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smokers with occasional cough with phlegm (p<0.01), and smokers with chronic bronchitis (p<0.001), compared with healthy. Also revealed a significant decrease of forced expiratory volume in 1 sec in smokers with symptoms of chronic bronchitis compared to smokers without respiratory symptoms (p<0.05). There was a statistically significant relationship between the decline of forced expiratory volume in 1 sec/forced vital capacity in individuals smokers with chronic bronchitis compared with the other study groups: healthy (p<0.0001), with smokers having the irregular cough with phlegm (p<0.05), with non-smokers with chronic bronchitis (p<0.05) and smokers without respiratory symptoms (p<0.05). Revealed similar link smoking with other speed performance of the forced exhalation. Rates of maximum flow rate during exhalation of 50% was significantly low, compared with "healthy", for nonsmokers, with occasional cough with phlegm (p<0.01), non-smokers with chronic bronchitis (p<0.005), smokers without respiratory symptoms (p<0.01) and smokers with chronic bronchitis (p<0.0001). The maximum volume rate during exhalation of 25% was significantly lower for nonsmokers with symptoms of chronic bronchitis than in healthy (p<0.05). The value of this parameter was significantly reduced in all smokers, without respiratory symptoms (p<0.005), and occasional cough with phlegm (p<0.005) and chronic bronchitis (p<0.0001), compared with "healthy". The average maximum flow rate during exhalation 75% was significantly higher in healthy compared with non-smokers, with intermittent cough with phlegm (p<0.01), non-smokers with chronic bronchitis (p<0.005), and also compared to smokers without respiratory symptoms (p<0.001), with occasional cough with phlegm (p<0.01), and chronic bronchi-
tis (p<0.0001). The parameter peak expiratory flow was significantly higher in healthy compared to non-smokers, with intermittent cough with phlegm (p<0.0001), with non-smokers with chronic bronchitis (p<0.0001) and also compared to smokers without respiratory symptoms (p<0.0005), with occasional cough with phlegm (p<0.001) and chronic bronchitis (p<0.0001). Smokers with symptoms of chronic bronchitis, the parameter peak expiratory flow were also significantly lower than in smokers without respiratory symptoms.
Thus, a significant relationship between indicators of respiratory function, Smoking and respiratory symptoms. The relationship of indicators of function of external respiration with the combination of Smoking and respiratory symptoms were highly significantly significant for all parameters of respiratory function, and more pronounced than the relationship of respiratory function only with the status of Smoking.
Conclusions:
1. The results of the survey showed that the prevalence of Smoking among adolescents and young men is 17.7%.
2. We found a significant relationship between the indicators of external respiratory function, Smoking and respiratory symptoms, indicating that the rate of progression and severity of symptoms depends on the exposure to the etiological factors and their summation.
3. There is significant inverse correlation between bronchial hyperresponsiveness and forced expiratory volume in 1 second, which indicates a close relationship between hyperactivity and the risk of developing chronic obstructive pulmonary disease.
References:
1. Бабанов С. А. Эпидемиология и профилактика табакокурения//Гигиена и санитария. - 2002. - № 3. - С. 33-36.
2. Камардина Т. В., Глазунов И. С., Соколова Л. А., Лукичева Л. А. Распространенность курения среди женщин России//Профилактика заболеваний и укрепление здоровья. - 2002. - № 1. - С. 7-12.
3. Левашова И. А., Чайка А. Н., Адельшина А. А. Состояние здоровья школьников и распространенность среди них курения//Материалы научно-практической конференции «Актуальные вопросы обеспечения санитарно-эпидемиологического благополучия и охраны здоровья центрального региона России». - 2002. - С. 147-149.
4. Сайт Федерального агентства США по комплексной профилактике и контролю за табачной зависимостью и курением (CDC)/http://www.cdc.gov/tobacco/global/gyts/.
5. Чучалин А. Г. Табакокурение и болезни органов дыхания//Российский медицинский журнал. - 2008. - Т. 16, - № 22. - С. 1477.
6. Шубочкина Е. И., Молчанова С. С., Куликова А. В. Курящие подростки как медико-социальная проблема//Материалы Х Съезда педиатров России «Пути повышения эффективности медицинской помощи детям». - М. - 2005. - С. 611.
DOI: http://dx.doi.org/10.20534/ESR-17-1.2-133-136
Fayzullaeva Dilfuza, Doctorant Specialized republican research andpracticemedical center of phthisiology andpneumonology of Health of the Republic of Uzbekistan E-mail: saodat@mail.ru
Comparative analysis of tubercular lymphadenopathy clinical pattern in hiv and non-hiv patients
Abstract: 156 patients suffering from tuberculous lymphadenopathy (TL) were examined at the Republican AIDS Center and the Republican Specialized Applied Research Medical Center of Phthisiology and Pulmonology. based on the obtained results we suggest on the apparent exacerbation of TL in case of HIV infection.
Thereat, symptoms changed along with the rapid development of HIV terminal stage. The clinical signs of TL in HIV-infected patients include a great variety of symptoms of local and general origin. TL course as compared with that in non-HIV patients especially in the progression stage is far severer and contributes to the mortality in patients reported with such comorbidity.
The clinical pattern features of concurrent TL and HIV-infection have been associated with the progressive formation of infectious and toxic syndrome.
Keywords: tuberculous lymphadenopathy, HIV-infected patients.
HIV outbreak is the global health-related challenge. In AIDS-patients (acquired immunodeficiency syndrome), tuberculosis is the most often opportunistic infection that makes 50-78% of the total pulmonary infection cases [6]. The underlying condition for high tuberculosis morbidity in HIV-infected is almost 100% contamination with the Mycobacterium tuberculosis in the adult population.
In most cases, the tuberculosis (TB) secondary to the progressive immune deficiency is followed by the process generalization [3; 8]. In this view, extrapulmonary tuberculosis is the significant clinical challenge as the HIV infection runs epidemic. The incidence rate of extrapulmonary tuberculosis, including tuberculous lymphadenopathy, is globally reportedto be associated with the HIV-infection spread. Most authors recognize the difficulty to diagnose tuberculosis in HIV-infected patients [1; 2]. The diagnostics is made difficult as the TB of extrapulmonary type develops in AIDS-patients in 50-70% cases [9]. Of clinical forms of extrapul-monary tuberculosis in HIV-infected patients, lymphatic system organs (tuberculosis of intraperitoneal and retroperitoneal lymph nodes in 24.4% cases, of spleen — in 16.0% cases, of peripheral lymph nodes — in 12.8% of patients) are most affected.
The HIV infection is characterized by the so-called persistent generalized lymphadenopathy. Most cases of the generalized lymph-adenopathy in HIV-infected are associated with the outburst of opportunistic infections in the stage of deuteropathies, especially at the stage ofAIDS. In 73.5% cases of HIV-infection, the tuberculous lymphadenopathy (TL) is most frequently reported at the 4C stage, in 23.5% cases (approximately 3 times less) TL is reported at the stage 4B and single cases of TL are reported at the Stage 3 of this disease. TB and related case mortality in HIV-infected and AIDS patientsis extremely high and ranges, as per international authors, within 22% to 34.1%. TB was reported in patients who died of HIV-infection (/ cases) and in the majority of them (86.7%), TB was the immediate cause of death [5].
Nowadays, due to the high lymphadenopathy prevalence ofvar-ious etiology, TL diagnosis remains the challenging and urgent issue ofphthisiology [7]. It is still unknown whether the lymphadenopathy results from the more common specific involvement of lymph nodes with TB mycobacteria or it is caused by other infections.
In this context, the study of clinical and laboratory pattern of TL in HIV patients and non HIV-patients is urgent.
Purpose of Study. To assess theprogress of TL pattern in HIV-infected and non HIV-infected patients, as well as to specify the clinical course and disease progression behavior.
Study Material and Methods.156 patients suffering from tuberculous lymphadenopathy (TL) were examined at the Republican AIDS Center and the Republican Specialized Applied Research Medical Center of Phthisiology and Pulmonology: 99 subjects were non HIV-infected (Group 1), 57 — HIV-infected (Group 2). TL was diagnosed based on specific clinical, radiologic, ultrasonography patterns, bacteriological analysis results and lymph node punctate cytology, histology results oflymph node biopsy, presence ofpulmo-nary tuberculosis or other TB-infected organs. The Mycobacterium tuberculosis (MTB)was identifiedby the microscopy analysis with samples stained by Ziehl-Nielsen and Gene Expert and cultures inoculated to the standard Lowenstein-Jensen medium.
The HIV infection was verified by detection of specific Ab to HIV by ELISA and immune blotting to HIV proteins of type
1. Clinical stages of HIV infection were classified as per V. I. Pok-rovsky as approved by the Order № 166 dd. 17.03.2006 of the Ministry of Health of RF; the AIDS was diagnosed in case of positive
HIV results and the account of CD4+--lymphocytes to be below
200 cells/^l.
The statistical analysis was performed based on MS Excell-97, MedStat, and the package of STATISTICA-99 Edition. To assess polygenic characters, the values of arithmetic mean and standard error of the mean were determined and the evidence frequency value was specified to assess qualitative characters. In case of normal distribution, differences in mean values in comparison groups was assessedas per the Student criterion. In case of deviation in the normal distribution, the data obtained was presented as the median and the reliability of differences was assessed by the nonparametric Wilcoxon-Mann-Whitney test.
Study Results. It is revealed that females prevail among HIV-infected and non HIV-infected patients with TL (Fig. 1 and 2). So, the female subjects amounted to 63.6±4.8%, accordingly, in Group 1 (P<0.001) and 57.9±6.5%, accordingly (P>0.5), in the Group 2.
Figure 1. Gender identity of non HIV-infected patients with TL, n (%)
Figure 2. Gender characteristics of HIV-infected patients with TL, n (%)
Young and middle-aged prevailed among the HIV and non HIV-subjects (Figure 3). Patients aged 21-30 were 2.7 times more often reported in the Group 1 as compared with the Group 2 subjects (37.4±4.8% and 14.0±4.5%, accordingly, P<0.001). On the contrary, middle-aged and elderly patients prevailed in the Group 2. So, in the Group 2, patients aged 31-40 were reported at 2.1 times more often, those aged 41 and older — 1.3 times more often than patients in the Group 1 (50.9±6.6% and 24.2±4.3%, accordingly, P<0.001; 35.1±6.3% and 26.3±4.4%, accordingly, P>0.5).
At the date of inclusion of HIV subjects in the study, the following clinical forms of pulmonary tuberculosis were diagnosed: focal (7.0%, n = 4), infiltrative (8.8%, n = 5).
During the study, non HIV-infected patientswere reported to be diagnosed with the following clinical forms of pulmonary tuberculosis: focal (8.1%, n = 8), infiltrative (4.0%, n = 4) and disseminated (4.0%, n = 4). The disseminated pulmonary tuberculosis is not common in HIV-infected patients in the pattern of clinical forms of tuberculosis.
Table 1. - Age pattern of HIV-infected and non HIV-infected patients with TL, n (%)
Age, years Non HIV-infected patients HIV-infected patients Statistical significance, P
Up to 20 12 (12.1 ± 10.7) - -
21-30 37 (37.4 ± 4.8) 8 (14.0 ± 4.5) P<0.001
31-40 24 (24.2 ± 4.3) 29 (50.9 ± 6.6) P<0.001
41 and older 26 (26.3 ± 4.4) 20 (35.1 ± 6.3) P>0.5
Total 99 (100.0) 57 (100.0) -
When studying clinical signs in HIV-infected patients, complains were reported as follow: fatigue in 63.2% cases (n = 36), drenching sweat — 75.4% (n = 43), fever — 73.7% (n = 42), loss of body weight at 10 kg and more — 87.7% (n = 50), diarrhea — 22.8% (n = 13). Clinical signs in non HIV-infected patients were
less pronounced, the patients complained of the fatigue in 34.3% cases (n = 34), drenching sweats — 10.0% (n = 10), fever — 40.4% (n = 23), body weight loss at 10 kg and more — 18.2% (n = 18), diarrhea is not reported.
Figure 4. Distribution by prevalence of TL
The chronic viral hepatitis C was among the concurrent diseases in HIV-infected patients to make 24,6% (n = 14) cases against the rate in non HIV-infected patients that made 3.0 (n = 3).
Localization of TL is shown in Figure 4. The figure shows that cervical lymph nodes were 5.5 times more often affected in non HIV-infected patients as compared with HIV-infected patients (67.7% and 12.3%, accordingly, P<0.001). Lymph node coexistent affection was 7.7 times more often reported in HIV-infected patients than in non HIV-infected patients (70.1% and 9.1%, accordingly, P<0.001).
Re-examination of histologic specimens showed that pathologic pattern features in case of TL are primarily determined by
patients with and without HIV infection, n (%)
the active phase of inflammatory activity in the lymph node. M. V. Chulochnikova (2005) identified three phases of active inflammation of tuberculous lymphadenopathy based on morphological features. We distinguished 3 phases of active inflammation in HIV and non-HIV patients (Figure 5). The figure shows that the inactive phase is 5.5 times more common in non-HIV patients than in HIV-infected patients (29.3% and 5.3%, accordingly, P<0.001). On the contrary, the active phase and the progression phase are 1.5 and 1.3 times more common in HIV patients as compared with non-HIV patients (19.3% and 13.1, accordingly, P>0.5; 75 4% and 57.6% accordingly, P<0.02).
Figure 5.Comparative characteristics of process phases in HIV and non-HIV patients with TL, n (%)
During the follow-up period, 9 (15.8%) HIV-infected patients died. Neither subject died in the Group 1. By comparing fatal cas-
es against other patients treated in the department, differences in the inflammatory activity were identified. Thus, all patients who died
were reported to be in their progression stage. The fatality occurred resulting from multiple organ failure with symptoms of severe intoxication. It should be noted that 5 (55.6%) patients were diagnosed with pulmonary tuberculosis and 3 (33.3%) patients — with Hepatitis C.
Thus, based on the obtained results we suggest on the apparent exacerbation of TL in case of HIV infection.
Thereat, symptoms changed along with the rapid development of HIV terminal stage. The clinical signs of TL in HIV-infected patients include a great variety of symptoms of local and general origin. TL course as compared with that in non-HIV patients especially in the progression stage is far severer and contributes to the mortality in patients reported with such comorbidity.
The clinical pattern features of concurrent TL and HIV-infection have been associated with the progressive formation of infectious and toxic syndrome.
Conclusion:
1. Significant differences in clinical and laboratory signs and stages of tuberculous lymphadenopathy have been identified in HIV-infected patients. Tuberculous lymphadenopathy in HIV-infected patients is much severer with concomitant diseases that
develop much more frequently and aggravate the underlying disease than those in non-HIV patients.
2. The progressive stage of tuberculous lymphadenopathy with generalization and lethality is reported in 15.8% cases.
3. TL in absence of HIV infection as compared with TL with HIV infection is clinically more favorable, it is known for limited lesions and, most importantly, for limited caseous-necrotic changes.
4. Having analyzed the histologic pattern of lymph nodes removed in HIV-infected patients, we identified three types of tuberculous lymphadenopathy activity: inactive phase (with prevalence of productive cell response) in 3 patients (5.3%), active phase (predominantly with productive-necrotic tissue reaction) in 11 patients (19.3%), pathology progression phase (mostly necrotic lesions, suppuration and fistula formation) in 43 patients (75.4%).
5. It is found that the inactive phase is 5.5 times more commonly reported in non-HIV patients as compared with that in HIV patients (29.3% and 5.3% accordingly, P<0.001), whereas the active phase and progression phase were 1.5 and 1.3 times more commonly reported in HIV patients as compared with that in non-HIV patients (19.3% and 13.1, accordingly, P>0.5; 75,4% and 57.6%, accordingly, P<0.02).
References:
1. Erokhin V. V. et al. Peculiarities of clinical sign identification and TB therapy in HIV-infected patients//Probl. Tub. - 2005. - No. 10. -P. 20-27.
2. Zimina V. N., Batyrov F. A., Kravchenko A. V. and et al. Clinical and radiological features of the incident case of TB development in HIV-infected patients depending on the original account of CD4 + lymphocytes//Tub. - 2011. - No. 12. - P. 35-41.
3. Frolova O. P. TB development features in HIV-infected and prevention measures: Author's abstract...Doctor ofMedical Science. - Spb., - 1998.
4. Chulochnikova M. V. Clinical and morphological characteristics of the peripheral lymph node tuberculosis in different phases of activity: Author's abstract .Candidate of Medical Science. - M., - 2005.
5. Demisse M. et al.//Int. J. Tuberc. And Lung Dis. - 2001. - Vol. 5, - No. 11. - P. 85.
6. Mu A.//Zhonghua Jie He He Hu Xi Za Zhi. - 1998. - Sep; - Vol. 21, - No. 9. - P. 526-527.
7. Richter C. et al.//Intern. J. Tuberc. And Lung Dis. - 1995. - Vol. 77, - No. 6. - P. 510-517.
8. Sepkowitz K. A. et al. Tuberculosis in the AIDS era//Clin. Microbiol. Rev. - 1995. Vol. 8, - No. 2. - P. 180-199.
9. Sharma S. K. Mohan A. Extrapulmonary tuberculosis//Indian J. Med. Res. - 2004. - Vol. 120. - P. 316-353.
DOI: http://dx.doi.org/10.20534/ESR-17-1.2-136-137
Halikov Shavkatbek, Andijan state medical instate Science researcher Abduhalikov Alimjon Karimjanovich Andijan state medical institute Doktor of chair traumatology and vertebrology E-mail: Vertebrolog-shavkatbek@yandex.ru
Surgical treatment of foraminal herniated disc of the lumbar spine
Absrtact: Herniated lumbar intervertebral disc have a significant impact on both the patient's life as well, and because of the high prevalence and economic impact on society as a whole. Designed scheduling algorithm foraminal hernia surgical treatment of lumbar intervertebral disc, based on the preoperative detection of compressing factors allows to define differentiated indications for decompressive or decompressive-stabilizing surgery. Keywords: herniated disc, foraminal foraminal.
The urgency of the problem of hernias of lumbar interverte- The prevalence of disease in the population is 58-84%, and the in-bral disc is made up of a number of reasons. First and foremost, cidence is 4-33% [9; 10].
the fact that the world is suffering from this disease a huge number The incidence of "low back pain" (low back pain) in the Neth-
of people — more than 80% of the world's population [1; 2]. And erlands amounted to 28 cases per 1000 population per year, and more often herniation of lumbar intervertebral disc found in de- for low back pain with sciatica — 11.6 cases per 1,000 persons per veloped countries where widespread sedentary, sedentary lifestyle. year. Herniated disks are a common cause of back pain. This pain,
