Пермская государственная медицинская академия им. Е.А. Вагнера, Российская Федерация В настоящее время во всех странах мира отмечается увеличение числа лиц, страдающих ожирением. При этом известно, что избыточная масса тела у детей является фактором риска ожирения в старшем возрасте. Цель исследования: изучить распространенность и гендерные особенности избыточной массы тела и ожирения у подростков г. Перми. Методы: в исследование включены школьники в возрасте 13-14 лет. Сопоставлены данные медицинских осмотров 2005 и 2013 гг. Всем детям измеряли вес, рост, окружность талии. Рассчитывали индекс массы тела и коэффициент стандартного отклонения. Оценивали половое развитие по критериям Таннера. Результаты: осмотрено 828 подростков (444 -в 2005, 384 -в 2013 г.). В 2005 г. распространенность избыточной массы тела у подростков составила 9, 4%, ожирения -3,1%, в 2013 г. -14,8 и 5,5%, соответственно (р = 0,023 и 0,140 в сравнении с когортой 2005 г.). Подростки с избыточной массой тела, но не с ожирением, существенно опережали своих сверстников с нормальной массой тела по росту (+0,75 ± 1,05 против +0,32 ± 0,96 SD; р = 0,005). Суммарная оценка полового созревания у мальчиков с избыточной массой тела была выше, чем у детей с нормальной массой тела и ожирением (р = 0,012). Заключение: в период с 2005 по 2013 г. распространенность избыточной массы тела (включая ожирение) среди подростков увеличилась более чем наполовину. В 2013 г. избыточная масса тела обнаруживалась уже у каждого пятого подростка. Ключевые слова: подростки, избыточная масса тела, ожирение, эпидемиология, гендерные отличия. (Вопросы современной педиатрии. 2014; 13 (5): 37-41) Background: Currently, there is a well-publicised worldwide increase in obese patients. The origins of adult obesity, in the majority of cases, are in children. Objective: Our aim was to study the prevalence and gender features of excess weight and obesity in adolescents in Perm. Methods: The study included adolescents aged 13-14, living in the city of Perm. Medical examinations were compared in statistics from 2005 and 2013. Weight, height and waist circumference were measured on all children. Body mass index was calculated, as wasa standard deviation coefficient. Sexual development was evaluated according to the criteria of Tanner. Results: 828 adolescents were viewed (444 in 2005 and 384 in 2013). The prevalence of overweight adolescents in 2005 was 12.5%, including 3.1% who were obese. In 2013, 20.3% of adolescents were diagnosed as overweight, with 5.5% being diagnosed as obese. Abdominal obesity to type was diagnosed in 52.4% of obese children. Over the past 8 years, the number of adolescents who are overweight and obese has increased by more than half. A statistically significant increase has beenrecorded for overweight adolescents ( 2 = 5,16; p = 0,023). In adolescents with excess body weight, growth rates were higher than in those children with either normal body weight or obesity; these differences were statistically significant in boys (p = 0.016). The total score of puberty i...
The present review examines the modern view on the problem of infectious mononucleosis. It is noted that this disease is a polyetiological entity and is usually caused by various lymphotropic infections that are often representatives of the Негреsviridae family. Etiological factors, pathogenesis, and the most typical clinical manifestations are described. Clinical and laboratory features depending on the type of pathogen are presented. Differential diagnosis complications are discussed. The authors present comparative analysis of different approaches to this issue reported by other investigators. The authors have made the following conclusions: 1. Infectious mononucleosis presents a variety of clinical manifestations, from asymptomatic to life-threatening, can have a chronic course and form a contingent of sickly children. 2. On the basis of using only routine clinical and laboratory methods of examination, it doesn’t always possible to diagnose the disease. 3. Today there is no single opinion about the treatment infectious mononucleosis, are clearly not designed clinical examination doesn’t clearly developed. 4. Currently, there is no doubt as to the urgency of the threat of infectious mononucleosis in pediatric practice and the need for more detailed study.
Background. It is known that obesity may influence the state of respiratory function and it is associated with a number of diseases of the respiratory system. Obesity in itself, even in the absence of other known causes, can cause a feeling of shortness of breath at rest. At the same time, the cardinal symptom of respiratory muscle weakness is shortness of breath, which promotes the reduction of exercise tolerance. At the moment the problem state of respiratory function and respiratory muscles in children with different degrees of obesity is relevant and understudied. Aim. Investigation of lung function and respiratory muscle strength in obese in children. Methods. 46 children with obesity were examined, with a prevalence of obesity of mixed origin with progressive, aged 7 to 16 years. We evaluated the lung function and strength of respiratory muscles in the form of maximum inspiratory pressure at the mouth (MIP), maximal expiratory pressure at the mouth (MEP) and nasal inspiratory pressure in the sniff-test (SNIP). Results. The children with obesity complained of dyspnea. The respiratory muscle dysfunction observed in the form of reduction of its forces. Reduced respiratory muscle strength (р 80% of the norm) was in 44% of patients on the MIP and 38% on the MEP and was increased with increasing body mass index. Conclusion. Children with obesity need to monitor the lung function and evaluate the strength of the respiratory muscles for early detection of functional disorders of the respiratory system.
государственная фармацевтическая академия» Минздрава России 2 ФГБНУ «НИИ вакцин и сывороток им. И. И. Мечникова», Москва 3 ФГБОУ ВО «Пермский государственный медицинский университет имени академика Е.А. Вагнера» Минздрава России Эпидемический паротит в России: эпидемическая ситуация, основные задачи и пути решения Резюме Актуальность. Во втором десятилетии XXI века эпидемический паротит по-прежнему привлекает внимание ученых и практиков всего мира своей эпидемиологической, социальной и экономической значимостью. Установлено повсеместное, но неравномерное распространение паротитной инфекции в различных регионах мира: в Европе, Восточном Средиземноморье, Юго-Восточной Азии, Африке, Америке и западной части Тихого океана. Цель работы. Осветить современное состояние заболеваемости эпидемическим паротитом в Российской Федерации. Выводы. Современная эпидемическая ситуация по эпидемическому паротиту в Российской Федерации, характеризующаяся преобладанием в возрастной структуре заболеваемости подростков и лиц молодого трудоспособного возраста, определяет необходимость разработки и внедрения в медицинскую деятельность стандартного определения клинического случая эпидемического паротита для правильной верификации диагноза с последующим лабораторным подтверждением. Появление феномена «повзросления» эпидемического паротита и регистрация периодических вспышек в многолетней практики вакцинации диктует необходимость совершенствования дальнейшей тактики вакцинопрофилактики с акцентом на взрослое население в рамках реализации Национального календаря профилактических прививок.
Background. The most frequent chronic lung pathology among infants and especially in premature children with extremely low and very low body weight is bronchopulmonary dysplasia (BPD). The aim of the study is to study the prevalence of bronchopulmonary pathology among premature children and justify the need to vaccinate against pneumococcal disease premature children suffering from BPD. Methods. The official statistics (Form №32) and data from annual reports of the catamnesis department of “the Honourary order” Perm Regional Clinical Hospital were used in order to measure the number of premature children born alive in Perm region in 2015-2017 yy. The estimation of prophylactic efficacy and reactogenicity of 13-valent pneumococcal conjugate vaccine (PCV13) at immunization of premature children with BPD. Results. The study group included vaccinated premature children with BPD (n=29), the experimental group included non-vaccinated premature children with BPD (n=29) and 30 vaccinated term children. Administration of PCV13 in premature children suffering from BPD has revealed its high prophylactic efficacy (no cases of community-acquired pneumonia among vaccinated children during the prospective study for 3 years), high tolerability (no cases of broncho-obstructive syndrome or negative effects on respiratory system such as apnoea or desaturation among vaccinated children). Low reactogenicity (17.2 ± 0.57%) and similar vaccine tolerance with term children (16.5 ± 0.55%) has been revealed as well. The combination of PCV13 with other vaccines from immunisation schedule did not increase the number of vaccine-induced diseases in comparison with administration of PCV13 alone. Conclusion. The scientific necessity of vaccination of premature children with BPD against pneumococcal disease has been proved. The high prophylactic efficacy and low reactogenicity of PCV13 in this children group at tertiary neonatological care (catamnesis department of perinatal center) has been established within the national immunisation schedule.
VACCINE PROPHYLAXIS OF PNEUMOCOCCAL INFECTION AMONG PREMATURE INFANTS WITH BRONCHOPULMONARY DYSPLASIA Introduction. Bronchopulmonary dysplasia (BPD) is the most common chronic lung disease among children of the first year of life, especially children born prematurely with extremely low and very low body weight. Material and methods. To estimate the number of children born alive in Perm Territory between 2015 and 2017, official statistics data were used. Experimental epidemiological studies were used to assess safety, reactogenicity, immunogenic activity and preventive efficacy of the Prevnar 13 vaccine when immunizing preterm infants with bronchopulmonary dysplasia under prospective controlled randomized clinical observation. Results. There were 29 premature infants with bronchopulmonary dysplasia under observation, the control group comprised 29 unvaccinated premature infants with BPD and 30 full-term infants. The PCV 13 vaccination of preterm infants with BPD established good tolerance, poor reactogenicity (17.2±0.57%) and vaccine tolerance like full-term infants (16.5±0.55%), high safety profile, high immunogenic properties (seroconversion-93.1%, seroconversion factor-5.5). Evaluation of immunogenic activity among children with BPD vaccinated with the PCV 13 vaccine revealed high immunological efficacy compared to unvaccinated healthy children. Conclusion. The need for vaccination of premature babies with BDL against pneumococcal infection has been scientifically substantiated. The study has confirmed safety, poor reactogenicity, high immunogenic activity and preventive efficacy of the Prevenar 13 vaccine among premature babies with BDL under the conditions of the catamnesis department of the perinatal center within the follow-up monitoring of vaccinated infants over three years. Cuvinte cheie: vaccin VPC13, infecție pneumococică, displazie bronhopulmonară. VACCINOPROFILAXIA INFECȚIEI PNEUMOCOCICE LA SUGARII NĂSCUȚI PREMATUR, DIAGNOSTICAȚI CU DISPLAZIE BRONHOPULMONARĂ Introducere. Cea mai frecventă boală pulmonară cronică la copii în primul an de viață, în special la sugarii născuți prematur, cu o greutate corporală foarte mică, este displazia bronhopulmonară (DBP). Material și metode. Pentru a estima numărul copiilor născuți vii în perioada 2015-2017, în regiunea Permi, Rusia au fost utilizate datele statistice oficiale. Au fost proiectate studii epidemiologice experimentale pentru evaluarea eficacității profilactice și a reactivității, demonstrarea siguranței și activității imunogene a vaccinului pneumococic conjugat (VPC 13) la imunizarea sugarilor născuți prematur cu DBP. Rezultate. Au fost investigați 29 de copii născuți prematur, diagnosticați cu DBP și pentru comparație-29 de copii născuți prematur, nevaccinați cu DBP și, respectiv, 30 de copii născuți la termen. Vaccinul VPC 13 administrat la sugarii născuți prematur care suferă de DBP a stabilit o toleranță bună, reactivitate scăzută (17,2±0,57%) și toleranță similară la vaccin ca și la copiii născuți la termen (16,5±0,55%), siguranță înaltă, propriet...
Background. It is required to perform estimation of epidemiological and cost efficacy (regarding morbidity rate) of mass routine vaccination against pneumococcal infection in Russian children and carried out earlier selective vaccination of children from high-risk groups on the basis of four-year experience. It is also important to estimate the rate of hospital admissions in this patient group, long-term and annual cycles, morbidity age and etiology structure, and mortality due to community-acquired pneumonia as one of the most common form of pneumococcal disease. The aim is to study the effect of selective and mass immunization against pneumococcal infection on the morbidity and mortality due to community-acquired pneumonia in children under 5 years of age. Methods. The analysis of communityacquired pneumonia morbidity (in 2003–2018) and mortality due to pneumonias (in 2003–2018) in children under the 14 years old in Perm was carried out. Serotypes of circulating pneumococcus, etiology of community-acquired pneumonias and immunization cost efficacy (direct expense on health care) were further studied. The analysis of study indexes was carried out following selective (vaccination of at-risk children in 2011–2014) and mass (vaccination of infants in 2015–2018) immunization strategies. Results. The morbidity rate of community-acquired pneumonias decreased by 4.0 times (from 267.0 to 66.7 for 1000) after performing selective vaccination (2011–2014) in at-risk children (frequently and chronically ill children). The morbidity rate of community-acquired pneumonias in non vaccinated children of the same group increased by 2.0 times (from 40.0 to 80.0 for 1000 non-vaccinated). The prophylactic efficacy index was 46.0. Whereby the antibacterial index among vaccinated frequently and chronically ill children was 0.11 on one child. This index has decreased by 2.6 times (from 0.11 to 0.04 on one child) in a year within the framework of prospective controlled randomized clinical study. The antibacterial index among non-vaccinated children of this group remained slightly the same: 0.09 and 0.12 respectively. During the selective vaccination the mortality rate among infants decreased by 2 times: long-term average index was 17.9 (2011–2014) against 35.2 (2003-2010) on 100 thousand children. Mass vaccination of infants against pneumococcal infection has reduced the incidence of community-acquired pneumonias among children under 2 years of age and has led to absence of multiple sites of pneumococcal infection in children’s organizations. It also has reduced the number of hospitalized children and achieved zero mortality due to pneumonias in infants by the third year of this immunization strategy implementation. The obtained results were achieved mainly due to circulation of 7 pneumococcal serotypes (6A, 6B, 9V, 14, 19A, 19F, 23F) in children under 5 years of age. The threshold level of vaccination against pneumococcal infection advancing morbidity and mortality due to pneumonias in children was specified. The strategy of mass vaccination of infants was cost-effective. Conclusion. The new data on epidemiological and cost efficacy of various immunization strategies against pneumococcal infection in children was obtained.
The aim. The article highlights the current state of the problem of mumps in the world and the Russian Federation.Materials and methods. The materials of the study were electronic resources WHO infection control, Cohrane, Elsevier, ScienceDirect, CDC infection diseases database, PubMed, eLibrary, CyberLeninka. The research methods were the analysis and generalization of scientific literature. The assessment is presented by the immunological structure of the population in different age groups to mumps (n = 593) in the study area (2018) according to the data of the Center for Hygiene and Epidemiology in the Perm Territory.Results. The spread of mumps is found to be widespread and uneven in different regions of the world in the form of sporadic cases and large epidemic outbreaks, despite the world practice of vaccine prevention of mumps. Analysis of the immunological structure to mumps in different age groups revealed a fairly high number of seronegative individuals (the largest number was found among adults aged 20–39 years) in the study area (2018). A decrease in the tension of post-vaccination immunity is the main cause for the emergence of an outbreak among the adult population, in addition to vaccination failures among vaccinated children. The immune defenses created by the vaccine strain do not have the same intensity and duration as with natural infection, and some genotypes of “wild” variants of the mumps virus can break through the immune barrier and cause disease. Antigenic differences between vaccine and circulating strains, low inoculation dose can weaken immunity and reduce the effectiveness of mass vaccine prevention.Conclusion. Ways of solving the problem were proposed to forestall an unfavorable epidemic situation with mumps.
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