Kondratyeva et al. Exogenous Factors in Vitamin D Results: We found that the blood level of 25(OH)D depended on the geographical location and the number of sunny days per year. The average blood level of 25(OH)D in adolescent boys was statistically significantly lower than in girls of this age group. The level of 25(OH)D also significantly depended on the prophylactic dose of cholecalciferol administered to the subjects. In the study, it was shown that a dose of cholecalciferol ≥1,000 IU per day can achieve a normal level of 25(OH)D in healthy children. We found no statistically significant association between single-nucleotide polymorphic variants of cytochrome P450 genes (CYP2C9 * 3, CYP3A4 * 3, CYP2C9 * 2, CYP2D6 * 4, and CYP3A4 * 1B) and blood level of 25(OH)D in the subjects. We also did not find a relationship between the TaqI, FokI, and BsmI polymorphisms of the VDR gene and serum 25(OH)D concentration. Conclusion: Exogenous factors (time of year, place of residence, and prophylactic administration of cholecalciferol), as well as endogenous factors (age and sex), play a determining role in the development of vitamin D deficiency and insufficiency; in contrast to genetic factors-polymorphic variants of the genes of xenobiotic phase 1 enzymes (CYP2C9, CYP2C19, CYP2D6, and CYP3A4) and the VDR gene-which do not play such role. This study shows the need to create a diagnostic algorithm for Vitamin D deficiency based on the age, season of the year, and prophylactic dose of cholecalciferol.
По определению Глобальной инициативы по бронхиальной астме, Глобальной стратегии лечения и профилактики бронхиальной астмы, главной задачей лечения бронхиальной астмы является достижение и поддержание контроля над симптомами болезни, улучшение качества жизни и снижение рисков в будущем. Несоблюдение врачебных назначений влечет за собой увеличение количества обострений, повышает потребность в госпитализации, снижает качество жизни и увеличивает затраты на лечение. Несмотря на достигнутые успехи в терапии бронхиальной астмы у детей, создание новых ингаляционных устройств с минимальными трудностями в использовании, растет число пациентов, по тем или иным причинам не выполняющих лечебные рекомендации. В данной статье отражены основные причины низкой приверженности больных с бронхиальной астмой, отмечена роль родителей в лечебном процессе, рассмотрены факторы (лекарственный и нелекарственный), приводящие к снижению уровня контроля над заболеванием, обозначены пути устранения низкой приверженности.
Генетическому разнообразию больных муковисцидозом (МВ) в России посвящены единичные работы на ограниченной выборке боль ных. Цель. Выявление особенностей генетического профиля больных МВ в России по данным Национального регистра (2014). Мате риалы и методы. Данные пациентов с МВ (n = 2 131) из 74 регионов России, включенные в Национальный регистр больных МВ (2014).
1 ФГБОУ ВО «Красноярский государственный медицинский университет имени профессора В. Ф. Войно-Ясенецкого» Минздрава России, Красноярск, Россия 2 КГБУЗ «Красноярская межрайонная детская больница №4», Красноярск, Россия 3 КГБУЗ «Красноярская межрайонная детская клиническая больница №1», Красноярск, Россия Цель: выявление этиологической роли, исследования серотипового пейзажа и определения преобладающих генотипов (сиквенс-типов) Streptococcus pneumoniae у 459 детей, госпитализированных по поводу острого гнойного среднего отита, острого тонзиллита, внебольничной пневмонии, гнойного бактериального менингита. Материалы и методы: Использовался культуральный (бактериологический) метод, молекулярные методы (ПЦР, секвенирование). Статистическая обработка проводилась с помощью программ Microsoft Excel 2007 и Statistica 6.0. Результаты: S. pneumoniae был выявлен в 16,8% случаев. Преобладали серотипы 19F (39,7%) и 19A (13,2%), относящиеся к мультирезистентному клональному комплексу 320. С меньшей частотой (8,82%) встречались пневмококки 6 серогруппы (6АВ)представители клонального комплекса 315, характеризующиеся устойчивостью к макролидам, клиндамицину и тетрациклину. Соответствие выявленных серотипов антигенному составу пневмококковых вакцин составило от 70,6% до 88,2%. Ключевые слова: Streptococcus pneumoniae, пневмококк, этиологическая роль, серотипы у детей, сиквенс-типы, резистентностьObjective: To study the etiological role, serotype distribution and prevalent Streptococcus pneumoniae genotypes (sequence types) in 459 children hospitalized with acute purulent otitis media, acute tonsillitis, community-acquired pneumonia, and purulent bacterial meningitis. Pneumococcal cultures isolated from patients were tested for sensitivity to antimicrobials, and presence of resistance genes. Materials and Methods: The cultural and molecular methods (PCR, sequencing) were used. Statistical analysis was carried out using Microsoft Excel 2007 and Statistica 6.0. Results: S. pneumoniae was detected in 16,8%. The prevalent serotypes were 19F (39.7%) and 19A (13.2%) -representatives of multidrug-resistant clonal complex 320. Isolates of serogroup 6 (6AB, 8.82%) belonged to clonal complex 315, and characterized by resistance to macrolides, clindamycin and tetracycline. From 70.6% to 88.2% of S. pneumoniae serotypes isolated from patients corresponded to «vaccine»-types.
Objective. To study the features of liver cirrhosis (LC) in patients with cystic fibrosis (CF) and the course of the disease after liver transplantation according to the 2019 registry. Materials and methods. We analyzed the data of 3111 patients with recorded data on the state of the liver in the register of 2019 in age groups: children under 18, children from 9 to 18, adults. LC was diagnosed in 190 patients, including 121 (63.7%) with LC with portal hypertension. LC was more often recorded in the male group – 62.4% (p = 0.015). The age at diagnosis in the group of children with LC was higher – 0.7 (2.5) years, than in the group without liver damage – 0.2 (0.8) years (p = 0.01). "Severe" mutations were characteristic of patients with LC and hypertension in all age groups. The body mass index of children (aged 2–18 years) in the group with LC with hypertension was Me = 21.5 (42.3), and in the group without liver damage Me = 29.8 (49.3), p = 0.008. Chronic colonization of the respiratory tract by Pseudomonas aeruginosa in the group of patients with LC and hypertension was more common than in children without liver damage (46.2% versus 24.4%, p < 0.001). By 2019, 12 patients have received liver transplantation. After liver transplantation, in the first three years, there is an increase in function of external respiration and nutritional status of patients. Conclusion. LP with portal hypertension is more common in children aged 9–18 years, patients are characterized by a predominance of males, "severe genotypes", low indices of physical development, a high frequency of pathogenic microbial agents of the respiratory tract and complications, which leads to a significant reduction in life. Key words: genotype, cystic fibrosis, nutritional status, portal hypertension, liver transplantation, lung function, cirrhosis
The aim of the program was to study the tolerability of Tigerase® in patients with cystic fibrosis (CF) of all ages in rutine clinical practice. Study design: retrospective open uncontrolled comparative multicenter solid. Materials and methods of research: retrospective data of clinical observations were collected from medical records of patients with CF on the use of Tigerase®. Results: therapy with Tigerase® was well tolerated by 668 (93,4%) of 715 patients included in the study. In 47 (6,6%) patients, 127 adverse reactions (ADRs) associated with the use of Tigerase® were recorded. ADRs from the respiratory system were the most common. Of these, 24 (3,4%) were coughing and 10 (1,4%) had increased viscosity of bronchial secretion. Among all patients included in the study, the proportion of patients in whom ADRs were registered based on clinical manifestations (3,9%) did not differ statistically significantly from the proportion of patients in whom ADRs were recorded based on complaints only (2,8%) (p=0,30). The distribution of ADRs by the source of registration and place of residence of patients did not depend on their gender and age. Registration of ADRs in different regions of the country differed statistically significantly both in frequency and in the source of detection (p<0,001). ADRs were not recorded in several regions, and the largest number of ADRs were registered in patients living in Moscow, and most of them were based only on patient complaints. 22 patients (47% of the number of patients with ADR) had medical commissions for ADR, and only in 8 (17% of the number of patients with ADR) of them had expertise of specialists with experience in the treatment of patients with CF. In 29 patients (62% of the number of patients with ADR), the development of ADR did not require cessation of the Tigerase® therapy. Conclusion: in the majority of CF patients (93,4%) tolerated the Tigerase® therapy well.
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