metabolic abnormality). The list of metabolic abnormalities  included  high triglyceride levels, low levels of high density lipoprotein  cholesterol (HDL-C), high blood pressure, impaired fasting glucose, increased  C-reactive protein  levels. Results: The  group  comparison   showed  that  the  mean levels  of  all studied   parameters  of  pro-atherogenic  metabolic  abnormalities  were significantly higher  in the  patients  with  metabolically  active obesity (the mean triglyceride levels in the groups of metabolically active and metabolically healthy obesity were 1.31 vs 0.74 mmol/L, glucose levels, 4.92  vs 4.54  mmol/L,  C-reactive protein,  3.15  vs 2.30 mg/mL, systolic and diastolic blood pressure, 118.97 vs 110.23 mmHg and 72.90 vs 68.58 mmHg, respectively; p < 0.001), with the  exclusion of the   mean level of anti-atherogenic HDL-C, which was lower (1.27 vs 1.49 mmol/L; p < 0.001). Also, in addition to abdominal obesity, 21.43% of school children with metabolically active obesity had ≥ 2 atherogenic factors, as well as some pro-inflammatory abnormalities (C-reactive protein levels were higher in one third of children and adolescents of this group, with a borderline  significance level). Sixty percent  of children and adolescents with obesity and metabolic abnormalities had abnormal lipid parameters. Pro-atherogenic metabolic abnormalities  were  found  in all children  and  adolescents with increased C-reactive protein levels. Conclusion:  Distinctly different  phenotypes  of obesity with various degrees  of metabolic  abnormalities were  found  in the  pediatric  population. Formation of combination of atherogenic clinical and metabolic abnormalities  (dyslipidemia, impaired glucose  tolerance,  high blood  pressure)  is possible already in children and adolescents with metabolically active obesity. They can be associated with chronic inflammation, and as such could be the first stage of development of atherosclerosis, metabolic  syndrome  and  cardiovascular  disease.

Background:   Only  medical   nutrition   therapy and physical activity can be used for treatment of the group  2 (p > 0.05). The fat mass in children of the group  1 decreased from 44.4% [39.1; 48.3] to Department of Pediatric Gastroenterology, Hepatology, and Nutrition1; Assistant, Chair of Dietetics and2obesity in children. In many cases, it is reasonable to  start  treatment in a hospital. Aim: To assess changes  of clinical and  biochemical  parameters and body composition with diet therapy in overweight  and  obese  children  in an  in-patient department. Materials and methods: We examined 537 children with obesity aged 13 years [11;  14] (group  1) and  104  overweight   children aged  13 [12; 14] years (group  2). Anthropometric parameters,   body   composition    by   means   ofbioimpedance  measurement,  clinical  chemistry 43.1% [37.9; 47.7] (p < 0.001), in group 2, from 33.8% [31.1; 38.5] to 32.6% [30; 36.7] (p = 0.017). The lean mass  decreased in 86.2 and  93.7% of patients, respectively.  There  were  significant  reductions on  the   levels  of  serum   total   cholesterol,  low density lipoproteins, triglycerides, high density lipoproteins  and  increase  in uric acid, compared to  their  respective  baseline  values. Conclusion: During  the  in-hospital  treatment period  obese children  show  improvements  of nutritive  status, Nutrition, Postgraduate Training FacultyPavlyuchkova Mariya S. – PhD, Dietologist1parameters of lipid and carbohydrate metabolism significant   reduction   of   fat   body   mass   with                were  assessed   at  baseline   and  at  the   end   of treatment. Duration of hospital stay was 14 days. The  children   were  on  a  diet  with  a  reduced caloric,  fat  and  carbohydrate  content.  Results: The bodymass  decreased by 5.7% [4.5; 6.9] from baseline  in the  group  1 and  by 5.3% [3.8; 7.5] in concomitant decrease  of lean mass due to a rapidbodyweight reduction.

Background:  A  special  attention  in  the treatment  of  acute   respiratory  disorders  (ARD) in  children   should   be   paid   to   correction   of defense mechanisms  of the body, including elimination    of    dysbiotic    abnormalities.    The use  of  probiotics,  whose  mechanism   of  action is directed  to restoration  of qualitative and quantitative composition  of normal microbiota, is considered  to be perspective  in the combination therapy  of ARD  patients. Aim: to  assess  clinical and  laboratory  efficacy of probiotic  Florin forte in children  with  ARD.  Materials and  methods: One  hundred  and   eleven   children  aged   from3 months  to 14 years with ARD were included into the study. In 81.1% of cases they had concomitant obstruction of upper  respiratory  ways. From day1 after admission to the hospital, 81 patients  (the main  group)  were  administered probiotic  Florin forte  as a part  of combination  therapy  for 5 to7 days, and  30 children  (the  comparator group) were  administered  the  standard   treatment without  probiotics. Parameters  of oropharyngeal and  mucosal  microflora, immune  parameters of anti-infectious resistance (phagocytic activity, phagocytic index, neutrophilic index of digestion), as  well  as  secretory   immunoglobulin  A levels in  saliva  were  measured  during  the  course  of the  illness. Results: In the  patients  of the  main group   under   the   combination  therapy,  there was   a   significantly   more    rapid    elimination of    respiratory     symptoms     and     intoxication (p < 0.05), with shorter  duration  of hospitalization (4.43 ± 0.19  days vs 6.03 ± 0.25  in the  comparator group, p < 0.001). The acute  phase  of the  disease in both  groups  of patients  was characterized  by dysbiotic   abnormalities   in  oropharyngeal   and gut  microbiota, with  a decrease  in non-specific host    resistance    parameters.   After   treatment, there was a significantly higher number  of indigenous   microbial  associations   in  the   main group, compared to that in the comparator group (43.4% vs 16.7%, p < 0.01), and  a higher  growth of enterobacteria  (16.9% vs 33.3%,  respectively, p < 0.1). In the patients  taking the probiotic, there was a trend towards restoration  of qualitative and quantitative  composition   of the  gut  microflora: in the main group, there was an increase in proportions of children  with a normal  counts  of bifidobacteria  (from 26.4% in the  acute  phase  to45.3%  after  treatment,  p < 0.05)  and  lactobacilli (from 7.5% to  16.9%, respectively,  p < 0.05), and a decrease of proportion of children with hemolytic Escherichia coli (in 32.1% before  treatment and in22.6%  after  treatment,  p > 0.05).  Improvements of immune parameters of the anti-infectious resistance  system  were  found  only in the  main group: the phagocytic  index at 120 minutes  after incubation  of neutrophils  was 4.26 ± 0.04  before treatment and 3.94 ± 0.09 after treatment (р < 0.05); the  neutrophil   digestion   index,  5.70 ± 0.71  and10.83 ± 0.94   (р < 0.01),  and   secretory   IgA   level in  saliva,  0.05 ± 0.03   and   0.125 ± 0.03   mcg/mL, respectively  (р < 0.05).  Conclusion:  Inclusion  of probiotic  Florin forte  into  combination  therapy of ARD patients  promoted more rapid clinical recovery, improvement of biocenotic  parameters in oropharyngeal and gut mucosa and an increase in anti-infectious resistance of the host.

Background: Enteric viruses (mainly rotaviruses) are the most common cause of infectious diarrhea in infants. One  of the  pathophysiologic mechanisms in rotaviral gastroenteritis is the  reduction of the  surface  activity of enterocyte disaccharidases  and  osmotic  diarrhea. Aim: To determine the clinical significance of metabolic activity of intestinal microbiota in the formation of the osmotic component of viral diarrhea in children of various ages. Materials and methods: The study involved 139 children aged  from 1 month  to 14 years admitted to the hospital in the first 24 to 72 hours of moderate-degree  viral gastroenteritis.  Rotaviral infection was the most prevalent  (90%). Viral etiology was confirmed  by the  reaction  of indirect hemagglutination and multiplex real-time PCR (in feces). Total carbohydrate content in the feces was measured and fecal microflora was investigated by two methods: bacteriological and gas liquid chromatography with the determination of short-chain fatty acids. Results: The mean carbohydrate content in the feces of children below 1.5 years of age was higher than  that  in older children (p = 0.014). There was an inverse correlation between the concentration of rotaviral antigens  and carbohydrate   contents (r = -0,43, p < 0.05) and the production of acetic and propionic acids (R = -0,35, p < 0.01). The carbohydrate content in acute stage of the disease was linearly associated with time to normalization of the stool (r = +0,47, p < 0.01). Previous acute  respiratory or intestinal  infections within 2 months (odds ratio [OR], 14.10; 95% confidence interval [CI] 3.86–51.53), previous  hospitalizations  (OR = 14.17; 95% CI 2.74–74.32) and  past  history of intestinal dysfunction (OR 5.68; 95% CI 1.67–19.76) were predictive of severe  carbohydrate malabsorption in children below 1.5 years of age. Conclusion: The lack of microbiota functional activity (assessed by production of short-chain  fatty acids) determines the  development of osmotic  phenotype of diarrhea, that marks the total carbohydrate contents in the feces. Its predisposing factors should be taken into account  when making a decision to hospitalize.

Background: High production of pro-inflammatory cytokines associated with procalcitonin synthesis  and  its increased  blood  levels play an important role in the pathophysiology of systemic inflammation  in generalized  bacterial  infections. Aim: To assess diagnostic  value of procalcitonin measurement as a marker of bacterial  inflammation in cerebrospinal  fluid for differential diagnostics of bacterial  and  viral meningitis. Materials and methods: Procalcitonin  levels in blood  and cerebrospinal  fluid were measured by immunoenzyme analysis in 88 children aged from 3 months to 14 years who had been admitted to the hospital. Forty five percent  (45.4%) of them had acute bacterial meningitis, 27.3%, viral meningitis and 27.3% had the meningitis-like syndrome (control group). Results:  There  was a high  procalcitonin  level in   cerebrospinal  fluid in patients with bacterial purulent meningitis  (0,14 [0.0; 0.34] ng/mL (р < 0.006), with  the  normal  range  in the  control  group  of 0.07 [0.0; 0.07] ng/mL. This parameter correlated with blood procalcitonin level (9.8 [2.05; 13.19] ng/mL)  and  severity  of  meningitis.  In  patients with viral meningitis, the procalcitonin levels were below the normal range  (0.02 [0.01; 0.07] ng/mL). Conclusion: Measurement of procalcitonin  levels in cerebrospinal  fluid could be recommended for inclusion into the differential diagnostic algorithm of meningitis of various etiologies in children.

Background: Cerebral palsy is the leading cause of physical disability in pediatric  age. The search for new methods and improvement of old rehabil- itation techniques is ongoing, due to low efficacy of the latter. Aim: To assess the efficacy of a func- tional programmed electrical muscle stimulation as a part  of combination treatment of patients with cerebral palsy in the form of spastic diplegia. Materials and methods: We analyzed the results of treatment of 71 children with cerebral palsy and spastic diplegia, who had  been  randomized  into two groups  depending on the type of treatment. In  the  first group,  the  patients  (n = 38) received a course of functional programmed electric stim- ulation  in combination with  other  non-medical treatment  methods.  The  second   group   (n = 33) underwent a usual  course  of electrical  stimula- tion in combination with non-medical  treatment, similar to that  in the first group. The third group (control)   included   41   children   without    cere- bral palsy. Clinical and  instrumental parameters were  assessed  in all study  participants. Results: After the course of combination treatment in the group  1, the  tonus  of m. gastrocnemius was de- creased significantly by 41%, that of the posterior group  of femur muscles by 43%, adductor group of femur muscles by 36%. In the group  2, the re- spective parameters decreased by 24, 21 and 21%. Muscle power  endurance was  increased  signifi- cantly in patients of both groups: that of long back extensors by 12.5 and 6.2 sec, of m. rectus abdomi- nis by 10.6 sec and 5.2 sec, of gluteal muscles by 9.3 and 4.6 sec, of m. quadriceps  by 19.8 and 7.2 sec, of m. anterior  tibialis by 12.1 and 4.6 sec, respec- tively. After the  treatment, the  active movement volume in the large joints of lower extremities  in the group 1 patients  improved as follows: by 15.6° in hip joints, by 11.1° in knee joints and by 10.6° in ankle joints. In the second group the correspond- ing values were 7.4° in hip joints, 5.1° in knee joints and 4.8° in ankle joints. The differences for all pa- rameters were statistically significant (p < 0.05), be- ing significantly better in the group 1. Conclusion: The course of the functional programmed electri- cal muscle  stimulation  at  walking,  compared to the usual electrical stimulation in spastic diplegia patients is significantly more effective in reduction of the spastic muscle tonus  of the lower extremi- ties. It improves power endurance of the weak legs and trunk muscles, increases the volume of active movements in big joints of the lower extremities.

Aim: To review data from clinical studies on a multichannel intraluminal impedance-pH measurement in children with gastroesophageal reflux disease (GERD). Key points: Esophageal pH measurement is considered a golden standard of GERD diagnostics   in  children.  However,  this  method can identify only the  acid reflux. Recently, multichannel  intraluminal impedance measurement of esophagus has been  introduced into the work-up of such children. This method gives the opportunity to diagnose  liquid, gas or mixed types of reflux and to determine whether it is acid, weakly acid or basic, as well as to obtain  data  on localization of the bolus in the esophagus, its length  and direction of movement (antegrade or retrograde). We present  the information on normal parameters of multichannel  intraluminal impedance and its use for assessment of infants,  as well as on changes in its parameters in children  with apnoe  and  on clinical value of non-acid reflux. The significance of multichannel intraluminal impedance in detection of esophageal disorders in patients  with otolaryngologic  symptoms   and  other  extra-esophageal signs  is discussed. Аn association  between the results  of this method and  endoscopic  and  histological abnormalities  found in GERD patients  is being actively studied. The authors  of the review focus their attention on the  data  on changes  of multichannel  intraluminal impedance parameters during  treatment of GERD  children  with  proton pump  inhibitors. Conclusion: Multichannel intraluminal impedance is a new modern  method with wide spectrum of diagnostic opportunities.

Aim: To assess the rates and changes  in morbidity, hospitalizations, lethality and mortality of pediatric population in the Moscow Region in 2014, compared to 2013, and similar data for the Russian Federation  (RF). Materials and methods: We calculated  and  analyzed  morbidity  (based  on referrals),  hospitalizations, lethality  and  mortality  of the pediatric population aged  from 0 to 17 years in the  Moscow Region. The information  was taken from the Federal Statistical Surveillance report forms No 12 and No 14, as well as the Rosstat data for the Moscow Region. Results: In 2014, total pediatric morbidity (age 0–14) in the Moscow Region was 2290.2 per 1000 pediatric  population, being 10% higher, than that in 2013, but lower than the Russian Federation  average  for 2014  (2332.9‰) and lower than that in the Central Federal District (2333.5‰).  Total  morbidity  among   adolescents of 15 to 17 years of age in 2014 increased non-significantly by 1.6% and achieved  2104.7‰. This is lower than Russian Federation and Central Federal District  average   values   (2267.8  and   2188.5‰,   respectively). In 2014, pediatric lethality (age 0–17) in in-patient  department of the  Moscow Region was 0.1% (in infants, 0.13%) and was mainly related to neoplasms  (0.32%), blood and lymphatic disorders  (0.33%), congenital  abnormalities  and  birth defects  (2.61%). In 2014, infant  mortality  in the Moscow Region was 6.8‰ (in 2013, 7.0‰) versus 7.4‰ in Russian Federation  in general. In the first 6 months  of the  year 2015, this parameter in the Moscow Region continues  to  be  lower than  the average  values in Russian Federation  and Central Federal District (5.1, 6.6 and 6.2‰). With this infant mortality, the  Moscow Region ranks 13th   among Russian  Federation   administrative   subjects  and 5th  in Central Federal District. Conclusion: Despite positive trends in many parameters in the Moscow Region, it is necessary to further improve the system of pediatric medical care at all its levels.