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The aim of the study was to evaluate the effect of a low protein diet (LPD) balanced with essential amino acids (EAA) / keto acid analogs (KAA) and protein “SUPRO-XT 219D” in the composition of the high-energy nutrient blend (HENB) for slow down of renal failure in patients in the pre-dialysis stage of chronic kidney disease (CKD) induced by systemic autoimmune diseases (SAD).Material and Methods: In this study, 46 patients (35 with systemic lupus erythematosus and 15 with various forms of systemic vasculitis) with CKD in stages 3-4 were randomized into three groups. Group 1 (18 patients: 10 with CKD stage 3 and 8 with CKD stage 4) was given LPD (0.6 g protein per kg of body weight per day comprising 0.3 g of vegetable protein and 0.3 g of animal protein) balanced with EAA/KAA (Diet #1); Group 2 (18 patients: 9 with CKD stage 3 and 9 with CKD stage 4) was given the same LPD, but with an increased vegetable protein content (purified soy protein SUPRO-XT 219D) up to 0.4 g/kg/day in the composition of HENB (Diet #2); Group 3, comparison group, (10 patients: 7 with CKD stage 3 and 3 with CKD stage 4) was given a free diet (Diet #3) based on the patient’s personal preferences. Both options of LPD were offered to all the patients of Groups 1 and 2 regardless of their baseline nutritional status (NS). The duration of the observation was 24-48 months. The NS was evaluated based on the bioelectrical impedance analysis. The protein and calorie intake was calculated from the 3-day food diary.Results: Among the 46 patients with CKD stages 3-4, NS impairment was detected in almost half the patients (45.7%). Both forms of LPD were well tolerated. The correction of the nutritive impairment was achieved in patients with baseline impaired NS; the remaining patients of Groups 1 and 2 demonstrated the safety of NS against LPD. At the same time, among Group 3 patients, during the progression of renal disorders, the NS rate was observed to increase by 1.5 times (from 40% to 60%). Slowing down the glomerular filtration rate (GFR) decline was observed in the patients treated with LPD for at least a year, which was more significant in the subgroup fed with the increased quota of vegetable protein SUPRO-XT 219D.Conclusion: Early restriction (on pre-dialysis stage) of the protein intake (0.6 g/kg/day) supplemented with HENB and EAA/KAA revealed a positive effect on the NS of CKD patients and was found to be able to slow down the GFR decline.

Genexpert MTB/RIF is an effective and feasible method for early diagnosis of tuberculosis. Using Genexpert MTB/RIF in combination with the culture technique on liquid medium in the automated microbiological system BACTEC-960 at the beginning of treatment, we will shorten the time of maltreatment of patients with newly diagnosed and recurrent tuberculosis that prevent the spread of drug-resistant strains of Mycobacterium tuberculosis

The article presents the clinical manifestations, diagnosis and differential diagnosis of tuberculosis of the tonsils and pharynx.

The clinical effectiveness of osmotic laxative drugs based on lactulose in restoration of gastrointestinal tract function in early postoperative period after transanal interventions and laparoscopic operations in 53 children 2–17 years old was studied. All patients had non-functional (cologenic and proctogenic) constipation. Patients underwent full-thickness laparoscopic or transanal biopsy due to suspicion of gastrointestinal malformation presence. Children from base group (n = 28) used lactulose (Duphalac) from the second day of postoperative period (dose complied with the age) once daily, in the morning. The control group (n = 25) received subcutaneous or intramuscular proserinum for the stimulation of peristalsis. Blood tests with serum potassium control were performed on 2nd and 4th day. The study showed clinical effectiveness of lactulose in treatment of postoperational hypotonic constipation in children with colon malformations. Key words: children, gastrointestinal malformations, postoperative period, chronic constipation, lactulose.(Voprosy sovremennoi pediatrii — Current Pediatrics. 2010;9(1):122-125)