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Biomarkers the forecasts are based on purulent-septic conditions in the postpartum period
tic infections in group 1 was detected in 27,8 of cases, and in group 2 was not possible.
These results demonstrate the comparability of treatment groups, the ratio of both unions, and seeded on the contents of the sheath main types of microorganisms.
Doing opinion on the above results, it would point to the diversity of microbiological pathogens landscape PSD and that timely diagnosis of pathogens along with other diagnostic methods can help reduce rates and improve the ef ciency of therapy.
The study allowed us to estimate the nature and extent of infection with inflammatory processes in childbirth and the postpartum period.
The literature shows the high frequency of infection of the birth canal and endometrium-specific (Chi. Trachomatis, M. Genitalium, U.urealiticum, Herpes virus and Cytomegalovirus) agents, and is set to a non-specific uslovnopa-patho-genicity coccal flora (Staphylococcus epidermidis, Staphylococcus aureus, Enterococcus faecalis) as the main etiological factors of inflammatory complications in the puerperium. The role of anaerobic and viral infections should be considered when selecting antibacterial and antiviral therapy in the event of complications [4; 6].
In the absence of clinical effect and worsening laboratory parameters within 48 hours from the start of therapy, added another antibiotic, often by the time the results were ready bacterial seeding, we added to the use of antibiotics or other substitutes for all antibiotics.
They were mostly of the fluoroquinolone drugs or aminoglycoside series with 4-generation cephalosporins, and viral lesions added antiviral drugs.
In group 1, which sought to provide treatment to all patients, referring to the study of bacterial and immunenzyme analysis diagnostic data, resulting in comparison with patients in group 2, remission septic complications advanced on 24-78 or more hours earlier than in the group where for various reasons, were treated without or with a delay of bacterial seeding.
Conclusion.
Determination of microbial landscape of the maj or strains of septic states in integration tests early di agnostics allow readings to review and, if necessary, to determine the timing of termination of pregnancy, and when the patient arrives at the hospital with the PSD, define the starting antibiotic therapy, which is the main obstacle generalization of infection which leads to a reduction in length of stay in hospital.
References:
1. Abramchenko VV., Kostyuchek D.F., Hadjiev E.J. Purulent-septic infection in obstetrics and gynecology. - SPb., 2005. - 460 p.
2. Baev O.R., Strizhakov A.N. ,Davydov A.I. Infectious complications of cesarean section. Modern principles of diagnosis and treatment policy//Mat.1H th All-Russia. Scientific Forum "Mother and Child". - M., 2007. - P. 17-18.
3. Gurtovoiy B.L., Kulakov V.I., Voropaeva S.D. Antibiotic use in obstetrics and reduce GSE among postpartum women//Mat. X jubilee All-Russian. scientific. Forum "Mother and Child". - M., 2009. - S. 60.
4. Atanesyan E.G. Features diagnosis of bacterial infections in women with miscarriage//Mat. XIII All-Russian-anniversary. scientific. Forum "Mother and Child". -M., 2012.- 12 pp.
5. Egoricheva S.D., Avchinnikov A.V., Mokrousov I.V Nosocomial infections in maternity homes: etiology, epidemiology and prevention (Review). - Efferentnaya Therapy. -2005. -T.11. -№ 1. -S.63-69.
6. Roberts J. M. Preeclampsia: What we know and what we do not know//Semin.Perinatol. - 2000. - Vol.24. - № 1. - P. 24-28.
7. Wutzler P., Sauerbrei A. Infections during pregnancy//Contrib. Microbiol. - 1999. -Vol. 3, № 4. -P. 141-149.
Muminova Nigora Hairitdinovna, Associate Professor of the Tashkent Institute of postgraduate training of doctors, Republic of Uzbekistan E-mail: evovision@bk.ru
Biomarkers the forecasts are based on purulent-septic conditions in the postpartum period
Abstact: TNF-a according characterizes the degree of generalization of infection and the main marker for monitoring the course of the inflammatory process. In our studies, it was 2 times larger than the data of the control group. High concentrations of serum TNF-a, along with IL-6 and IL-8 testify to high risk of development of sepsis. Keywords: Biomarker, purulent-septic, postpartum period.
In the pathogenesis of pyo-septic diseases (PSD) preg- system, in particular the content of a number of cytokines nant are important changes in the reactivity of the immune on systemic and local levels [1; 2; 7; 9]. Of great interest are
Section 7. Medical science
the results of a study of pro- and anti-inflammatory cytokines and the possibility of using these data for diagnosis and treatment in obstetrics PSD [2; 13; 12; 14].
Purpose of the study.
Study parameters proinflammatory cytokines IL-6, IL-8, TNF-a and anti — inflammatory cytokine IL-4 in the sera of patients as a possible test for determining the degree of risk of infection, as well as their interconnection.
Material and methods.
A total of 65 women surveyed, communities, 45 of them with purulent-septic conditions and 27 healthy. Of the 45 women of the main group of births resulted in 22 (48.9%) after vaginal delivery, cesarean section done 23 (51.1%). In the control group in 22 (81.5%) were spontaneous labor, 5 (18.5%) — caesarean section.
To determine the level of cytokines in the serum used enzyme-linked immunenzyme method (EIA). The results were subjected to statistical analysis using applications Excel.
Results and discussion. Group 1-patients we are seeing a high concentration of serum cytokine IL-6, which has increased 19 times (38,6 ± 3,71) (P <0,001) in comparison with those in the control group, amounting to an average of 2,7±0,13. In the analysis in 45 women with none were not a result of normal, in contrast to the 8 samples were within 103pg/ml, which is 50 times the data- healthy women
The concentration of IL-8 was 43,4 ± 7,725pg/ml (P <0,001), exceeding 6 times more than in the control group, where health indicators wives communities were within 6,9 ± 0,25 pg/ml.
The concentration of serum TNF-a levels were on average only 2 times higher than the control group, amounting to 13,1 ± 1,47 pg/ml (P <0,001). At 7 serum samples of patients with PSD index was above 37.5 pg/ml in the two samples above 15 pg/ml, the rest within 9-13 pg/ml.
Taking into account that IL-4 being inflammatory cytokine, its concentration also along with pro-inflammatory cytokines, we significantly increased up to 28,7 ± 0,82 pg/ml (P <0,001) and 8.7 pg/l greater than the data of the control group (20,2 ± 0,38). Of the 45 samples from 17 patients with pyo-septic diseases IL-4 values were high, averaging 34.5 pg/ml, 14 within 25,5-27,8 pg/ml, the rest was in the same range of values as in healthy women.
Currently, there is a look at the following immunomodu-lating reactions in response to the introduction of the infectious agent. Initially marked local reaction immunity. Increased levels of proinflammatory cytokines at the site of inflammation, then compensatory increases the concentration of antiinflammatory agents. Furthermore, if local damage are severe enough, there is a significant increase in pro-inflammatory agents and their penetration into the blood. At the level of the whole organism proinflammatory cytokines mobilize the action of all authorities to fight the infection by activating the production of non-specific anti-inflammatory agents, occurring in the first 1-2 days, later supplemented by the activation of anti-inflammatory agents and achieved the balance of these
systems, as was observed in our study, where at increasing concentrations of serum cytokines IL-6,8, TNF-a, raised IL-4.
Analysis of the data showed that initially appeared as a high level of pro-inflammatory cytokines IL-6, IL- 8 and TNF in all patients, indicating the presence of an infectious process expressed in the body, capable of generalization of inflammation.
TNF-a according to some authors [2; 6; 9] characterizes the degree of generalization of infection and the main marker for monitoring the course of the inflammatory process. In our studies, it was 2 times larger than the data of the control group. High concentrations of serum TNF-a, along with IL-6 and IL-8 in 7 samples coincided with the PSD clinic patients postpartum period, where he was diagnosed with sepsis or sepsis syndrome is the presence of 2 or 3 multiple organ disorders.
The immune system of the organism in addition to producing the activating cytokines also starts to produce serum cytokine IL-4,, the average content of which was 28,7 ± 0,82 pg/ml (P <0,001). High concentrations of IL-4, in contrast to the pro-inflammatory cytokines restrict dissemination of the immune response to, on the one hand, to inactivate the foreign agent, and the other — to prevent development of septic shock and autoimmune pathological reactions, which coincides with the literature [12; 14] that It observed in 33 samples where clinically ill received in the initial stages of SIRS only insignificant-tive changes in the uterus.
In such cases, the appropriate response of the immune system (with a timely combination therapy with immunomodulators) in response to an inflammatory process of the activation of pro-inflammatory cytokines that occurs in the first 1-2 days, later supplemented by the activation of anti-inflammatory agents, and reaches equilibrium of those systems. In our studies, in the 27 samples were also obtained high concentration of serum IL-4, which relates to anti-inflammatory cytokines.
Initially, the high concentration of IL-4 testified prosperous during the inflammatory process, without the generalization of infection.
In 3 cases where the rates of IL-6 and IL-8 were high but serum concentration of TNF-a and IL-4, low, clinically matched picture of septic shock and further generalization of infection, because the excessive increase in the activity of proinflammatory cytokines and the absence of effective opposition from the anti-inflammatory agents quickly (which can happen with immunodeficiency), for 1 to 2 days increases the severity of systemic reactions to inflammation, which develop into more severe forms of the GSS, which also coincided with the investigations of a number of authors [12; 13].
Our data demonstrate significant relationship between elevated serum levels of IL-6 and IL-8 and outcome of the disease: during the entire period of observation at a concentration of not surviving patients remained consistently high,
