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Correlation of hormonal status indicators of physical and sexual development in children with chronic bronchitis
DOI: http://dx.doi.org/10.20534/ESR-17-1.2-159-161
SharipovaOliyaAskarovna, PhD, Associate professor of the Pediatric Department of Samarkand Medical Institute, Uzbekistan E-mail: sharipova7323@bk.ru BobomuratovTurdikulAkramovich, MD, Professor of the Pediatric Department of Tashkent Medical Academy, Uzbekistan E-mail: tura.b@mail.ru MamatkulovaDilraboHamidovna, PhD, Assistant of the Pediatric Department of Samarkand Medical Institute, Uzbekistan Turaeva Nafisa Omonovna, Assistant of the Pediatric Department of Samarkand Medical Institute, Uzbekistan E-mail: omonovnaN@gmail.com
Correlation of hormonal status indicators of physical and sexual development in children with chronic bronchitis
Abstract: The evaluation of physical, sexual development, has been carried out, hormonal status and the relationship between these parameters in patients with chronic bronchitis children have been evaluated. The study included 84 children with chronic bronchitis at the age of10 to 16 years and 230 practically healthy children matched by age and sex, of them, 37 (35,7%) — girls and 47 (64,3%) -boys. It was found that in children with chronic bronchitis the amount and force of significant correlations changed. Impairment of physical and sexual development in children with chronic bronchitis promotes activation of intraendo-crine relations in the absence of significant correlations between the content of the hormones of the studied links of endocrine system, may contribute to more frequent disturbance of physical and sexual development in children with chronic bronchitis.
Keywords: chronic bronchitis, physical and sexual development, blood hormones, correlation.
Epidemiological studies carried out in various countries of the old and more 13 (15,5%) children. By the degree of severity of the
world show a steady increase in the number of lower respiratory tract diseases, which have attracted attention due to a high prevalence, disability and mortality [6; 9].
The delay of physical development often leads to difficulties in psychological and social adaptation, the consequences ofwhich can persist even when they reach the normal physical development [1; 3; 7; 8].
Hormonal deviations are significant in the occurrence of various abnormalities in children's health. Chronic somatic diseases play an important role in the formation of the reproductive function of adolescents, there is significant relationship between the state of somatic and reproductive health of adolescents.
Complicated relationship of neurohumoral mechanisms require a comprehensive study of the hormonal profile and its evaluation, taking into account the impact of chronic pathology, including that on the part of broncho pulmonary pathology [2; 7; 9; 10].
Taking into account the above data, the correlation study was carried out aimed at exploring the relationship of indicators of hormonal status, physical and sexual development in children with chronic bronchitis (ChB).
Purpose of the research.To identify the features of the relationship between the parameters of physical, sexual development, and hormonal status in children with chronic bronchitis.
Materials and methods.A total of 84 (46 obstructive, 38 nonobstructive) children with chronic bronchitis at the age of 10 to 16 years were studied. Of them, 37 (35,7%) — girls and 47 (64,3%) — boys. According to duration of the disease, the patients were distributed as follows: 5-6 years old 32 (38%), 7 years old 14 (16,7%), 8 years old 13 (15,5%), 9 years old 12 (14,3%), 10 years
condition, the patients were divided as follows: moderately severe course of the disease was revealed in 48 (51,1%) children, severe — in 46 (48,9%). The control group consisted of practically healthy children (110 boys and 120 girls) of comparable age.
Indicators ofphysical development were evaluated by the absolute values oflength, weight and chest circumference. Body mass index was calculated using the formula BMI = weight/height (m2). The received data were compared for children's growth and development standards, recommended by WHO (2007). To check the status of sexual development in boys we carried out genetometric analysis and evaluation of the stages of sexual development by J. M. Tanner (1967). When evaluating the sexual development of girls we paid attention to the severity of the pubic and axillary hair distribution, the growth of the mammary glands, for a period of menarche.
In the blood serum of children surveyed,, hormone levels are de-finedby enzyme immunoassay (EIA): TSH (mlE/L), T3 (ng/ml), T4 (mcg/dl), growth hormone (ng/ml), follicle-stimulating hormone (FSH, mle/ml), luteinizing hormone (LH mle/ml), testosterone (nmol/l), estradiol (E2, pg/ml). Blood sampling was carried out from the cubital vein in the morning on an empty stomach.
To identify the relationship between the analyzed indicators we carried out a correlation analysis using the correlation coefficient r and test of its significance using Student's t test and Pearson 2.
Results of the research and their discussion. Harmonious physical development was determined in 14.3% of patients. Delayed physical development was revealed in 72 patients, accounting for 85,7% of the total number of examined patients, 32 of them (44,4%) — were girls and 40 (55,6%) — were boys. Individual
Section 8. Medical science
analysis of anthropometric data showed: 61 (84,7%) patients had a delay of average growth, 69 (95,8%) loss of body weight. In 11 (15,3%) patients aged 15-16 years, body length was above average and significantly (P <0.05) different from the group of healthy peers. In patients of both genders with a delay of physical development a decrease in weight and growth indices occurred, which were in -2SD -3SD zone. This point to a significant underweight.
Delayed puberty was diagnosed in 68 patients, accounting for 80,9% of the total number of patients examined, 32 of them (47%) — girls and 36 (52,9%) — boys, We found lagging of all genetometric indicators in 26 patients aged 14, 15 and 16 years. Comparative evaluation of the appearance of secondary sexual characteristics showed that in 17 sick boys with chronic bronchitis aged 14, 15 and 16years secondary sexual characteristics were on the I — II stage of sexual development according to Tanner.
Clinical examination of girls found out that by the age of16 in 8 (25%) patients with chronic bronchitis mammary glands were at Ma3 stage and in 24 (75%) did not exceed Tanner II degree. By the age of 16 the sexual body hair was in P2Ax2 stage in 26 (81,3%) and in P3Ax2 stage was only in 6 (18,7%) sick girls. Steady menstrual cycle had only 5 (15,6%) girls aged 14-16.
When comparing the data of the physical and sexual development of children with severity and duration of chronic bronchitis, we noted a clear link between them. The more severe and prolonged the illness proceeded, the more often the children's physical development was delayed r = 0,50; r = 0,39 (P <0.05).
In the study of correlations in a group of healthy boys a high positive correlation was marked between: testosterone and growth (r = 0,64), weight (r = 0,65) and the degree of pubic hair (r = 0,72), genetometric rates (r = 0.7). Also strong (r>0,8) correlations between the parameters of physical, sexual development and levels of hormones of the pituitary-thyroid-genital systems were identified. In the group of healthy girls average positive relationship between the level of testosterone (r = 0,56), and growth, the weight (r = 0,59), pubic hair distribution degree (r = 0,51), maturity of mammary glands (r = 0, 56); between LH and growth (r = 0,50), and maturity, of mammary glands (r = 0,51); between and FSH and growth (r = 0,42), the weight (r = 0,51), pubic hair distribution degree (r = 0,37), maturity of mammary glands (r = 0,46) were marked. GH, TSH and thyroid hormones with indicators of physical and sexual development in girls and boys have a negative correlation. The revealed relationships confirmed the basic physiological processes that occur at puberty. In boys with chronic bronchitis correlations between systems and within them in comparison with the control group were established. So strong positive relations (r = 0,6, r = 0,74) between the identified parameters of physical development and genetometric indicators were revealed. Mean positive connections were between FSH and growth (r = 0,42), body weight (r =0,45) and LH
(r =0,34). Between LH and weight (r = 0,39), genetometric indications (r = 0,37). The average positive relationships between TSH and body weight (r = 0,35), between T3 and body weight (r = 0,32), the size of the penis (r = 0,33), between T4 and indicators of physical development (r = 0,35, r = 0,37), penis size (r = 0,37), between testosterone and body weight (r = 0,48), growth (r = 0,44), testicular size (r = 0 47) and FSH (r = 0,59) were revealed. Weak positive associations between T4 and genetometric indications (r = 0,27), between FSH and the size of the testicles (r = 0,25) were revealed.
As it is known morphogenetic FSH has an effect on the development of the convoluted seminiferous tubules and testicular stroma, which is accompanied by a significant increase in the size of the testicles to the appearance of secondary sexual characteristics [5]. Boys ill with ChB with low genetometric indications most of connections are losing their strength in comparison with the control. New connections develop: the average negative relationships between E2 and T4 (r = -0,58), TSH (r = -0,35). In the group ofpa-tients with above-average growth rates average negative correlations with FSH (r = - 0,44), LH (r = - 0,46), testosterone (r = -0,45), TSH (r = -0,49) and genetometric performance (r = -0,48) are determined. This group of adolescents with high growth had low levels of FSH, LH, testosterone and genetometric parameters. The revealed relationships of gonadotrophic function of the pituitary and gonads functional state in children with ChB lead to a change in the of relations in the system of negative and positive revers connections.
Girls with ChB also had relationships, both between systems and within them. Less strong (r = 0,76), plurality ofaverage (r = 0,42) and weak (r = 0,28) positive relations between physical, sexual development, and hormones of the pituitary-gonadal system were revealed.
From the above data it can be concluded that in patients with chronic bronchitis the delayed puberty, cautes considerable decrease of interference indicators of physical and sexual development and the secretion of hormones of the studied units of endocrine system however, activation of intraendocrine relationships in these groups and the development of new significant correlations were marked.
Conclusions. Thus, between indicators of physical, sexual development and levels of hormones of the pituitary-thyroid-genital systems in children with chronic bronchitis during puberty there are certain correlations that allow you to learn more about the pathogenesis of this pathology.
In general, the identified correlations between the studied parameters of physical, sexual development and functional activity of the endocrine system in children with chronic bronchitis at puberty have their characteristics in comparison with the healthy ones. Change of the number, strength and direction of significant correlations may contribute to more frequent impairment violations of physical and sexual development in children with chronic bronchitis.
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Assessment of the effectiveness of ultrasound sonography among children with appendicular peritonitis
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DOI: http://dx.doi.org/10.20534/ESR-17-1.2-161-163
Yusupov Shukhrat Abdurasulovich, Samarkand State Medical Institute, Associate Professor, Chief of the Department Pediatric Surgery
E-mail: shuchrat-66@mail.ru
Assessment of the effectiveness of ultrasound sonography among children with appendicular peritonitis
Abstract: 93 children with diffuse purulent appendicular peritonitis (DPAP) have been evaluated by sonographic indicators. 96% of the patients of the first group with appendicular peritonitis were admitted to the Clinic on 1-4 days from onset of the disease, in the second group all patients were admitted in later days (3-10 days). In the first group, in 4 patients local, in 36 - diffuse and in 5 patients - spilled appendicular peritonitis was diagnosed. In the second group, all patients were diagnosed with DPAP. Application of ultrasound sonography (USS) at DPAP, complicated with intestinal paralysis in children in the preoperative period allows us not only to establish the spread of peritonitis, but also to determine the severity of impairment of the motor-evacuation function of the intestine. USS in dynamic allows timely to identify postoperative intraabdominal complications and choose the best surgical treatment strategy.
Keywords: children's appendicular peritonitis, ultrasound sonography, diagnostics.
Introduction. Diffuse purulent appendicular peritonitis (DPAP) complicated with intestinal paralysis (IP) is one of the imperative problems in pediatric surgery. Diffuse appendicular peritonitis is the most frequent and severe complication of acute appendicitis in childhood, occurring in 8-10% of all cases, and 4-5 times more often in the first 3 years of childhood than in older age [1; 3]. In recent years, it was managed to reduce mortality among patients hospitalized in the early phases of the disease, however mortality remains very high in advanced forms.
Diagnosis of diffuse purulent appendicular peritonitis (DPAP), complicated with intestinal paralysis (IP), and the correct assessment of its severity before surgery in children are the basis for the further therapeutic tactics selection and prognosis of the disease [5; 10; 11]. To assess spread ofpathological process in the abdominal cavity and the severity of intestinal paresis in children, we used ultrasound sonography (USS) of the abdominal cavity in the pre-and postoperative periods [1; 2; 4; 8].
Studies that require the insertion of foreign bodies (e.g. instruments, contrast and radioactive substances) is acceptable only in the preoperative period, when indicated, but they cannot be used in the next few hours and days after the operation, because they themselves can cause serious complications [6]. Phonoenterography and electroenterography, which are commonly used to objective assessment of bowel activity, record ofheart sounds and lung rales as well, along with registration of peristaltic bowel noises, [7], which lead to the difficulties of diagnosis. All of them prove that the problem of diagnosis of appendicular peritonitis form and degree of severity of paresis of the intestines in the preoperative period remains actual.
In this context, it is of great scientific and practical interest to use abdominal ultrasound sonography (USS) to assess the spread of pathological process in the abdominal cavity and the degree of
paresis of the intestines in case of peritonitis in children in the pre-and postoperative periods [3; 9].
In the diffuse purulent appendicle peritonitis in children the active use of dynamic sonography of the abdominal cavity could allow us to determine the significance of motor-evacuator function of intestine and promotes the early recognition of postoperative intra-abdominal complications. However hereinafter it is needed to carry out investigation directed to elaboration of the new methods intended for prediction the development and prevention of complication (purulent-inflamed and commissural processes) in the abdominal cavity in such disease.
The aim of our study was to improve the non-invasive diagnostics, ultrasound study opportunities of ultrasound sonography, complicated with intestinal paralysis, in pre- and postoperative periods among children.
Materials and methods. The research is based on the data of USS of 93 children with peritonitis in Clinic № 2 of the Samarkand State Medical Institute. Their age ranged from 2 to 15 years (40 girls, 53 boys). Children's conditions were assessed without prior preparation, in a horizontal position on the back, with ALOKA.-5Q0-SSD and SIEMENSE devices: SOWOLIN E S1-50 using linear sensors 3.5; 5.5; and 7.5 MHz, in real time using the dosed compression of the sensor to the abdominal wall, and motor-evacuation activity of the intestine, the spread of inflammation in children with appendicular peritonitis in dynamics were evaluated: the localization and distribution of free fluid in the abdominal cavity, the presence of intestinal peristalsis and its character, intestine diameter, accumulation of fluid and gas in the lumen, the dynamics of promotion of chyme on intestinal tube.
Depending on the results of the primary surgical examination and clinical manifestations of IP as well as a type of treatment carried
