[Surgical treatment of rare combination of intestinal malrotation with secondary lymphangiectasia].

The rare combination of intestinal lymphangiectasia with malrotation of the duodenum in a child of three months of life is described. Basing on the literature review only 3 similar cases were described in the world practice. The boy with protein-losing enteropathy was examined at Moscow Scientific Centre of Children's Health. The child had vomiting, diarrhea, loss in body weight, hypoproteinemia, lymphopenia. The infectious nature of the disease was excluded. It had been suggested the Waldman desease (primary intestinal lymphangiectasia). The prognosis for such disease is unfavorable. An examination of the child was continued against the backdrop of ongoing symptomatic therapy. Complete physical examination included monitoring laboratory blood tests, X-ray examination with contrast, CT-scan, gastroduodenoscopy with biopsy of the mucosa of the small intestine. Malrotation duodenum with the recurrent mid-gut volvulus with the development of secondary intestinal lymphangiectasia was diagnosed. Modern methods of examination and multidisciplinary approach made it possible to diagnose the case. Operation to eliminate fixation duodenum resulted in the recovery of the patient. At the present time the child grows and develops according to age and does not require treatment. The prognosis for this disease is regarded as favorable.

[Advances and challenges in immunoprophylaxis].

A significant progress in the management of controllable infections achieved by the early XXI century made it possible eliminate poliomyelitis across the nation, and practically eliminate measeles by vaccinating 96-99% of the children without raising the complication rate. The list of counterindications was shortened significantly, the Calendar of immunoprophylaxis was supplemented by inoculations against hepatitis B, rubella, flu, and type b Haemophilis influenzae infections. Morbidity of controllable infections in Russia decreased substantially compared with that in the 1990s. Nevertheless, the public health services are faced with the necessity of speedy application of new vaccines (including combined ones) allowing the inoculation impact on the child to be reduced. A rationale for the use of vaccines against pneumococcal and meningococcal infections, hepatitis A, varicella and for scaling up anti-pertussis vaccination coverage is proposed. Equally important is more extensive vaccination against papillomavirus infection as a means of cervical cancer prevention and introduction of the rotavirus vaccine to control most viral diarrheas.

[Perspectives of development of immunoprophylaxis in Russia].

Analytic materials on prevention of controlled infections in Russia and perspectives for extension of immunoprophylaxis field are presented. It was determined that immunization against pertussis should be expanded. Necessity to include vaccines against hepatitis A, Hib, pneumococcal infection, varicella as well as rotavirus and human papillomavirus infection in National immunization schedule is substantiated. It was noted that introduction of new vaccines will require both increase of funding for immunization and switch on use of combination vaccines containing 4 - 6 components.

[Pneumococcal infection is a vaccine-preventable disease now].

Analysis of pneumococcal disease burden in Russia, which is a serious threat to children's and adults' health and which was underrecognized until last decade, is presented. Extrapolating data about etiologic structure of pneumonia and meningitis on published incidence figures, we can estimate the incidence of pneumococcal pneumonia in children in Russia: 490 per 100,000 for children aged 1 month - 15 years, and 1060 per 100,000 for children aged 1 month - 4 years. For complicated forms, these figures are 90 and 181 per 100,000 respectively. Mean incidence of pneumococcal meningitis is 8 per 100,000 children aged < 5 years with variations from 2 to 15 depending from region. Estimated overall incidence of pneumococcal bacteremia in children < 5 years in Russia is 100 per 100,000. Despite of antibacterial therapy, bacteremic forms of pneumococcal infection lead to death in 15 - 20% of adult patients, whereas in elderly this figure amounts 40%. These data demonstrate the importance of wider use of both polysaccharide and conjugated pneumococcal vaccines licensed in Russia.

[Current problems of immunoprophylaxis of infectious and non-infectious diseases].

Progress in immunology greatly contributed to the understanding of mechanisms of infectious immunity and vaccine action. Moreover, it facilitated the development of new vaccines and vaccination not only of healthy children but also of subjects with health problems and chronic diseases including the use of several vaccines. The number of contraindications could be decreased without a rise in the frequency of post-vaccination complications. Immunoprophylaxis allowed the incidence of controllable infections to be reduced; the level of epidemiologic well-being achieved in the course of this work provided a basis for eradication of some diseases. At the same time, successes of vaccination made mankind dependent on the use of vaccines. As a result, discontinuation of mass vaccination and even temporal decrease of its scale in the absence of certain infections or in the situation of their sporadic occurrence (i.e. the lack of natural immunization) lead to their reappearance. Specific features of modern immunoprophylaxis of infectious and non-infectious pathology and its timetable are described.

[Results of Russian multicenter trial of immunogenicity, reactogenicity and safety of new combination vaccine against hepatitis A and B (Twinrix)].

Results of registration trial of combination vaccine for prevention of hepatitis A and B are presented. The trial was conducted in 5 centers of Russia in 2004-2005 with full accordance to good clinical practice requirements and standards for multicenter open randomized trials. Immunogenicity of studied combination vaccine Twinrix was evaluated in comparison with two simultaneously administered monovalent vaccines against hepatitis A and B (Havrix and Engerix-B) in 200 healthy subjects aged 18-40, which were seronegative to hepatitis A and B. Reactogenicity based on interviewed and non-interviewed symptoms ranged on intensity was assessed also. 1 month after completion of primary vaccination all subjects in both groups were seropositive to hepatitis A. Sero-protection level of antibodies to hepatitis B virus was detected in 98.9% of participants vaccinated with Twinrix and in 95.6% of participants vaccinated with Engerix-B and Havrix. Overall, reactogenicity of vaccines was minor, marked adverse events caused by vaccination were rare (approximately 1%). Study shows that combination vaccine against hepatitis A and B (Twinrix) at least non inferior in terms of immunogenicity, safety and tolerability to monovalent vaccines (Havrix and Engerix-B), were registered in Russia.

[International clinical trials of vaccines].

Modern principles of organization and planning of international clinical trials of vaccines and stages of development of domestic vaccines are presented. Factors that determine the success of large-scale clinical trials are thoroughly described. Differences between domestic registration trials and international multicenter randomized clinical trials are discussed. It has been recommended how national regulatory acts that legitimate conducting of clinical trials of both national and foreign vaccines should be harmonized.

[Antibiotics in bacterial acute respiratory tract infection in children]. / Antibiotiki pri bakterial'nykh ORZ u detei.

The data on changes in the susceptibility of the most frequent respiratory tract pathogens i.e. Pneumococcus spp. and Haemophilus influenzae within the last 15 years and Streptococcus spp., Staphylococcus spp. and Moraxella spp. at the present time as well as recommendations based on the original and some literature data on the choice of the antibacterial drugs for the initial treatment of bacterial complications of acute respiratory tract viral infections such as otitis, sinusitis and pharyngitis are presented. The necessity of decreasing the unjustified use of antibiotics in cases of uncomplicated acute respiratory tract viral infections is indicated.

[Etiology and treatment of pneumonia in children]. / Etiologiia i lechenie pnevmonii u detei.

The most widespread pathogens of pneumonia in children i.e. Streptococcus pneumoniae and Haemophilus influenzae and their antibiotic susceptibility are described. The ways of selecting starting antibacterial drugs for the treatment of community-acquired and hospital pneumonia are recommended proceeding from the original findings and some literature data. Oral drugs for the treatment of uncomplicated pneumonia are shown to be preferential. In the treatment of nosocomial or hospital pneumonia the starting regimen should allow for the previous antibacterial therapy.

[Use of oral macrolide and azalide antibiotics in children with bronchopulmonary diseases]. / Primenenie peroral'nykh makrolidnykh i azalidnykh antibiotikov pri bronkholegochnoi patologii u detei.

The therapeutic efficacy of oral macrolides (erythromycin base and midekamycin, macropen) and azalides (azithromycin, sumamed) in the treatment of children with acute and chronic (during the aggravation) bronchopulmonary diseases was studied. The main etiological factors of acute and chronic pneumonia were Streptococcus pneumoniae and Haemophilus influenzae. The proportion of Staphylococcus aureus was high in infants with acute pleuropulmonary inflammations. The susceptibility of the isolates to the antibiotics was found to be high. The results of the trials showed that erythromycin, macropen and azithromycin were efficient in the treatment of acute and chronic pneumonia. The foci of acute pneumonia dissolved after oral administration of the drugs within the same periods as after the use of other parenteral antibiotics. The comparative estimation of the drug efficacy revealed that azithromycin was more active. The ease of the azithromycin administration (in the form of a suspension) in infants and children once a day for a shorter treatment course up to 5 days, high efficacy and no adverse reactions permitted to consider the antibiotic as the most promising antibacterial agent for the treatment of respiratory infections in children in hospitals and outpatient departments.

[The periodic and regional characteristics of the pneumococcal serotype spectrum in children with respiratory diseases and in healthy carriers]. / Peridodicheskie i regional'nye osobennosti serotipovogo spektra pnevmokokkov u detei s respiratornymi zabolevaniiami i zdorovykh nositelei.

The aim of the work was the comparative study Streptococcus pneumoniae serotypes, isolated from healthy carriers and acute pneumonia patients in different regions of the CIS; in Moscow observations were carried out for 10 years. Specific antibodies to different S.pneumoniae capsular polysaccharide antigens were determined in blood serum samples by the method of heterogeneous enzyme immunoassay. The study revealed that S.pneumoniae serotype spectra in healthy children and in children with acute respiratory viral diseases were similar, while from pneumonia patients with complications of pleuritis caused by S.pneumoniae serotypes 1, 3, 5 and 14, were more frequently isolated. During 10 years of observations changes in the occurrence of individual serotypes were noted both in carriers and in patients. Differences in the serotype spectra of S.pneumoniae isolated in different regions were established. S.pneumoniae serotype 5 caused 70% of pleuritis cases in Tashkent, while rarely occurring in regions with the moderate climate. S.pneumoniae serotype 14, formerly causing complicated forms of pneumonia, lately became more widespread, but at the same time caused fewer cases of pneumonia with complications. High occurrence of pneumonia among children aged 1-3 years correlated with a low level of specific antibodies in the child population.

[Use of oral antibacterial drugs in the treatment of acute pneumonia in children]. / Ob ispol'zovanii oral'nykh antibakterial'nykh sredstv v lechenii ostrykh pnevmonii u detei.

The efficacy of oral antimicrobial agents was studied under conditions of monitored clinical trials. Overall 279 children with different clinical forms of acute pneumonia were entered into the study. It has been shown that the treatment of uncomplicated acute pneumonias may be started since the day of admission to the hospital. The total efficacy of oral drugs was 75%. This does not differ essentially from the efficacy of antibiotics administered parenterally (89%). It has been established that early change (on days 1-3 since the effective treatment) from parenteral to oral administration of antibiotics does not reduce the treatment efficacy but noticeably lowers the injection load of the patients. The side effects (dyspeptic disorders) that occur very frequently during erythromycin treatment suggest that this antibiotic should not be administered to infants.

[Streptococcus pneumoniae serotypes in children with acute pneumonia and pleurisy]. / Serotipy Streptococcus pneumoniae u detei, bol'nykh ostroi pnevmoniei i plevritom.

The study of pneumococci of different serotypes, isolated from patients with acute pneumonia and pleuritis and from healthy children was carried out. Among the pneumococcal serotypes causing pneumonia and pleuritis in children serotypes 1, 6, 19, 14 and 3 were most widely spread and constituted 62.3% of all isolated pneumococci. In young children cases of acute pneumonia and pleuritis were more often induced by serotypes 6 and 14 and in older children, by serotypes 1 and 3. In patients with uncomplicated pneumonia and pleuritis differences in the detected serotypes of pneumococci were observed, and the disease course differed in severity. Serotypes 14, 3 and 3 induced destructive processes in the lungs more often than other serotypes. Monitoring of the sensitivity of pneumococci to antibiotics showed that most of the strains retained high sensitivity to penicillin and ampicillin. In most cases the detected resistant pneumococcal strains belonged to serogroup 19.