|
.................................... Search the net .................................... |
|
Paediatric pulmonology and allergology
|
|
|
|
Vytautas Usonis, Bronius Morkunas, Nerija Kupreviciene, Dalia Rokaite, Vytautas Bakasenas. National programme of immunisation in Lithuania and its implementation Giedra Leviniene, Jolanta Kudzyte, Apolinaras Zaborskis, Ruta Liesiene. Results of breastfeeding promotion programme in Lithuania Arunas Valiulis, Iveta Skurvydiene, Violeta Radziuniene, Migle Klimantaviciene, Jurga Reimeriene. ETAC study: is it real way to prevent bronchial asthma? Linas Sumskas. Behavioural rist factors in school-aged children and socio-economic status of their families Apolinaras Zaborskis, Joana Makari. The effects of the school and family environments on the students' health Petras Kaltenis. Primary and secondary prophylaxis of urinary tract infection in children Birute Skerliene. Reye syndrome imitated by inherited fatty acid oxidation disorders Jovile Vingraite. Prevention of iron deficiency anaemia in infant and small child Elena Suciliene, Danute Jadzeviciene, Arunas Valiulis. BCG: history, present time and perspectives Aldona Rainyte. Immunostimulators in pediatric practice S.Milciuviene, V.Vaitkevicius, E.Slabsinskiene. Baby bottle caries Migle Klimantaviciene, Jonas Sadauskas, Arunas Valiulis. Use of anticholinergic bronchodilation in children Birute Cijunskiene. Analysis of injuries and accidents among infants and children resulted in death in Klaipeda district in 1994-1999 Ramune Mykolaitiene, Aldona Rainyte, Petras Stakenas. Oral therapy with clarithromycin in children with community acquired Mycoplasma pneumonia Vaidotas Urbonas. Current standpoint to the nutrition of the child Kamelija Kadziauskiene, Roma Bartkeviciute, Algimantas Vingras, Rimas Stukas. Recommended daily nutrient and energy standards for infants and children Jolanta Kudzyte, Ilona Gluosniene, Jurgis Bojarskas. Adverse reactions to food Ruta Usinskiene. Prevention of genetic diseases Abstracts of the Annual Meeting of Lithunian Paediatric Society "Prophylactic Paediatrics" National guidelines of allergic rhinitis Paediatric pumonologist: orders, duties, compentce and responsibilities |
|
National Programme Of Immunisation In Lithuania And Its Implementation
Vytautas Usonis, Bronius Morkunas, Nerija Kupreviciene, Dalia Rokaite, Vytautas Bakasenas
Wide-scale immunisation programmes are among the main measures for prevention of infectious diseases in society. The first National Immunisation Programme of Lithuania was launched in 1992 following the recommendations of the World Health Organisation (WHO). Presently the Programme for the year 1998-2005 has been approved. The principle of the National Immunisation Programme of Lithuania and the main institutions involved in the realisation of this programme are reviewed in the given paper. Lithuania has a high coverage rate of immunisation with the main WHO recommended vaccines. In 1999 the coverage rate for immunisation against tuberculosis (BCG) was 99.3 perc., hepatitis-B - 95.6 perc., diphtheria and tetanus - 93.1 perc., pertussis 93.0 perc., polio - 96.9 perc., measles - 96.9 perc., mumps - 96.9 perc., rubella - 96.8 perc. High immunisation coverage rate results in the effective control of vaccine preventable diseases, however the incidence of tuberculosis, mumps and rubella is still high. Immunisation of teenagers with hepatitis-B vaccine and the introduction of infants immunisation with the Hemofilus influenzae-B vaccine are the next goals in the expansion of the Programme on Immunisation in Lithuania.
|
|
Results of Breastfeeding Promotion Programme in Lithuania
Giedra Leviniene, Jolanta Kudzyte, Apolinaras Zabroskis, Ruta Liesiene
In order to obtain data about prevalence and duration of breastfeeding and to evaluate process of breastfeeding promotion programme questionnaire-based random survey was carried out in 1994 and 1999 in Kaunas city and 5 rural areas of Lithuania. The prevalence and duration of breastfeeding 5 years later were higher. Medical personnel was not active in promoting and protecting breastfeeding.
|
|
ETAC study: Is it real way to prevent bronchial asthma?
Arunas Valiulis, Iveta Skurvydiene, Violeta Radziuniene, Migle Klimantaviciene, Jurga Reimeriene
During the last three decades the prevalence of atopic dermatitis, asthma and hay fever in many countries has been increase. These chronic diseases result in important direct medical costs, indirect disability costs and impaired quality of life for millions of affected persons. Childhood asthma is increasing in both prevalence and morbidity. Consequently, the possibility that early pharmacological treatment of high risk infants could break the well-documented progression from atopic dermatitis to asthma (or at least reduce the severity of the symptoms if the disease does develop) very much deserves the spotlight. Over two years period, 817 infants aged one to two years who suffered from atopic dermatitis and with a history of atopic disease in a parent or sibling were included in the ETAC® (Early treatment of the Atopic Child) trial, a multi-country, double-blind, randomized, placebo-controlled trial. The infants were treated for 18 months with either cetirizine (0.25 mg/kg b.i.d.) or placebo. In the placebo group, the relative risk (RR) for the developing asthma was elevated in patients with a raised level of total IgE (>30kU/L) or specific IgE (>0.35 kea/L) for grass pollen, house dust mite or cat dander (RR=0.6). There were no clinically relevant differences between the cetirizine and placebo groups for neurologic or cardiovascular symptoms or events, growth, behavioral or developmental assessments, laboratory test results, or electrocardiograms, and no child receiving cetirizine therapy had prolongation of the QT interval. The safety of cetirizine has been confirmed in study, the largest the longest safety investigation of any H1-antagonists ever conducted in children
|
|
Behavioural risk factors in school-aged children and socio-economic status of their families
Linas Sumskas
The aim of this investigation was to study trends of behavioural risk factors for chronic diseases as well as relationship between health behaviour of school-aged children and socio-economic status of their families in Lithuania in period of 1994-1998. Data from 2 cross-sectional questionnaire surveys (1994 and 1998) were used to analyse health behaviour inequalities in school-aged children. According to the international protocol of WHO Cross-National Survey Health Behaviour Study in School-aged Children (HBSC) the data on representative samples of 5428 and 4513 students aged 11, 13 and 15 years old were collected. The prevalence of smoking increased significantly in boys (from 11.3% to 19.8%) and in girls (from 3.6% to 8.5%) in the period between two surveys. Consumption of alcohol has not changed significantly (9.4% to 10.0% in boys, 4.2% to 5.2% in girls). Prevalence of low physical activity decreased significantly only in boys (form 42.1% to 37.8%). Socio-economic differences were observed between low and high socio-economic groups. Risk fro smoking, regular use of alcohol was increased in the higher socio-economic group. However, risk for low physical activity was significantly higher (odds ratios were calculated) in the lower socio-economic groups both for boys and girls. No evidence of change of health inequalities mentioned above was observed between surveys of 1994 and 1998. |
|
The effects of the school and family environments on the students' health
Apolinaras Zaborskis, Joana Makari
The goal of the study was to evaluate the effects of school and the family on the students' health. The data from a 1998 WHO cross-national survey on Health Behaviour in School-Aged Children those included 4513 children (11, 13 and 15 years old) were used. These results showed that girls felt better than boys at school, however they admitted to feeling ill and unhappy much more often than boys did. The students feeling of well being in school was directly related to the level of achievement and to the degree of how happy and healthy they felt. The degree of help the parents offered their child and the degree of interest they showed in their child's schoolwork positively influenced the child's feeling of well being. By demanding too much from their children parents influenced negatively their children's feeling of happiness and healthiness. |
|
Primary and secondary prophylaxis of urinary tract infection in children
Petras Kaltenis
Prophylactic measures depend on etiology and risk factors of urinary tract infection. Among means of primary prophylaxis, breastfeeding, hygiene of external genitalia and regulation of intestinal functions have to be mentioned. The main method of secondary prophylaxis is long-term use of antimicrobial agents in low doses. Nitrofurans, trimethoprim or its combination with sulfamethoxazole are most commonly used antimicrobials for long-term prophylaxis. Vaccines are being developed as well, however, they seen to be not yet sufficiently effective.
|
|
Reye syndrome imitated by inherited fatty acid oxidation disorders
Birute Skerliene
The new group of inherited metabolic disorders - fatty acid oxidation defects - is presented. In may instances the acute decommpensation associated with these defects is attributed to intercurrent infections or fasting and has Reye-like clinical and laboratory presentations: drowsiness, coma, hepatopathy, elevated activity of transaminases, hypoglycemia, hyperammonemia, fatty infiltration of the inner organs. These defects are associated with high mortality and morbidity rates, therefore the early diagnosis is necessary. Initial urine and blood specimens which were obtained before glucose therapy in the emergency department and showed hypoketotic hypoketotic hypoglycemia must be saved for the organic acid and carnitine analysis. Evidence of myopathy or cardiomyopathy either of acute onset or of more chronic nature should lead to assessment of carnitine, also. A correct diagnosis can lead to appropriate early interventions and avoid recurrences. The firs cases of this disease are diagnosed in Lithuania recently.
|
|
Prevention of iron deficiency anaemia in infant and small child
Jovile Vingraite
Prevention of iron deficiency anaemia is important because of its short and long term effects. The most important negative effects on infants and small children are impaired growth, cognitive and motor development, and impaired cellular immune function. The principles for prevention of iron deficiency anaemia in this age group are: assurance of sufficient iron stores in newborns (prevention of maternal anaemia, prematurity); promotion of breast-feeding: timely started complementary feeding (around 6 months of age); food rich in enhancers of iron absorption (meat factor, vit. C and other acids); restriction of foods rich in inhibitors of iron absorption (fitates, polyphenols, oxalic acid and others); avoidance of cow's milk during infancy, later limit its amount up to 500 ml per day; sufficient amount of vit. A in food. Also negative effects of iron overload, diagnostic criteria of iron deficiency anaemia for this age group are discussed.
|
|
BCG: history, the present time and perspective
Elena Suciliene, Danute Jadzeviciene, Arunas Valiulis
The tuberculosis incidence is a problem both in low-income and industrial countries. The only BCG as antituberculosis vaccine is used for tuberculosis prevention from 1921 till now. The history of development of BCG, which is named after it's authors French scientists Albert Calmette and Camille Guerin, is interesting and moral. The efficacy of BCG varies between different authors, but the prevention against childhood tuberculosis and tuberculosis meningitis is the best. The spreading of HIV and drug resistant tuberculosis needs the creation of new antituberculosis vaccines. There are hypothesis that BCG can protect against other infections and allergy. It is successfully used for the treatment of tumours.
|
|
Immunostimulators in pediatric practice
Aldona Rainyte
The article presents short historical data on natural immunostimulators, which were used in ancient medicine and artificial ones, which we are using now. In addition we report on basic immunostimulators that were in use earlier and nowadays in Lithuania, including data about theirs activity, indication for use and duration of treatment.
|
|
Baby bottle caries
Simona Milciuviene, Vilija Vaitkeviciene, Egle Slabsinskiene
Total number of 260 aged 3 years children were examined in Kaunas and Siauliai. Findings of the present study showed that prevalence of dental caries was 42.3 perc. in Kaunas and 29.6 perc. (P<0.02) in Siauliai, dmf was 1.67±0.22 in children of Kaunas. Respectively dfs was 2.14±0.4 in Kaunas and 0.82±0.11 in Siauliai. Oral hygiene is better among children in Siauliai. In this city PLI (oral hygiene index) was 1.23±0.32 compare to PLI 1.84±0.32 in the group of children from Kaunas. Baby bottle caries was found in 6 perc. of all examined children.
|
|
Anticholinergic bronchodilation in pediatrics
Migle Klimantaviciene, Jonas Sadauskas, Arunas Valiulis
Ipratropium bromide is one of the most important drugs for the treatment of chronic obstructive lung diseases and may be successfully applied in some cases in childhood. Ipratropium bromide is qatered ammonium anticholinergic bronchodilatator, which is minimally absorbed through blood - airway barrier. So, it is well tolerated, safe and almost has no systemic side effects such as suppression of saliva or bronchial secretion. When it is used in combination with ß2-agonists for the treatment of acute asthma, ipratropium bromide shows a better bronchodilatation, then each of drugs does alone. In the few studies there was observed its efficacy for the treatment of brochopulmonary dysplasia and periodical infant wheeze. Together with ß2-mimetics ipratropium bromide proved a good efficacy in management of both persistent and acute asthma in older children. In the case of exercise asthma it can protect from attack of decrease postexercisal wheeze. There is relatively limited studies directed on the using of ipratropium bromide in bronchiolitis treatment. The obtained results don't support its efficacy, probably due to the changes of osmolarity and pH. Also it may be related with insufficient getting of aerosolum on damaged site or with lower density of cholinoreceptors in the smallest lower airways. Experimental bronchiolitis treatment is suggested, having in mind its safety, and suspecting a good effects, especially in combination with other drugs.
|
|
Analysis of injuries and accidents among infants and children resulted in death in Klaipeda district in 1994-1999
Birute Cijunskiene
The purpose of this work is determination of main causes of death among infants and children under 16 years of age as well as of main directions for preventive activity in order to ensure safe environment in Klaipeda city and area. We have sifted in retrospect 207 cases of death of infants and children under 16 years of age in Klaipeda city and Klaipeda area in 1994-1998 and 1999. During the said period 136 boys died (66 perc.) and 71 girl (34 perc.). It was determined that drowning caused death in 38 perc. of cases, traffic accidents - in 24 perc., suicides in 6 perc., violent death burns - in 5 perc. each, intoxication - in 4 perc., asphyxia, fallings and electric traumas - in 3 perc. each and other - in 9 perc. Over 50 perc. of children died in May, July and August. In 1994-1998 accidents mostly occurred in nature's lap - perc., on the streets - 20 perc., at home - 20 perc., near the houses - 9 perc., in other places - 16 perc.. The main direction of decreasing the number of drowning and traffic accidents is creating the safe environment on the streets, in the car and outside the cities
|
|
Oral therapy with clarithromycin in children with community acquired Mycoplasma pneumonia
Ramune Mykolaitiene, Aldona Rainyte, Petras Stakenas
26 hospitalized patients with Community acquired pneumonia (CAP) were studied. Pneumonia was diagnosed radiologically. Mycoplasma pneumoniae infection was confirmed by blood agglutination reaction and polymerize change reaction (PCR) in throat swabs. Clarithromycin 7.5 mg/kg bid was administered for 7 days. Clinical success of cure was achieved in 25 patients (96 perc.). Adverse events were mild and present in 2 patients (8 perc.). The results show that under clarithromycin therapy the clinical signs and symptoms improved rapidly, and adverse events were rare.
|
|
Current standpoint to the nutrition of the child
Vaidotas Urbonas
Prevention of many chronic diseases start in early childhood. Nutrition has important place in prevention as well as treatment of many diseases. In this paper we review the importance of some nutrients in prevention of disease.
|
|
Recommended Daily Nutrient And Energy Standards For Infants And Children
Kamelija Kaziauskiene, Roma Bartkeviciute, Algimantas Vingras, Rimantas Stukas
The "Recommended or physiological nutrient and energy standards" were prepared in 1999, and were confirmed by the Lithuanian Health Minister's order No 510 at November 25, 1999. The Standards present recommendations for nutrients (proteins, fats, carbohydrates, vitamins, minerals) and energy for infants, children, Teenagers and adults. The Standards are assigned for the use by nutrition specialists, paediatricians, general practitioners, health workers, involved into preparation of physiological menus. According to the Standards, the nutrition status of children and adults will be assessed. The Standards were designed taking into consideration physiological. peculiarities, geographical situation of Lithuania. They should be used only considering healthy persons. They are oriented to cover the physiological nutrient and energy requirements of absolute majority of the population. During the preparation of the Standards, the official nutrient and energy recommendations by WHO, Nordic countries, European Union, United Kingdom, Germany, USA, Poland, Russian Federation and some other countries were used. The paper presents nutrient and energy standards and their necessity for individuals/different groups of Lithuanian population.
|
|
Adverse reactions to food
Jolanta Kudzyte, Ilona Gluosniene, Jurgis Bojarskas
It is known that many people complain of adverse reactions to food but only a few people are in fact allergic. 14-33 perc. of people thing they have adverse reactions to food, but in fact only 3-4 perc. of children and 1-2 perc. of adults have food allergy. Adverse reactions to food are classified by European Academy of Allergy and Clinical Immunology to toxic and non toxic food reactions. Non-toxic adverse reactions are divided to immune mediated (food allergy) and non-immune mediated (food intolerance) reactions. The most severe allergic reactions to food are anaphylaxis and other more common symptoms are form the gastrointestinal tract, respiratory tract and from the skin. Usually these symptoms occur in combination with each other. Food intolerant symptoms can be the same as food allergic symptoms and probably represent the majority of food sensitivities in children. Diagnose is made with the help of medical, family and food history, skin tests, blood tests for specific IgE, elimination-reintroduction diet and double-blind-placebo-controlled food challenge. Thus, antihistamines, serotonin antagonists and steroids are generally recognized as the mainstay of therapy, recently new families of drugs, such as leukotriene-modifying agents have become available and being used clinically.
|
|
Prevention of genetic diseases
Ruta Usinskiene
Congenital anomalies (CA) occur in 3 perc. of all newborns. CA are a major cause of perinatal mortality and childhood disability in Europe. The term "congenital anomalies" here refers to structural defects (congenital malformations, deformations, disruptions, and dysplasias), chromosomal abnormalities, inborn errors of metabolism and hereditary diseases. Primary or true prevention of congenital anomalies is at present limited and can at best prevent just a small proportion of CA. Secondary prevention applies methods which enables to reduce the number of individuals with congenital anomalies. Tertiary preventions, or successful surgical or medical treatment of the early diagnosed CA leads to an increased number of survivors. As technology increases and skill improves, more genetic diseases or their serious complications are being prevented, but the attitude of some practitioners still remains skeptical. The aim of this article is to give an overview of the main principles and methods of preconceptional, preimplantation, prenatal and postnatal prevention of genetic diseases used at present in the world.
|
|
|
May, 2000, Vol. III, No.2 (p. 790-964)
