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8NEW APPROACHES IN THE TREATMENT OF COMMUNITY-ACQUIRED PNEUMONIA IN CHILDREN WITH MYOCARDITIS Shavazi N.M.1, Kardjavova G.A.2, Lim M.V.3, Lim V.I.4,
Nosirova D.A.5
1Shavazi Nurali Mamedovich - Professor, Head of Department; Kardjavova Gulnoza Abdulkarimova - Assistant; Lim Maksim Vyacheslavovich - PhD, Assistant;
4Lim Vyacheslav Inokentevich - Assistant of Professor;, 5Nosirova Dilangiz Akbarovna - Student, DEPARTMENT OF PEDIATRICS № 1, SAMARKAND STATE MEDICAL INSTITUTE, SAMARKAND, REPUBLIC OF UZBEKISTAN
Abstract: according to statistics, in young children, respiratory diseases are in the first place, which are one of the main causes of death in this age group (Baranov A. A. 2010, Samsygina G. A. 2014). According to the literature data, the frequency of pneumonia, the severity of the course and the prognosis largely depend on the combination of the influence of modifiable and unmodified factors on the child's body, the socio-economic status of the child's family, the conditions of infection, as well as on the availability of medical care.
Keywords: pneumonia, myocarditis, treatment, children.
Relevance. Respiratory diseases are the most common group of diseases among the child population and occupy the first place in the structure of the overall morbidity of children [8, 9, 10]. The relevance of chronization of bronchopulmonary processes, disability and mortality remains [1, 3]. Myocarditis is a disease of the myocardium of inflammatory origin that occurs under the influence of various infectious and non-infectious factors, characterized by inflammatory infiltration of the myocardium with fibrosis, necrosis and / or degeneration of myocytes [5, 7,11]. In recent years, there has been an increase in the number of myocarditis, but the true frequency of the disease in children is unknown due to the lack of uniform diagnostic criteria
for the disease, even taking into account pathomorphologies data and the extreme variety of clinical symptoms of the disease (from low-symptom "erased" forms to severe diffuse myocarditis such as Fiedler's myocarditis), as well as the almost complete lack of coordinated multicenter studies [2, 4, 6].
Objective: to determine the effectiveness of levocarnitine in children with community-acquired pneumonia on the background of myocarditis.
Materials and methods of research:
Due to the need to optimize the treatment of community-acquired pneumonia against the background of myocarditis, we studied 40 patients with community-acquired pneumonia against the background of myocarditis who were on inpatient treatment in the Samarkand Branch of the Republican Center for Emergency Medical Care, in pediatrics departments No. 1,2, who were divided into 2 groups of 20 patients, group I received standard therapy, group II received a complex of standard therapy in combination with levocarnitine.
Results of the study:
Upon admission, the general condition was assessed in children of group I as moderate in 2 (10.0%), in 16 - severe (80.0%) and extremely severe in 2 (10.0%), and in children of group II -moderate in 3 (15.0%), in 14-severe (70.0%) and extremely severe in 3 (15.0%), which indicates the relative same severity of the condition in patients of both groups.
The main pathological syndrome in almost all patients of this group, which causes the severity of the condition, as well as in patients receiving a traditional complex of therapy, was the syndrome of respiratory failure.
The clinical symptom complex was characterized by a combination of symptoms of acute hypoxia and characteristic signs of acute respiratory failure: cyanosis of varying severity from perioral to generalized cyanosis, participation of auxiliary muscles in the act of breathing, inflating of the wings of the nose, paroxysmal cough, impaired consciousness from arousal to coma, pasty skin, signs of peripheral blood circulation disorders.
There were also characteristic physical data in the lungs: box sound during percussion and diffuse expiratory wheezes. The analysis of physical changes in the lungs showed that if the percussive changes in the lungs were normalized by 4.6±0.3 and auscultative changes by 5.1± 0.3 days against the background of traditional therapy, then in the group with levocarnitine there was a significantly accelerated improvement in these indicators (3.9±0.4; 4.1±0.3; P<0.02). The inclusion of oral levocarnitine in the complex of traditional treatment was ultimately manifested by a decrease in the length of hospital stay of patients in comparison with patients of group II, on average by 1.0 day, while in patients of group II it was 4.8±0.3 bed days (P<0.05).
Conclusions: The results obtained indicate a typical clinical manifestation of community-acquired pneumonia against the background of myocarditis, at the same time, the study revealed a high clinical effectiveness of oral administration of levocarnitane, which was manifested in a reduction in the duration of hospitalization and oxygen therapy for the disease in children.
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