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Results of the research: in the analysis of the achieved data of the poll we determined that, 537 children out of 1350 had sedentary life style (39.8%). And it was met 1.5 fold more often than in boys, respectively, in 47.1% (312 girls) and 31.4% (216 boys) cases (p<0.05).
Among the teenagers with sedentary life style disharmony of physical development was met 5.6 fold more often, than among physically active teenagers (35.6%; 191 teenagers versus 6.4% (52 teenagers)).
According to the performed studies, both in our country and foreign ones, sedentary life gradually transforms to hyperkinesias, and later to somatoform dysfunction of vegetative nerve system [1].
On the basis of the analysis we determined presence ofveg-etative distention (including 3.5% excessive) in 23.2% of teenagers with sedentary life, and it provided prognosis of decreased tolerance to physical, emotional, and intellectual loads. Physically active teenagers had distention in 6.4% (52 teenagers).
Besides that, teenagers with sedentary life had anemia 3 times more often than physically active teenagers.
Rise of arterial pressure was registered in 17.9% of teenagers with sedentary life, while physically active teenagers had high arterial pressure only in 7.7% (63 teenagers), and it was 2.3 times rarer. Hypo tension was observed in 25.3% (136) of the teenagers with sedentary life. In that category ofchildren teenagers with "D" registration of various specialists were met 2.6 fold more often.
Totally, about half of the teenagers have some forms of diseases (49.5%; 668 teenagers). It should be specially noted
that, the greatest amount of pathologies was observed among the teenagers with sedentary life.
In this category of teenagers the most often met pathologies were diseases of endocrine system (58.2%; 389 teenagers), diseases of GIS (24.3%; 162 teenagers), rarely cardiac-vascular diseases (15.7%; 105 teenagers), renal diseases (5.1%; 34 teenagers). And the indicated states were combined in 1/3 of the cases.
Thus, the results provide definition of the medical-social risk group among the teenagers. The revealed tendencies and dependence let us determine priority measures for the prophylaxis of diseases among teenagers, taking into account their life style, risk factors for the development of chronic infectious diseases, life conditions, and physical status.
Conclusions:
1. 39.8% of the teenagers have sedentary life style, which has direct impact on their health.
2. Insufficient volume of physical loads in educational institutions is the factor decreasing physical health of studying teenagers.
3. Anemia was observed 3 times more often among the teenagers with sedentary life, and in 17.9% we registered rise of arterial pressure, while in 25.3% oppositely decrease was noted.
4. 49.5% of the teenagers have some forms of pathologies in the majority of cases characterized by diseases of endocrine and GI systems.
References:
1. Velikanova L.P. Clinical-epidemiological monitoring of neural-psychological status of children and teenagers. Pediatrics 2004; 1: 67-70.
2. Katelnitskay LI., Akhverdiyeva M.K., Glova S.Y. et al. Health passport and prophylaxis of non-infectious diseases: educational manual. - Rostov-on-Don: GOU VPO Rost SMU Roszdrav, 2007. - 192 p.
3. Korchina T.Y., Denejkina V.L. Prophylaxis of non-infectious diseases in children and teenagers of urban north region // Success of modern natural science. - 2009. - № 6 - 72-73.
4. Menshikova L.I. Risk factors of cardiac-vascular diseases in children. Human ecology 2003; 3: 45-50.
5. Chekhonadskaya Y.I. epidemiology of behavioral risk factors of non-infectious diseases in adolescent and adult population. Politics and strategy of targeted school prophylactic programs. Abstract of Dissert. ... Cand.Sc. - Orenburg, 2003. - 23 p.
6. Volek J.S., Westman E. C. Very-low-carbohydrate weight-loss diets revisited// Cleve. Clin. J. Med. 2002; 69: 849, 853, 856-848.
Umarova Lola Nabievna, Senior Research Fellow of Republican Specialized Scientific-Practical Medical Center of Pediatrics E-mail: evovision@bk.ru
Neonatal adaptation preterm infants with intrauterine growth retardation
Abstract: Catamnestic monitoring of children with intrauterine growth retardation (IUGR) during the year revealed that the vast majority of them (82.9%) were observed by the neuropathologist. The predominant clinical syndromes were pyramidal insufficiency syndrome, movement disorders, neuro-reflex excitability, hypertensive, asthenic-neurotic syndrome.
Neonatal adaptation preterm infants with intrauterine growth retardation
Keywords: Neonatal adaptation, premature infants, intrauterine growth retardation.
Relevance. Perinatal pathology of premature infants is a leader in the structure of perinatal and neonatal mortality, morbidity and subsequent disability [1; 2].
Special attention is deserved the problem of the syndrome of intrauterine growth retardation (IUGR), that is not only medical but also social value. IUGR is one of the first places in the structure of perinatal morbidity and mortality, the cause of infectious and somatic morbidity in preterm infants, as well as further violations of physical and sexual development. On the average every tenth baby is born with a low birth weight for gestational age [3; 4].
Therefore, the identification of the causes of IUGR and characteristics of children with this pathology is an urgent task of neonatology.
Objective: assessment of the state of newborns with intrauterine growth retardation, depending on the mother's obstetric pathology.
Materials ofresearch. To achieve the goal we have been analyzed 50 stories of preterm infants with IUGR, in which took account of the the delay and its degree of development, gestational age, their status at birth and the course of their postnatal adaptation, as well as various risk factors of formation of the pathology of the mother during pregnancy.
Results and discussion. It was revealed that the hypotrophic options of IUGR was observed in the vast majority of the analyzed stories (92.5% of cases), which corresponds also to the literature data. Other variants of IUGR were noted much less frequently: thus, a hypoplastic variant encountered in 8.8% of cases, and dysplastic — only 2.5% of cases. The vast majority of children were born at term of 34-36 weeks of gestation — 67.5%, 30-33 weeks — 20.0%, and 26-29 weeks — 7.5%.
The level of severity of children with hypotrophic option of IUGR in term infants were determined by the weight-height coefficient: I st. — 59-55, II art. — 54-50, III Art. — Less than 50. It was revealed that with the I degree of severity of hypotrophic option of IUGR was in 19.5% of full-term children, with grade II — in 65.8%, III grade — in 14,6%. In preterm infants degrees of severity of hypotrophic option of IUGR were calculated on deficiency of body weight at the given gestational age: thelst degree — deficiency of weight up to 10%, the 2nd degree — deficiency 10-20%, the 3d degree — 20-30%. It was revealed that the vast majority of preterm infants (85.7%) were from the III degree, and only 14.3% — with I degree of severity. If to summarize the above figures, among all infants (both term and preterm) with hypotrophic option of IUGR the I degree of severity was observed in 22.5% of children, the II degree — 56,3%, the III degree — 21.2%.
In this group of children in the early neonatal period, there was a violation of postnatal adaptation, wherein 33.8% of them were in need of observation and treatment in the intensive care unit. More than 50% of infants in this group had abnormalities in the neurological status, most
often in the form of a syndrome of increased neuro-reflex excitability syndrome, depression, hypertension syndrome and the syndrome of vegeto-visceral dysfunction. Apgar score of the newborn revealed the presence of moderate (82.5%) and severe (5.0%) degree of asphyxia. It is characteristic that clinical symptoms of perinatal encephalopathy in these children were noted in the first days of life, wherein severity of clinical symptoms corresponded to degree of disturbance of cerebral blood flow. These children tended to a small weight loss, but its slow recovery, there was a tendency to long transient jaundice and slow healing of the umbilical wound. These children do not retain heat, some of them needed microclimate ditch. Even within the normal birth to these children, in most cases it proved traumatic therefore the period of postnatal adaptation flowed with various complications. In addition to the changes in the central nervous system, in 7.5% of children have respiratory distress syndrome in the form of atelectasis, hyaline membrane disease, pneumopathy, which indicates not only about the general immaturity in children with of IUGR, but the immaturity of the lungs, leading to a deficiency of surfactant.
The severity degree of hypoplastic variant of IUGR was determined by deficiency of body length and circumference of the head in relation to gestational age. In these children was observed relatively the proportional decrease of all parameters of physical development (below 10% percentile) at the given gestational age. Therefore, children had been the proportionally built but they been small and relationship between head circumference and chest had not been violated, the edge of seams and of fontanels were soft. As children with hypotrophic option of IUGR, these children were prone to rapid cooling, respiratory disorders, and hypoxic encephalopathy.
In children with dysplastic option of IUGR were noted multiple stigma of dis embryogenesis (more than nine) from the skull, face, eyes, ears, neck, limbs and skin, and also pronounced neurological disorders.
In this regard, attempt was made to evaluate the etiology of IUGR highlighting recommended in the literature four major groups of risk of disease. The first group is the social and biological risk factors. For this were refined age of parturient women, their profession and occupation. It was found that in 10.0% of cases was marked the birth of children with IUGR from mature primiparas and 3.8% of cases — from young primiparas. When taking into account profession and occupational exposures revealed that the majority of women (76.3%) were not working (housewives), in most cases, have a low level of the welfare in the family; 7.9% postpartum women were students and female students who have psychological and physical stress, as well as insufficient and unbalanced diet have had an extremely adverse effect on fetal development. After the students by the frequency of occurrence followed women who engage in heavy physical labor (11.9%) and
women working at hazardous industry (3.9%). It is such a profession as a painter, Press operator, punch press operator and working in paint workshops.
The second group of risk factors is the so called maternal factors, leading to fetal growth retardation. Here in addition to the defects of nutritional status of women (deficiency of protein, vitamins, zinc and other microelements) are different concomitant factors of health state of maternal: pathology of pregnancy, harmful habits, taking certain medications. Thus, among the accompanying diseases of mother in 31.3% of cases, there is cardiovascular disease (various options neurocirculatory dystonia, rheumatism, varicose veins), in 28.6% of cases — inflammatory diseases of the female genital organs (appendages of the uterus, uterus), in 12.5% of cases — hormonal disorders (obesity, hypothyroidism, ovarian dysfunction, adrenal neuroendocrine syndrome). Next by frequency of occurrence, there was renal failure (chronic pyelonephritis, nephroptosis) and infectious diseases of the mother (hepatitis, SARS, syphilis, trichomoniasis).
The leading place among pregnancy pathology takes the chronic fetoplacental insufficiency (87.5%), which progresses rapidly when the duration of pregnancy begins to exceed the capacity of the placenta to provide the fetus with nutrients. Chronic fetoplacental insufficiency was present in all women with post-term pregnancy, and 2/3 of women with normal pregnancy on the background of concomitant pathology. This is followed by the previously tolerated abortion (medical abortions — 35.0%, self abortion — 2.5%), worsening of course of this pregnancy, and the presence of a long period of infertility (13.8%), the threat of termination of pregnancy (57.6%), toxemia of pregnancy (48.5%), anemia (46.3%), gestational pyelonephritis.
The third group of factors is the placental risk factors. These include developmental defects of the placenta (17.6%), placental abnormalities (19.6%), the entwining of umbilical cord around the baby's body parts (17.6%) absolutely short
umbilical cord (3.9%). These structural abnormalities of the placenta, as well as its attachment led to a decrease in the surface area participating in the exchange of substances between mother and fetus. To this also contributed a pathology that occurs at birth: the early discharge of amniotic fluid (46.3%), the presence of the total evenly narrowed pelvis (27.5%), rapid delivery (16.3%), and post-partum haemorrhage (7.9%).
The fourth groups of risk factors (fetus factors) in this group of children were not identified. These include multiple pregnancy, chromosomal diseases, hereditary metabolic abnormalities, congenital malformations, intrauterine generalized infection.
Catamnestic monitoring of children with IUGR during the year revealed that the vast majority of them (83.8%) were observed by neuropathologist. The predominant clinical syndromes were pyramidal insufficiency syndrome, movement disorders, neuro-reflex excitability, hypertensive and asthenoneurotic syndromes. The positive dynamics on the background of the treatment was observed at the vast majority of children (67.5%) and only 32.5% of the children remain under the supervision of a neurologist at the second year of life with minimal cerebral dysfunction.
Conclusions. Thus, according to the survey, the most common risk factors for preterm birth of children with IUGR include the following:
1. Pathology of pregnancy and childbirth (chronic fetoplacental insufficiency, and the threat of termination of pregnancy toxicosis, anemia, previous abortions).
2. Somatic and infectious diseases of mother as a before pregnancy and during it (cardiovascular disease, inflammatory diseases of the genital organs and kidney, hormonal dysfunction, various infectious diseases).
3. Unbalanced and poor nutrition during pregnancy (almost complete lack of fruit and necessary vegetables in their diet).
References:
1. Gomella T. L. Neonatology: management, procedures, on-call problems, diseases, and drugs. 5 th ed. New York, McGraw-Hill. - 2004. - 724 p.
2. Polin R. A., Spitzer, A. R. Fetal and neonatal secrets. 2th. Philadelphia: Hanley & Belfus Publication. - 2006. - 499 p.
3. Ahmina NI Perinatal health of children with a constitutional predisposition to diseases: Author. Dis. .. .PHD. - M., 2000. -37 p.
4. Jila T. N., Sirotina ZV. Factors of preterm birth and the characteristic of the early period of adaptation in preterm children//Materials II interdisciplinary conference on obstetrics, perinatology, neonatology "Women's health - Healthy Newborn" is dedicated to founder of the domestic neonatology Acad. A.F Turu (1894-1974). - 2007. - SPb. - 207 p.
Instrumental correction of scoliolytic disease in children and teenagers in the Republic of Uzbekistan
Umarkhodjayev Fathulla Rikhsikhodjayevich, Department of Neurosurgery with traumatology and orthopedics course,
Tashkent Pediatric Medical Institute E-mail:: skoliozdoc@rambler.ru
Instrumental correction of scoliolytic disease in children and teenagers in the Republic of Uzbekistan
Abstract: The article presents therapy results of 71 patients with scoliolytic disease treated by means of three-stage surgical correction method. It was noted that segment reconstruction and instrumental correction was more successful than other modern world analogies, and it was a selective method in the complex radical therapy of severe (95 -186 ° Cobb) forms of scoliolytic disease among children and teenagers. Keywords: scoliolytic disease, surgical correction, children and teenagers.
Topicality. The therapy of axis deformations of ver- (108-+36°). According to etiology there was prevalence
tebral collumn is one of the most difficult problems of the modern vertebrology. In spite of the significant success in the surgery of vertebral axial deformations in the recent decades, instrumental correction is still difficult for vertebrologists and the result of operations are not always satisfactory for orthopedists and the patients. The main reason is that the majority of surgeons make an accent on the application of various correction and fixation devices, paying little attantion to the whole impact complex [1].
The surgical method of instrumental correction of scoliolytic deformations most widely spread in Europe according to CDI [3] is not always effective and safe. The volume of correction after the application of that technology among the patients with average angle of scoliolytic drift equal to 55 ° deformation correction is only 54.5%, and at the remote terms only 41.9% of the corrections are preserved [1]. The number of complications is still high — 26% [2], among them acute neurological disorders can reach 17% [4].
Sometimes it is possible to stop progression of vertebral deformation, to prevent development of inner organs' involvement, to protect a patient from various complications and to normalize social aiming only by means of complex surgical operations. For the successful salvation of these problems it is rational to follow the principle of step-by-step therapy.
The aim of the research was the estimation of three stage reconstructive correction method efficiency for the severe forms of scoliolytic vertebral deformations.
Materials and methods of the research. From 2001 to 2014 on the territory of Uzbekistan 71 patients were operated with the application of three stage surgical correction method. The average age of the patients was 16.6±5.8 years (13-33 years old). The average angle of scoliosis in the group was 125.4±2.60 (from 95 ° to 186°) Cobb, Risser's symptom — 3.4.
It was mostly in thoracic-lumbar 57.7% (41) and thoracic 42.3% (30) location. Pathologic kyphosis was detected in 71.8% (51) with average central angle of projection hyper-kyphosis 91.6±1.9° (42 °-181°), misbalance of corpus to co-cix in 71.8% (51). The average kyphosis angle of T1-T12 was equal to 45±2.6 0 (5°-108°), L1-L5 lordosis (-) 49.9±1.2°
of idiopathic 49.3% (35) and dysplastic 23.9% (17) scoliosis. Congenital abnormalities and systemic pathology (neurofibromatosis, Ehlers-Danlos syndrome) was 14.1% (10) and 12.7% (9) correspondingly. 74.6% (53) of the patients had complicated anamnesis, associated pathology and complications, such as pyelonephritis, cholecystitis, osteoporosis, syringomeylia, hypothyroids, hyposomia, myelopathy, myocarditis, sepsis and others.
Results of the research. At the first stage of three stage correction course we performed correction of vertebral deformation on the value of functional component of deformation mobility achieved in the process of conservative extension preparing. Single-shaft telescopic distractor with 4-5 hooks for sublaminar fixation to vertebrae was attached along concave side of deformation.
The second stage included transpleural mobilization disk ectomy (average 5.2 disks (from 3 to 7)) with segment reconstruction ofvertebral bodies and intervertebral spondylodesis with auto transplants. The procedure was finished by additional correction of deformation with periosteum resection of 3-6 ribs, segment resection of dorsal parts of vertebral column along the arch and dorsal spondylodesis with bone transplantants. For the correction of the deformation we applied singleshaft and double-shaft endocorrectors (patent № IAP 03203. dated 22.09.2006).
The surgical correction was performed in three stages (totally 241 operations), average 3, 2 stage operations per a patient and 19.6 days (14-25days) for a stage. Average 49.2 days for the complete therapy term. The average mean for scoliosis correction was 46.7% (31.2-58.6%) after the first stage and 64.1% (43,7-79,2%) at the end of the correction. And the average remaining angle of scoliosis curve after correction was 44.1° (23°-92°).
There was registered growth increase to 12.5cm (4-29) because of prolongation of body length.
Complications occurred in 10.8% of the children. These were: 3 pyramidal disorders, 5 soft tissues fistulas (St.Aureus. Ps.aerugenosae), 1 liquorrhea, and 3 exacerbations of chronic diseases. All complications were eliminated by means of prolonging of hospitalization term to 4.3 days average.
