Possibilities of prediction of the development of cardio-vascular complications in acute pneumonia in young age children

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The data reflect incompetence of anti-viral protection of an organism with background immunologic deficiency, and that decreases the capabilities of a micro organism in the control of virus replication and leads to persistence ofviral infection and reproduction of the virus, shortening of the period between relapses and the
number of relapses. That in its turn leads to the conclusion about mono therapy failure, including its suppressive scheme, and the necessity of complex therapy for the patients with recurrent genital Herpes taking into account peculiarities of the immunity system functioning in compliance with the literature data [2- 12].
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2. Borisova A. M., Alkeyeva A. B, Saidov M. Z. The role of the system of natural cytotoxicity in immune pathogenesis of recurrent herpetic infection and the impact of immune modulators on the clinical-immunologic status//Immunology — 1991. — № 6. — P. 60−63.
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Israilova Nigora Amanullaevna, Tashkent Medical Academy, assistant of the department of GP pediatrics E-mail: nigora99@gmail. com
Possibilities of prediction of the development of cardio-vascular complications in acute pneumonia in young age children
Abstract: Elaboration of prognostic criteria of the development of cardio -vascular complications in acute pneumonia in young age children may promote detection of earliest signs of the disease, to choose the periods which is the most probable process of sanogenesis helps more deeply understand the pathogenesis of disease and according to timely prescription of adequate therapy.
Keywords: prediction complications, cardio-vascular system, acute pneumonia, children.
Topicality of problem. According to the requirement of life the number of researches on prediction in medicine has increased for the last decades [3,5]. On the basis of prediction there is knowledge, thinking and abilities of human brain to forestalling, anticipation, leading the reflection of reality. The main aim of medical prediction consists of decreasing uncertainty of future. The other important peculiarity of medical prediction is its active character which gives a possibility of indirect or direct influence to the object of prognosis [1- 2].
In the structure of morbidity and mortality of young age children, acute pneumonia takes the leading lace. According to WHO data children with pneumonia in developed countries of the world compose 3−4% from total number of patients, but in developing countries — 10−20%- lethality varies from 5,5 to 7,2%, children at the age from 1 to 6 months 15−20% [7]. In Uzbekistan (by the data of WHO, 2007) infantile mortality makes up 13,2%, in the structure of it where the portion of pneumonia is 40%.
In pneumonia in pathologic process of cardio-vascular system is involved, combination of infectious -inflammatory process in the lungs and heart is often observed [1- 4- 9]. Cardio — and hemodynamic disorders in pneumonia in young children, as an important team of pathogenesis of pneumonia, aggravates its course, worsen the prognoses and often become one of the cause of lethal outcomes [6- 8]. Elaboration of prognostic criteria of the development of cardio -vascular complications in acute pneumonia in young age children may promote detection of earliest signs of the disease, to choose the periods which is the most probable process of sanogenesis helps more deeply understand the pathogenesis of disease and according to timely prescription of adequate therapy.
Purpose of research. To elaborate prognostic criteria of the risk of development of cardio-vascular complications in young children with acute pneumonia.
Possibilities of prediction of the development of cardio-vascular complications in acute pneumonia in young age children
Materials and methods.
Totally 212 children at the age from1to3 were examined: 1-group was made up 107 (50,5%) young children with acute pneumonia, complicated with carditis- 2-group — 105 (49,5%) younger children with acute pneumonia without carditis. From 107 children of the 1st group the boys were 59 (55,1%), girls — 48 (44,9%). At the scientific work clinical, laboratorial, instrumental and functional methods of study were used. Accounts of attributive and relative risk were carried out in studying the risk of development of cardio-vascular complications in acute pneumonia in young children. The index of attributive risk (attributive risk-AR) (FletcherR., 1998) was estimated by formula: AR= (OR-1)/OR, and relative risk (OR, Oddis ratio) (Kelmansonl. A., 2004): OR=ad/bc, where the number of observations exposed to the studied factor and existing diseases- b-number of observations exposed to the influence and non- existing diseases, c- the number of observations which were not exposed to existing diseases- d-number of observations which were not exposed to non-existing diseases. With the help of consequently analysis of Vald, the prognostic coefficient (PC) was estimated for revealing of probability of the development of cardio- vascular complications in acute pneumonia in young age children.
Results of research. The base of prognosis is correctly and fully collected anamnesis. It allows validly to come to the solution of the task about possible reason of unfavorable outcome and prescribe necessary complex medical measures, which were used in our work. Analyses of anamnestic data about the state of mothers health during pregnancy, course of birth, state of new born at birth shows that highly informative in prognoses of probability of the development of cardio-vascular complications in acute pneumonia in young age children is: the number of family members with cardio-vascular diseases 2 and more (PC=2,0), the number of family members with often respiratory diseases 2 and more (PC=2,5), respiratory infections of mothers during pregnancy (PC=2,0), of bio mechanism disorder of the births (PC=1,5), nephropathy (PC=1,5), asphyxia (PC=2,5). Quantitative assessment due to between prognostic unfavorable factors of perinatal development and forming of carditis in children with acute pneumonia confirms this: the number of family members with cardio- vascular diseases 2 and more (AR =0,176), the number of family members with often respiratory diseases 2 and more (AR=0,218), respiratory infections of mothers during pregnancy (AR=0,243), mechanism disorder of the births (AR=0,183), nephropathy (AR=0,203), nephropathy in birth (AR=0,259).
The analysis of adoptive and concomitant diseases in young age childrenwith acute pneumonia shows that 53,3% patients of the 1st group and 27,6% - 2nd group patients suffered from pneumonia. Children with HIE, hypotrophy, thymomegaly authentically more frequent occur in the 1st group in accordance with 21,5%, 51,4% and 25,2%, by comparison with 2nd group 4,8%, 24,8% and 8,6%. Patients with food and drug allergy are registered three times more often in the
1st group (6,5%) by comparing with 2nd group (1,9%). Quantitative assessment due to between prognostic unfavorable factors of perinatal development and forming of carditis in children with acute pneumonia confirms, that coefficient of relative risk is rather high in patients with above mentioned transferred and concomitant diseases: transferred pneumonia (OR=2,0), HIE, hypotrophy, thymomegaly (correspondingly OR=4,51- 2,08- 2,94), food and drug allergy (OR=3,43).
Unfavorable prognostic information has the signs, which indicate the presence of artificial feeding from the first day of life (PC=1,5), suffered from pneumonia (PC=2,0), background condition of — hypotrophy (PC=1,5), diathesis (PC=2,0), HIE (PC=1,5).
The analysis of clinical manifestations of pneumonia and results of laboratory — instrumental investigations shows higher informative prognosis of probability of the development of cardio- vascular complications in acute pneumonia in young age children are of bilateral confluent foci inflammatory process in the lungs (PC=3,5), late hospitalization (PC=3,0), presence of cardiologic symptoms at admission such as: expansion of the heart edge (PC=3,5), muteness of the heart tone (PC=2,5), bradycardia, (PC=2,0), hepatomegaly (PC=3,0), the signs of blood circulation disorders (PC=4,0), increasing of concentration IL-1p in 2 and more times (PC=3,5), decreasing of concentration IL-1RARA (PC=3,0). Numerical threshold for assumption of certain conclusion (with 95% probability) is equal ±13. It is taken by algebraic adding of prognostic coefficients of each proposed in the table of signs. In cases, when generalized prognostic coefficient is less conditional size (±13), received results must be also considered and taken into account in conducting prophylactic measures. So, in amount of grades of PC (±10,0) (90% the level of probability or 8 chances from 10) we can say about high probability of performance of prognosed event, in amount of grades of PC (±6,0) we can say about the risk increase 4 times- in amount of grades of PC (±3,0−5,5) we can say about probable performance of prognosed event. The prognosis is not a prediction that is why certain amount of mistakes is planned in advance- also it is not planned but some amount of uncertain responses are supposed. In presented algorithms approximately 5% mistakes of prognosis is planned. Difference of prognosis with the reality was conditioned by two reasons. First, while prognosing all influencing factors are not considered- second, factors influence the health condition of the child, joined consequences, not active and that is why they are not considered while prognosing. If the doctor can consider these factors from the first stage of examination and predict their occurrence, accuracy of prognosis increases.
Thus, elaboration of prognostic criteria for revealing probability of cardio- vascular complications in acute pneumonia in young age children will give possibility to diagnose the disease, to plan and to carry out medical- prophylactic measures for prevention of unfavorable outcome of diseases.
References:
1. Afonaskov O.V. Acute myocarditis in patients with community-acquired pneumonia of young age: Dissert. Candidate of medical sciences. Khabarovsk- 2006.
2. Vibornov Yu.D. Prognosis of time of probable children diseases //Pediatrics. — M., 2006. — № 2. — P. 106−109.
3. Karimova M.N. with coauthors. Possibilities of prediction of development and approach of allergy in children. Journal of theoretical and clinical medicine. Tashkent № 7 — 2012. — P. 15−17.
4. Nikolayevskiy E.N., Kalabashkin N., N. Ismagilov M., Motin Yu.K. Possibilities of treatment of complicated community-acquired pneumonia at the department of intensive therapy and reanimation //Bulletin of Russian military -medical academy. — 2005. — № 1(13). — P. 120. — 500 copies. ISSN 1682−7392.
5. Prognostic criteria of health state of children /R.S. Jubatova., Z.S. Umarova., R.A. Gulyamov., Sh. Sh. Shoikromov//Palliative medicine and rehabilitation. — Tashkent. — 2002. — № 2. — P. 40−42.
6. Samsigina G.A., Durdina T.A., Korpushin M.A. Severe community-acquired pneumonia in children// Pediatrics (M). 2005- 4: 87−94.
7. Samsigina G.A. Pneumonia in children//Pneumonia. — M.: Economics and informatics, 2002. — P. 198−218.
8. Shepelenko A.F. Community-acquired pneumonia combined with cardiac pathology: peculiarities of clinics, diagnostics and treatment// Pulmonology. — 2010. — 1. — P. 87−92.
9. Ilten F. Cardiovascular changes in children with pneumonia. Turc.J. Pediatr. 2003- 45 (4): 306−310.
Karabayeva Indira, research worker Republican specialized scientific — practical medical centre of dermatology and venereology, Uzbekistan E-mail: ikarabaeva. 73@mail. ru
The state of immune reactivity in patients with microsporia
Abstract: The immunological investigations were performed in patients with different forms of microsporia in group of 4−14 year old children depending on the term of disease, remoteness of disease less than lmonth was registered in 55 patients, more than lmonths in 24 patients. In patients with microsporia the changes in the structure of circulating pool of lymphocytes as the decrease of functional activity of T -lymphocytes, T — helpers/inductors as well as indexes of nonspecific resistance, activization of humoral group of immunity were noted.
Keywords: zooanthroponosis microsporia, immunological investigations, children.
Nowadays zooanthroponosis microsporia with affection of skin coverlet and hair is one of the most common mycosis in children [1, 43−44]. In some countries microsporia makes up 60 to 97% of all dermatophytosis, but year-on-year increase of morbidity reaches 8% [3, 68−69−7, 8−12]. At present the increase of morbidity with microsporia caused by the changes of properties on the one hand, agents (appearance of the new types of fungi, increasing of their pathogenicity and contagiosity, disorders of structure and edges of nosoreals), — the host (decrease of natural resistance, the rate of immunodeficiency state, unfavorable epidemiological and social condition) on the other hand [5, 17].
The important place in pathogenesis of microsporia is due to different changes of immune status, in which clinical course of mycosis, its prognosis and the choice of rational therapy depend on them [1, 43−44−5].
Different authors note the various versions of deviation — from immunodeficiency until increased activity. Performed analysis of literary data allows to make a conclusion about the absence of single treatment of the character of immune changes in patients with microsporia. At present the disorders of system and local immunity were not studied fully, it was not revealed the role of nonspecific immune response [2, 25- 4,113- 6, 87−88].
The purpose of research.
The study of some immunological parameters in particular, T-lymphocytes and B- lymphocytes, subpopulation T- lymphocytes, humoral group of immunity as well as the factors of nonspecific protection in children — patients with microsporia.
Materials and methods
At the age of 4 to 14 years old 79patients with different clinical forms of microsporia with remoteness of disease from 1 week to 6 months were under the observation. The general number of patients predominated the person of male. The state of cellular and humoral immunity was determined by study of absolute and relative
number of leucocytes in 1 ml peripheral blood, relative content of T and B — lymphocytes and their subpopulation — T — helpers, T- suppressions and their ratio (by methodical recommendations of F. Yu. Garib with coauth., 1995). Indexes of humoral immunity were revealed by content in blood serum of immunoglobulins A, M, G (with method of radial immunodiffusion by Mancini G.) and circulating immune sets (CIS, method of M. Digeon and others (1977). Phagocytic index (Phi) and phagocytic number (PhN) were determined by incubation of mixture of leucocytes and particle of latex from indexes of nonspecific reactivity. According to the data of different investigators (V. N. Fedoseeva and coauthors., 1993) confidence bound inprobability 95% content T- and B-lymphocytes and immunoglobulins in children at the age from 4 to 14years old was practically the same, because of the analysis of results of immunological investigation was performed in all children who were in this age group.
Results and their discussion.
Immunological investigation were conducted in 79 patients with microsporia, among them 8 patients suffered from microsporia of smooth skin, on 39 -microsporia of fibrous part of the head and 32 -with combined lesions of fibrous part of the head and smooth skin.
Immunological indexes in general group ofpatients with microsporia were presented inTable 1. Evidiently, the changes of lymphocytes activity — the main immunocomponent cells is marked in patients with zoophilous microsporia, which expressed with increasing of leucocytes and general number of lymphocytes and decreasing of relative number of T- lymphocytes, T-helpers, decreasing of im-munoregulatory index and relative number of T-suppressors.
Increasing of B-lymphocytes, increasing of the content of serum immunoglobulins G, circulating of immune complexes was revealed at simultaneous decreasing of the number of immunoglobulins A and M in the indexes of humoral immunity.
Table 1. — Immunological indexes of patients with microsporia
Indexes Control, n=26 Patients, n=79
1 2 3
Leucocytes, abs 4,4 ± 0,11 5,7±0,09 ****
Lymphocytes,% 30,9 ± 0,62 37,2±0,72 ****

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