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of chronic foci of infection revealed in mothers during pregnancy: chronic tonsillitis, sinusitis, chronic bronchitis, inflammatory diseases of the urinary tract (44, 1% — in the group with sepsis vs. 12.04% in the group with local infection, which is 3.6 times more often than in the group with local infection). The incidence of genital diseases in mothers during pregnancy in both groups was similar.
The above variations in ante- and intrapartum period could contribute to the development of acute or chronic fetal hypoxia by increasing the risk ofperinatal brain damage in the child as confirmed by the high frequency ofperinatal pathology (hypoxic-ischemic encephalopathy) among children with sepsis — 143 (87.6%) patients that more than seven times higher than the local infections. In addition, the fact of presence of foci of chronic infection in the history of women indicates failure of nonspecific immunological defense mechanisms and factors of nonspecific resistance in the mother, and this is the evidence of presence of infection and persisting infection and possible microbial contamination from mother to child.
The analysis of background premorbid factors revealed that frequency- of lymphatic hypoplastic development and allergic diathesis in both studies groups is almost the same. Deficient conditions in sepsis occur at a high frequency, so severe anemia occurs in virtually every patient with sepsis, whereas in local infection anemia in children was observed 2.5 times less and, as a rule, they have developed anemia of mild and moderate severity. Rickets is 2 times more often developed in the group of septicemic form and apparently is related to the fact that the children in this group had a long period of disease.
It is natural that the development of sepsis on the background of the intensification of catabolic processes contributes to malnourished children' s cachexia. Thus, virtually all children with sepsis had weight deficiency. In 73 (44.8%) patients with sepsis the 1 degree hypotrophy occurred, while in the remaining septic cases (35.6%
and 19.6%) hypotrofhy of the 2d-3d degree developed. In local infection incidence of hypotrophy was significantly less: the 1st degree hypotrophy — in 9 (10.8%) children, the 2d- degree hypotrophy — in 7 (8.4%) patients and the 3d degree hypotrophy was revealed in 1 patient (1,2%).
Identified deficient condition were more likely the result of sepsis than predictors of disease.
Analyzing the cause of the disease, and reflecting on the entrance gate of infection in sepsis, we found out that according to mothers information the illness in the studied infants began with the manifestations of intestinal infection in 37.4% of cases, and in 13.8% cases, the manifestation of the disease was observed after or on the background of pneumonia and acute respiratory infection. In other cases, the cause of the beginning of the child's illness was unknown. Although risk factor for catheter-associated sepsis could serve as a fact that — 84 (78.5%) infants studied by us were often for a long time and in the intensive care unit in the community and were receiving infusion therapy through multi-day central venous catheterization. It is impossible to distinguish and clarify in practical life the time of infection. Shabalov N. P., Ivanov D. O. 2002).
Thus, in the formation of septic risk in infants the important role is played by the low level of mothers, health the low degree of attention to the child that determines the development of new directions in health education and preventive measures. In addition, when analyzing septic risk in young children it has been established that the main predictors of the generalization of bacterial infections in early childhood are the causes that lead to the development of acute and chronic hypoxia of the fetus and newborn (complications during pregnancy and childbirth, moderate and severe anemia in mother), as well as the presence of persisting infection in mothers.
References:
1. Aliyev A. F. role ofperinatal pathology in the formation of "burden of disease"//Russian Gazette Perinatology and pediatrics. - 2002. -No 3. - FROM. 58.
2. Baibarina E. N., Zubkov V. V., Mikhailova O. I., Tyutyunnik V. L. condition of health of newborns born to women with placental insufficiency and infection//Russian Gazette Perinatology and pediatrics. - 2009. - No 5. - S. 14-19.
3. Gnusaev SF, Shibayev AN, Federyakina OB Cardiovascular disorders in newborns with perinatal hypoxia//Pediatrics. - 2006. - No 1. - S. 9-13.
4. Kasymov Sh. Z., Davlatov S. S. Hemoperfusion as a method of homeostasis protection in multiple organ failure syndrome//Academic Journal of Western Siberia. - 2013. - T. 9. - No. 1. - C. 31-32.
5. Makhmudov OS, Nosirova Sh Factors Affecting during sepsis in infants//Herald doctor. -Samarkand, - 2008. - № 4. - S. 45-46.
6. Mironov P. I., Ivanov D. O., Bulanov A. S., Lekmanov M. A., AW Pilot assessment of the validity terms of the international consensus conference on pediatric sepsis (2005) in domestic ICU//Journal of intensive care. - 2006. - № 4. - 61-64.
DOI: http://dx.doi.org/10.20534/ESR-16-11.12-79-83
Ravashanov Shavkat, the junior scientific researcher, department of adolescent's orthopedics, Scientific Research Institute of Traumatology and Orthopedics of the Ministry of Health of the Republic of Uzbekistan.
E-mail: sixatfarm@mail.ru
Formation deformity of foot with congenital IV brachymetatarsia
Abstract: The radiological features (linear and angulometric) at 49 patients with congenital shortening of metatarsals are studied and measured. Characteristic changes in forefoot with congenital brachymetatarsia are revealed. Roentgenograms of
one patient with left sided congenital IV brachymetatarsia were studied dynamically before (within 5 years) and after surgery and studied the development typical deformation of forefoot.
Brachymetatarsia can develop further deformation in other departments of foot.
Keywords: Brachymetatarsia, linear and the angulometric radiological parameters, forming typical deformation.
Introduction. Brachymetatarsia is an anomaly of development of foot which leads to a shortening of one or several metatarsals as a result of premature closing of distal epiphyseal plate. Condition isn't shown clinically to age of 7-10 years [3], but Smizzi A. [8] reports detection of cases of brachymetatarsia from 4 years. By 12 years old the shortening compound 15-45% of metatarsal length [7; 2]. Brachymetatarsia can be unilateral or bilateral, at the same time any of five the metatarsals are involved [5], but the shortening of the fourth metatarsal is more often observed [1].
The close anatomic and functional interrelation between structures of foot inevitably leads to emergence of a chain ofpathological changes in a case of damage of one of elements [4; 6]. In case of congenital brachymetatarsia except shortening of metatarsals, deformation of forefoot is also formed which often isn't considered by orthopedists. Unfortunately, the mechanism of its forming isn't described in scientific literature. Early knowledge of availability or a possibility of development typical deformation of adjacent foot beams in case of a congenital brachymetatarsia can give invaluable help in treatment of patients, and it is essential to prevention of development typical deformation offorefoot, to improve results of surgical treatment. Otherwise correction of deformation of adjacent beams of foot is required, except lengthening of the shortened metatarsal.
Research purpose — is studying of forming typical forefoot deformity; linear and the angulometric radiological parameters of forefoot with congenital IV brachymetatarsia.
Materials and methods. We studied linear and angulometric radiological parameters of forefoot in 49 patients with congenital IV brachymetatarsia. Unilateral shortening were observed in 23 (13/10) patients and bilateral — in 26 patients. Roentgenograms
of one patient with left sided congenital IV brachymetatarsia were studied dynamically before (within 5 years) and after surgery. We determined the following X-ray metric indicators of foot:
I. The parameters characterizing the shortened metatarsals:
1. Length shortened metatarsal
2. Lagging of the shortened metatarsal from parabola (mm).
3. The second-fourth angle (normal value-50,5°).
II. X-ray parameters of forefoot:
4. M1-M2 distance — distance between centers of heads I and II metatarsals -19.7 mm.
5. M2-M3distance — distance between centers of heads of II and the III metatarsals -12.7 mm.
6. M1P1 angle is formed by between axes I metatarsal (M1) and a proximal phalanx (P1) — normal value 8-16.
7. M1M2 angle — is formed between axes I and II metatarsals-normal value 5-8.
8. M4M5 angle — is formed between axes IV and V metatarsals- normal value 6.5° — 8.
9. M5P1 angle — is formed between axes V metatarsal and proximal phalanx- normal value 0-7.
Results. The analysis data showed average age of patients underwent surgery was 16,4±4,1 years (from 11 to 28 years), average age appearance ofbrachymetatarsia was — 7,7±1,9 years (from 5 to 15 years). From the moment of detection of metatarsal shortening until the surgery passed from 3 to 6 years, on average 5±0,6 years.
The analysis ofx-ray films ofpatients with IV brachymetatarsia showed that shortened IV metatarsals are thinned, declined from an axis and rotated, heads have spherical shape with the expressed osteoporosis, and there is a goblet form irregular fusion zone (fig. 1).
Figure1. Roentgenogram of patient P. with the congenital bilateral IV brachymetatarsia
Figure 2. Frequency of occurrence of different distances between metatarsals, %
The average shortening were 17,8±2,8 mm (from 11 mm to 24 mm), that composed 38,2±8,3% from initial length. The second-fourth angle was ranging from 25 ° to 46 ° (on average 36,0±5,42 °). All patients had an angle of shortened metatarsal <50,5°. Distance between M1-M2 and M2-M3 were respectively 24,2±2,3 mm (from 20 to 32 mm) and 13,7±1,4 mm (from 10 to 18 mm). The major-
ity of feet had in distance between M1-M2> 20 mm (95,2%) and between M2-M3> 12 mm (84,1%) (Fig. 2).
M1P1 angle was average 21,1±7,7 ° (from 10 ° to 45 °). M1M2 angle was before treatment 12,4±3,4 ° (from 6 ° to 20 °). At most of patients feet M1P1 angle were more than 16° (74,6%) and M1M2 angle deviation more than8° (93,7%) (Fig.3).
0 5 10 15 20 25 30 35 40
Figure 3. Prevalence of patients on degree M1-P1 and M1M2 angles,%
M4M5 angle in feet was average 11,3±3,2 ° (from 5 ° to 20 °). averaged 7,8±4,5 °. At most ofpatients M4M5 and M5P5 angles has M5P5 angle initially fluctuated in the range from 0 ° to 20 ° and has turned out > 8 ° (79,4%) and <12 ° (81,0%) respectively (Fig.4).
Figure 4. Prevalence of patients depending on a deviation M4M5 and M5P5 angles,%
On table 1 linear and angulometric radiological parameters of forefoot patient 's A. with congenital left sided IV brachymetatarsia are shown in dynamics before and after surgery. The patient underwent X-ray annually. Brachymetatarsia of IV metatarsal was
Table 1.
firstly diagnosed in 2009 at the age of 8. But no treatment was offered. Surgery (callus distraction with Ilizarov's devise) was performed in 2014. Term of treatment was 153 days.
2009 y. 2012 y. 2014 y. 2016y. (after treatment)
1 2 3 4 5
Length of Ml (mm) 45 52 55 57
М2 (mm) 52 62 63 65
М3 (mm) 50 60 62 64
М4 (mm) 40 42 42 62
М5 (mm) 49 60 64 67
1 2 3 4 5
r4 (mm) 16 17 17 17
M1 М2 distance (mm) 20 21 23 20
М2 М3 distance (mm) 11 13 13 12
Angle М1 n,° 9° 13° 25° 30°
Angle М1 М2,° 10° 10° 15° 14°
Angle М4 М5,° 5° 12° 15° 4°
Angle М5 r5,° Valgus 8° Valgus 8° 0° 0°
The length of normal metatarsals had increased within 5 years: Ml to 12 mm, M2 to 13 mm, M3 to 14 mm and M5 to 18 mm. And length of the shortened M4 before operation has increased only to 2 mm. The length of P4-main had increased only to 1,0 mm. Distance of M1M2 has increased within 5 years to 23 mm, and after surgery have decreased to 20 mm. The same
tendency is noted when studying M2M3 distance. Angulometric parameters have shown that they increased in dynamics to surgery in comparison to healthy foot. After surgery M1M2, M4M5, M5P5 angles haven't changed, but M1P1 angle continued to increase. All these changes show formation of transversal flatfoot and hallux valgus (fig. 5-8.).
Table 2.
2014 y.
2009 y.
2011 y.
2012 y.
Annual roentgenograms of patient 's A. with congenital left sided IV brachymetatarsia
before and after surgery
Thus, radiological changes of foot with brachymetatarsia point to malformation of the foot skeleton relation that can lead fUrther to deformation in other parts of foot. IV brachymetatarsia is followed by metatarsus varus and hallux valgus, shortening of proximal phalanxes. Patients shall be dynamically to be observed. Conservative treatment of congenital IV brachymetatarsia shall be early and is directed to preventions of adjacent beams deformation.
2016 y.
In general, the research showed that congenital IV brachymetatarsia is characterized by the progressing development of deformation not only in the shortened IV metatarsal, but also in adjacent the metatarsals. Often these accompanying changes require conservative or surgical treatment.
References:
1. Al Kline, Endolyn Garden. Brachymetatarsia: One-Stage Correction using a Cadaver Bone Allograft. The Foot and Ankle Online Journal - 2 (5): 1. - Volume 2, - No. 5, - May - 2009.
2. Bahubali Aski, Devendra Kumar P., Mohan Patil C., Shashidhara H. A rare case of bilateral idiopathic brachymetacarpia and brachymetatarsia. International Journal of Advances in Medicine Int J Adv Med. - 2014 Aug; - 1 (2):162-164.
3. Bartolomei FJ. Surgical correction of brachymetatarsia. J Am Podiatr. Medical Assoc. - 80:76-82, - 1990.
4. Brenner E. Insertion of the tendon of the tibialis anterior muscle in feet with and without hallux valgus. Clin Anat. - 2002. - May. - 15 (3). - 217-23.
5. Choudhury S. N., Kitaoka H. B., Peterson H. A. Metatarsal lengthening: case report and review of the literature. Foot Ankle Int - 1997. -18:739-745.
Epidemic encephalitis: clinical features, diagnosis, modern treatment methods
6. Coughlin M.J and E. Freund, - 2001. The reliability of angular measurements in Hallux Valgus deformities. Foot Ankle Int, - 22 (5).
7. Kirkos M, A rare case of bilateral idiopathic brachymetacarpia and brachymetatarsia. Acta orthopedica Belgika. - Vol. 65. - 4-1999, -532-535.
8. Schimizzi A., Brage M. Brachymetatarsia. Foot And Ankle Clinics [Foot Ankle Clin], - ISSN: 1083-7515, - 2004. Sep; - Vol. 9 (3), -P. 555-70.
DOI: http://dx.doi.org/10.20534/ESR-16-11.12-83-84
Raikova Svetlana, 4th year student of the medical faculty
Shevchenko Petr,
Candidate of Medical Sciences, Associate Professor, SM
Karpov Sergey, Doctor of Medical Sciences, professor Potapova Irina, clinical intern Maulanberdinova Svetlana, clinical intern
Stavropol State Medical University, Russia Department of neurology, neurosurgery and medical genetics
E-mail: karpov25@rumbler.ru
Epidemic encephalitis: clinical features, diagnosis, modern treatment methods
Abstract: Epidemic encephalitis was first described by Viennese neurologist Professor KA Economo in 1915 during an epidemic in Austria. In 1918-1926 the disease was mass distributed and enveloped in a pandemic a number of European countries. However, according to the authors [1,2,7] many etiology and pathogenesis questions, diagnosis and drug therapy are still not fully studied and this makes scientists turn to this problem again. Objective: To analyze the modern methods of diagnosis and treatment in the clinic of epidemic encephalitis.
Keywords: epidemic encephalitis, encephalitis, modern treatment methods.
The acute stage of the disease begins with fever which reaches up to 38-39 °C. In addition to fever patients have a headache, muscle pain, nausea and vomiting, and they suffer from intoxication symptoms such as weakness, lethargy, catarrhal phenomena in the upper respiratory tract. The fever period lasts about 14 days. Neurological symptoms, such as drowsiness, start developing. The patient sleeps for two — three weeks with only short periods of awakening [6]. Pathological insomnia is registered in rare cases [2]. The patient can sleep neither during the night nor during the daytime. This can cause sleep and wakefulness disorders, which means the patient is constantly sleeping during the day and is awake at night. Insomnia and pathological sleepiness can replace each other. A characteristic symptom of the acute phase of the disease is considered to be the affection of the nuclei of oculomotor nerves such as drooping eyelids, diplopia, anisocoria, vision palsy and blurred vision due to paresis of accommodation. The photoreaction of pupils to light is missing, which is the main pathognomonic symptom of epidemic lethargic encephalitis [2; 5].
The chronic stage of the disease is characterized by extrapyramidal disorders that manifest in hyperkinesis such as choreoatheto-sis, athetosis, myoclonus, eye seizures and akinetic-rigid syndrome which includes amimia, akinesia and tendency to catatonia [6].
Mental disorders such as visual, auditory and olfactory hallucinations and changes in perception can occur in the acute stage of the disease. Disorders of the cardiovascular system, hyperthermia, consciousness disorder, respiratory rate and respiratory rhythm
disorders may develop and it can lead to death due to heart and breathing failure in severe forms of the disease.
It is impossible to determine the epidemic encephalitis incubation period definitely. The acute stage lasts from 2 days to 4 months. Almost half of the cases of the acute phase is transformed into a chronic one, which is characterized by parkinsonism, slurred speech and slowness. Besides parkinsonism frequent endocrine disorders, such as infantilism, diabetes insipidus, menstrual disorders and obesity can develop. These pathological changes can cause mental disabilities, children suffer from increased aggression, eroticism, agitation [1].
Thus, it is found that the basis for diagnosis of epidemic encephalitis is a combination of sleep disorders with psychosensory disorders and symptoms of oculomotor nerves. The cerebrospi-nal fluid in the acute stage of the most patients has pleocytosis-40 cells in 1 mm and a slight increase in protein and glucose content. The blood analysis shows leukocytosis with an increase in the number of lymphocytes and eosinophils, as well as an increase in ESR [1; 2].
The diagnosis of the chronic phase of the epidemic encephalitis is based on Parkinson's syndrome, endocrine disorders of central genesis, mental disorders. Today this disease occurs rarely and develops atypically. The majority of cases happen in winter and spring. Epidemic encephalitis affects all age groups of people, including children and the elderly, but people within the age group from 20 to 40 have more risk to catch this disease. Not clear asymptomatic and
