CC BY
44
Prevention of polio, results and achievements
from the “inner standard serum” in that case were detected only in the patients with IE (ААВ GABA 71.8±4.7 r. u., Р<0.05; АА^ DA 74.4±4.2, Р<0.01; АА^ SER 76.9±3.4 r. u., Р<0.05). Among the examined patients with SE reliable differences were detected only in relation to AAB to dopamine (62.6±5.0 r. u., Р<0.05).
High level of auto antibodies to GABA is the proof of disorders in the work of GABA-ergic system, intensifying neurotoxic effect of glutamate on the one hand, and inhibiting structures of anti-epileptic system on the other (Gusev Y. I., Gekht A. B., 2009). In particular, reliable rise of AAB to this neurotransmitter in the patients with idiopathic epilepsy can prove deep misbalance in glutamate-ergic system and expressed exhaustion of GABA-ergic system in that group of the patients, and it serves to be a trigger for the processes ofneuronal sprouting. The presence ofhigh levels ofAAB to dopamine and serotonin in the patients with IE and a reliable difference from the values of “inner standard serum” proves a close link of glutamate-ergic system with the system of biogenic amines, misregulation of which leads to destructive effect on neurons and has proepileptic effect. In that case that kind of correlation of AAB can be interpreted as a proofofexpressed auto immune reaction from the side ofnerve tissue, which, in its turn, promotes maintenance of pathologic epileptic system in the patients with IE.
Thus, the rise of AAB to ligand-binding site of neural mediators’ receptors (Glu-R, GABA-R, Dop-R, Ser-R and Chol-R) indicates changes in the corresponding systems of neurons. The higher serum level ofAAB to receptors of neural mediators can indicate the presence of various mechanisms of neural mediation and neural plasticity realization in the patients with IE and SE.
Conclusion. The total sum of the achieved data, relevant to immunologic aspect, testify that inadequate reaction of immune system can lead to formation of pathologic convulsive activity. In other words, immune pathologic mechanisms, including those which are manifested by abnormal alterations in the production and serum content of neurotropic AAB, are involved to epilepsy pathogenesis.
One of the leading mechanisms of pathogenesis of epilepsy is complex reconstruction of neuralimmune interrelations, manifested by one-direction rise of the level of auto antibodies to neural specific proteins S100, GFAP, NF-200, CBP and neural mediators glutamate, GABA, dopamine, serotonin and voltage-dependent Ca channel. And the key part in the pathogenesis of idiopathic epilepsy is neural mediator misbalance, and in the pathogenesis of symptomatic one — rise of AAB level to GFAP and CBP.
References:
1. Asanova L. M., Morozov S. G., Yakovlev N. A., Zinkovski K. A. Serum auto antibodies to glyospecific antigens of brain in the patients with epilepsy//Neuroimmunology. - 2003, - V 1., № 2. - P. 57-58.
2. Vetrile L. A., Yevseyev V A., Karpova M. N. Neuroimmunepathologic aspects of epilepsy//Bulletin of RAMS. - 2004. -№ 8. - P. 43-46.
3. Krijanovski G. N., Magayeva S. V., Makarov S. V., Sepiashvili R. I. Neuroimmunopathology. Manual. М.: 2003., 438 p.
4. Lusnikova I. V Clinical and neuro immunologic aspects of pharmaco-resistent epilepsy: Abstract of doctoral diss. - М.: RGMU, 2008. - 32 p.
5. Poletayev A. B., Alferova V V., Abrosimova A. A., Komissarova I. A., Sokolov M. A., Gusev I. I. Natural neurotropic auto antibodies and pathology of nerve system//Neuro immunology. - 2003. - V.1., № 1. - P. 11-17.
6. Prokhorova A. V. The role of neuro immune mysregulation in the pathogenesis of post-traumatic epilepsy in children//Jour-nal of theoretical and clinical medicine. -2011.- № 5. - P. 64-67.
7. Engel J. J. ILAE classification of epilepsy syndromes//Epilepsia. - 2006. -Vol. 70. - P. 5-10.
8. Gusev E. I., Guekht A. B., Poletaev A. В., Lusnikova I. V., Feygina A. A., Kovaleva I. U. Changes of serum levels of natural neurotropic autoantibodies in patients with partial symptomatic/cryptogenic epilepsy//Epilepsia. - 2006. - Vol. 47, suppl. 3. - P. 38.
Saydaliev Saydimurat Saydiganievich, Ministry of Health the Republic of Uzbekistan Tashkent, Uzbekistan E-mail: [email protected]
Prevention of polio, results and achievements
Abstract: Regularly by independent experts of the World Health Organization, evaluates the quality of immunization and surveillance for acute flaccid paralysis in the Republic of Uzbekistan.
Due to the high level of immunization coverage against polio, as well as the absence of polio cases during at the appropriate level of surveillance for acute flaccid paralysis, the Republic of Uzbekistan for 12 years, retains the status of a “territory free of wild polio.”
77
Section 8. Medical science
Thus, all of the foregoing proves that in Uzbekistan due to proper management of immunization policy managed to eradicate the disease polio.
Keywords: OPV — oral polio vaccine, IPV — inactivated poliovirus vaccine, AFP — acute flaccid paralysis, VAP — vaccine-associated polio, NID — national immunization days, SUB. NDI — up campaign in a particular area.
OPV — oral polio vaccine, IPV — nactivated poliovirus vaccine, AFP — acute flaccid paralysis, VAP — vaccine-associated polio, NID — national immunization days, SUB. NDI- up campaign in a particular area
In the world there are countries in which year after year is maintained circulation of wild poliovirus. Among them there are Afghanistan, Pakistan and Nigeria. In addition, in 2013, after years of epidemic wellbeing became identified cases of polio in Syria, Cameroon, Ethiopia, Somalia, and Kenya. In 2014 to these countries were joined Equatorial Guinea and Iraq. In 2014 in the world laboratory confirmed 358 cases of polio. The main share ofthese diseases occurs in Pakistan (305 cases). On the second place by incidence is Afghanistan, where laboratory confirmed 28 cases. In third place — Nigeria, where revealed 6 cases. Also on the 5 cases in Somalia, Cameroon and Equatorial Guinea, 2 cases — in Iraq and in one case — in Syria and Ethiopia. As for the new cases, in January 2015 have revealed 8 and laboratory-confirmed 7 cases of polio in Pakistan. The latter case is identified in 17.01.2015. Since 2013, all cases were caused by polio virus type I.
The Republic of Uzbekistan with a population over 30 million people, of whom 2.9 million forms children under 5 years old, bordering states such as Afghanistan, where constantly from year to year are recorded cases of polio, Turkmenistan, Kazakhstan, Tajikistan, where in 2010 there have also been cases of wild poliovirus detection. Therefore, special attention is given to activities in the country to prevent the introduction and spread of the disease in the country.
The main directions of measures to prevent the introduction and spread of polio in Uzbekistan are the constant maintenance of a high level of coverage against polio. This is achieved by carrying out routine (according to the calendar
of preventive vaccination) and additional (epidemic indications) immunization, as well as maintaining a high level of surveillance for acute flaccid paralysis (AFP), with mandatory laboratory testing of each patient.
Immunization policy in Uzbekistan is based on the Constitution, the Law of the Republic of Uzbekistan “On protection of republic health”, which guaranteed access to free vaccination in the national calendar of preventive vaccinations, as well as epidemic indications.
Results and their discussions
Global polio eradication program in the world goes on, and Uzbekistan has been actively involved in the program of the World Health Organization (WHO) to eradicate polio. Before the start of mass vaccination against polio, in the world sick every year 500 000 children, of whom tens of thousands children have been disabled.
The last outbreak of polio was registered in Uzbekistan in 1993 and 1994, when it was revealed 68 and 117 cases against the background of low routine immunization coverage (46% in 1993), due to poor availability of vaccines. As a result of the implementation of national programs and increase immunization coverage outbreak was over, the last case occurred in 1195 [1, p. 17].
By virtue of started in 1988 on the initiative of WHO mass polio vaccination using the “MECACAR” in 1994 in the country conducted a mass campaigns against polio — National Immunization Days (NDIs) in all regions of the country and Sub-national Immunization Days (SubNDI) in the border 8 regions of the country among children aged 0 to 5 years.
As a result of immunization since 1996 in the Republic there were no cases of diseases caused by wild poliovirus stains.
78
Figure 1. Disease incidence of polio and prophylaxis vaccination coverage against polio of children in Republic of Uzbekistan in 1991-2003
Prevention of polio, results and achievements
In 2002, the World Health Organization declared the European Region free from polio. This status has received 51 states, including the Republic of Uzbekistan, which for many years held the status of the territory of the free circulation of wild poliovirus, thanks to systematic efforts to ensure the immunization of children in the national immunization program and functioning of the system of surveillance for acute flaccid paralysis (AFP) [2, p.5].
Given the progress on the 2011-2020 WHO has developed the concept of the Decade of Vaccines, the objectives of which proclaimed:
— Aspiring to free the world from polio.
— Achievements global and regional targets for elimination of diseases.
— Achievements targets for immunization coverage in each region, country and community.
— Development and implementation of new and improved vaccines and technologies.
— Outreaching planned target millennium reduces infant mortality [10, p. 10].
In the Republic of preventive vaccination under the National calendar financed from the state budget. In order to provide a centralized supply ofvaccines for the expanded program on immunization in 2004, the Ministry of Finance of the State Budget opened the account number 01841 and from 2006 carried out a centralized allocation of funds; If in 2004, on the on the resources of the state were purchased 54.1% of the vaccines, then from 2011 to the present day, this figure increased to 100.0%.
In connection with insufficient arrival of the vaccination in republic in 1992-1995 was registered outbreak of the poliomyelitis with most amount of diseased in 1994114 people.
Table 1. Considering complication of the epidemic situation since 1995 to 2006, in 2010-2013 in republic were conducted NDI and Sub-NDI against poliomyelitis among children under 5 years old.
Years NDI SubNDI
Subject to vaccinated % Subject to vaccinated %
1994 2.566050 2.524226 98,4 - - -
1995 3.185818 3.091198 97,0 - - -
1996 2.487657 2.443436 98,2 - - -
1997 2.469203 2.453749 99,3 - - -
1998 2.370345 2.349795 99,1 - - -
1999 2.259447 2.251211 99,6 - - -
2000 2.157181 2.146142 99,4 443885 442354 99,7
2001 2.056240 2.045442 99,5 447178 445811 99,6
2002 2.011287 2.000831 99,4 455191 454378 99,8
2003 - - - 744770 739549 99,3
2004 - - - 1.262553 1.257388 99,5
2005 - - - 1.118574 1.115508 99,7
2006 - - - - - -
2007 - - - - - -
2008 - - - - - -
2009 - - - - - -
2010:0-5 years 2.896447 2.910685 100,5 - - -
0-15 years 9.266279 9.283307 100,2
Surh.0-25years 425086 394787 92,9
2011 3.096401 3.100614 100,1
2012 - - - 1.942898 1.939347 99,8
2013 - - - 1.937809 1.937710 99,9
Polio vaccination convincingly demonstrated its outstanding performance and efficiency. However, epidemiological welfare achieved if immunized at least 95% of children during the first 2 years of life.
If the long-term aim of mass vaccination was to reduce the incidence of childhood infections and mortality, it is now the main task is to maintain that well-being and progress of the epidemic spread it to all new infection. And it is necessary to take into account identified in recent decade’s phenomenon of vaccine dependence, which is controlled by the return of infections after the cessation of mass vaccination
against the background of zero or sporadic incidence. It has been repeatedly demonstrated in practice: termination of vaccination or even a temporary reduction in their coverage leads to the development of epidemics.
Can be imported wild polioviruses in an area free from polio exists as long as anywhere else in the world, these viruses are circulating. To prevent the spread of infection is necessary to maintain a high level ofvaccination coverage against polio, as well as providing high-quality surveillance for polio and AFP.
According to V. B. Seybilya and L. P. Malyshkina [9, pp. 41-44], we can not talk about polio eradication, and about
79
Section 8. Medical science
the elimination of the disease or reduce it to the minimum possible size and the maintenance of this state by continuing mass vaccination of the population.
In an era when there were no vaccines, the disease was of epidemic, leaving children with disabilities. There is reason to believe that defects in the organization of vaccination which resulted in a large number of children are not vaccinated, are a major cause some increase in the incidence of polio, noted in 1961 in the Tashkent city [3, p. 9].
With the introduction of vaccination incidence decreased to some isolated cases. Therefore, it is important to continue to vaccinate the entire child population.
Worldwide polio vaccinations care carried out using two types of vaccines — oral polio vaccine (OPV) and inactivated polio vaccine (IPV). In the 50 years of the last century, scientists have been proposed, these two types of vaccines. Sabin offered live oral polio vaccine (OPV), later named after — Sabin vaccine. In the parallel with him Solk was developed vaccine from a killed virus — called inactivated polio vaccine (IPV). Both vaccines contain the three basis types of polio virus, thus they are both protected from the infection of all variants.
Total calendar child receive 6 doses of polio vaccine (neonatal period 2-5 day from the moment of birth — ldose, up to 1 year — 3 doses, 1-2 years — 1 dose and 7 years — 1 dose). It is used polio oral trivalent vaccine composed of attenuated Sabin strains of polio virus 1, 2, 3 types. Manufacturers: “Glazko Smith Kline”, Belgium and “Sanofi Pasteur”, France.
OPV — oral polio vaccine (OPV) (Sabin’s vaccine).
A characteristic feature — if vaccination is created “collective”, cascading immunity, that is, the vaccine virus from vaccinated child in the body multiplies, released into the environment and into other children, causing them to “vaccinate” and “revaccinate”. This allows creating a large stratum of children with sufficient immunity to polio. The vaccine is of little value and can be used anywhere, so recommended by WHO for mass immunization for polio eradication in the world.
By virtue of mass immunization with the vaccine achieved wide coverage with inoculation and eradicate polio occasion. OPV have another unexpected pleasant property — it able to stimulate the synthesis of interferon in the body (an antiviral agent). Therefore indirectly such vaccination may protect against influenza and other viral respiratory infections. Drip vaccine using a special plastic dropper. It is usually 2 or 4 drops, according to the instructions of the vaccine, and if the child vomits, performs the procedure again. The child is not recommended to feed and water after instillation of a vaccine for about an hour. Total spends 6 cycles instillation, as established immunity to protect against disease. If the intervals between doses were highly elongated, just need to complete the necessary administration according to plan.
Local or general reaction to the introduction of the drug is usually absent, rarely can slightly raise the temperature (up
to 37.5 degrees C) for about 5-14 days after vaccination in young children. Usually up to two years may experience a slight dilution of the stool, but it is not a complication
after vaccination.
OPV is contraindicated in children with identified severe immunodeficiency, AIDS, or children whom have relatives in the immediate vicinity with similar problems.
Vaccine efficacy is very sensitive to storage conditions, it should be at -20 degrees C and even inaccurate dosing due to the peculiarities of small patients — part of the vaccine is lost in the feces, spit up, and digested in the stomach if swallowed. Due to the fact that children receiving OPV, isolated environment vaccine viruses, it prevents end polio (small mutation probability polio vaccine viruses to pathogenic saved always). A child having severe problems with immunity or health in general, after improper administration of vaccine, or if he has received the vaccine virus by contact from other kids, very rarely, but it may develop a severe complication — vaccine-associated poliomyelitis (VAP), which is very rarely, occurs as the present, with paralysis ofthe limbs. This condition can develop on the introduction of the first, at least — the second dose of OPV, more often in children with AIDS and severe combined immunodeficiency, also susceptible to the development of VAP and children with malformations of the gastrointestinal tract. In healthy children do not develop this complication. But if there is a risk, it is necessary to minimize it. This is possible with the introduction of the first dose of inactivated vaccine (IPV injection), and the other to inculcate OPV. Then by the time of the introduction of the child will already be sufficient to prevent the development of vaccine-associated polio.
Experience in other countries has shown that the transition to the use of inactivated polio vaccine (IPV) is the best choice. The transition to the use of IPV is logical enough to prevent the circulation of the modified vaccine viruses.
42. Today IPV included in the calendar of vaccinations most European countries, mainly also to eliminate of vaccine-associated poliomyelitis (VAP). The cost of IPV is about ten times higher than OPV.
IPV — inactivated polio vaccine (by Solk).
This is a special individual-dose syringe with clear liquid 0.5 ml, is introduced it is usually up to one and a half years in the thigh, and the older children — in the shoulder. Immediately after the inj ection, children can eat and drink — restrictions are not available. It is advisable not to rub the injection site, do not expose it to direct sunlight about two days. Bathe your child to walk with him is possible and even necessary. Just avoid crowded places, so as not to catch ARVI and other infections.
The action of the vaccine is as follows — at the site of IPV at the kid body begins to form antibodies that enter the blood and form a common defense. In the application of this vaccine there is no any vaccine-associated polio and it can safely be administered even to children with HIV or other immune deficiencies. Normal reaction is considered to be a local
80
Prevention of polio, results and achievements
reaction in the form of swelling and redness, which should not exceed a size of 8 cm, even more rarely there may be a common reaction — short-term and low temperature rise (up to 38 degrees C), the child may be restless at first and second day after vaccination. Rare side effects may be an allergic rash. Any other reactions (nausea, diarrhea, vomiting, fever above 38 degrees C, runny nose, cough, etc.) to vaccination against poliomyelitis have no relationship.
IPV has a many of advantages over the oral polio vaccine. It is safer than OPV, because it does not contain live viruses that could cause VAP. IPV cannot cause adverse reactions in the intestine in the form of intestinal disorders and loose stool, it does not compete with the normal intestinal microflora of the child and does not reduce the resistance of the wall to intestinal infections. Inactivated vaccine is more convenient in practice. It is available in individual sterile packaging, each dose for one child, does not contain preservatives based on salts of mercury — thimerosal. For the formation of sufficient immunity requires the introduction of a 4-dose baby up to two years, instead of five with OPV, which reduces the stress of the child from going to the children’s clinic. And most importantly — effective IPV then OPV because more precisely dosed, because the vaccine is given by injection, and drop the child can swallow or vomit. Keep IPV easier. It does not require such demanding conditions, sufficient of a conventional refrigerator, as well as for storage of other vaccines. In practice, the rate of IPV vaccination produces immunity virtually all
properly vaccinated children, and after a full course of OPV unformed immunity against certain types of polioviruses remain up to one third of children.
In order to prevent and avoid registration of vaccine-associated polio among children in the country in 2015 plans to introduce the first dose immunization with inactivated polio vaccine in 4 months.
Calendar immunization.
Adopted in 1980, the National Calendar, its revision in 2002 and 2007 and 2013, completed an important phase of modernization vaccination business in Uzbekistan. Laid down in the provisions of these documents conform to WHO recommendations, as set by the vaccine, and in the methods and timing of their introduction. New rules for vaccination and reduction contraindications have significantly improv ed immunization coverage of children without increasing the incidence of complications. Since the introduction of the new calendar in our country and mass immunization campaigns (NIDs and sub NIDs) against polio in the country made significant progress in the control of vaccine-preventable diseases. Since 1995, the country has not recorded polio caused by wild strain of the virus.
National Immunization Calendar regularly reviewed in light of the introduction ofnew vaccines and recommendations of the World Health Organization (WHO), focus on continuous improvement of the national immunization schedule based on international best practices, the introduction of new vaccines.
Table 2. - Calendar of preventive vaccinations (SanPin “Immunoprophylaxis of infectious diseases in the Republic of Uzbekistan”, 2013, Supplement 2)
Age Name of vaccinations
1 day HBV-1
2-5 day OPV-0 + BCG-1
2 month OPV-1, Rota-1, penta-1 (DTP Vaccine-1, HBV-2, HIB-1)
3 month OPV-2, Rota-2, penta-2 (dTP Vaccine-2, HBV-3, HIB-2)
4 month OPV-3, пента -3 (DTP Vaccine-3, HBV-4, HIB-3)
12 months MMR-1
16 months OPV-4, DTP Vaccine-4
6-7 years MMR-2, OPV-5, DTV-M-5
16 years DTV-M-6
Table 3. - Calendar of preventive vaccinations (SanPin “Immunoprophylaxis of infectious diseases in the Republic of Uzbekistan”, with the changes introduced in 2015)
Age Name of vaccinations
1 day HBV-1
2-5 day BCG-1
2 month OPV-1, Rota-1, penta-1 (DTP Vaccine-1, HBV-2, HIB-1)+pneumococcus-1
3 month OPV-2, Rota-2, penta-2 (DTP Vaccine-2, HBV-3, HIB-2)+pneumococcus-2
4 month OPV-3, penta-3 (DTP Vaccine-3, HBV-4, HIB-3) + IPV
12 months MMR-1 + pneumococcus-3
16 months OPV-4, DTP Vaccine-4
6-7 years MMR-2, OPV-5, DTV-M-5
13 years (girls) HPV
16 years DTV-M-6
81
Section 8. Medical science
It should also be noted that, in general, vaccination is highly effective in the economic action plan. Immunization coverage against polio doses 6th 1995 and the country is 98-99%. Deadlines repeatedly carried out vaccination and revaccination is a prerequisite for the eradication of polio in the country. [6, p. 10]. In the Republic ofpreventive immunization services are provided in the 4075 vaccination points at children, family, multidisciplinary clinics, and maternity facilities.
An important issue is the proper storage of vaccines. To this end, in the Republic of organized system of inventory control, forecasting, improving refrigeration equipment and training of personnel responsible for the storage of vaccines.
Over the past decade, with the support of international organizations, it was improved equipment with new modern refrigeration equipment, refrigeration bags for transporting vaccines and icepacks. At the appropriate level to date and refrigeration capacity at the national, regional and district warehouses. Patient clinics are also fully equipped with refrigeration equipment.
At the final stage of the global polio eradication particularly it is becoming important to control the state of immunity [8, p. 31-39], as the dynamic tracking of the voltage level of immunity to polioviruses in children allows to establish epidemiological signs of trouble.
Over the past 3 years in the regions studied indicators of immunity to polio in 6534 people. Percentage of people with antibodies to the appropriate type poliovirus was 98.4% of seronegative individuals — 1.6%. The obtained results allow reading that the state of immunity to polio in the population surveyed regions good — high rates of immunity. This clearly explains why the presence of registered cases of poliomyelitis in 2010 in neighboring Tajikistan, in our country has not been a single case. These data clearly show the need to continue conducting mass polio vaccine prevention of quality, despite the absence of disease in the country.
The system of surveillance for polio serological monitoring the state of immunity plays an important role and is essential for the assessment of individual and collective immunity in a particular area, the actual level of protection against infection in some age groups, as well as for assessing the quality of routine immunization services [10, p.51-52].
Epidemiological surveillance for acute flaccid paralysis (AFP).
Since 1992, T recommended to carry out surveillance of OPV among children under the age of 5 years. In February, the Global Commission for the Certification of Poliomyelitis stated that the standard for certification purposes must be
AFP surveillance among children under the age of 15 years [4, p. 9].
To perform this task in the country since 1997, there is an ongoing surveillance for acute flaccid paralysis (AFP).
The purpose of surveillance of AFP with the mandatory laboratory testing every patient — do not miss polio. The quality of surveillance is defined by absence or minimization of AFP cases without laboratory examination.
Every year in Uzbekistan it was detected more than 1 case per 100,000 children under 15 years, and since 01.01.2011 AFP surveillance index, according to WHO recommendations approved within the meaning of at least 2 per 100 000 children under 15 years.
Virus isolation is a fundamental aspect of how cases of diagnostic and epidemiological studies. Determining the type of poliovirus vaccine and differentiation of these viruses’ wild viruses are necessary to determine the characteristics of the outbreak [5, p. 9].
Based on this, each patient with the syndrome AFP laboratory examined polio accredited virology laboratory of the National Center for State Sanitary and Epidemiological Surveillance Ministry of Health of the Republic of Uzbekistan. From 2000 to 2013 was examined by the Republic of Uzbekistan in 1900 patients with the syndrome ofAFP single patient wild polio virus has not been found.
As part of surveillance for acute flaccid paralysis, each patient with the syndrome AFP after 60 days of onset of paralysis passes re examination by a neurologist for the presence of residual effects, as in poliomyelitis in 100% of cases irreversible paralysis, and in the case of paralysis for other reasons motor functions often within 2 months restored.
In each case, the AFP National Expert Committee to review the epidemiological, clinical and laboratory data and gives the conclusion on the absence or presence of the disease polio.
Conclusions:
Regularly by independent experts of the World Health Organization, evaluates the quality of immunization and surveillance for acute flaccid paralysis in the Republic of
Uzbekistan.
Due to the high level of immunization coverage against polio, as well as the absence of polio cases during at the appropriate level of surveillance for acute flaccid paralysis, the Republic of Uzbekistan for 12 years, retains the status of a “territory free of wild polio.”
Thus, all of the foregoing proves that in Uzbekistan due to proper management of immunization policy managed to eradicate the disease polio.
References:
1. The tenth meeting of the Regional Commission of the European Regional Office ofWHO on Certification of Poliomyelitis Eradication. P. 17.
2. Pediatric Journal, 2010; No 3-4 «Problems and measures of conservation status of polio-free areas in Uzbekistan» P. 5.
3. Boyko V. М. Epidemiology and towards polio eradication in the Uzbek SSR in 1965. P. 9.
4. Global polio eradication. Report of the WHO Technical Consultation. 1996. P. 9.
82
Characteristics of the functional state of the liver in postpartum women undergoing preeclampsia
5. The epidemic of polio surveillance: Lessons learned from the outbreak in the Netherlands in 1992-1993. P. 9.
6. Аtaliyeva S. G. Poliomyelitis and it’s prophylaxes in 1979, P. 10.
7. Reported data on the form No6 on vaccinations.
8. Sutter R. W., Caceres V. M., Mas Lago P. The role of routine polio immunization in the post-certification era. Polio Weekly Bulletin. WHO. 2004, 82 (1): 31-39.
9. Seybil V B., Malishkina L. P. The elimination of the polio virus — the problem with no apparent solution in the coming years. Problems of Virology, 2011, No1; P. 41-44.
10. Actual problems of vaccine prevention in the Russian Federation. (G. G. Onishenko, Y. B. Yejlova, А. А. Melnikova). P.10.
11. Immunity of poliovirus in the child population. Journal of Microbiology Epidemiology and Immunobiology. N. I. Ro-manenkova, M. А. Bichurina, N. R. Rozayeva, L. A. Shishko. P. 51-52.
12. Information BULLETIN WHO January 2015 «Update on the global situation of polio in the world.» P. 2-3.
Tuksanova Dilbar Ismatovna, Senior Research Scientist — researcher, State Medical Institute. Abu Ali Ibn Sina, Department of Obstetrics and Gynecology, Ministry of Health of the Republic of Uzbekistan Bukhara E-mail: [email protected]
Characteristics of the functional state of the liver in postpartum women undergoing preeclampsia
Abstract: The study of liver function in women undergoing preeclampsia. A clinical and laboratory study. The study included 60 patients in the postpartum period. Of these, the main group consisted of 40 women had undergone preeclampsia varying severity. In the history of viral and autoimmune liver disease were excluded. In biochemical studies revealed liver cell deficiency syndrome. In women who have had varying degrees of severity of PE, noticed violations of the functional activity of the liver, manifested cytolysis, hepatocellular failure, lipid and protein metabolism, the severity of which corresponded to the severity of the disease. Change indicators promoted early onset, duration of preeclampsia.
Keywords: Preeclampsia, liver, cytolysis, biliary tract duskiness.
Preeclampsia (PE) — a disease of the whole organism, therefore, by its very nature it always has many faces [1; 4; 7; 11]. Preeclampsia often atypical (erased), and is complicated by deep disorders of the most important organs and systems [2; 5; 6; 9].
The frequency of preeclampsia according to different authors from 9 to 17% of all pregnant women; in hospitals of high risk, it is 30% or more [4; 6; 7; 10]. Currently, 70% of PE occurs in pregnant women with extra genital pathology.
During pregnancy, there is a substantial restructuring of the functions of a number of bodies, including the liver [3; 5; 7; 9]. Liver, depleting their reserve capabilities as pregnancy progresses, it becomes more vulnerable [2; 4; 5; 8]. Therefore, special attention should be necessary to pay in the development of PE. The liver is the organ with the developed capillary system in one degree or another always gets involved in a deep microcirculatory disorders and chronic tissue hypoxia [5; 6; 9; 11].
Objective: The study of the functional state of the liver in women undergoing preeclampsia.
Materials and methods
The study involved 60 patients in the postpartum period. Of these, the main group consisted of 40 women have
undergone varying degrees of severity of preeclampsia. The control group consisted of 20 patients with physiological pregnancy.
In the study group surveyed identified 2 groups: 1st subgroup consisted of 20 patients who underwent mild PE, 2nd of 20 women who had undergone severe PE severity.
All the surveyed women were nulliparous. The average age of patients was 20,3 ± 2,5 years. The history of viral and autoimmune liver disease were excluded. Investigations were carried out on 5-8 th day of the postpartum period; biochemical, ultrasound examinations of the hepatobiliary system.
Results and discussion.
In the studied group of patients did not differ in age — from 18 to 36 years. Compared group were women of a similar age, fertility, and historical data.
In the study of history it noted that 36 patients of the main group had extra genital pathology. Most identified anemia: 80% — in the 2nd subgroup and 65% — in the 1 st subgroup: Metabolic syndrome: in 40.2% ofwomen of the 1st subgroup, 2nd subgroups -60.3%; biliary tract duskiness (4.3% of cases in the 2nd subgroup and 2.1% — in the 1st subgroup).
83
