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A positive dynamics is observed in both groups after 2 months with regard to the blood lipids in patients with myocardial infarction, which is characterized by a decrease in total cholesterol (31 %, p < 0.01; 24.5 %, p < 0.01), triglycerides (19.5 %, p < 0.01; 20.0 %, p < 0.05), LDL (13 %, p < 0.05; 9 % uncertain (UC)).
On the 5th day of admission and after 2 months, all patients have undergone echocardiography. In Group 1 the index of end-systolic volume (ESV) was 89.41 ± 1.4 ml. and in Group 2 it was 87.07 ± 1.7 ml.; the index of end-diastolic volume (EDV) in Group 1 was 159.6 ± 2.101 ml. and in Group 2 it was 154.45 ± 2.161 ml.
The EF indicator in patients with acute myocardial infarction was 45.21 ± 0.54 (Group 1) and 46.14 ± 0.61 % (Group 2), no differences between the groups were detected. On the 2nd month of therapy in Groups 1 and 2 a significant uncertain reduction of EDV, ESV and increase in EF were observed.
The results analysis showed that both Normopress and Enala-pril lead to increase in serum basic NO metabolites in patients with AMI. Thus, after two months of treatment with Enalapril, the activity of NO complex in serum increased by 49 % (p > 0.05). While when taking Normopress, this indicator increased by 50.0 % (p > 0.05) in comparison with the initial value (fig. 3).
Group 1 NO, mcmol/1, before treatment ONOO, mcmol/1, before treatment Control Group
Fig. 3. Indicators of serum NO system in patients with AMI
However, the NO level in patients of both Groups remained significantly lower than in the control group. The reduction was identified in ONOO concentration by 29 % (p < 0.05) in the first group and by 11 % (p < 0.05) in the second group.
Thus, the 2 month therapy with Normopress and Enalapril, associated with the basic therapy has shown efficacy in the development
of regression of the pathological process, the increase in AOS, reducing the activity of lipid peroxidation process, reducing the fraction of atherogenic lipids, improvement of endothelial dysfunction and restoration of myocardial contractility. At the same time, our research revealed more pronounced and significant dynamics in patients with MI treated with Normopress.
References:
1. Эндотелиальная дисфункция при заболеваниях сердечно-сосудистой системы и методики ее коррекции/Е. Н. Ющук, Ф. Ю. Васюк, Б. А. Хадзегова и др.//Клин.фармакол. и терапия. - 2005. -№ 14. - С. 85-87.
2. Angiotensin II Type 2 Receptor-Mediated Vasodilatation in Human Coronary Microarteries/W. W. Batenburg, I. M. Garrelds, C.Ch.Ber-nasconi et al.//Circulation. -2004.- Vol.109. - P. 2296-2301.
3. Matchar D. B., McCrory D. C., Orlando L. A. et al. Systematic review: comparative effectiveness of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers for treating essential hypertension//Ann Int Med. - 2008. - 148: 16-29.
Teshabaeva Dilnavoz Abdihamidovna, Republican Specialized Scientific-Practical Medical Center of Dermatology and Venerology, Ministry of Health of the Republic of Uzbekistan, researcher E-mail: [email protected]
Clinical-microbiological parameters of the atopic dermatitis
Abstract: This report presents results of the study of clinical features of atopic dermatitis in 120 patients in relation to the character of contamination with staphylococcal flora on the skin of patients.
Keywords: atopic dermatitis, pathogenesis, clinical forms, staphylococcal flora, contamination.
The pathological changes in the skin, developing at the atopic decrease in quantity of other representatives of the normal micro-dermatitis (AD), result in favorite conditions for growth and devel- flora (propion bacteria, streptococci, gram negative microorgan-opment of the total number of microorganisms with predominant isms) [1; 3; 5; 6; 7; 8]. As a result the infectious agents have become staphylococcal flora (predominantly of Staphylococcus aureus) and active inductors of the strengthening of the immunopathological
Clinical-microbiological parameters of the atopic dermatitis
reactions, being resources of the paradox immune response that results in development of the severe resistant to therapy frequently relapsing forms of atopic dermatitis [1; 2; 4; 7].
Purpose
To study character of the clinical development of AD in relation to qualitative and quantitative compositions of the staphylococcal flora of the skin in the patients with AD.
Material and methods of research
Clinical methods: diagnosis of AD according to the criteria of J. Hanifin and G. Rajka (1980). Assessment of the severity degree of disease by index ACORAD (Severity Scoring of Atopic Dermatitis).
Microbiological methods were carried out with help of international standardized tests "Liofilchem" (Italy).
Statistical processing of the results was performed with use of the program of Statistica V.55A according to the criteria Shapiro-Willk (2006).
Results and discussion
On the basis of Clinic of RSSPMC D and V of MH RUz there were studied 120 patients with AD, of them males were 66 (53.0 %) and women — 54 (47.0 %) at the age of 4 to 71 years. Control group comprised 36 healthy subjects of the matching age.
The results of microbiological investigation showed that of 120 patients with AD in 96 (80 %) there were cultivated gram+ he-moorganotropic facultative-anaerobic bacteria from the series of Mycrococcaceae — Staphylococcus spp. on the skin in the focuses of lesions. The growth of staphylococcal flora was revealed in all clinical forms of disease, however mostly frequent at lichenoid (28.1 %) and pruriginous (23.9 %) forms of AD, while at the erythematous-squamous form — in 13.5 %, erythematous-squamous form with lichenification — 14.6 % and exudative — 19.8 %.
Determination of the proper type of Staphylococcus spp in the patients with AD showed that on the skin of the focuses of lesions there was noted growth of Staph. aureus in 58.3 % of cases, Staph. epydermidis — in 13.5 %, Staph. saprophyticus — in 12.5 %, Staph. haemolyticus — in 8.3 %, Staph. hominis — in 7.3 %. It is interesting that on the skin free from eruptions the growth of Staphylococcus spp. was in 55 (57.3 %) patients with AD, of them Staph. aureus — 51.7 %, Staph. epydermidis — 20.0 %, Staph. saprophyticus — 16.4 %, Staph. hominis — 7.3 %, Staph. haemolyticus — 3.6 %. In the control group of healthy persons the spectrum of Staphylococcus spp strain was as the following: Staph. epydermidis — in 13 (36.1 %), Staph. saprophyticus — in 15 (41.7 %), Staph. hominis — 5 (13.9 %), at the same time Staph.aureus was cultivated in 5.6 % of the studying subjects.
In dependence on the clinical form of AD the identification of the type of Staphylococcus spp was characterized by high growth of Staph.aureus in the patients with lichenoid and pruriginous forms — 32.1 % and 28.6 %, respectively.
Analysis of the parameters with regards to severity course ofAD (taking into account the index SCORAD) Staphylococcus spp in the patients with light form (to 50 numbers) was presented by Staph. aureus — in 7 (38.8 %), Staph. epydermidis — in 5 (27.8 %), Staph. haemolyticus — in 1 (5.6 %), Staph. saprophyticus — in
5 (27.8 %). At the moderate degree of severity (50-80 unmbers) the type spectrum of staphylococcus strain contained: Staph. aureus — in 32 (62.7 %), Staph. epydermidis — in 5 (9.8 %), Staph. haemolyticus — in 4 (7.8 %), Staph.hominis — in 3 (5.9 %), Staph. saprophyticus — in 6 (11.8 %) patients. However in the patients with severe development of atopic dermatitis (more than 80 numbers) there was found Staph. aureus — in 17 (62.9 %), Staph. haemolyticus — in 3 (11.1 %), Staph. hominis — in 3 (11.1 %), Staph. Saprophyticus — in 1 (3.7 %).
Study of the level of colonization with Staphylococcus spp. on the skin of patients with AD in the centers of lesions showed that colonization with Staph. aurus was maximum, on the average — 3129.4 ± 127.8 CFU/cm 2, Staph. hominis — 114.3 ± 12.2 CFU/cm 2, Staph. epydermidis — 1421.5 ± 215.6 CFU/cm 2, Staph. saprophyticus — 180.9 ± 40.4 CFU/cm 2. The increased colonization with staphylococcal microflora was also noted on the skin free from eruptions: Staph. aureus — 725.5 ± 12.2 CFU/cm2, Staph. hominis — 51.9 ± 10.8 CFU/cm 2, Staph. haemolyticus — 29.4 ± 5.1 CFU/cm2, Staph. Epydermidis — 25.2 ± 5.5 CFU/cm 2 and Staph. saprophyticus — 42.7 ± 9.4 CFU/cm 2, that was also differed reliably from features in the group of healthy subjects (P < 0.05).
The study of the character of colonization with Staph.au-reus in relation to the clinical form of AD, revealed high parameters of lichenoid and pruriginous forms of AD (3317.4 ± 239.7 and 3719.5 ± 144.5 CFU/cm 2, respectively). At the same time in erythematous-squamous forms of colonization accounted for 1930.4 ± 139.1 CFU/cm 2, in erythemaous-squamous form with lichenification — 2668.0 ± 229.5 CFU/cm 2, in exudative — 2760.0 ± 295.4 CFU/cm 2
The study of the colonization of skin in the patients with AD in dependence on the severity degree at the hard clinical course of AD showed the higher level of colonization with Staph. aureus — 3715.4 ± 135.8**CFU/cm 2 in comparison with moderate and mild stage of the process (3016.8 ± 172.5* CFU/cm 2 and 2088.5 ± 194.7 CFU/cm 2, respectively).
Conclusions
The results of the microbiological investigations showed that in spite of absence of the symptoms of secondary infection-ing (pustule, impetigo, folliculitis) in the patients with AD on the skin focal of the contamination in 58,3 % of cases there was found growth of microflora of series Micrococcacea — Staph.aureus with high level of colonization — 3129,4 ± 127,8 CFU/cm 2 The highest parameters of colonization were registered in lichenoid and pruriginous forms of AD (3317,4 ± 239,7 and 3719,5 ± 144,5 CFU/cm 2, respectively). In our opinion the contamination of the skin in the patients with AD with Staphylococcus spp explains the severity of course in these forms that was coincide with the parameters of SCORAD index.
The data obtained confirm significance of microbiological factors in the pathogenesis and clinical course of atopic dermatitis that requires development of pathogenetic approaches to the therapy of dermatosis with taking into account of microbiological status of the skin in patients with atopic dermatitis.
References:
1. Voronina V. R., Smolkin Yu. S., Chebirkin A. A. The role of mucous and bacterial flora of the skin in the pathogenesis of atopic dermatitis: Review//Wesnt. Dermatol. Venerol. - M., 2003. - 1: 16-19.
2. Korotkiy N. G., Tichomirova A. A., Belova A. V. Features of the development of the infectious processes and role ofbacterial superantigens in the formation ofvarious clinical-pathogenic variants ofatopic dermatitis in children. Pediatria after G. N. Speranskiy. - M., 2003. - 6: 26-32.
3. Mocronosova S. A., Maximova A. E., Baturo A. P., Fedorov S. M., Selisskiy G. D., Levin M. M. Role of skin colonization with Staphylococcus aureus for differential diagnosis of atopic dermatitis//Vestn. Dermatol. - 1997. - 5: 37-39.
4. Tekucheva A. B., Zayceva E. V., Arzumanyan V. G., Temper R. M. Monitoring ofthe staphylococcous microflora of the skin in patients with atopic dermatitis//Jurnal Vestnik dermatologii I venerologii. - Moscow, 2006. - 5: 69-72.
5. Abek D., Mempel M. Staphylococcus aureus colonization in atopic dermatitis and its therapeutic implications//Br. J. Dermatol. -1998. - 139: 13-16.
6. Matsui K., Nishikawa A., Suto H. et al. Comparative study of Staphylococcus aureus isolated from lesional and non-lesional skin of atopic dermatitis patients//Microbiol. Immunol. - 2000. - 11: 945-947.
7. Noble W. C. Scin bacteriology and the role of Staphylococcus aureus infection//Br. J. Dermatol. -1998. - 139: 9-12.
8. Takapan M. O., Kamar P. Role of staphylococcal superantigens in atopic dermatitis: from colonization in inflammation//Ann. Allergy Asthma Immunol. - 2000. - 84: 3-10.
Tulyaganova Nodirahon Malikovna, Assistant of Department child neurology, Tashkent Institute of Postgraduate Medical education, Uzbekistan
E-mail: [email protected]
Shamansurov Shaanvar Shamuradovich, Professor, Head of Department child neurology, Tashkent Institute of Postgraduate Medical education E-mail: [email protected]
Nazarova Sadokat Odilovna, Research scientist of Pediatric neurology department, Tashkent Institute of Postgraduate Medical Education E-mail: [email protected]
Shadybekova Oksana Borisovna, Doctor-laboratory assistant, Department of Molecular Medicine and Cell Technology Research, Institute of Hematology and Blood Transfusion MoH E-mail: [email protected]
Nasimov Sobir Tohirovich, Research scientist of child neurosurgery department, Republican Scientific Center for Emergency Medical Aid, Uzbekistan
E-mail: [email protected]
Hemorrhagic stroke in children: link between clinic-anamnestic data and hemostasis
Abstract: To conduct the correlation analysis between clinical and anamnestic data and indicators of the system of hemostasis of children who had a hemorrhagic stroke (HS).
Keywords: childhood stroke, etiology, hemostasis, hemorrhagic strokes, ischemic stroke.
Background
One of the major problems of neonatal and pediatric neurology is the Acute Cerebrovascular Accident (CVA) in neonates and infants children (from birth to 3 years). Over the past two decades, the world's attention is given to the group of a formidable cerebral pathology. There is a growing identification of strokes in infants and young children, but the questions of diagnosis and treatment require further improvements, as in present time, it is well known that there is multiple factorial cases of the stroke in this age category. Besides that, even greater difficulty is the lack of common approaches to the treatment required. Thus, in contrast to adults, where ischemic stroke (IS) makes 85 % and hemorrhagic strokes 15 % of children which are divided almost equally in to approximately 55 % of ischemic and 45 % of hemorrhagic strokes (HS) [8; 9]. The level of incidence rate varies depending on geographic location, country, nationality and way of life. As noted by Lynch J. K., Hirtz D. G., De Veber G., the incidence rate of stroke of children below 1 year in the USA is 7.8, in France —
about 13, and in older age is barely 2-3 person per 100 thousand of population annually [2; 6; 7].
Hemorrhagic strokes — is intracranial hemorrhage acquired due to changes in blood vessel malformations: anatomic changes of small perforating lentikulo-striatal arteries; saccular cerebral aneurysms; arteriovenous malformations (AVM); amyloid angiopathy; mikroangiomas; arteriovenous fistulas of the dura mater; Intracranial venous thrombosis; septic arteritis and mycotic cerebral aneurysms; carotid-cavernous fistula syndrome Moya-Moya [1; 2; 3; 9].
If we analyze the direct causes of death in the neonatal period, it is revealed that one of the most frequent complications of severe neonatal disease is trombohemorrhagic disorders. It was not enough researched backup capabilities of the system hemostasis especially in preterm infants, both in normal and in other various forms of pathology.
Hemostasis, its mechanisms, as well as the hemostatic system reaction to these or other etiological factors and risk factors, create
