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Indicators nitroxide ergic system at mycoplasma pneumonia in combination with herpes infection in children with immunotherapy
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Tadzhihanova Dono Pulatovna, Junior Researcher of Republican Specialized Scientific and Practical Medical Center of Pediatric, Republic of Uzbekistan
E-mail: evovision@bk.ru
Indicators nitroxide ergic system at mycoplasma pneumonia in combination with herpes infection in children with immunotherapy
Abstract: In children with mycoplasma pneumonia associated with herpes infection, there is overproduction of nitric oxide and peroxynitrite-related activation of the inducible form of nitric oxide synthase. It appears more pronounced in patients with MP + HSV + CMV association.
Keywords. Mycoplasma, herpes, nitrogen oxides, children.
Actuality
Currently, one of the urgent problems of Pediatrics is mycoplas-ma pneumonia, which is caused not only widespread among it early childhood, despite the widespread use of modern antibiotics [2; 4; 8]. Today emerged pneumonia is often due to the addition of herpes virus infection (HVI). In recent years there has been growth in the proportion of "intracellular" (atypical) pathogens in the etiological structure of community-acquired pneumonia in children, such as Mycoplasma pneumoniae (MP) [1; 3; 5]. Frequency of MP reaches 35-50 %. The absence of a rigid cell wall at mycoplasma determines the polymorphism of cells, resistance to penicillin, ami-noglycosides and cephalosporins. Often MP associated with herpes infection (HSV + CMV or HSV+VEB + CMV), determining the severity and recurrent nature of pneumonia [6; 7; 8]. It should be said that lip polysaccharide (LPS) of bacterial origin that trigger inflammation, interact with neutrophils, macrophages, cause accumulation in the body of a free-radical oxygen species that interact with the azo containing compound may form a nitrogen oxides [6; 10]. The radicals of these compounds (NO), superoxide and it's reaction product peroxynitrite, formed by the infectious diseases have a significant role in the development and pathogenesis of diseases: they are mediators of inflammation, modified proteins and nucleic acid damage [9; 10]. The constant change of the microbial
landscape, dynamic changes of reactivity and immune response in children with mixed infection dictate the need for adequate path genetically oriented immunostimulatory therapies. It should be a differentiated approach to the treatment according to the identified infectious agents to avoid polypharmacy. In this regard, promising a differentiated inclusion in the basic therapy MP with herpesvirus infection glycyron and anaferon. However, it is necessary to study the mechanism of action of the proposed systems of the therapy, which determined the purpose of the present study.
Objective
Influence of treatment of mycoplasma pneumonia in combination with herpes infection in children to the performance of nitric oxide system.
Material and methods
The study involved 190 infants with mycoplasma pneumonia (MP), combined with the herpes simplex virus (HSV) (40 children - group 1), cytomegalovirus (CMV) (50 children - group 2) or association (100 children - group 3) in the active phase of the disease, are hospitalized in the children's center of the RSSPMC Pediatrics of Health Ministry of Republic of Uzbekistan. The most serious disease proceeded in patients with MP + CMV + HSV. Clinical diagnosis of mycoplasma pneumonia was established based on clinical-anamnestic and additional laboratory and radiological data.
Section 4. Medical science
The control group consisted of 30 healthy children of comparable age. The diagnosis of mycoplasma pneumonia was based on the classification of clinical forms of bronchopulmonary diseases in children adopted in Moscow at a symposium on improving the classification of non specific lung diseases in children (1996). Biochemical studies include determination of the amount of NO metabolites nitrite and nitrates (NO2 and NO3). In a modification Metelskaya V. A. and et al. it was showed activity of nitric oxide synthase (eNOS); nitrate reductase activity (NR) level peroxynitrite (ONOO). Statistical analysis of the results of research conducted with the help of software «Microsoft Excel XP» and «Statistic 6.0».
Results and discussion
Clinical symptoms of MP in association with herpes virus infection in infants characterized by severe symptoms of intoxication and hyperthermia, dryness of mucous membranes of the upper respiratory tract, cough and painful events conjunctivitis with severe bronchial obstruction syndrome. Radiological findings revealed infiltration of the lung tissue, and in some cases determined by the deformation and blurring of pulmonary pattern, increased vascular component and interstitial changes. It was marked anemisation, neutropenia, mild leukocytosis with signs of eosinophilia, monocytosis, lymphocytosis, and in some cases with leukopenia, lymphocytopenia, accelerated erythrocyte sedimentation rate (ESR), all of which indicate the presence of inflammation in the body with pronounced decrease in immunore-activity in children.
Along with these children with MP in combination with herpes infection, we observed an increase in the level of the end products of nitric oxide metabolism, especially in the third group of patients. Increased production of NO- observed on the background of inhibition of eNOS and over expression of inducible nitric oxide synthase forms. Subsequent reaction of NO- with oxygen radicals results in the formation of the toxic effect of high oxidation activity of the agent — ONOO-. When generating nitric oxide and superoxide same system it increases the probability of the interaction, so that these enzymes may contribute significantly to the formation of OOO- in the cells and tissues, often becoming a cause of cell death. Research ONOO- content in the blood of children with mixed-pneumonia showed a statistically significant increase of its content in 1.87; 2.25 and 4.22 times, respectively, in the 1st, 2nd and 3rd groups of children. More pronounced changes in the indices of nitric oxide observed in the mixed infection. During the basic pharmacotherapy MP + HSV (comparison group) on the 10th day of treatment, we observed a tendency to reduce the high levels of NO-, significant decrease of 1.27 times the content of ONOO- in the background of a some decrease NR in 1.11 times. By 30 days of the study the tendency to normalization of nitric oxide maintained. Values NO-, ONOO- and NR significantly decreased in 1.25; 1.4 and 1.15 times the original values, respectively. Follow-up study of the above parameters is shown approaching the content of NO- and NR activity to the values of the control group children, but the level and activity of eNOS ONOO-differed significantly from them (Table 1).
Table 1. - Indicators of nitric oxide in children with mycoplasma pneumonia, M ± m
Groups Contents of products Activity of ferments
NO2 (NO3), mcmol/l ONOO-, mcmol/l eNOS, mcmol/mini NR, mcmol/mini
Control group n = 30 9.67 ± 0.43 0.08 ± 0.003 16.88 ± 0.87 0.22 ± 0.005
1st group, n = 50 12.47 ± 0.48*** 0.15 ± 0.006*** 12.57 ± 0.36 0.32 ± 0.011
2nd group, n = 40 13.49 ± 0.39*** 0.18 ± 0.006*** 12.30 ± 0.31 0.39 ± 0.007***
3rd group, n = 100 15.75 ± 0.24*** 0.33 ± 0.007*** 9.45 ± 0.51 0.48 ± 0.011***
Note: * — differences with respect to the data of the control group significant: * — P < 0.05; ** — P < 0.01; *** — P < 0.001.
Inclusions in the complex therapeutic measures anaferon and glycerol have a more pronounced positive effect in stabilizing the performance of the nitrogen oxide. Thus, high levels of NO and ONOO- significantly decreased in 1.24 and 1.5 times, low activity eNOS increased somewhat, and the high activity of the NR declined relative to baseline values. On the 30th day of treatment studied parameters close to the values of healthy children, remained within those limits and catamnesis. As can be seen from the above data, the inclusion of a set of glycerol and anaferon promoted earlier normalization of nitrous oxide compared with conventional therapy.
Standard MP + CMV pharmacotherapy for 10 days reduced the high values ofNO-, NO and ONOO- in 1.14; 1.18 and 1.31 times the original values, respectively. By the 30th day of treatment the decrease was 1.22; 1.3 and 1.31 times, respectively, the above figures. Despite ongoing treatment and preventive measures, even catamnesis children undergoing MP + CMV, remained low values of eNOS, high activity NR and high levels of peroxynitrite. This indicates that the risk of relapse in the presence ofprecipitating factors. Inclusion in the complex therapeutic measures MP associated CMV, glycerol and anaferon contributed to the earlier normalization ofthe studied parameters. So, for the 10th day of treatment higher values NO-, NR and ONO O- under the influence of the proposed therapy significantly decreased in 1.34; 1.31 and 1.64 times as compared to baseline, in 1.1; 1, 14 and 1.8 times the performance of comparison group respectively. This positive trend will continue in the future, bringing the studied parameters to the values in healthy children, especially in the follow-up study.
Such dynamics of changes of indicators of nitrogen oxide under the influence of glycerol and anaferon coincided with positive dynamics of reduction of clinical manifesttations of pneumonia. According to some authors including anaferon activating antiviral immune system of children, helped to reduce the concentration ofvirus in the affected tissues. According to researchers, anaferon increases interferon production, their binding to the receptors that is essential for the body's defense against the virus. Basic pharmacotherapy MP + PIP + CMV to the 1st day of treatment has no significant effect on nitric oxide system. We noted a significant decrease in high-level NO. NO- and 1.14 and 1.37 times the original values. By the 30th days of the decline was 1.2 and 1.57 times, while the activity of eNOS was significantly increased by 1.26 times, the high activity of the NR declined to 1.42 times compare to baseline values. Despite the disappearance of the clinical manifestations of CAP in catamnesis in this group of children, changes in the indices of nitric oxide maintained: the level of NO and NO- exceed the normative values of 1.2 and 2 times the activity eNOS remained low at 1.27, the high activity of the NR 1.23 times. Inclusion in the complex therapeutic measures MP, associated herpesvirus infection, glycerol, anaferon and polyoxidonium helped to reduce NO, NR and ONOO- in 1.21; 1.3 and 1.57, increase the activity of eNOS by 1.33 times compared to baseline values. Even more pronounced positive changes we have seen in the 30 days of treatment: the value NO-, NR and ONOO-were lower than the comparison group of 1.1; 1.18 and 1.91 times, the activity of eNOS exceed 1.19 times. However, despite this,
Efficacy of laser therapy in infants with infectious-inflammatory respiratory diseases
the values of the above parameters were significantly different from the values of the control group children. However, despite this, the values of the above parameters were significantly different from the values of the control group children.
In our opinion, the intensification of anti-viral defense Anafer-on against the backdrop of a significant stimulation of the immune system with glycyron stimulate earlier elimination etiological factors, earlier regress of clinical manifestations of pneumonia and reduce the recurrence of the disease. Indeed, according to the literature data, glycyron activate killer cells, blood phagocytic function of blood, antibody production and cytokine production. Have detoxification properties of the drug is determined by its structure and high molecular weight contributes to the rapid elimination of exo-and endotoxins, increases the resistance of the cell membrane to the cytotoxic action of these substances. It can be said that the proposed
complex of therapeutic measures bacterial and viral pneumonia can significantly enhance the antibacterial and anti-virus protection in children, reduce the incidence of complications and relapses.
Based on these data, we can make the following conclusions:
1. In children with mycoplasma pneumonia associated with herpes infection, there is overproduction of nitric oxide and peroxynitrite-related activation of the inducible form of nitric oxide synthase. It appears more pronounced in patients with MP + HSV + CMV association.
2. During the basic treatment of the MP on the background ofherpes virus infection violations persist in the system of nitric oxide. Inclusion in the complex treatment viferon, especially polyoxidonium promotes earlier restoration of the balance of enzyme eNOS and iNOS, preventing the overproduction of nitric oxide and peroxynitrite.
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Tashmukhamedova Barno Erkinovna, Senior Research Fellow researcher of Tashkent Institute of Advanced Medical
Mukhamedova Hadicha Tulkunovna, Head of the Department of Neonatology, MD, Professor of Tashkent Institute of Advanced Medical E-mail: evovision@bk.ru
Efficacy of laser therapy in infants with infectious-inflammatory respiratory diseases
Abstract: The developed schemes and regimes for assigning the low-intensity laser therapy percutaneous approaches to optimize the therapy of infectious and inflammatory diseases of the respiratory tract in infants, reduce the incidence of complications and loss of physiological diseases, speed up recovery periods. Keywords: Respiratory diseases. infants, pneumonia, immune system.
Despite the fact that over the last decade in our country and the world have achieved significant progress in the diagnosis and treatment of infectious and inflammatory diseases of the respiratory system in infants, these diseases are still an acute problem not only pulmonology, pediatrics and as a whole. Thus, according to WOH, about 155 million cases of pneumonia in children in the world each year, with one killed about 1.4 million before the age of five years. Thus, this disease is one of the leading causes of child mortality worldwide [1; 2].
According to sample surveys in a number of cities on the stages of nursing infants, infectious diseases detected in 50-60 % of hospitalized children, preterm children — 70 %. Of these, up to 35 % of newborns come with purulent- inflammatory and other infectious diseases directly from maternity hospitals [3; 4].
Including 20 % of children pyo-inflammatory diseases are detected in the first 3-5 days after admission, which suggests their infection in the maternity hospital. Admission to the children's hospitals of the large number of infected infants poses a
