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until the fusion of the bone fragments. Also, it reduces the load on the fracture site when the patient walks.
Conducting the early osteosynthesis oflong bones by the external fixation device in case ofmultiple and associated injuries has allowed the general stabilization ofthe patients and the early development ofmove-ments in adjacent joints. Also it prevents the appearance of hematoma at the fracture site and promoted the fusion of bone fragments. Rigid stabilization ofbone fragments eliminated the pain in the affected limbs, which contributed the early activation of patients and prevention of secondary complications and restore the anatomy of the affected limb.
Conclusion
The designed apparatus of transosseus osteosynthesis of long bone fractures based on rod mechanism of the known modern locks may be the method of choice in case of multiple injuries.
The use of the rod system for the patients with multiple and associated injuries allows to achieve the general stabilization ofpatients and early development of the movements in adjacent joints. The rod device helps to manage the displacement of bone fragments and provides a rigid fixation in the period of fusion, maintaining the joint function and it may widely used in traumatology and orthopedics.
References:
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12. Theddy Slongo, M.D, Timo Schmid M.D., KayeWilkins, DVM, MD, and Alexander Joeris, MD. Lateral external fixation for di splaced unreducible supracondylar humeral fractures in children. The journal of bone & Joint surgery volume 90-a d number 8 d august -
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DOI: http://dx.doi.org/10.20534/ESR-16-11.12-63-66
Lim Maksim Viacheslavovich, Samarkand State Medical Institute Assistant Professor, Department of Children's Diseases № 1 E-mail: korisarimi@gmail.com Shavazi Nurali Mamedovich, Samarkand State Medical Institute Professor, Chief of Department of Children's Diseases № 1 E-mail: korisarimi@gmail.com
The combined use of acetylcysteine and 3% of sodium chloride in the nebulizer therapy of acute bronchiolitis
Abstract: Aim: to assess the effectiveness of the combined use of 10% acetylcysteine and 3% of sodium chloride in the nebulizer therapy of acute bronchiolitis in infants. 82 patients with acute bronchiolitis have been examined. In the I control group there were 21 patients who received traditional therapy, patients of the II-IV groups have received nebulizer therapy with
different medications: in the II group 21 patients received 10% acetylcysteine, in the III group 20 patients received 3% sodium chloride, in the IV group 20 patients received 10% acetylcysteine and 3% sodium chloride. In the IV group of patients we examined a reliable improvement of cough, sputum, indexes of saturation — scale assessment (SSA), duration of hospitalization and oxygenation not only in the comparison with the control group, but also in the comparison with II-IV groups (P<0,05; P<0,01; P<0,001). Combined nebulizer therapy with use of 10% solution of acetylcysteine and 3% solution of sodium chloride can be recommended for the treatment of children with acute bronchiolitis.
Keywords: acetylcysteine, 3% sodium chloride, children, combined therapy, nebulizer therapy, acute bronchiolitis.
Introduction. It is known that in the genesis of bronchial obstruction in children is based on different pathogenetic mechanisms (bronchospasm, inflammatory infiltration, mucociliary insufficiency, hypersecretion of viscous mucus), leading to changes in the quantity and rheological properties of sputum, disorders of drainage function of bronchi — mucostasis [1, 7].
The main therapeutic measures at the syndrome of acute bronchial obstruction in children aimed at the reduction or relief of infectious-inflammatory edema, bronchospasm, and ensure adequate oxygenation of the blood [3].
A number of studies show ineffectiveness sympathomimetic medications in young children with broncho-obstructive syndrome due to the weak development of the bronchial muscles, as well as due to the bronchial obstruction with swelling of the mucous membrane and thick difficult separated mucous secret in this age [11].
Nebulized inhalation ofhypertonic sodium chloride solutions in the complex treatment of bronchiolitis in children, allowing to reduce the time of the disease have been offered in the present time [9]. Application acetylcysteine in the broncho-obstructive syndrome in children leads to depolarization mucoproteins, helps to decrease mucus viscosity and facilitates removal from the bronchial tract [2; 4; 6].
In recent years, perspective trend in therapy is the combined use of not only multi-directional drugs, but also drugs of complementary action [8].
There are studies of nebulized inhalation bronhiolitics (ventolin, epinephrine), together with hypertonic solutions of sodium chloride in the treatment of bronchiolitis, leading to a decrease in the duration of hospital treatment for bronchiolitis in children of the first six months of life [10]. It is noted that the combined drugs affecting on the several mechanisms of mucosta-sis is insufficient.
In this case, it is considered necessary to study the effectiveness of the combined use of acetylcysteine and hypertonic sodium chloride solution in the nebulizer treatment of acute bronchiolitis in infants.
The aim was to evaluate the efficacy of combined use 10% of acetylcysteine and 3% of sodium chloride in the inhalation treatment of acute bronchiolitis in infants.
Materials and methods of investigation. We observed young children (from 6 months to 3 years old) with acute bronchiolitis who were hospitalized in the pediatric emergency departments and pediatric intensive care units of SBRSCEMC. Admission criteria were as follows: age before 3 months, assessment due to RDAI scale > 6 points, assessment due to SSA scale > 7 points, a high risk of the disease complications, the absence of home treatment effect for > 48 hours, unfavorable premorbid background and the presence of comorbidities. The carried out investigation was corresponded to prospective randomized controlled design.
Exclusion criteria of patients from the observation groups were as follows: chronic (hereditary) diseases of respiratory system and congenital heart malformations.
In the course of our scientific research it was examined 85 infants with acute bronchiolitis who corresponded to the inclusion criteria, 3 patients were excluded: in 1 child was diagnosed chronic
obstructive bronchitis, in 2 patients were diagnosed congenital heart malformations. As a result, 82 patients were enrolled in the study.
All patients by the use of randomized method were divided into 4 groups. 21 patients who received traditional therapies with oral ambroxol have included in I group (control group). Patients of II-IV groups were also received traditional treatment in combination with a particular medication. In the II group it has been included 21 patients treated with inhalation of 10% acetylcysteine solution through compression nebulizer. 20 patients treated with inhalation of 3% sodium chloride solution through compression nebulizer have in the III group. In the IV group it has been included 20 patients treated with a 10% solution of acetylcysteine and 3% sodium chloride solution through compression nebulizer. Acetylcysteine dosage was 15 mg/kg, the drug is diluted in 5 mL of 0.9% sodium chloride solution. Dosage of sodium chloride was 0.5 ml/kg of body weight. Inhalation therapy was conducted 3 times a day at intervals of 8 hours for 4-5 days.
The severity of the cough reflex was assessed by the point system: 0 points — no cough, 1 point — a single cough, 2 points -moderately expressed cough and 3 points — frequent, painful cough and sputum discharge severity was assessed on a scale of 0 points — the sputum is absent, 1 point — discharge easily, 2 points -heavily discharge and 3 points — does not discharge.
Assessment of the effectiveness of the performed therapy along with clinical and laboratory — instrumental methods of investigation have been carried out by the use of SSA — saturation-scale assessment which was developed by us and calculated with using the following formula: SSA = (95-SpO2) + RDAI [5].
As additional criteria for the effectiveness of the treatment, the duration of oxygen therapy and the duration of hospitalizations have been studied. The general condition of the patient was assessed both due to studied parameters, and due to the results of the general daily examinations before and in 60 minutes after the nebulizer therapy.
The results of investigation. On admission, the boys were — 44 (53.7%), girls — 38 (46.3%), the average age was 9,0±1,1 months, patients hospitalized in the department on the 2,4±0,3 day of the disease.
The dynamics of the cough reflex intensity (Figure 1) shows that in patients of all examined groups, there was improvement of symptoms (in points) in the background of the performed therapy. So, on the 1-3 days it has been occurred the enhancement of cough reflex associated with clinical features of the disease and on the 4th day the improvement of such symptom was observed. Thus, the comparative effectiveness of nebulizer application both in isolation of 10% solution of acetylcysteine and 3% sodium chloride solution (II and III group) and their combination use (IV group) as compared with oral administration of ambroxol was significantly observed an average on 3 (2 2±0,2 in the control group, 1.6±0,2 in group IV; P<0.05), 5 (1,7±0,1 in the control group, 1,1±0,1 in group II, 1,2±0,1 in group III, 0,9±0,1 in group IV; P<0.01, P<0,05, P<0,001), and 8 (1,4±0,2 in the control group, 0,8±0,1 in group II, 0,9±0,1 in group III, 0,6±0,1 in group IV; P<0.01, P<0,05, P<0.001) days of observation.
group ill group iv group Figure 1. Dynamic of cough reflex in patients of I — IV groups
Figure 2. Dynamic of sputum discharge in patients of I — IV groups
It was found that during admission to hospital the sputum was heavily discharged with varying severity of coughing, but starting from 3 days of mucolytic therapy in most patients «productive» cough with sputum discharge was examined. It has been determined a significant advantage of nebulizer therapy in the II-IV groups over the control group with oral use of ambroxol, which was demonstrated on average in 5-8 days of follow-up (P<0.05, P<0,01, P<0,001).
Table 1. - The dynamic of indexes of saturation — scale assessment of the observed groups
Groups Day 1 Day 2 Day 3 Day 4 Day 6 Day 8
I group (control) 13,0±1,0 10,2±0,8 8,9±0,6 6,8±0,5 4,6±0,3 1,9±0,1
II group 13,2±1,1 9,8±0,7 7,5±0,4* 5,5±0,4* 1,8±0,1*** 0,6±0,1***
III group 12,7±0,9 8,3±0,5* 6,3±0,4** 5,1±0,4** 3,4±0,3** 0,9±0,1***
IV group 13,1±0,8 7,8±0,5** A 5,3±0,3*** A, # 3,8±0,3***, A, # 1,1±0,1***, a, # 0,4±0,1***, #
Note: * - P<0,05, ** - P<0,01, *** - P<0,001 - reliability of differences in the comparison with II-IV and control groups, A - reliability of differences between II and IV groups, # - reliability of differences between III and IV groups.
The study of the dynamics SSA indexes (table 1) shows that in patients of II-IV groups who received nebulizer therapy by 10% solution of acetylcysteine and 3% solution sodium chloride have been observed more significant clinical-laboratory effect, compared with patients of the control group. There was a significant difference in improving the clinical symptoms of bronchial obstruction between the patients of II-III groups and IV group, which was
observed on average from 2-3 days of therapy, reaching its peak at 5-6 days. The combined use of 10% acetylcysteine and 3% of sodium chloride reduces mucosal edema; improve drainage properties and decrease formation of mucus in the bronchus of medium and small caliber, at the same time eliminating the most important links in the pathogenesis of bronchial obstruction.
Table 2. - Duration of hospitalization and performed oxygen therapy in patients of I-IV groups
Criterion I group II group III group IV group
Duration of hospitalization (days) 7,0±0,4 5,8±0,3* 6,0±0,3* 4,9±0,3***, A, #
Duration of oxygen therapy (days) 4,7±0,3 3,8±0,3* 3,4±0,3** 3,1±0,2***, a
Note: * - P<0,05, ** - P<0,01, *** - P<0,001 - reliability of differences in the comparison with II-IV and control groups, a - reliability of differences between II and IV groups, # - reliability of differences between III and IV groups.
Combined use 10% solution of acetylcysteine and 3% solution of sodium chloride as an nebulizer inhalation resulted in a significant decrease in duration of oxygen therapy, shortening of hospital treatment of patients on average for 2.1 bed-days in patients of IV group compared with the control group, and for 0,9 and 1,1 bed-days compared with II and III groups respectively (table 2).
Nebulizer therapy 10% solution of acetylcysteine and 3% sodium of chloride solution in this study was not associated with significant
adverse side effects, which corresponded to a sufficient level of the drug safety.
Conclusion. Thus, the combined use of a nebulizer inhalations of 10% solution of acetylcysteine and 3% solution of sodium chloride in comparison with the isolated use ofmedications is an effective method of complex treatment of acute bronchiolitis in infants, promotes the improvement of patency and decreases edema of airways, the intensity and duration of cough, decrease sputum viscosity, reduce the duration of oxygen therapy and periods of hospital treatment.
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DOI: http://dx.doi.org/10.20534/ESR-16-11.12-66-69
Mirzakarimov Bahrom Halimjonovitch, PhD, Andizhan State Medical Institute Lecturer, the department of pediatric surgery E-mail: baxromjon73@gmail.com Yulchiev Karimjon Salimjonovitch, Andizhan State Medical Institute Senior researcher, the department of pediatric surgery E-mail: chtoubib@rambler.ru Djumaboev Jurakul Usmanovitch, PhD, Andizhan State Medical Institute Lecturer, the department of pediatric surgery E-mail: djumabayevju@mail.ru Toshboev Sherzod Olimovich, PhD, Andizhan State Medical Institute Lecturer, the department of pediatric surgery E-mail: shertoshboev@gmail.com Haydarov Nodir Sarviddinovich, graduate student of Andijan State Medical Institute
New technologies in the treatment of congenital chest deformities of in children
Abstract: Malformation of the thorax in children are serious diseases that pose serious difficulties for the correction. This paper presents the authors developed methods of surgical treatment of children with different variants of the funnel and keeled
