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DOI: http://dx.doi.org/10.20534/ESR-16-11.12-104-106
Sharipova Oliya Askarovna, PhD, Associate рrofessor of the Pediatric Department of Samarkand Medical Institute, Uzbekistan E-mail: [email protected]
Bobomuratov Turdikul Akramovich, MD, Professor of the Pediatric Department of Tashkent Medical Academy, Uzbekistan E-mail: [email protected] Bahranov Sherzod Samievich, Assistant of the Pediatric Department of Samarkand Medical Institute, Uzbekistan E-mail: [email protected]
Features of physical development and bone mineral density in children with chronic bronchitis
Abstract: The estimation of physical development, bone mineral density and the relationship between these parameters in patients with chronic bronchitis have been carried out. The study enrolled 84 children with chronic bronchitis aged 10-16 years. Of them, 37 (35.7%) — girls and 47 (64.3%) — boys. It was revealed that in children with chronic bronchitis there are significant adverse changes in the key somatometric indicators, bone mineral density and biochemical markers of bone formation, the extent ofwhich is closely correlated from remteness, severity of the disease, which necessitates the development of targeted interventions. Keywords: chronic bronchitis, physical development, osteopenia.
Epidemiological studies carried out in various countries 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 [5; 8].
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. The psychological effects of short stature have a negative impact on the social integration of children and adolescents, lead to the restriction ofprofessional capacity [1; 2; 3; 6; 7; 10].
One of the serious complications of chronic lung disease is respiratory insufficiency, delayed physical development and decrease in bone mineral density, due to the underlying disease pathogenesis. There are few data confirming that delay of physical development and osteopenia develops in severe progressive course of chronic lung disease [4; 11]. At the same time it was found out what anthropometric indices were largely changed, the relationship of such disturbances with severity of patients condition and the disease duration, the markers and predictors of osteopenia development were not defined. Meanwhile, these data are of great scientific and practical importance.
Taking into account the above data, the study, directed to investigation of physical development and bone mineral density in children with chronic bronchitis (CB) was carried out.
Purpose of the research. To study the features of physical development, bone mineral density and the relationship between these parameters in patients with chronic bronchitis.
Materials and methods. A total of84 (46 obstructive, 38 nonobstructive) children with chronic bronchitis at the age of10 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 old and more 13 (15,5%) children. By the degree of severity of the condition, the patients were divided as follows: medium heavy course of the disease was revealed in 48 (51,1%) children, heavy — in 46 (48.9%). Indica-
tors of physical development were evaluated by the absolute values of length, 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 of the standards recommended by WHO (2007). External breathing function was examined using «Medicor» spirography company (Hungary). Biochemical studies included determination of the content of Ca +, phosphorus, and alkaline phosphatase in blood serum by immune enzyme analysis using a standard set of "Human" firm (Germany). The concentration of TNF-a cytokine IL-1b, IL-6 in blood serum were determined by hard phase immune enzyme analysis (IEA) using a test system for «IEA — TNF-a, IL- 1b, IL-6» («Vector-Best» Russia, 2009). Bone mineral density was measured by osteodensitom-etry on the unit "SONOST 3000", equipped with a children's program (South Korea). The results of ultrasound osteometry chronic bronchitis patients were compared with those of the control group ofhealthy children (n = 42). Measurement of the bone strength was carried out on the heel bone. The criterion of osteopenia was considered to be the decline in BMD from — 1 to -2,5 SD for Z- criterion, and SD decrease to more than -2,5 was classified as osteoporosis.
Results of the research and their discussion. Harmonious physical development was determined in 14.3% of patients. These patients were mainly with disease duration of 5 years, and whose, exacerbation of the disease was observed infrequently and had a mild course. 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 analysis of anthropometric data showed: 61 (84.7%) patients had a delay of average growth in 69 (95.8%) lass 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. Differential analysis by age showed that the maximum frequency of FR disturbances in boys accounted for 12,13, 14 and 15 years old whose indicators were in -3SD zone (P <0.001), 16-year-olds were in -2SD zone — 3SD (P <0.05), and
Features of physical development and bone mineral density in children with chronic bronchitis
the most rare in the group of10,11 years old — in 4 (10%) patients with P> 0,1. In patients ofboth genders with a delay ofphysical development a decrease in weight and growth index occurred, which was in -2SD--3SD zone. This points to a significant underweight. When comparing the data of the physical 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 spirography and peak flow metry the of decline in forced expiratory volume in 1 second. (FEV1) and PEF in patients with chronic bronchitis in relation to the proper values it was revealed: Moderate sererity (FEV1 and PEF 60-79% of normal) in 44 (46.8%), severe (- FEV1 and PEF <60% of normal) in 13 (13.8%) patients. When studying capillary blood oxygen saturation, we have found the oxygen reduction to 80.2 ± 4.2% with chronic bronchitis, whereas in healthy children, this index was equal to 98,5 ± 1,5%. Reduced bone mineral density (BMD) was diagnosed in 74 (88%) children with chronic bronchitis. The frequency of osteopenia was determined in 46 (62,2%) children, osteoporosis in 28 (37,8%) patients. It was revealed that bone mineral density (BMD) is closely related to the length (r = 0,80), body weight (r = 0,88), BMI (r = 0,65).
Overall, our findings suggest a significant negative impact of chronic bronchitis on bone mineral density, the cause of which is likely associated with chronic hypoxemia, adversely affecting the harmonious development. Patients with osteoporosis differed with severe underlying disease, early onset of clinical symptoms, frequent exacerbations of chronic bronchopulmonary process, resistant hypoxemia and marked impairments of bronchial patency.
When studying the effect of disease duration on bone mineral density of the interrelation between them has been established. So when the disease duration iz more than 9 years the majority of
patients 26 (35,1%) had osteoporosis r = 0,45 (P <0.05). In the study based on gender significant differences were not observed. The study on the content of calcium, phosphorus, and alkaline phosphatase in the blood was also carried out. The results of studies of mineral metabolism showed that, calcium in healthy children group was 2,5 ± 0,03 mmol/l. In the group of patients with chronic bronchitis Ca was reduced to 1,77 ± 0,04mmol/l (P <0,001). Inorganic phosphorus level in healthy children was 1,25 ± 0,02 mmol/l. When considering the level of inorganic phosphorus indicators a significant decrease in patients with chronic bronchitis 0,8 ± 0,05mmol/l (P <0,001) was revealed. In healthy children alkaline phosphatase level was 290 ± 8.92 U/l. We found a tendency to AlPh 305 ± 7,4U/l increase in patients with HB aged 12-13years (P> 0.1) compared to the control. The group of patients aged 15-16 years showed a significant decrease in alkaline phosphatase compared with controls (P <0.05). From the literature it is known that alkaline phosphatase activity largely depends on the age and, to a lesser on patients gender [4; 9]. In, in particular, increases during puberty and is associated with the intensive growth of bone tissue, so in children from 10 to 14 years OAlPh concentration increases to 280E/l and from 15 to 19 years begins to decrease to 160 U/l. In our studies, this pattern of OAlPh changes were not observed. Summarizing the results of the analysis of OAlPh concentration by age groups, it is possible to come to the conclusion that in patients with chronic bronchitis the process of osteoblast differentiation is slowing down.
It is known that in hypoxia IL-1, TNF-a and IL-6activate, which promotes osteoclastic resorption of bone tissue [4]. As it can be seen from Table 1, the revealed content of pro-inflammatory cytokines IL-1, IL-6, TNF-alpha in the blood serum of patients with chronic bronchitis, is significantly higher than their levels in healthy children.
Table 1. - The level of IL-1|, IL-6 and TNF- a in chronic bronchitis children, (M ± m)
Indices Control n=45 In children with chronic bronchitis, n=56
HA-1ß, nr/ml 21,5±2,2 229,6±5,4
HA-6, nr/ml 27,9±2,5 119,6±6,2
TNF, anr/ml 27,6±2,3 120,1±4,6
Increasing concentrations of IL-1p was clearly allocated, it was 10 times higher and, IL-6, which was 4,3 times higher than the control level as compared to the control group. It also significantly it came to TNF-a level. This cytokine has been 4.3 times higher than the control level (P <0.001). Premature apoptotic death of osteoblasts, the stimulants of which are apparently IL -1 and TNF-a can lead to impairment ofbone tissue remodeling process in chronic bronchitis. The analysis of the literature data suggest that IL — 6, act as growth factors of osteoclast progenitors and has indirect effect on bone tissue resorption, while IL -1p, TNF-a stimulate osteoclast maturation steps [4].
Conclusions. Thus, the contact materials of the morphological characteristics of physical development, the features of
calcium-phosphorus metabolism and bone system in patients suggest that in children with chronic bronchitis there are significant adverse changes in the main somatometric indices, bone mineral density and biochemical bone formation markers and their, degree depends on duration, severity of the disease. In order to ensure the normal development of the physical parameters is necessary to promptly recognize and treat, and reduce the impact of risk factors for the disease. Increased levels of proinflammatory cytokines in patients with children determine the need for monitoring of mineralization of the skeleton as a basis for the primary prevention of osteoporosis in adults.
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DOI: http://dx.doi.org/10.20534/ESR-16-11.12-106-107
Ergasheva Munisa, Reseacher, Institute of Virology, Tashkent, Uzbekistan E mail: [email protected]
Polymerase chain reaction in diagnostics of an enteroviral infection at patients with implications of acute intestinal infection
Abstract: Results of a laboratory research of 170 patients with acute intestinal infection (AII) regarding identification of enteroviruses are presented in article. It was taped that an appreciable part of AII is presented AII to an enteroviral etiology. Features epidemiological features and a clinical picture of a disease were defined.
Keywords: enteroviral infection, acute intestinal infection, polymerase chain reaction.
Introduction. In recent years activation of an enteroviral infection (EVI) in all regions of the world, irrespective of their social and economic development becomes perceptible. Often EVI is difficult to make the diagnosis that is bound to a variety of clinical forms of illness, which similar under traditional respiratory infections or intestinal infections in this connection early diagnostics of enteroviral infections and well-timed delivery of health care is complicated. Avariety of various forms of acute intestinal infection doesn't allow us to establish the final diagnosis in this connection laboratory confirmation of the diagnosis surely is required. In such cases diagnostics ofEVI in structure of acute intestinal infections requires use of the polymerase chain reaction (PCR). The most important advantage of the PCR before other methods, is its high sensitivity allowing to define single molecules of infectious pathogens. So, the PCR allows to define a contagium, to carry out monitoring of geographical distribution of options of EVI. Due to above listed by us the work object was set: to define EVI contribution in development of symptoms of acute intestinal infection (AII) in patients of the Kashkadarya region of Uzbekistan.
Material and methods: The clinical laboratory research of 170 patients from AII on the basis of the Regional infectious diseases hospital of Qarshi is conducted. At all patients from AII for identification of RNA of enteroviruses the PCR method was carried out. Excrements which got for 1-3 days are investigated. PCR was conducted (3) at the Reference laboratory of the Research Institute of Virology of the Ministry of Health of the Republic of Uzbekistan by means of the Ampli-sens Enterovirus test system (TsNIIE of Ministry of Health of the Russian Federation, Moscow).
The results of the research and their discussion. Results of a research showed that in fecal samples of 170 patients from AII the 73rd on identification of an EV had a positive result that made 43%, Thus, almost each 3 and 4 patient from AII at the heart of an etiological factor of a disease had an enteroviral infection. Among patients from aII and the confirmed enteroviral infection children from the birth up to 18 years — 50 children (68,4%) prevailed, at the same time the largest frequency was made by children of early age till
1 year — 21 children (28,7%), children of 1 year to 3 years made 18 people (24,6%), there were only 4 children from 4 to 7 years (5,4% of cases), from 8 to 14 years — 3 children (4,1% of cases), from 15 to 18 years of 5 children (6,8% of cases) and the remained contingent adults made, so sick from 19 to 30 years made 11 people (15,5% of cases) and 30 years of 10 patients (13,6%) are more senior. Thus, our data coincide with data of literature which speak about the largest frequency of distribution of the EVI intestinal form at children of early age. This fact is bound to the reduced local immunity of children of early age, especially if children don't receive or receive not enough breast feeding, the gastro intestinal tract GIT forming local immunity. At the same time prevalence of boys/men 43 (59%), against girls/women — 30 became perceptible (41%).
At the collecting of the epidemiological anamnesis first of all prevailed giving not boiled raw water from open reservoirs, even to children till 1 year of life: 32 patients (43,8%), at other contingent were taped meal in public dining rooms — 9 patients (12,3%), 15 mothers (20,5%) claimed that the diarrhea at their children developed after contact to patients with an ARD and AII.
At other sick causal factors of development of AII it wasn't succeeded to tap (17 patients — 23,2%). When determining the residence ofpatients it was taped that most ofall patients with the EVI intestinal form arrived from rural areas. Prevalence of larger number of patients with EVI from the rural area — 56 patients (76,7% of cases) tells about a possible water factor of transfer of an EV.
In diagnostics ofEVI detection of seasonal features was important, it was so taped that at observation in spring and summer — the autumn period, the greatest number of patients with the taped EV by means of the PCR was observed in May — 54 cases (73,9%) when comparing with patients at which the negative result on an EV was observed, it was taped that at this contingent ofpatients the greatest case rate was distributed almost evenly in April and May months — 46,3% and 42,1% of cases.
The disease at patients of an enteroviral etiology generally began with All sharply 56 (76,7%). Patients arrived for 1-2 days of
