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Section 7. Medical science
References:
1. Matsuyama K., Matsumoto M., Matsuo T. Slowly developing perigraft seroma after a modified Blalock-Taussing shunt.//Pediatr. Cardiol. - 2003. Jun-Aug; - 24 (4):412-4/Epub - 2003. - Jan 15.
2. Sivakumar K. Catheter closure of an atrial septal defect in anatomically corrected malposition with left juxtaposition of atrial appendages. Cardiol Young. - 2009. - Sep;19 (5):534-6. Epub - 2009. - Aug 13.
3. Williams J. A., Collardey K. R., Treadwell M. C., Owens S. T. Prenatally diagnosed right ventricular outpouchings: a case series and review of the literature. Pediatr Cardiol. - 2009 Aug; - 30 (6):840-5. Epub -2009. - May 27. - PMID: - 1947-1995.
DOI: http://dx.doi.org/10.20534/ESR-16-11.12-78-79
Rabbimova Dilfuza, Samarkand State Medical Institute, PhD in medicine, department of pediatric disease E-mail: [email protected]
Risk factors and features of septic course in infants
Abstract: In this paper we present the data from clinical observations and special studies of246 children aged from 1 month to 1 year with purulent inflammatory diseases. Clinical monitoring of sick children were held in the branch of Samarkand Pediatric Surgery. 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, as well as the presence of persisting infection in mothers.
Keywords: septic course, children, purulent inflammatory diseases.
According to the modern concept of PIRO (Predisposition, Infection, Reaction, Organ disfunction) the diagnosis of sepsis predetermines identification of predictors, i. e. predisposing factors of the disease, clarification of infectious agent and its localization, assessment of the response of the organism to the infectious agent, and the identification of organ dysfunction.
In this paper we present the data from clinical observations and special studies of 246 children aged from 1 month to 1 year with purulent inflammatory diseases. Clinical monitoring of sick children were held in the branch of Samarkand Pediatric Surgery (director — prof. A. M. Shamsiev).
Patients were divided into groups: I group with sepsis (generalized infection) — is basic 163 patients (of them 109 patients with septicemic form and 54 patients with septikopiemic form). II group — the group of local infection comparisons -83 patients.
In assessing the flow, acuteness, severity of inflammation in sepsis, we used clinical criteria and laboratory parameters were compared with those of a localized infection. Children in this group underwent the smallest period of severe condition and the period of fover, and had a shorter total duration of the disease.
For a detailed analysis of the contributing factors of the disease associated with the development of sepsis were comparison with frequency of these factors at a local infection was carried out. This approach allowed us to build a logical chain in predicting the possible development of sepsis and in the selection of appropriate measures to reduce the adverse outcomes. In this work, a thorough analysis of the psycho-social and medical-biological factors of high septic risk in infants was carried out.
Of psychosocial factors on the frequency of septic group mothers low medical culture was leading: so 84% of mothers showed ignorance and failure to comply with hygiene items, not timely appealed for medical aid, about 59.3% of mothers showed reduced attention to the child: wrong feeding, care, walkings and etc. The contingent of patients, as in sepsis, so at the local infection, was mainly from rural areas: 79.4% and 76%, respectively. It was found that the average age of mothers of the studied was higher group
than in the control: 65,7 ± 3,2% of mothers in the control group were between the age of 19-28 years, i. e. during the period of the most active reproductive function. The maximum number of mothers of children with sepsis are located in a range of less than 19 and older than 30 years, which increases the risk of sepsis in infants in 1.5 and 1.8 times respectively. There were no significant differences in nulliparous women over multiparous ones in both groups: the first birth was in 58 (54.2%) women in the group with sepsis and in 14 (48.2%) women in the group with a local infection.
From medical and biological factors we analyzed the factors of perinatal period with peculiarities of pregnancy and childbirth and maternal health during pregnancy.
Comparative analysis of perinatal factors associated with the development of sepsis in infants revealed that the frequency of pathology of pregnancy in mothers of septic children is over 4 times higher than that of mothers of children with local infection.
The structure of the complicated pregnancy. In particular, in toxicosis in 42 (25.7%), in sepsis threat of termination of pregnancy — 54 (33.1%), preeclampsia was observed in 25 (15.3%), polyhydramnios — 21 (12.8%) women. In some cases, there is a combination of complications of pregnancy in a woman.
Complications during childbirth and with significantly greater frequency occurred in the groups with sepsis and made 68% of cases, which is 5 times more likely than in mothers of children with localized infections. Among the complications there were: entanglement of umbilical cord around the neck, premature detachment of normally situated placenta, powerless labor, precipitated labor and they were the cause of neonatal asphyxia during labor.
In the structure of extragenital diseases in mothers of the studied children anemia had a leading position. Anemia of moderate and severe degree in mothers is 4 times more common in the group with sepsis than in the mothers in the group of children with local infection (74.8% — in sepsis, against 18.1% — by local infection).
Also, when carrying out a retrospective analysis of the results of interviews with the mothers of the studied children, it was revealed that they had a high infection index, confirmed by the high frequency
Formation deformity of foot with congenital IV brachymetatarsia
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: [email protected]
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
