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VI. Literature:

Main:

Lectures of internal pediatrics

Nelson Textbook of Pediatrics/ edited by Richard E. Behrman, Robert M. Kliegman, Ann M. Arvin; senior editor, Waldo E. Nelson-15th ed.-W. Saunders Company, 1996.-2200 p.

Additional:

Leus J, Van Biervliet S, Robberecht E: Detection and follow up of exocrine pancreatic insufficiency in cystic fibrosis: A review.  Eur J Pediatr  2000; 159:563.

Johnson PR, Spitz L: Cysts and tumors of the pancreas.  Semin Pediatr Surg  2000; 9:209.

Montemarano H, Lonergan GJ, Bulas DI, et al: Pancreatoblastoma: Imaging findings in 10 patients and review of the literature.  Radiology  2000; 214:476.

Werlin SL,  Taylor A: ERCP. In: Howard ER, Stringer MD, Colombani PM, ed. Surgery of the Liver, Bile Ducts and Pancreas in Children,  2nd ed.. London: STM Publishing; 2002:509-520.

Whitcomb DC: Genetic predispositions to acute and chronic pancreatitis.  Med Clin North Am  2000; 84:531.

MODYLE 4. Theme: “Meningococcal infection. Enterovirus infection.

Poliomyelitis”.

Professional motivation:

Meningococcal infection – is an acute infectious disease that is caused by meningococcus, and characterized by a variety of clinical forms: from nasopharyngitis and healthy carriers to generalized (meningococcemia, meningitis and meningoencephalitis). The importance of the problem is determined by the spread of meningococcal disease in all world countries . The carriering of meningococci occurs quite often. On the one patient with a symptomatic form of meningococcal infection accounts for up to two thousand carriers of Neisseria meningitidis. Meningococcal meningitis occurs in a small number of infected persons. Weakening resistance of the body due to exposure to environmental factors, the presence of concomitant severe disease or immunodeficiency status contribute to the development of this infection. Susceptibility to infection with meningococci of people is common, generalized forms occur in 20% of patients with meningococcal infection.

The mechanism of transmission is droplet, but it is less active than in the flu, chickenpox, measles. Pathogens that are contained in the nasopharynx, are excreted with droplets of mucus during breathing, coughing, sneezing and talking. In closed collectives (pre-school institutions, boarding schools, barracks) infection is associated with lack of space, crowding, long-term communication of people.

Meningococcal disease is characterized by the periodicity with large intervals between epidemies (4-11 years). The incidence of this infection increases in February - March, regardless of geographical location and climatic conditions. All age groups suffer from this infection, but most of them are children under age 5 - 14 years. Today it is mostly sporadic. However, mortality in this disease remains high, especially among infants. It depends on several factors: the timeliness of diagnosis and provided adequate care to the patient during the prehospital phase, adequate treatment in hospital, premorbid background of the child, complications, mixed infection. The urgency of meningococcal infection is also because of serious complications after the disease, which often leaves an organic brain changes that lead to mental disorders in humans, as well as disturbances in different organs and body systems.

Enteroviral infection combines a large group of acute viral diseases that have similar pathogenetic mechanisms of development and are characterized by a wide spectrum of clinical signs - from asymptomatic course to severe injuries of the nervous system or internal organs. There are more than 70 serotypes of enteroviruses, 15 of which cause disease in humans. In recent years in the world thereis a clear tendency of the increasung in the number of cases caused by enteroviruses. Epidemiologically important increase in morbidity is observed both in developed countries and developing countries. High morbidity is caused by a large layer of nonimmune to enteroviruses contingent of the population, and long virus carriering (the virus can be released from the human body up to 5 months.), which facilitates the spread of the pathogen among different age groups (children, adults). Enterovirus infections are common in all parts of the world. In countries with temperate climate, peak incidence occurs annually in the summer and early fall, although some agents may circulate in the population throughout the year. Enteroviruses cause 33-65% of all diseases with fever. Risk factors for incidence and severity of the infection include early age of the child, male sex, a violation of the rules of hygiene, overcrowding of housing, low socio-economic status.

Poliomyelitis – is an acute infectious disease caused by poliovirus and characterized by lesions of gray matter of spinal cord with the development of flaccid paralysis. The disease can be asymptomatic (90 - 95% of cases of infection), in the form of abortive poliomyelitis (5%), notparalytic poliomyelitis (1%) or paralytic poliomyelitis (0.1%). The main mechanism of transmission is fecal-oral, due to the duration of viral excretion in feces and its high concentration in it. The massive release of poliovirus from feces in the environment creates the opportunity to spread through water, food, arms, and flies. Children of the first years of life become infected with the poliovirus mostly and spread it. Ukraine from June 21, 2002 granted the status of a territory free from poliomyelitis. WHO declared the eradication of wild-type of poliovirus in the Western Hemisphere. However, vaccination is not canceled. This is because of the circulation of the pathogen in other parts of the world that retains the risk of poliomyelitis
Aim

Students must know:

1. Epidemiology, etiology and pathogenetic factors of meningococcal infection, enteroviral infection and poliomyelitis.
   2. Classification and typical clinical manifestation of meningococcal infection, enteroviral infection and poliomyelitis.

   3. Laboratory diagnostic research methods.
   4. The treatment and prevention principles of meningococcal infection, enteroviral infection and poliomyelitis.

Students should be able to:

1. Follow basic rules of work with patient with meningococcal infection, enteroviral infection and poliomyelitis.
2. Collect patient’s medical history in case of meningococcal infection, enteroviral infection and poliomyelitis.
3. Inspect the patient to identify the main clinical signs of disease.
4. Display the history and examination data in the case history to confirm the diagnosis.
5. Make a plan of the laboratory and instrumental examinations in different clinical forms of meningococcal infection, enteroviral infection and poliomyelitis.
6. Perform differential diagnosis and establish the preliminary diagnosis of meningococcal disease, enteroviral diseases.
7. Estimate the oropharyngeal mucosa in a child with meningococcal nasopharyngitis.
8. Estimate the morphological rash elements on the skin at meningococcemia.
9. Make a treatment plan and to calculate the dose of drug for children with meningococcemia, meningococcal meningitis.
Questions for self-control:

Meningococcal disease

1. The main features of meningococcus.

2. Major morphological changes in the vessels, skin, adrenal glands, membranes of the brain and spinal cord.

3. Basic epidemiological chain of meningococcal infection.

4. The main elements of the pathogenesis of meningococcal infection.

5. Name meningeal symptoms.

6. Eith what is headache at meningitis associated?

7. What causes vomiting at meningitis?

8. Children of what ages often suffer from meningococcal disease?

9. At what points need to pay attention, gathering history of the patient with suspected meningococcal meningitis?

10. Name the major clinical forms of meningococcal infection.

11. What are the clinical manifestations of endotoxic shock at meningococcal disease.

12. What are the symptoms of meningococcal meningitis.

13. What shows syndrome of intoxication with this infection?

14. Basic laboratory methods at generalized forms of meningococcal infection.

15. Characteristic changes of peripheral blood at the generalized form of infection.

16. Indications to lumbar puncture.

17. Name the changes in cerebrospinal fluid at meningococcal meningitis.

18. What are the substrates can be identified at the meningococcus meningitis

19. With which diseases should be carried out differential diagnosis of suspected meningococcemia?

20. Wth which diseases should be carried out differential diagnosis of suspected meningococcal meningitis?

21. Name the basic principles of meningococcemia treatment.

22. Name the basic principles of treatment of meningitis.

23. What anti-epidemic measures are in the focus of infection?

Enterovirus infection

1. What is the etiology of entorovirus infections?

2. What are the epidemiological features of enteroviral infection (a source of infection, routes of transmission, the level of disease incidence in different age groups)?

3. What are the clinical forms of enteroviral infections?
4. Features of enterovirus infection in infants and young children.
5. Perform a differential diagnosis between poliomyelitis and poliomiyelitic-like form of enterovirus infection.
6. What are the methods of laboratory diagnosis of enteroviral infections?
7. Treatment of children with entrovirus infection.
8. What is the prevention of enteroviral infections?

Poliomyelitis
1. What is the cause of polio?
2. What are the epidemiological characteristics of poliomyelitis (the extent of Ukraine, the source, routes of transmission)?
3. The pathogenesis of the disease.
4. What is the classification of polio?
5. Clinical manifestations of disease.
6. What methods of laboratory diagnosis of polio?
7. Treatment of patients with paralytic form of the disease.
8. Polio prevention (vaccination, follow-on contact).
9. Vaccineassociated polio (definition, clinical, therapeutic tactics, surveillance of contacts).

LITERATURE

Main:
1. Children's Infectious Diseases (Clinical lectures.) Under. Ed. Sci. S.O. Kramarev - Kyiv, "MORION." - 2003. - 480 p..

2. Fedortsiv O.Ye, Horishna I.l., Horishniy I.M. Manual of Children’s Infectious Deseases. – Ternopil: TSMU, 2010. – 382 p.

Additional:
1.Krugman’s infectious diseases of children 11th edition, 2003.

2. Fisher, Randall G.; Boyce, Thomas G. Moffet's Pediatric Infectious Diseases: A Problem-Oriented Approach, 4th Edition, 2005 Lippincott Williams & Wilkins.

3. Infectious disease in children / ed. V.V.Yvanova. - Moscow: MYA, 2002. - 923s.
4. Guide to infectious diseases in children / VF Uchaykyn. - Moscow: HEOTAR Medicine, 1998. - 809 p..

MODYLE 6. Theme: “Differential diagnosis of acute gastrointestinal infections in children.Emergency issues. Diagnostics and treatment”.

Professional motivation:

Acute gastrointestinal infections (AGI) - a group of infectious diseases of different etiology (viral, bacterial, fungal, parasitic), characterized by fecal-oral route of transmission, primarily involving the gastrointestinal tract.

Among infectious diseases in children acute intestinal infections require special attention. Only acute respiratory illness exceed them by the spread of morbidity, and in the structure of mortality from infectious causes in Ukraine AGI take 2-3 place.

According to the WHO classification, all human diarrheal diseases are divided into infectious and noninfectious. In turn, infectious diarrhea are divided into invasive (inflammatory, blood) and secretory (noninflammatory, watery).

Secretory diarrhea in most cases are caused by viruses and some bacteria that secrete enterotoxins. Secretory diarrhea pathogens, above all, are: rotavirus, noravirusy, adenoviruses, enteroviruses, astroviruses, coronaviruses, reoviruses and bacteria such as Vibrio cholerae, enteropathogenic, and enterotoxygenic enteroaggregative esherychias. In addition, some of the protozoa can cause secretory diarrhea: lambliosis, cryptosporydia, mikrosporydia, balantydia, izospora.

Invasive diarrhea - a disease usually caused by bacteria: Shigella, Salmonella, and enteroinvazive enterohemorragical escherichia, intestinal iersinia, campylobacter, clostridium, staphylococci and some other enterobacteria. Invasive diarrhea can be caused by amoeba histolitika.

In the group of agents of intestinal infections we can identify those pathogens that cause disease only in people with compromised immune systems. It is cytomegalovirus, mycobacteria tuberculosis (avium, tsellyulyarum), koktsydiyi, biospora Bailey and some others.

Aim

Students must know:

1. Features of etiology, epidemiology, pathogenesis of acute intestinal infections.
2. Clinical course of escherichiosis, staphylococcal enterocolitis, viral diarrhea.
3.Laboratory diagnostics.
4.Treatment of escherichiosis, staphylococcal enterocolitis, viral diarrhea, salmonellosis, shigellosis.
Students should be able to:

Conduct clinical examination of patients with AGI and differential diagnosis at escherichiosis, salmonellosis, shigellosis , staphylococcal enterocolitis, viral diarrhea.

Questions for self-control:

 Shigellosis

1. The value of anatomical and physiological characteristics of the gastrointestinal tract in children for the occurrence of intestinal infections.

2. Influence of features of metabolic processes in children in the course of intestinal infections.

3. The flora of the gastrointestinal tract in children, its dependence on age.

4. Incidence rates for shigellosis in children.

5. Sensitivity to shigellosis infection, the nature of specific immunity.

6. Classification .

7. Resistance of shigella to the influence of environmental factors.

8. Sources of shigellosis.

9. Ways and factors of transmission of shigellosis in children.

10. Preventive measures at the source of infection.

11. The conditions necessary for the development of shigellosis in children.

12. Pathogenesis of shigellosis in children.

13. The duration of the incubation period in children.

14. Clinical forms of shigellosis in children. The clinical diagnosis of shigellosis.

15. What are the clinical forms of shigellosis are more common in young children?

16. Laboratory methods of examination of patients in shigellosis.

17. What complications occur in children more often?

18. Causes of complications of shigellosis in children.

19. Factors that affect the duration of bacterial carriage in children who have suffered shigellosis.

20. Indications for hospitalization of children with shigellosis on.

21. Principles of treatment of shigellosis in children.

22. Terms of hospital discharge, and the indications for the reading to the children's admission to schools of children who have suffered shigellosis.

SALMONELLOSIS

1. Classification of Salmonella.

2. Salmonella resistance to the influence of environmental factors.

3. The sources of salmonellosis.

4. Ways and factors of transmission of salmonellosis in children.

5. Preventive measures at the source of infection.

6. The conditions necessary for the development of salmonellosis in children.

7. Pathogenesis of salmonellosis.

8. The duration of the incubation period in children.

9. Clinical forms of salmonellosis in children. Clinical diagnosis of salmonellosis.

10. What are the clinical forms of salmonellosis are the most common in young children?

11. Laboratory methods of examination of patients with salmonellosis.

12. What complications occur in children more often?

13. Causes of complications of salmonellosis in children.

14. Factors that affect the duration of bacterial carriage in children who have suffered salmonella.

15. Indications for hospitalization of children with salmonellosis.

16. Principles of treatment of salmonellosis in children.

17. Terms of hospital discharge, and the indications for the reading to the children's admission to schools of children who have suffered salmonella.
Escherichiosis

1. Classification of Escherichia.

2. The source of infection and transmission.

3. Characteristics of the clinical forms escherichiosis depending on the type of agent.

4. Identify the main indicators of the severity of escherichiosis.

5. The main features of dehydration and toxicosis at escherichiosis for infants.

6. Indications for hospitalization of patients with escherichiosis.

7. Which diseases should be a differentiation escherichiosis?

8. Principles of treatment of children with escherichiosis.

9. Criteria for discharge from the hospital convalescent after escherichiosis.

10. Control measures at the source of infection.
Rotavirus

1. The etiology of rotavirus infection.

2. Peculiarities of the epidemiology of rotavirus infection.

3. The pathogenesis of diarrhea syndrome at rotavirus infection.

4. The clinical symptoms of rotavirus infection.

5. Laboratory diagnosis of rotavirus infection.

6. Principles of treatment of rotavirus infection, indications for hospitalization.
LITERATURE

Main:
1. Mikhailova AM, Tryshkova LA, Kramarev SO, AN Kochetkova. Infectious diseases in children. Textbook for students in higher educational institutions 3-4 accreditation of doctors and interns, K.: Health, 1998. - 418 p..
2. Children's Infectious Diseases (Clinical lectures.) Under. Ed. Sci. SO Kramareva - Kyiv, "MORION." - 2003. - 480 p..

Additional:
1. Infectious disease in children / ed. VV Yvanovoy. - Moscow: MYA, 2002. - 923s.
2. Guide to infectious diseases in children / VF Uchaykyn. - Moscow: HEOTAR Medicine, 1998. - 809 p..
3. Infectious disease in children / ed. VN Timchenko, L. Bystryakova. - SPb.: SpetsLyt, 2001. - 560 p..
4. Bohadelnykov IV Differential diagnosis of important infectious diseases in children. - Simferopol, 1999. - 528 p..
5. Lobzin Y. Pilipenko VV, Gromyko, JN Meningitis and encephalitis. - LLC "Publisher FOLIO", 2003. - 128.


2.3.3. ТЕМИ ДЛЯ ІНДИВІДУАЛЬНИХ ЗАНЯТЬ І ЇХ ФОРМИ.

Форми індивідуальних завдань: статистичні дослідження, виконання рефератів, складання таблиць, участь у предметній олімпіаді та наукових конференціях.
3. МАТЕРІАЛЬНЕ ЗАБЕЗПЕЧЕННЯ НАВЧАЛЬНОГО ПРОЦЕСУ:

комплекти слайдів, учбових фільмів, таблиць, тестових та ситуаційних завдань.

Зав. кафедрою педіатрії

професор А.Б. Волосянко


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