Introduction: The article discusses the issues of the long-term glucocorticosteroid therapy in children with nephrotic syndrome that results in severe adverse side effects. Methods: This retrospective study included 89 case reports of patients with nephrotic syndrome, aged 1–18, who received treatment at Voronezh Regional Pediatric Hospital №1 in 1999–2014. The children’s BMI Z-score was calculated from neasured height and weight. The authors considered therapeutical complications revealed through clinical-laboratory and instrumentation examination. Results and discussion: Long-term administration of glucocorticosteroids in patients with steroid-dependent nephrotic syndrome caused overweight and obesity. The patients who had received glucocorticosteroids for 6 months prior to the examination were overweight or obese (78%), had reactive pancreatitis (72%), leukemoid reactions (67%), liver damage (50%), Cushing’s syndrome (44%), chronic gastroduodenitis (33%), hyperglycemia (11%), arterial hypertension (6%), or infectious diseases (6%). The children observed during the period of prolonged remission of nephrotic syndrome had neither overweight, nor obesity or growth failure; signs of chronic gastroduodenitis were observed in 15% of the children. Conclusion: The long-term glucocorticosteroid therapy in children with nephrotic syndrome caused the excess body weight or obesity and gastro-intestinal disorders. So, proton pump inhibitors should be applied simultaneously with glucocorticosteroids to prevent gastro-intestinal disorders.

1 -ФГАОУ ВО «Российский университет дружбы народов»: 117198, Москва, ул. Миклухо Маклая, 6; 2 -ГБОУ ВПО «Смоленский государственный медицинский университет» Минздрава России: 214019, Смоленск, ул. Крупской, 28; 3 -НИИ антимикробной химиотерапии ГБОУ ВПО «Смоленский государственный медицинский университет» Минздрава России: 214019, Смоленск, ул. Кирова, 46а; 4 -Межрегиональная ассоциация по клинической микробиологии и антимикробной химиотерапии: 214019, Смоленск, ул. Кирова, 46а; 5 -ГБОУ ВПО «Воронежский государственный медицинский университет имени Н.Н.Бурденко» Минздрава России: 394036, Воронеж, ул. Студенческая, 10; 6 -ГОБУЗ «Мурманская областная клиническая больница имени П.А.Баяндина»:183047, Мурманск, ул. Павлова, 6; 7 -ГБОУ ВПО «Владивостокский государственный медицинский университет» Минздрава России: 690002, Владивосток, Проспект Острякова, 2; 8 -НУЗ «Дорожная клиническая больница на ст. Новосибирск Главный ОАО "РЖД"»: 630003, Новосибирск, Владимирский спуск, 2а; 9 -ФГАОУ ВО «Северо Восточный федеральный университет имени М.К.Аммосова»: 677000, Якутск, ул. П.Алексеева, 83а Резюме Внебольничная пневмония (ВП) является распространенным заболеванием у взрослых. При определении места лечения больного и объема терапии большое значение имеет точная оценка степени тяжести ВП. Цель. Исследование критериев, используемых врачами в клинической практике для определения тяжести ВП. Материалы и методы. При анкетировании врачей (n = 165) многопрофильных стационаров в 6 городах России установлено, что важным маркером тяжелой ВП считаются данные рентгенографии органов грудной клетки (80 % респондентов). В качестве критериев тяжести ВП 78,8; 66,1; 55,8 и 23,6 % опрошенных отмечены клинические особеннос ти, наличие сопутствующих заболеваний, лабораторные изменения и данные анамнеза соответственно. Среди клинических критериев тяжести наиболее часто упоминались одышка / тахипноэ (78,8 %) и нарушение сознания (78,8 %), среди рентгенологических -наличие очагов деструкции (80,6 %), лабораторных -гиперлейкоцитоз или лейкопения (89,7 %). Прогностические шкалы у пациентов с ВП в ру тинной клинической практике используют 10,3 % респондентов, при этом только в единичных случаях указывались рекомендованные национальными клиническими руководствами шкалы PORT и CURB / CRB 65. Результаты. По результатам опроса установлено, что в целом врачи информированы о ключевых критериях оценки тяжести ВП и факторах риска неблагоприятного прогноза. Заключение. Для более эффективного внедрения в клиническую практику валидизированных шкал, позволяющих объективизировать оценку степе ни тяжести и / или прогноза ВП у взрослых, следует предпринять дополнительные усилия. Ключевые слова: тяжелая внебольничная пневмония, критерии тяжелой внебольничной пневмонии, шкалы оценки степени тяжести и прогноза. SummaryWe aimed to assess the criteria used by physicians in routine clinical practice to assess severity of community acquired pneumonia (CAP) in adults. Methods. A survey of 165 physicians from multi profile hospitals was performed at six Russian cities. Resu...

Introduction: Acute poisoning by nasal decongestants is an important issue in pediatrics due to physiological and anatomical characteristics of the child’s body and pharmacokinetics of drugs in early childhood. Epidemiology: The number of poisonings by this group of drugs ranged from 4% to 39% during the period from 2000 to 2018. All the studies reported that the most severe degree of intoxication was observed in children aged 1–3 years. Mechanism of action of nasal decongestants: The peculiarity of selective alpha2-adrenergic agonists is that when taken orally, misused or overdosed, they lose their selectivity for the target receptor. As a result, the drug causes acute poisoning and most often this effect occurs in children and adolescents. Clinical features and diagnostic criteria: Clinical signs of acute poisoning can appear both as a result of an overdose of the nasal decongestants and due to a therapeutic use of the drug according to the instruction. The symptoms are manifested by hypothermia, skin pallor, bradycardia, arterial hypotension, profuse sweating, and acrocyanosis. Imidazoline receptors and new opportunities: It is assumed that toxic effect of topical decongestants occurs not only by activation of alpha2-adrenergic receptors, but also through their influence on the selective imidazoline receptors. Based on the structure of these drugs, it is assumed that imidazoline receptors are the primary binding site for these drugs. Conclusion: Understanding the described mechanisms of alpha2-adrenergic agonist action and peculiarities of the child’s symptoms in acute poisoning is necessary for the timely diagnosis and selection of the correct treatment strategy.

Background. It is necessary to study the microbial spectrum of urine in order to determine the features of the urinary tract infection (UTI) course and to make the right choice of a therapeutic approach. Objective. Our aim was to study the structure of urine microflora in children with community-acquired UTI and its change in the period from 1990 to 2015.Methods. We conducted a continuous analysis of case histories of children admitted to hospital with UTI (pyelonephritis, cystitis, non-site specific urinary tract infection) in 1990, 2000, and 2015. We studied the results of triple (in succession) urine cultures. Shedding in a concentration of ≥ 103 cfu/ml for primary pathogens, ≥ 103 cfu/ml in boys and ≥ 104 cfu/ml in girls for secondary pathogens, ≥ 105 cfu/ml for doubtful pathogens considered to be a diagnostically significant one.Results. Members of the family Enterobacteriaceae were the main causative agents of the UTI in 1990 (found in 90.4% of 502 samples), 2000 (in 79.7% of 632 samples), and 2015 (in 67.6% of 801 samples, df = 2, p < 0.001). Escherichia coli remained the most common microorganism, the isolation rate of which decreased from 79.9% in 1990 to 39.5% in 2015 (p < 0.001). In the period from 2000 to 2015, there was a decrease in the frequency of urine detection of Enterobacter spp. (from 5.9 to 2.5%; p < 0.001) and Citrobacter spp. (from 5.2 to 1%; p < 0.001) and, on the contrary, an increase in the isolation rate of Proteus spp. (from 7.8 to 11.7%; p = 0.005), Klebsiella spp. (from 2.8 to 12.9%; p < 0.001) and Enterococcus spp. (from 1.8 to 19.1%; p < 0.001); the latter two — due to more frequent shedding in boys (by 10.5 and 19.9%, respectively).Conclusion. The Enterobacteriaceae members, mainly E. coli and Enterococcus spp., remained the predominant UTI pathogens in children in 1990, 2000, and 2015. The isolation rate of E. coli has declined significantly in recent years, whereas that of Klebsiella spp. and Enterococcus spp. has increased.

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