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and rising of indicators of viscosity of a blood is noted at 28 (80%) the surveyed. At the same time at 7 persons (20%) results of researches corresponded to the indicators received at persons in group of the control. Besides, after a splenectomy observed augmentation of an index of aggregation of erythrocytes and an index of deformation of erythrocytes (p < 0,05). Undoubtedly, change of these indicators has led to development of disturbances of microcirculation which were clinically shown by development of vegeto-vascular disturbances (a headache, giddiness, rising of arterial pressure, a pain in the field of heart). Such complications are taped at 18 (31,5%) surveyed in the remote postoperative period.
Thus, the research carried out by us has shown that
at the patients who have transferred organ saving operations on a lien, it does not become perceptible disturbances of rheologic properties of a blood. While after a splenectomy added autolientranspolantation, in the remote period some changes in these indicators are noted. At patients after a splenectomy of change of indicators of viscosity of a blood are most expressed.
Conclusion. Changes of rheologic properties of a blood in the remote postoperative period, shown by rising ofviscosity of a blood at all rates of shift, are noted in 80% of cases after a splenectomy, in 45% — after auto-lientranspolantation and in 0,8% — after organ saving operations.
References:
1. Babich I. I. Chepurna G. and, Stepanov V. S. Treatment of the closed injuries of a spleen at children a splenektomiya in combination with geterotopichesky autoliyentransplantatsiy selezenochny fabric//Messenger of surgery of name I. I. Grekova, 1989. - № 2. - P. 93-96.
2. Gafarov O., Leontyev A. F. Senyakevich V. M. The immune status of children with extra hepatic portal hypertensia after a splenektomiya//Surgery, 1992. - № 11-12. - P. 68-72.
3. Kopystyansky N. R. O influence of a spleen on properties and function of platelets//Theses of reports of conference on fibrillation problems. - To tank, 1966. - P. 142-145.
4. Kurtov I. V. Otsenka of efficiency of methods of treatment idiopathic trombotsitopenichesky purples/Avftoreferat of the thesis ... candidate of medical sciences. - Ufa, 2000.
5. Savelyev V. S., Stupin I. V. Volkoyedov V. S. Perspektiva of use of a plasma scalpel in surgical practice//Surgery, 1986 - № 10 - P. 153-156.
6. Uraski U. Splenektomia w swiete wspoezecnych pogladow//Polski tigodnik lekarski, 1982. - Vol. 37. - P. 11091112.
Pasechnik Oksana Alexandrovna Omsk State Medical Academy of the Ministry of Healthcare
of the Russian Federation assistant professor of the epidemiological department E-mail: opasechnik@mail.ru Pitsenko Natalia Dmitrievna Omsk State Medical Academy of the Ministry of Healthcare
of the Russian Federation assistant professor of the epidemiological department E-mail: nata_pitsenko@mail.ru
The prevalence of secondary diseases of the HIV patients in the Omsk region: cross — sectional study
Abstract: The prevalence of secondary diseases of the HIV — infected patients who were under observation in medical organizations of Omsk region in 2013 has been studied. 16, 8% of HIV-infected patients had a wide spectrum of secondary diseases, mainly infectious etiology. In the structure of secondary infections the leading position was occupied by tuberculosis (32, 3%), candidiasis (24,4%), bacterial diseases (23,7%). The average risk of tuberculosis diseases is 24 cases for 1000 HIV-infected patients.
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Section 4. Medical science
Key words: HIV-infection, tuberculosis, tb hiv co-infection, HIV secondary diseases, population surveillance, Omsk region.
According to the statistics of the World Health Organization the region of Eastern Europe and Central Asia are characterized by the highest rate of increase of the HIV epidemic in the world and by the significant rate of deaths because ofAIDS. [1, 4-5]. Over a period from 2001 to 2012 the quantity of people having HIV in the countries of region has increased to 860 thousand and it was 1,4 million people [2, 9-10].
With decreasing immunity in HIV-infected patients begin to develop secondary disease. In the countries where the population is infected with mycobacterium tuberculosis, the basic secondary disease is tuberculosis [3, 202-203].
Like the majority of Siberian regions Omsk region has been characterized by a high level of the prevalence, incidence and mortality from tuberculosis infection for many years and also a tendency to increase the incidence of HIV- infection.
The aim of this research was to study the prevalence of secondary diseases of the HIV- infected patients and assessment of average risk of tuberculosis of the HIV-infected patients.
Materials and methods: the research was set on the territory of Omsk region of the Russian Federation. The Table 1. - Medical-demographic characters'
material of this research is based on the data of the federal state statistical observation «The information about the contingent of the HIV-infected patients» (F.№ 61), «The information about the TB patients» (F.№ 33) for
2013 year. The cross-sectional epidemiological study was set. The objects of the research were 4405 HIV- infected patients, who were under regular medical check-up in medical organizations of Omsk region qualifying date 1 January 2014 year. The observational descriptive methods of the epidemiological study were used in this work. The statistical data manipulation was carried out with the use of resources of Microsoft Excel.
Results and discussions: At the beginning of
2014 there were registered 7657 cases of HIV-infection among the population of Omsk region. The prevalence of HIV- infection among the population of the region was 387,4 per 100 thousand population. At the time of the study, HIV- infection was amazed 0,38% of the population of Omsk region, which corresponded to the concentrated stage of the epidemic.
There were 4405 HIV- infected patients under check-up and among them people over 18 years were 98,4%, were males — 60,2%, urban residents — 73,5% (table 1).
; of the HIV-infected patients of Omsk region
Characteristics N=4405 cases (abs) %
Age
0-7 47 1,06
8-14 6 0,18
15-17 16 0,36
18 and older 4336 98,4
Sex
males 2653 60,2
females 1752 39,8
Place of living
urban 3240 73,5
rural areas 1165 26,5
The clinical phase of HIV-infection disease
The phase of primary symptoms 800 18,1
Subclinical phase 2890 65,6
The phase of secondary diseases 709 16,1
Terminal phase 4 0,09
Phase not determined 2 0,04
The analysis of the distribution of the number of patients with HIV infection according to the degree of the disease progression showed, that 18,1% patients (n=800) has been the phase of primary symptoms, among them 37,1% (n=297) cases had an
acute disease and 17,7% (n=142) had the secondary diseases in that period. Asymptomatic disease course in the phase of primary symptoms (2A) was recognized in 45,1% cases (n=361). The subclinical phase of the HIV-infection, which is characterized by
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Секция 4. Медицина
a slow progression of immunodeficiency and by an excessive producing of the CD4+ lymphocytes had 65,6% (n=2890) cases.
On the stage of secondary diseases was diagnosed with 16,1% HIV-infected patients (n=709) among them: 4A stage with 80,95% (n=574), 4B with 15,2%
Table 2. - Secondary disea:
(n=108),4V with 3,8% (n=27). The terminal phase was found in 0,04% cases (n=4).
Latest stage diseases (4B, 4V, 5), which are characterized by severe immunodeficiency, development on the background of secondary diseases, had with 3,1% of HIV-infected patients (n=139). in patients with HIV infection
The name of the diseases The code number according to the ICD-10 Abs. %
Total B 20-B 22 744 100
Mycobacterial infection (tuberculosis) B 20 241 32,3
Other bacterial infections B 20.1 177 23,7
Cytomegalovirus infection B 20.2 8 1,07
Other viral infections B 20.3 92 12,3
Candidiasis B 20.4 182 24,4
Other mycosis B 20.5 22 2,95
The deployment of other infectious and parasitis infections B 20.6, B 20.8 4 0,53
Plural infections B 20.7 100 0,13
Malignant neoplasms, including: B 21 17 2,28
- Kaposi’s sarcoma B21.0 1
- Non-hodgkin’s lymphoma B 21.2 4
For early detection of secondary diseases were examined to 82,9% of HIV-infected patients (n=3656).
Among secondary diseases in HIV-infected patients 97,5% (n=726) cases was infectious and parasitic diseases. Malignant neoplasms was 2,28% (n=17) of cases (table 2).
The study of the structure of secondary infectious diseases showed that the leading position occupied mycobacterial infection (tuberculosis) 32,3% (n=241), candidiasis — 24,4% (n=182), bacterial infections — 23,7% (n=177) cases.
Tuberculosis deserves special attention among comorbidities in HIV-infected patients. Tuberculosis is characterized by the potential severity of disease, rapid progression and the need to use long specific antituberculosis therapy. In the structure of causes of death of HIV-infected percentage of tuberculosis is 19,2% of cases.
On the background of the increasing incidence of HIV infection in the Omsk region and the high prevalence of tuberculosis among the population there is a high risk of the occurrence of comorbidity.
The epidemic process oftuberculosis, co-infected with HIV in Omsk region for the period of 2004-2013 years had a marked tendency for the growth of morbidity having an average accession rate 14,7%. Co-infection of tuberculosis and HIV infection was among 253 patients, including 41,8% (106 cases) new cases detected in 2013.
In a cohort of HIV-infected individuals the prevalence of tuberculosis infection has reached
57,4 per 1000 population, which is 28 times higher than the prevalence of tuberculosis in the population of Omsk region. An average risk to get tuberculosis for the HIV- infected patients was 24 cases for 1000 HIV-infected, whereas the risk to get tuberculosis in the general population of Omsk region was 0,98 cases for 1000 population.
Tuberculosis of the HIV-infection people was set with the help of different screening methods. The largest share was accounted for by radiation methods — of 99,1% cases (n=3251), the method of microscopy was 9,1% (n=299), bacteriological method was 7,7% cases (n=255). The index of detectability of tuberculosis among the HIV- infection cohort was 29,8 for 1000 examined.
Chemo-prophylaxis oftuberculosis had got 177 HIV-infected patients that was 24,9% of the quantity of sick people who were in the phase of secondary diseases. Antiretroviral therapy was appointed to 641 HIV-infected patients that was 14,5% of the general quantity of individuals who were under medical control.
The pervasiveness of the viral hepatitus B and C was 316,2 for 1000 examined and besides in most cases the viral hepatitus C — 98,1% (n=2278) is registered. The viral hepatitus B was diagnosed less often that is probably connected with the vaccination and comparatively lower potential for chronization this infection.
The prevalence of the sexually-transmitted infections among the HIV-infected patients was 20,7 for
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Section 4. Medical science
1000 examined (n=152). The largest share among them occupied trichomoniasis (30,2%), chlamydia infection (21,0%) and genital herpes (29,6% cases).
Conclusions:
1. The HIV-infection epidemic in Omsk region was characterized by a further development and growth of the advanced stages of disease.
2. 16,8% HIV-infected patients was a wide range of secondary diseases, predominantly infectious etiology.
3. In the structure of secondary infections the leading role took place tuberculosis (32,3%), candidiasis (24,4%), bacterial infections (23,7%). The average risk of getting tuberculosis was 24 cases for 1000 HIV- infected patients.
4. The received results show the necessity of optimization of the approaches to the organization of the early diagnostics and prevention of secondary disease of the HIV- infected patients.
References:
1. Global report. UNAIDS report on the global AIDS epidemic 2013. UNAIDS, 2013. http://www.unaids. org/en/resources/campaigns/globalreport 2013.
2. European Centre for Disease Prevention and Control/WHO Regional Office for Europe. HIV/AIDS surveillance in Europe 2012. Stockholm: ECDC; 2012.
3. Getahun H, Gunneberg C, Granich R, Nunn P. HIV infection associated tuberculosis: The epidemiology and the response. Clinical Infectious Diseases: Synergistic Pandemics: Confronting the Global HIV and Tuberculosis Epidemics. 2010 May; 50 (3): 201-207.
4. Aksutina L. P., Pasechnik O. A. Approaches to the Management of the Epidemic Process in Terms Pathomorphosis Tuberculous Infection. Epidemiologija i vakcinoprofilaktika.2014; 2 (75): 16-20.
5. Borowski I. V., Tumensev A. T., Kalacheva G. A. Evolution of the epidemic process of HIV infection in the Siberian Federal District. Sibirskij medicinskij zhurnal.2014; 1:91-3.
Lebedenko Alexander Anatolyevich, Head of the Department of Childhood Diseases, Rostov State Medical University Nektarevskaya Julia Borisovna, Head of the Department of Foreign Languages with a course of Latin, Rostov State Medical University
Semernik Olga Evgenyevna, Assistant Professor of Childhood Diseases, Rostov State Medical University,
E-mail: semernick@mail.ru
The value of vascular endothelial growth factor in the diagnosis of cardiohaemodynamics disorders in children with asthma
Abstract: The authors found that the increasing of VEGF concentration in the serum of children with asthma is a poor prognostic factor, indicating the activation of neoangiogenesis processes and the formation of pulmonary hypertension.
Keywords: asthma, children, vascular endothelial growth factor, cardiohaemodynamics disorders
Introduction. Asthma is one of the most common childhood diseases, often leading to the formation of pulmonary hypertension (PH), the development of «pulmonary» heart and patients disability [1]. The formation of PH in patients with chronic lung disease is always associated with structural changes of the vascular bed — with remodeling of the pulmonary vessels being characterized by a medial layer proliferation, migration
and proliferation of smooth muscle cells into the intima, fibroelastosis of intima and thickening of the adventitia [2, 3]. However, remodeling of pulmonary arteries occurs not only in the advanced stages of the disease but also in the early stages of pathology development. Vascular endothelial growth factor (VEGF) may be one of the most informative factors reflecting the initial microcirculation changes [4].
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