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Conclusions:
1. The blood serum of patients in the study using the method of wedge dehydration, with significant differences from the norm, is characterized by the presence of at least one of the major structural elements (large cracks, sectors, individual or nodules). In addition to the identified changes in the main items of the facies in the structural organization of the serum examined patients determined a wide variety of abnormal structures.
2. revealed the most typical and most common abnormal structure with cirrhosis who were treated leaf
structure and various types of cracks, concentration, etc. are free. The hallmark of facies serum in liver disease was pathologically modified polymorphism cracks. There were cracks circulatory, knotted blocks, the structure of the "harness" in the central area and the periphery.
3. It was found that the leaf structure was significantly more common with cirrhosis than in chronic hepatitis and moss figure rounded circular crack on and recorded at approximately the same frequency.
4. We were the first in liver disease have been found, "moss" figure is a sign of increasing concentration of bilirubin in the blood.
References:
1. Abdumanonov A. A., Botirov M. T., Karabaev M. K. Development of computer programs and algorithms for automatic morphometry bioliquid facies//New look. International Scientific Gazette. - 2014. - №. 6.
2. Botirov M. T., Abdumanonov A. A., Karabaev M. K. Diagnostic informativeness crystallographic imaging ofbio-logical fluids and their computer recognition//Prospects of development of information technologies. 2013. № 12.
3. Shabalin V. N., Shatokhina S. N. Morphology of biological fluids in laboratory diagnostics//Clinical Laboratory Diagnostics. - 2002. - № 3. - S. 25-32
4. Shabalin V. N., Shatokhina S. Morphology human biological fluids. - M.: Chrysostom, 2001. - 304 p.
5. Shatokhina S. N. Diagnostic value of the crystal structures of biological fluids in the clinic of internal diseases: Dis.dokt. honey. nauk. - M., 1995. - 225 p.
Muratova Zhanara Kochkorovna Teacher at Osh State University, Osh E-mail: allergyjasu@rambler.ru Sulaimanov Shayirbek Alibaevich Sh. A. Director of Osh inter-regional united clinical hospital
New aspects of atopic dermatitis in children living in Southern Kyrgyzstan
Abstract: The results of clinical and diagnostic examination and treatment of 93 children with atopic dermatitis (AD) living in the south of the Kyrgyz Republic are presented. High level of presence of family history, increased concentration of total IgE in blood serum and co-occurring pathology is established in examined children. The efficiency of complex AD therapy (77,2%) that includes antihistamines of first and second generation, topic and systemic corticosteroids, antibiotic therapy and diet therapy is confirmed. The necessity of anti-relapse treatment and long-term individual regular medical check-up is proved.
Keywords: children, atopic dermatitis, antihistamines, antibiotic therapy, corticosteroids, diet therapy.
Relevance. Atopic dermatitis (AD) is a chronic Eastern Europe, Asia and other world regions [3; 4;
recurrent inflammatory skin disease that is charac- 10; 12; 16].
terized by a disorder of barrier function of epidermis The interaction of genetic and environmental factors
with intensive itching, dryness and increased absorp- with further development of sensibilization of organism
tion of skin with respect to irritating substances of the plays an important role in AD development, although the
environment [1; 2; 12, 28]. Prevalence of AD among direct reasons of growth of occurrence of this pathology
children of all ages is the highest in the countries of remain quite unclear [6; 13; 17; 19; 20]. Western Europe, where the disease affects up to 22% Taking into account multi-factor pathogenesis
of child population. Prevalence of AD is growing in and variable course of the disease, its therapy should
correspond to the peculiarities of the course of the disease and include a combination of various preventive and therapeutic measures [2; 3; 5; 7; 9; 11; 14; 16; 18].
Information about the clinical course of AD in permanent dwellers of the south of the Kyrgyz Republic is absent, which is the ground for the conduct of the present research.
The aim of the present work is the study of clinical peculiarities and therapeutic aspects of atopic dermatitis in children living in the south of the Kyrgyz Republic.
Materials and methods of research. 93 children with AD aged from 3 months to 14 years were under observation at the Department of Pulmonology of the Osh interregional children clinical hospital, 49 (52,7%) boys and 44 (47,3%) girls. The disease duration fluctuated from 2 weeks to 9 years. In 67 (72%) children, the manifestation of AD fell on the early age.
Diagnosis of AD was established on the basis of allergological anamnesis, results of clinical-laboratory
and allergological methods of diagnostics (enzyme-
linked immunosorbent assay). To evaluate the severity of AD, the semi-quantitative scale SCORAD was used in some children [1; 2; 7]. The diagnosis was established on the basis of AD classification proposed by the scientific research program of the Union of Pediatricians of Russia [2].
Results and discussion. As a result of the analysis of obtained data, it was established that the parents of 48 (51,6%) children with AD noted family history with regard to allergy, more frequently maternally (56,2%).
The anamnesis of61 (65,6%) children showed hypersensitivity to allergens of food products. In 24 (25,8%) cases, the deterioration of the course of skin process was related to psycho-emotional factors. 7 (7,5%) patients showed inclination to frequent infections. In the course of examination, 21 (22,6%) child was diagnosed with dyskinetic defects in biliary tracts, 9 (9,7%) — manifestations ofbronchi obstruction, 12 (12,9%) — lambliasis and 5 (5,4%) — ascariasis. 1 (1%) child was diagnosed with bronchial asthma, and 5 (5,4%) children showed allergic rhinitis. 23 (24,7%) children suffered from moderate and severe iron-deficient anemia.
Every age period is characterized with its own typical clinical-morphological peculiarities, which is manifested in the age evolution of rash elements. In this respect, five clinical-morphological forms (exudative, erythe-matic-squamosal, erythematic-squamosal with licheni-fication, lichenoid and pruriginous) and three stages of disease development (infant, child and teenage-adult) were distinguished. 52 (55,9%) children had exudative,
23 (24,7%) patients had erythematic-squamosal with lichenification and 18 (19,3%) children had erythemat-ic-squamosal forms of AD. In 68% of children, the skin process was of generalized nature and in other 32% — of limited nature. All children were in the period of aggravation of skin process.
Clinical polymorphism of rashes is typical for AD. The true polymorphism of rashes is a general feature of all clinical forms of AD. They create a complex clinical syndrome with combined features of eczematous and lichenoid disease accompanied with itching. Skin process in observed children was accompanied with skin itching in all cases (100%), oozing in 85 (91,3%) cases, lichenification in 54 (58%) cases and erythema of skin cover in 45 (48,4%) cases.
Papule-vesicular elements were observed against erythematous edematous background, which were mainly located on the hairy part of the head, face (cheeks, forehead, chin) (53,4%), extensor surface of upper and lower extremities, buttocks (25%), had symmetrical character and were accompanied with intensive itching.
«Dry» form of AD is characterized with erythema-tous-squamosal, slightly infiltrated loci, epidermal-dermal very itching papules. There were many secondary elements: erosions, crusts, squama and excoriations.
According to the data of allergological examination, 30 (32,2%) children with AD showed increased concentration oftotal IgE in blood serum. The level of total IgE in blood serum fluctuated from 215 to 3084 IU/ml.
Hence, hypersensitivity reaction of immediate type is a significant immune-pathological mechanism in AD pathogenesis. Factors confirming the role of IgE in AD pathogenesis are family history in respect of atopy, increase of the level of total IgE in blood serum, decrease of IgE level during remission and increase during AD aggravation, as well as presence of co-occurring allergic diseases in such children.
Diet therapy is the most important factor in complex treatment of AD patients. It is proved that appropriately selected hypo-allergic diet accelerates clinical recovery, contributes to the improvement of disease forecast, reduces the frequency and intensity of aggravations [5; 11]. Despite the fact that with years hypersensitivity to food allergens weakens and many of them can be introduced to daily ration, the observance of hypo-allergic diet is recommended to all children during the period of AD aggravation.
In case ofAD in a breastfed child, the ration ofbreast-feeding mother was corrected. Products with high sen-sibilizing activity as well as onion; garlic; radish; meat,
fish and chicken broth and spices were excluded. Dairy products were only given in the form of fermented milk drinks.
The most frequent reason ofAD during the first year of life is allergy to proteins of cow milk. Soy powders (Al-soy, Bona soy, Nutrilon soy, Similac Isomil, Tuttelli soy, Frisosoy, Humana SL, Enfamil soy) were recommended as substitutes for cow milk. In case of allergic reaction to soy proteins, powders based on products of high hy-drolysate of milk protein (Alfare, Alimentum, Pepti Junior, Pregestimil, Nutramigen) were prescribed. Powders based on products of partial hydrolysate of milk protein (Humana GA1, Humana GA2, Friso Pep) were used in children with weak or moderate sensibility to cow milk proteins; they were also used for prevention of milk allergy in children from AD risk group [1; 3; 11; 16].
Control of the environment of a child with AD came to several important measures allowing reducing the contact with domestic, mite-born, mold fungi and pollen allergens.
Drug therapy of AD included system (general) and local (external) therapy.
When choosing a drug of system action, the patient's age, disease period, presence of co-occurring diseases and drug sensibilization were taken into consideration.
Antihistamines were prescribed mainly for acute inflammatory manifestation of AD (reactions of hypersensitivity of immediate type). Out of antihistamines of first generation, dimedrol (61,3%, diphenhydramine — 18,3%), diazolin (26,9%) and chloropyramine (supras-tin) (21,5%) were used most often.
Antihistamines of first generation were prescribed for short-term courses (7-10 days) during expressed aggravation, when not only anti-itching, but also sedative effect is required. For long-term use, drugs of second generation (ketotifen — 52,7% and loratal — 2,1%) were selected.
During persistent intense itching, a combination of histamines of first generation was prescribed for night, and histamines of second generation were prescribed for day.
Recovery of functional condition of central and vegetative nervous system is an important element in complex treatment ofAD patients. Sedative and psychotropic drugs (luminal (1%) and carbamazepine (2,1%)) were prescribed for this purpose.
In case of expanded skin lesions and intense itching, calcium gluconate (65,6%) was used. Herewith, one should remember that the drug is mainly prescribed parenterally as tablet form does not give required therapeutic action.
Correction ofdisorders ofgastro-intestinal tract plays an important role in AD treatment. Any chronic inflammation sooner or later leads to disbalance of intestinal flora, namely, to decrease of bifidogenic and increase of opportunistic flora [2; 16].
During AD aggravation, a 5-10 day therapy with enterosorbents (activated carbon) was prescribed, then, eubiotic (bifidumbacterin etc.) and enzyme agents (pan-creatin, 44%) were added.
In order to correct disorders of separate indicators of metabolism in AD patients, a range of vitamin products was used. Among children with AD, 1 (1%) was given ribiksin, 2 (2,1%) — ascorbic acid and 14 (15%) — ae-vit. These groups of drugs were prescribed for subacute stage and period of AD remission.
Relapsing pyoderma, viral infection, mycosis are indications for immunomodulating/immunostimulating therapy (thymalin, 2,1%). Immunocorrecting therapy should be performed under a strict control of immunological indicators and under the guidance of allergologist-immunologist.
In very severe, persistent cases, with wide skin lesions as well as in case of unbearable, torturing itching where other products couldn't stop it, system hormones (hydrocortisone, prednisolon) were used. Corticosteroids (prednisolone — 31,2%, hydrocortisone — 16,1%, dexametha-sone — 7,5%) were prescribed for short 3-5 day courses according to age dosage with further discontinuation without gradual reduction of dosage and switching to products affecting the function of suprarenal cortex along the way of physiological regulation of its activity (glycyram, etimizol).
In case of the overlay of secondary infection, antibiotics of wide spectrum were used. Indication for system application of antibiotics was insufficient efficiency of external anti-bacterial therapy in children with pussy crusts covering erosions and skin cracks, pustular rash elements as well as in case of chronic loci of bacterial infection, expressed lymphadenitis. Amoxicillin (17,2%), ampiox (10,7%), azithromycin (9,7%) and ciprofloxacin (4, 3) were used in empiric therapy.
Antibiotics from the group of macrolides (sumamed, klacid, wilprafen etc.) are the most effective, due to high sensitivity of activators to them and least risk of adverse allergic reactions [1; 2; 9].
Ceftriaxone, cefuroxime, oxacillin can be used for children with severe AD and its torpid course. Ceftri-axone can be the first line product in severe skin infections caused by S. aureus; cefuroxime and oxacillin can be the second line products or products of active reserve [9; 15].
The aim ofexternal therapy is elimination ofsigns ofthe disease, ensuring of psychological comfort of a child and long-term control ofdermatosis process. Treatment should be appointed depending on the stage ofAD, acuteness of inflammatory manifestations and presence of complications.
In case of acute inflammatory disease accompanied with oozing, exudation, dermatological moist packs with furacilin solution (16,1%) were prescribed for 1-2 days, after which ointments/pastes — furacilin (80,6%), salicyl (4,3%), zinc (3,2%), indomethacin (2,1%), levomycitin (in case of an overlay of secondary infection) (1%) were applied.
Currently, in pediatrics, non-fluorinated products of the last generation (elocom, advantan, afloderm, lo-coid) are preferred when prescribing corticosteroids [2; 3; 16]. They have high efficiency and safety, applicable for children of very young age (cream and ointment elocom — no age restrictions, advantan — from 4 months, locoid — from 6 months) [3].
For children with AD observed by us, advantan was prescribe in 25,8% of cases, gioksizon in 7,5% of cases and sinaflan in 2,1% of cases.
Products were applied in morning hours, once a day, in short courses of not more than 10-14 days, after which there were breaks in treatment for not less than a month. The product was applied on the skin surface not exceeding 20% of the total area. Children with severe AD, with relapses of more than 2-3 times per month, were recommended to take topic gluco-corticosteroids for two consecutive days per week to prevent aggravations (intermitting scheme). Evaluation of efficiency and review of treatment tactics were performed every 3-6 months.
During an acute period of disease, intra-nasal electrophoresis with the solutions of dimedrol and calcium chloride (4,3%) were prescribe in order to reduce itching. Light therapy (UV, 44,1%) was used as an auxiliary method in treatment of torpid course of AD.
In case of lichenification, paraffin therapy in the form of application of40-50 minute on lesions was prescribed.
During a stage anti-relapsing therapy of AD, resort treatment and high mountain climate therapy in the conditions of Issyk-Kul lake were recommended.
Evaluation of clinical-laboratory efficiency of performed complex therapy in children with AD was performed after 3-6 months. In 77,2% of children with AD, who received such therapy, positive clinical dynamics was achieved, which was manifested in decrease of AD aggravation period, prolongation of remission and reduction of total IgE concentration in blood serum.
Thus, complex treatment of atopic dermatitis with the use of wide spectrum of modern pharmaceutical and non-medicament products allows significant increase of the effect of performed treatment, achieving prolongation of clinical remission and performing control of the disease process.
Conclusions:
1. Risk factors ofAD in children living in the south of the Kyrgyz Republic are: family history in allergy (51,6%, maternally — 56,2%), manifestation of hypersensitivity to food allergens (65,6%) and psycho-emotional disorders (25,8%).
2. In clinical picture of AD in children, generalized forms (68%) in the form of exudative (55,9%), erythe-matic-squamosal with lichenification (24,7%) and ery-thematic-squamosal (19,3%) variants of process prevail against the increased concentration of total IgE in blood serum (32,2%).
3. Success in treatment of AD patients can be achieved by using a complex therapy that includes elimination measures, diet therapy, long-term conduct of pharmaco-therapy, including external therapy and a complex of rehabilitation measures. Performance of such therapy in children with AD leads to clinical efficiency in 77,2% of cases, which is manifested in reduction of AD aggravation period, prolongation of remission and, in some children, decrease of concentration of total IgE in blood serum.
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Study of cytokine profile in newborns with necrotizing enterokolitis
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Nasirova Sevinj Ramiz kizi, Scientific Research Institute of Pediatrics, Candidate of medical science E-mail: sevincnesirova40@gmail.com Mehdiyeva Sevinj Amil kizi, Scientific Research Institute of Pediatrics, Research Assistant E-mail: sevincm@box.az Huseynova Nurana Qahraman kizi Azerbaijan Medical Universite Assistant chair
Study of cytokine profile in newborns with necrotizing enterokolitis
Abtract: The main goal of the research is to study of cytokine profile in newborns with necrotizing enterokolitis
[NEK]. Research revealed, that course of NEK clinical-exographic picture is associated with greater disbalance of
pro-inflammatory cytokines.
