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DOI: http://dx.doi.org/10.20534/ESR-17-1.2-56-57
Juraeva Zuhra Yorievna, PhD, Associate Professor of the Department of Hospital of Pediatrics Tashkent Pediatric Medical Institute, Tashkent Uzbekistan E-mail: [email protected]
Comparative analysis of the immune system at often and rarely ill children depending on the stage of disease
Abstract: The article is devoted to the study of the immune system (IS) and cytokine sta-tus in frequently ill children (FIC) in the acute phase and remission in comparison with rarely ill with children (RIC). The immune status in these children not infrequently formed were tran-siently response by Th2-type by hyperproduction of IL-4 and IL-1fi, stimulating high production of IgE by B lymphocytes IgA against decrease synthesis.
Keywords: children, immune system, cytokine status, respiratory diseases, immune cells.
Problem defeat limfoadenoid pharyngeal ring Pirogov-Waldey-er from FIC is relevant, sin-ce this tissue is morphofunctional substrate local immunity. In terms of lymphoid tissue hyperp-lasia and concomitant chronic exudative-proliferative inflammatory viral infection begins to ex-hibit the properties of the trigger, inducing infectious-dependent immunopathological condition, as well as autoimmune reactions, often manifested by at FIC [1-3].
Recent studies have shown that FIC even during clinical well-being and the absence of signs of ARI identifies distinct changes in cell-cell interactions in the immune system: signify-cantly increased the content of pro-inflammatory interleukins (IL-2, IL-4), including interleu-kins involved in chronic inflammation (IL-6, IL-8). This is accompanied by a decrease in cell cytotoxicity and increased levels disimmunoglobulinemia cells expressing receptors that induce apoptosis. In this regard, we have been set a target [4-7].
The purpose: To examine the performance of the immune system in FIC and RIC, depending on the stage of the disease in a comparative perspective.
Materials and methods. We carried out a study on the state of the immune system in children surveyed, depending on the stage of the disease (remission and relapse stage): In the group of FIC, the number of children was 28, whereas in the group (RIC) — 20.
Criteria for selection of children in the FIC group formulated in 1986 and VYu.Albitski A. A. Baranov.
• up to a year — 4 and more;
• up to 3 years — 6or more;
• 4-5 years — 5or more;
• Over 5 years — 4 and more.
This takes into account SARS, and exacerbation of chronic diseases of ENT — organs and respiratory tract (I. E. Elagina, M. R. Bogomilsky, 2004).
Immunological studies were performed at the Institute of Immunology of the Academy of Sciences of Uzbekistan. The main parameters of cellular and humoral immunity was determined by identifying the cell surface cluster of differentiation of CD3, CD4, CD8, CD16, CD19 with monoclonal antibodies Series LT (LLC ""Sorbent Service", Russia). The study of the concent-ration of serum immunoglobulin A, M, G in peripheral blood was performed according to the method Mancini G. et al (1965). Levels of cytokines (IL- 1b, IL-4 and TNFa), IgE and sIgA in nasal washes were determined by ELISA (cytokines produced by "Cytokine", St.-Petersburg). Statistical analysis of the data obtained by the methods of variation statistics, Fischer-Student
Results and discussion. The next stage of our work was to study the above immune-logical parameters, depending on the stage of the underlying disease.
Analysis of the data showed a significant difference, as in the period of exacerbation and remission in level CD3+-lymphocytes in sickly children compared to those suffering from rare (P<0,05). Also, a significant difference was observed in the reduction of
Comparative analysis of the immune system at often and rarely ill children depending on the stage of disease
CD4+-lymphocytes in sickly children in the acute phase (P<0,01). The smallest number of T-suppressor cells defined in the acute stage at FIC, but fluctuations are unreliable, that still caused significant reduction in the immunoregulatory index in the group. In the group of FIC in remission as a decline of the index, but compared to the RIC data unreliable.
In studying the factors of nonspecific protection significant difference of all parameters in the acute phase and in remission from frequent and prolonged ill children. Thus, the level of natural killer cells in the group of FIC in the acute stage was 18,0 ± 1,1%, and in remission — 13,9 ± 0,7% in comparison with the group RIC — 14,3 ± 1,0% and 11, 2 ± 0,7%, respectively (P<0,05).
Data analysis of the phagocyte activity of neutrophils showed that in the period of acute level of phagocytosis was significantly reduced, both in the group RIC, and in the FIC group (54,5 ± 1,2% vs 50,7 ± 1,1%, p <0.05 and 48,3 ± 1,2% vs 43,6 ± 0,9%; p<0,05). Rate increase was observed in the content of B cells (P<0,05).
Revealed that the FIC with concomitant ENT pathology shows signs disimmunoglobulin-emia with higher levels of IgG, and a significant decrease in the concenration of IgA, IgM more pronounced in the acute stage of the basic pathological process.
In particular, the level of IgG group FIC in the acute stage was 1420 ± 38mg%, and in remission — 1160 ± 22 mg% in comparison with the group RBD — 930 ± 19 mg% and 1050 ± 25 mg%, respectively, (P<0.01-0.001). It should be noted marked decrease secretion of IgA in the acute stage at FIC, P<0,01. In other words, the spread of inflammation to the lymphoid tissue of the upper respiratory tract is associated with severe proliferative IgA, indicating mobilization of reserve capacity of local immunity in chronic inflammation.
With frequent acute respiratory epithelial damage the respiratory tract gets receptor hy-persensitivity to external influences. In the immune status of these children are often transiently formed response to Th2-type with overproduction of IL-4 and IL-1fi, enabling high production of B-lymphocytes against decrease in IgE synthesis of IgA.
In our study showed a significant decrease in IL-1^ in the acute stage at FIC, P <0,05, and in remission on the contrary increase that is more than 2-fold compared with a group of children suffering from rare, P <0,05. The level of IL-4 in sickly children during episodes of exacerbation was significantly increased (18,1 ± 2,4 pg/ml vs 13,5 ± 1,6 pg/ml in the RIC, P <0.05).
A similar trend is observed in the study of the level of TNFa. Progressive dynamics increasing concentrations of IL-4, TNFa in the serum of sickly children in the acute phase of the basic pathological process is associated with a more pronounced effect of the exposure of fre-quent and complicated by recurrent episodes of infection of the upper respiratory tract for a long time
Thus, the FIC is a problem that has not only medical, but also the socio-economic aspect, which requires a comprehensive approach to deal with it in the implementation of therapeutic, rehabilitative and preventive measures for the FIC.
Conclusions:
1. Depending on the stage of the underlying disease revealed significant differences, both in acute and in remission. The level of CD3+, CD4+ lymphocytes, phagocyte activity of neutrophils and immunoregulatory index in frequently ill children in the acute stage in 1,2 times less (P<0,05), than compared to remission, and the level of natural killer cells in 1,4 times in both groups in the acute stage.
2. FIC with concomitant ENT pathology detected signs dis-immunoglobulinemia with higher levels of IgG indicating the long antigenemia and chronic intoxication, and a significant decrease in the concentration of IgA, IgM.
3. A significant decrease in the level of IL-1p in the acute stage, the FIC, while in remission on the contrary increase that is more than 2 times in comparison with a group of RIC. The level of IL-4 and TNFa in FIC during exacerbation episodes was significantly increased. Progressive dynamics up concentration IL-4, TNFa in the blood serum of FIC acute stage pri-mary pathological process associated with a more pronounced influence of the exposure to frequent and complicated process infectious relapse episodes ofupper respiratory tract for a pro-longed time.
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DOI: http://dx.doi.org/10.20534/ESR-17-1.2-58-64
Zayniddin Norman ugli, c. m.s., postgraduate student, Yakkasaray Medical Corporation of CMC Polyclinic and In-Patient Hospital Department
of the Vascular Surgery, acad. V. Vakhidov Republican Specialized Center of Surgery.
The Republic of Uzbekistan E-mail: [email protected] Bakhriddinov F.Sh., professor, Head of the Department of Vascular Surgery, acad. V. Vakhidov Republican Specialized Center of Surgery
The Republic of Uzbekistan
Optimization of the surgical tactics in difficult localizations of vascular injury consequences
Abstract: The study of problem shows that for today such aspects as clinical picture, diagnosis, methods of surgical treatment and their consequences in the difficult localization of vascular injuries (aneurisms and fistulas) have been studied insufficiently well. We performed 45 surgeries in patients with TAA and TAVF. Of them 28 (62,2%) patients with TAA; 17 (37,7%) patients with TAVF. Before their admission to our center they were performed primary surgical debridement (PSD) of the wounds in the regional hospitals. The examination of the patients showed that there was not kept up alertness in relation to injuries of the main vessels; activity of surgical tactics in treatment of bleedings; in performance of more careful revision of the wound canal in order to achieve complete hemostasis.
In each concrete case the tactics of surgical treatment depends on, first of all, the accuracy of preoperative diagnosis including data of angiography, multispiral computed tomography (MSCT). On the basis of data obtained there was reliably revealed localization of fistulas and aneurisms, their types, forms, anatomic and technical conditions for carrying out various kinds of vessel reconstructions. The surgeon need in improvement of the knowledge and experience of liquidation of complex difficult for access of the injuries of vessels as well as special learning for performance of surgical restoration or reconstruction of the vascular injury consequences. The purpose of this article is diagnosis and optimization of the surgical treatment of TAA, TAVF in difficult to access localization.
Keywords: vascular injury, traumatic arterial aneurysm (TTA), traumatic arterio-venous fistula (TAVF), difficult localization, diagnosis, surgery.
Introduction
Recent years are characterized by a sharp increase in the number of injuries involving damage of the main vessels. Surgical treatment of traumatic vascular injuries and their effects has a long history. Despite this, some questions are still not solved and require further elaboration. Diagnosis and surgical treatment of traumatic vascular injuries is an actual problem of modern angiosurgery. This is confirmed by studies of this problem a number of domestic and foreign scientists, which underline the feasibility of further development of technologies of diagnostics and principles of optimization of surgical treatment of traumatic vascular lesions [3; 4; 6; 7; 8; 9; 10; 11]. In such injuries mortality reaches up to 15.4-25.5%, and primary amputation is performed to 17.3% of patients, after reconstructive operations from 9.6 to 12.2% [2; 5]. If the damage of large arterial and venous vessels mortality is 10-56%. According to the Korole-va M. P. and others the mortality rate is 25.3% (2011). The wound of the great vessels of the neck is among the severe kinds of injuries. To date, their complications remains complex and poorly solved problem in terms of diagnosis and treatment. In this regard, the unsatisfactory results of treatment, reaching up to 27-75%. For injuries of the neck injuries ofthe vessels occur in approximately 25% of cases. Most patients go to the district hospital where surgery is 63.1% of
them, to specialized departments of vascular surgery reaches only 6.1% of the victims. In this regard, there is a large number of organizational, diagnostic, tactical and technical errors that in some situations leads to disability and even death of patients.
It is pertinent to note that late diagnosis and improper surgical treatment of traumatic vascular injuries lead to death or development of severe complications, ending with a disabilities [1; 7]. In the last decades in Uzbekistan and in the world has increased the demands on the diagnosis and surgical treatment of vascular injuries and their consequences. In this regard, before the health care system and its specialized research centers tasked with developing effective methods of diagnosis and optimization of methods of surgical treatment of traumatic damages vessels.
The analysis of practical materials for the studied problem shows that to date insufficiently studied: clinic, diagnostics, methods of surgical treatment and their consequences, in remote localizations of vascular damage (aneurysmal and fistulas).
Material and methods
In the clinic under our supervision there were 48 patients regarding traumatic arterial aneurysmal (TAA) and traumatic arteriovenous fistulas (TAVF), with hard-to-reach localization. Causes TAA and TAVF are presented in table 1.
