The Ministry of Health of the Russian Federation jointly with professional association and experts in the field of pediatrics, infectious diseases and resuscitation has revised guidelines “Clinical Features and Management of the Disease Caused by New Coronaviral Infection (COVID-19) in Children” in order to provide the child population with effective medical care during the pandemic of the new coronaviral infection. The practical experience of specialists from various countries was considered during the development of this document. Special attention should be given to the evidence base of the presented data, as well as to the efficiency and safety issues of medications used in treatment of coronaviral infection and its complications. The authors highlight the problems of prevention, diagnostics and management of pathological conditions caused by COVID-19 in the article according to the presented guidelines. Patient’s management is presented depending on the age and severity of the disease itself. The therapy is considered with regard to etiological, pathogenetic and symptom focus.
Objective. To evaluate the significance of therapeutic drug monitoring of adalimumab (ADA) concentration levels and antibodies to it in inflammatory bowel disease (IBD) in children. Patients and methods. In this study, 103 children with IBD (24 patients with ulcerative colitis (UC) and 79 with Crohn’s disease (CD)) aged 3–18 years were examined during maintenance therapy with ADA (100 mg/mL in 0.4 mL). Body weight, duration of disease and therapy, use of azathioprine (AZA), achievement of clinical and endoscopic remission, albumin levels, residual levels of ADA and antibodies to the drug, circulating cytokine levels in serum were assessed. Results. A significant decrease in ADA levels in children in the absence of clinical remission in CD (5.21 [3.32; 7.43] μg/mL in remission) and in UC (2.42 [0.42; 4.51] μg/mL, p = 0.001) was shown. A high-quality separation model for residual ADA levels for exacerbation/remission conditions for clinical and endoscopic activity for children with CD and UC was obtained through ROC-analysis. The minimum residual ADA levels for maintaining clinical remission in children with CD were 8.1 μg/mL and 10.5 μg/mL for mucosal healing. In children with UC, as well as in children weighing <40 kg, these levels were higher. The formation of antibodies to ADA was minimal; combination therapy with AZA showed no efficacy. Key cytokines correlating with ADA concentration were interleukins IL-6, -13, -31, -27, -9, and tumor necrosis factor-α. Conclusion. To improve the efficacy of ADA therapy in children with IBD, therapeutic drug monitoring should be performed, considering the nosology and body weight of the child, as well as the goal of therapy (clinical and endoscopic remission). Key words: inflammatory bowel disease, Crohn’s disease, ulcerative colitis, adalimumab, therapeutic drug monitoring, tumor necrosis factor-α, cytokine profile, azathioprine
In surgical patients sepsis develops on background of oxidative stress. Significant reduction of SH-groups in proteins by the moment of sepsis diagnosis is an unfavorable factor for outcome. The degree of multiple organ failure in patients with abdominal sepsis correlates with oxidative injury of proteinic structures.
Aim: to establish the patterns of changes in leukocyte blood parameters to determine their diagnostic significance in the different activity of Crohn’s disease (CD) and ulcerative colitis (UC) in children. Materials and methods. 370 5-18-year children (198 boys, 172 girls) with inflammatory bowel disease (IBD) were examined. Leukocytic blood parameters, concentrations of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), faecal calprotectin (FC) levels were determined. Changes in clinical activity in Crohn’s disease (CD) and ulcerative colitis (UC) cases were determined using pediatric activity indices: PCDAI and PUCAI, respectively. Analysis of endoscopic activity in 160 CD and UC patients was determined using the scales: SES-CD and UCEIS, respectively. Results. It was found that with an increase in the clinical activity of CD in children, the absolute numbers of leukocytes, lymphocytes and monocytes did not change significantly. In contrast, a significant increase in neutrophil reactivity was noted. In patients with high endoscopic CD activity an increase in the absolute number of monocytes and neutrophil reactivity was found. In patients with high clinical activity of UC, an increase in the number of leukocytes and the absolute number of neutrophils was found. At the same time, the granularity and reactivity of neutrophils increased from remission to moderate and high clinical activity of UC. In children with high endoscopic UC activity, the number of leukocytes, the absolute number of neutrophils and monocytes increased. At the same time, the granularity of neutrophils significantly increased as the endoscopic activity of UC increased from remission to moderate activity. Leukocyte parameters in UC patients correlated moderately with FC level, and the absolute number of neutrophils was closely related to its content. The granularity and reactivity of neutrophils positively correlated with ESR and CRP levels in children with CD and CRP concentrations in children with UC. Conclusion. The established patterns of changes in the quantitative composition of leukocytes and their functional properties (reactivity and granularity) are directly determined by the different activity of IBD in children and have diagnostic value
С позиций хорош ей лабораторной практики и на основании собственного опыта авторы сформулировали некоторые требования к лабораторной информационной системе (ЛИС). Приведено несколько рекомендаций по выбору и сопровождению ЛИС.
Prolactin exists in various forms including the monomeric biologically active form (23kDa) and a higher molecular weight form, bound most commonly to IgG, known as macroprolactin (>100kDa). Macroprolactin lacks biological activity and is one of the causes of false-positive results. In Russian Federation the most common method for macroprolactin determination is PEG precipitation test. We had conducted a retrospective analysis of 37 samples of patients with hyperprolactinemia (3 of them were males). The mean age was 30 [25;35] years. Prolactin level was measured by the immunoenzyme method with manual PEG precipitation and TRACE. The mean values found by the immunoenzyme method with manual PEG precipitation were 461,6 [375,0;821,2] mU/l, by TRACE - 449,9 [357,2;749,2] mU/l. The number of patients with normal prolactin levels was 30% (11) confirmed by two methods, high prolactin level at 46% (17). The prevalence of clinical symptoms of hyperprolactinemia was not differ depend the groups. The phenomenon of macroprolactinemia was registered in 32% (12) of patients. In 8 persons of this group normal prolactin level was revealed and in 4 patients hyperprolactinemia was found by TRACE. Measurements of prolactin levels by the TRACE method is useful for correct diagnosis in patients with equivocal results received by traditional method with PEG precipitation.
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