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Section 6. Medical science
(1.03±0.04 versus 0.32±0.01, p<0.001), and meaningful increase of the concentration was noted not only in the group with complications (1.47±0.05, difference reliability with the CG — p<0.001), but also with the background uncomplicated progress of the disease (0.58±0.01, difference reliability with the control group and complicated progress group — p<0.001), and it proved lesion of kidneys even with background uncomplicated progress of the disease.
Distribution of the children according to age categories revealed that with the background pneumococcal pneumonia cystatin C concentration gradually increased with aging (p<0.05 between the groups of 5-7 years and 1-2, 5-7 years and 2-5; p<0.01 between the groups younger than 1 year old and 1-2 years old; and p<0.001 between the groups under 1 and 2-5 years old, under 1 and 5-7 years old), while cystatin C concentration in the urine of healthy children till 5 years old stayed stable and a little bit increased only to 5-7 years old in comparison with 2-5 years old group (p<0.05). That effect was also notable in patients with uncomplicated progress of pneumonia, where we observed higher values in the children above 2 years old (p<0.05 between the groups of 2-5 years old and under 1 year old and p<0.001between the groups of 2-5 and 1-2 years old and between the groups of 5-7 and 1-2 years old), and in case of the development of complications it became significantly expressed (p<0.001 for all pair comparisons, except 1-2 and
2-5 years old groups). Inside all age groups we revealed reliable differences both between the patients with pneumococcal pneumonia and both variants of the progress and the control group.
The revealed patterns testify that with background pneumococcal pneumonia there is disorder of tubular reabsorption of cystatin C which is manifestation of ARD. The renal function becomes more open to injure with the aging of children (from 0 to 7 years old).
We also performed correlation analysis of the interrelations of lipocalin and cystatic C concentrations in urine of the children hospitalized because of pneumococcal pneumonia with the values of fever period duration. Totally in the group of children from 0 to 7 years old we revealed reliable average positive link of the concentration of both studied ARD markers with the duration of fever (r=0.44 and 0.52 respectively).
Conclusion. Endogenic and bacterial intoxication cause acute renal damage the biomarker of which is increase of lipocalin and cystatin C amount in urine. The present study demonstrates that concentration of lipocalin and more cystatin C can be used as prognostic factors of complications development in children with pneumococcal pneumonia. Cellular response to ARD is maximal in children of the first year of life, then its activity decreases and increases again with aging, while expression of renal dysfunctions in ARD increases with aging.
References:
1. Baranov A. A., Namazova L. S., Tatochenko V. K. Pneumococcal infection and diseases linked with it is a serious problem of the modern health care//Pediatric pharmacology. 2008, v. 5, № 1. P. 7-13.
2. Yermolenko V. M., Nikolayev A. U. Acute renal failure. - M.: GOETAR-Media, 2010. - 240 p.
3. Haase-Fielitz A., Bellomo R., Devarjan P. The predictive performance of plasma neitrophil gelatinase-associated lipocalin (NGAL) increases with grade of acute kidney injury//Nephrol. Dial. Transplant. - 2009. - Vol. 24. - P. 3349-3354.
4. Kjeldsen L., Cowland J. B., Borregard N. Human neitrophil gelatinase-associated lipocalin and homologous proteins in rat and mouse//Biochim. Biophys. Acta. - 2000. - Vol. 1482. - P. 272-283.
5. Mishra J, Dent C, Tarabishi R, et al: Neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker for acute renal injury after cardiac surgery//Lancet. - 2005. - P. 365:1231.
6. Schneider J., Khemani R., Grushkin C. et al. Serum creatinine as stratified in the RIFLE score for acute kidney injury is associated with mortality and length of stay for children in the pediatric intensive care unit//Crit. Care Med. - 2010. - Vol. 38 (3). - P. 933-939.
7. Waikar S. S., Liu K. D., Chertow G. M. Diagnosis, epidemiology and outcomes of acute kidney injury//Clin. J Am Soc Nephrol. -2008. - Vol.3. - P. 844-61.
Rizaev Kamal Saidakbarovich, PhD Republic Research Center of Emergency Medicine, Tashkent, Uzbekistan,
Deputy Director General E-mail: [email protected] Makhamadaminov A. G., PhD 2-Tashkent Institute for Post-graduate Education of Doctors, Uzbekistan Khadjibaev Abdukhakim Muminovich, Phd, ScD, Professor Republic Research Center of Emergency Medicine, Tashkent, Uzbekistan,
Director General E-mail: [email protected] Muhamedjanova Nailya Nakipovna, Republic Research Center of Emergency Medicine, Tashkent, Uzbekistan
Sputum cytology indexes condition in patients with acute destructive pancreatitis
Abstract: The steady increasingof the incidence of acute pancreatitis (AP), especially its destructive forms, significant difficulties in recognition and a large percentage of diagnostic errors, debated issues of medical tactics, high mortality determine
Sputum cytology indexes condition in patients with acute destructive pancreatitis
the need for further study of some etiopathogenic aspects of this disease. The main causes of mortality in acute destructive pancreatitis (ADP) are untreatable endotoxemia and multiorganfailure.
Since circulating with a blood, pancreatic enzymes, chemical polypeptides, biogenic amines and other products of enzymatic auto-aggression result to severe degree of toxemia expressed disorders of blood circulation and lymph flow, and morphological changes of different anatomical and physiological systems.
According to several authors, bronchopulmonary complications (BPC) obtained in 15-55% of patients with signs ofAP. When ADP complicated by widespread peritonitis pancreatogenic acute pulmonary insufficiency is formed due to the impact of pancreatic enzymes in the lung capillaries and respiratory disorders at the same time there are in 50% of patients, often being one of the causes of death. In this regard, further in-depth study of the functional state of the respiratory apparatus in different periodspancreatogenic toxemia in patients with ADP seems urgent task for emergency pancreatology.
Keywords: acute pancreatitis, pancreatic toxemia, lung circulation, lung ventilation, bronchopulmonary complications, prevention.
Background. Together with such main reasons as uncorrected endo-toxicosis and multiple failure, broncho-pulmonary complications (BPC) are playing an important role in the high lethality at acute destructive pancreatitis (ADP) [1; 4; 9; and 11]. BPC are determined in 15-55% patients with ADP clinics and at spread peritonitis it is observed in each second patient, often being one of the death's reason [2; 3; 5; 9; 10; 13].
As it was described above, a certain interest is in estimation of the severity of developed BPC course in patients with ADP. Partly it is possible by investigating of mucociliary clearance (MCC) in such type of patients.
MCC is a complicated process of excretion from respiratory tract inhalated particles, bacteria, products of their metabolism and it is performed as a result of activity of ciliated epithelium at optimal viscosity and flexibility of tracheobronchial secrete. This process provides a protection of the entire respiratory tract as in normal conditions microorganisms' invasion in epithelium is practically impossible due to their short-term contacting [6; 8].
The aim of this investigation is to detect the change level of MCC condition by the way of study some indexes of sputum cytology and possibilities of using them in the severity estimation of BPC in patients with ADP.
Materials and methods. Study have been done in 58 patients with destructive pancreatitis in abdominal and endosurgical departments of RRCEM. There were 32 females and 26 males. Average age was 48.2 years.
It can be pointed from the data given from the table 1 that patients with ADP have disorders of sputum cytology indexes. They are significantly differ from the sputum cytology indexes of the control group. So, at the analysis of the received data it has been detected that in patients with ADP significant decrease of scyphiform cellular hyperplasia of bronchus epithelium Ki (0.33±0.06) was noted. In addition, at the same time, the decrease of the index of evacuator mechanism condition connected with the lessening of the absolute quantity of ciliated cells was determined. Such changes led to the increasing of producing of bronchial secretion and to broncho-
All patients together with general clinical, echo-scopy, X-ray and endoscopic ways of investigation were performed the study of cytological analysis of sputum with verification of cells contents: epithelial (ciliated, scyphiform, intermediate, dystrophically changed cells of ciliated epithelium), neutrophilic and eosinophilic leukocytes, monocytes, lymphocytes, basocytes and fat cells.
The following coefficients (C) showing specific weight of the separate types of cells in the total mass or co-relation of separate types of cells:
Ci — ratio of percent quantity of scyphiform cells to the percent quantity of ciliated ones.
C2 — ratio of percent quantity of dystrophic changed epithelial cells to the all-epithelial ones.
C3 — ratio of percent quantity of basocytes to the amount of all epithelial ones.
C4 — ratio of percent content of ciliated cells to the amount of all epithelial ones.
C5 — ratio of percent content of neutrophil leukocytes to the percent content of the other cells penetrating into bronchus lumen by the way of migration: lymphocytes, macrophages, eosinophilic leukocytes, basocytes, fat cells and others.
As estimation, criteria there was used the results of cytological characteristics of sputum in 10 practically healthy men of the control group. The received results coincided with given ones in the reference [6; 8].
Results and discussion. Investigations results of sputum cytology in examined patients are given in table 1.
clearance processes disorders (inhibition of MCC). As the result of that was a significant increase in them the index of inflammatory reaction K5 (0.46±0.07) (P<0.01).
At the detailed analysis of the received data, the important fact is that the level of changes sputum cytology indexes in observed patients was different. On the background of that, all investigated patients were divided into 2 groups: with moderate (group 1) and evident (group 2) changes of investigated indexes of sputum cytology (table 2).
Table 1. - Sputum cytology indexes in examined patients with ADP (M ± §)
Indexes Control group (10) Patients with ADP (58) P<
Ci% 0,24 ± 0,05 0,33 ± 0,06 0,01
C2% 0,008 ± 0,0012 0,018 ±0,003 0,01
C3% 0,02 ± 0,007 0,033 ±0,006 0,02
C4% 3,5 ±0,9 2,36 ± 0,5 0,01
C5% 0,24 ± 0,04 0,46 ± 0,07 0,01
Note: P — validity between indexes of both groups
Section б. Medical science
Table 2. - Distribution of patients according to the level of sputum cytology indexes changes (M ± 6)
Indexes Control group (10 patients) Group 1 (46 patients) Group 2 (12 patients) Pi< P2<
Ci% 0,24 ± 0,05 0,27 ± 0,05 0,36 ± 0,08 >0,5 0,01
C2% 0,008 ± 0,0012 0,012 ±0,002 0,024 ± 0,005 >0,5 0,01
C3% 0,02 ± 0,007 0,043 ± 0,007 0,026 ± 0,004 0,01 >0,5
C4% 3,5 ± 0,9 3,1 ± 0,6 2,23 ± 0,5 0,02 0,01
C5% 0,24 ± 0,04 0,2910,046 0,52 ±0,1 >0,5 0,01
Note: Pi h P2 - validity of data between control group and group 1, group one and group two.
On the base of the data analysis from table 2, it can be say that there are disorders of broncho-clearance processes due to MCC failure in both groups. It is important that if in patients of the group 1 this failure ofMCC has functional, reversible nature, in patients from group 2 that failure becomes absolute one. The reason for such judgement is data of ciliated cells regeneration indexes C3 that in patients of group 1 exceeded from the men of control group (0.02±0.007 u 0,043±0,007). It attested about the fact that possibilities of compensatory mechanisms of MCC in such patients group are not lost.
At the same time this index was reduced in patients from group 2 — it points to existing emaciation of compensation processes in them. It conditions significant deterioration all sputum cytology indexes in patients of group 2 in compare with group 1 patients.
Such judgements and conclusions got their clinical confirmation by the fact that in majority patients of group 2 (78.2%) it was observed the developing of BPC of parenchymatous and ventilatory nature as severe pneumonias. Unlike that in patients of group 1 such severe course of BPC was significantly less and was observed in 34.6% cases. As an example, we are giving the following case of the clinical observation.
Patient O., 55 years. History ease № 6523/820, admitted to hospital with the complains on pains of belting nature in epigastric area
Table 3. - Sputum cytology
and left hypochondria, nausea, multiple vomiting, weakness. Pains appeared the day before admission after fat meals.
Patient's general condition is severe. The patient is anxious due the abdominal pains. Skin and visible mucous are pale. Pulse 100 str.\min, rhythmic, BP 100/60 mm. There is a weak vesicular respiration in lungs. The tongue is dry with lush yellow incrustation. Abdomen is participated in breathing; there is an evident palpatory tenderness in epigastric area and in the left hypochondria. Shetlin-Blumberg's syndrome is negative. Liver and spleen are not palpated. There is no duPmss in flat places. Intestinal peristalsis is received. She has been examined. Hb 134 g/L, erythrocytes 3.5 min, leukocytes 15.8 thnds/ml. Shift of the •leukogram to the left is pointed. ESR 26 mm/h. General urea analysis is without peculiarities. There are hyper coagulation signs on coagulogram. Biochemical blood analysis is normal except increasing of blood diastase up to 260 mmol/l. There was determined the presence of the mean severity pancreatitis by Ranson.
There is no pathology by chest X-ray. Investigations of respiratory tracts' aerodynamics has not detected any pathology. Nevertheless, there were detected an evident changes to the worse at cytodiagnostics (tab.3.)
indexes of the patient O.
Indexes Mi% K2% K3% K4% K5%
Meanings 0,32 0,020 0,025 2,28 0,48
Left-sided bronchopneumonia has been developed in patient in dynamics. She suffered from cough with purulent sputum, evident weakness, and dyspnea. She was prescribed antibacterial (ceftriaxon+metranidazol), bronchodilatatioal and mucolytic therapy. On the base of the therapy, patient's condition has been improved. Leukogram came to the normal data, there was a decreasing of leukocytosis up to 7.3 thnds/ml and blood diastase up to24 mmol/l. Abdominal pains disappeared. Patient was discharged.
Above mentioned clinical observation shows that sputum cytology indexes together with other laboratory methods attest about
a presence of big possibility of developing BPC in patient. Further, she really had BPC as left-sided bronchopneumonia.
Conclusions.Summarizing all mentioned above, we may conclude that all patients with ADP had different levels of abnormalities of sputum cytology conditions data.
Investigations of cytological view of sputum allow to detect intensity level of MCC abnormalities and to predict the possible severity of clinical course of BPC in them.
Including appropriate procedures for correction of sputum cytology data at ADP into the treatment scheme will lead to improvement of treatment results in whole.
References:
1. Gostishev V. K., Glushko V. A. Pancreonecrosis and its complications, th main principles of surgical tactics. Xirurgia 3, 2003.
2. Malinovskiy N. N., Agafonov N. P., Reshetnikov E. A. Treatment of acute destructive alimentary pancreatitis.//Xirugia. - 2000, - № 1. - P. 4-7.
3. Milnikov E. D., Fedorov P. L. Acute biliary pancreatitis: diagnostics and treatment possibilities.//Rossiyskiy jumal gastroenterologii, gepatologii, koloproctologii. - 1999. - № 2.- P. 73-80.
4. Filimonov M. I., Gelfand B. R., Bumevich S. Z., Orlov B. B., Tsidenjapov E.Ts. Acute pancreatitis. - M., 2002. P. 124.
5. Filin V. N., Kostyuchenko A. L. Emergency pancreothology. - СПб.: Питер, 1994. - P. 416.
6. Chuchalin A. G. Chronic obstructive lungs' diseases-Чучалин AT. Хронические обструктивные болезни легких. - М., 2000. - P. 509.
7. Sharafutdinov G.Kh.et al. Hospital pneumonias in surgical practice.//Uzbekistan xirurgiyasi. - 2005. - № 1. - P. 84-86.
8. Emmanuel V. X. Tracheabronchial content and new possibilities of its laboratorial investigation.//Klinicheskaya laboratomaya diagnostika. - 1997. - № 1. - P. 25-33.
9. Donahue P. E. Vasoactive drugs in acute pancreatitis//Arch. Surg. - 1994. - V.119, N.4. - P. 477-480.
Osteoporosis and osteoarthrosis in women of uzbek nationality of old age based on digital x-ray and densitometry research
10. Hollender L., Lehnert P., Wanke M. Akute Pankreatitis. - Munchen, 1993.
11. Montravers P, Veber B, Auboyer C, et al. Diagnostic and therapeutic management of nosocomial pneumonia in surgical patients: results of the Bole Study,//Crit Care Med. - 2002; 30:368-375.
12. Montravers P, Veber B, Auboyer C, et al. Diagnostic and therapeutic management of nosocomial pneumonia in surgical patients: results of the Eole Study.//Crit Care Med. - 2002; 30:368-375.
13. Schulz H., Schulz E. Akute pankreatitis - atiologie, pathologische anatomie und pathogenese. - Zschr. Inn. Med. - V. 117. - № 8. -1990. - P. 467-475.
Rustamova Umida Mukhtarovna, MD, senior scientific researcher, Head of X-ray Department of Scientific Research institute Of Traumatology and Orthopaedics under the Ministry
of Healthcare of The Republic of Uzbekistan [email protected]
Osteoporosis and osteoarthrosis in women of uzbek nationality of old age based on digital x-ray and densitometry research
Abstract: Based on the analysis of the association of the two diseases in the age aspect, data, and digital X-ray densitometry studies it was revealed a positive dependence between osteoartrozis and osteoporosis. The results show that the incidence of osteoarthritis and osteoporosis is mainly observed after 40 years, but most often after age 50, whereas the expressed structural radiographic changes of the knee joint bones epimetaphysis are observed more after 60 years old.
Keywords: Osteoporosis, osteoarthrosis, women, menopause, knee, digital radiography, densitometry.
Introduction. Problem of osteoporosis and osteoarthritis is currently very topical. This pathology is very common and is increasing as the population ages [2; 5]. In recent years particular attention is paid to the relationship between these two pathologies [4; 6]. Since osteoporosis is a common systemic metabolic disease of the skeleton, except for changes microarchitectonics bone may be affected all the components of the knee joint — the articular cartilage, capsule and periarticular tissues. Osteoporosis and osteoarthritis according to some authors may be interconnected or mutually complementary disease [1].
The first reports about it appeared about 40 years ago. In the beginning there were conflicting views on diseases and eventually began to appear information about the relationship ofbone mineral density of the peripheral skeleton with the risk of osteoarthritis [7]. According to research of M. C. Hochberg et al. (2004), increased risk of osteoartrosis of knee is associated with high bone mineral density [3].
Purpose — to identify connection of osteoporosis and osteoarthrosis in women in menopausal age by interpreting the results of digital radiographic and densitometric studies.
Material for the study — 280 women of Uzbek nationality were treated in the sports injury department, orthopedics and adult outpatients who came for counseling to clinic of SRI of Traumatology and Orthopaedics of Ministry of Health of the Republic of
Uzbekistan.
Methods of research is Digital X-ray and densitometry. Radiological studies were conducted on the digital X-ray machine Flexavision Company Shimadzu (made in Japan). Densitometric studies were conducted by using a densitometer Stratos Campaign DMS (made in France) under the "whole body" and standard programmes. It was studied bone structural changes of epimetaphysis bone and joint status of mineral density bones. Received research results are compared.
The main results and their discussion. All of the surveyed women were divided into two groups: the first group of women (168 women — 60%) with osteoarthritis of the knee and a second
group were women (112 women — 40%) without osteoarthritis. Surveyed from 45 to 85 years of age, 168 (60% of all amount of patients) women of the main group were distributed in the following age aspect: from 45 to 55 years — 22 women (13% of the number of main group), 56-65 years — 49 women (29,2%), 66-75 years — 55 women (32.8%), 76-85 years — 42 women (25%).
112 surveyed (40% of total patients) in the control group were women aged 45 to 55 years — 76 women (67.9 among the control group), 56-65 years — 35 women (31.2%), 66 -75 years — female 1 (0.9%) there were not any patients aged 76-85 years. The average age of a main group of women = 64.2 years, in the control group = 53.3 years. As digital radiographs the condition of the knee was evaluated in patients in both groups: joint space, the contours of the articular surfaces, X-ray angles, the structure of the bones of the joint.
To determine the radiological stage of osteoarthritis of the knee we use a classification J. Kellgren and I. Lawrence (1957), M. Le-quesne improved in 1982, based on an assessment of the severity of narrowing of the X-ray joint space, subchondral osteosclerosis and edge magnitude bone growths, where 4 stage are divided: 0 — absence of radiographic signs; I — doubtful; II — minimal; III — average; IV — expressed. Using this classification, we divided the surveyed women into 5 groups, depending on the severity of the disease: Group 1 — Stage 0, i.e, the formation of arthrosis, Group 2 — Stage 1, Group 3 — Stage 2, Group 4 — Stage 3, Group 5 — Stage 4 osteoarthrosis.
In women of a main group X-ray changes were minimal at the first stage. At this stage — the stage of formation of osteoarthri-tis — pain and inflammation are clinically observed. In the second stage unevenness moderate joint space narrowing was found. When the third and fourth stages of osteoarthritis of the knee it is defined noticeable uneven contraction and deformation of the X-ray joint space. It was marked deformation and uneven narrowing (medial segment) of joint space. It was mentioned that seal subchondral cortical layer inside ofwhich there were visible portions dilution — cortical and subchondral cysts ofvarious shapes and sizes.
