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State of neuro-humoral regulation in congenital heart defects in children
Through 2 days after an initiation of treatment patients of control group had a microorganisms that as before treatment, the microbial contamination didn't change, and was even in certain cases enlarged. In the main group with use of RLAT the microbial contamination decreased with 105,4 to 103,6 on КОЕ cm2 of a wound surface, the vysevayemost of P. aeruginasa and S. aureus decreased. Against treatment of RLAT by 5 th days microorganisms were allocated only at 2 patients, from them at 1-P. Aeruginasa, 1 Acinetobacter spp.
Depression oflevel of a microbial contamination ofburn wounds against complex treatment with 103,6 to 101,2 on КОЕ™2 of a wound surface became perceptible. In group of comparison in 2 cases against traditional treatment by 5th days allocation of microorganisms from burn wounds is noted. In 3 cases the two-component association is received (S. aureus with P. aeruginasa). The microbial contamination of burn wounds against traditional treatment decreased with 105,5 to 103,4 on KOEcm2 of a wound surface.
Prior to treatment all patients of the main and control groups had the following cytologic picture: types of cytograms prevailed inflammatory (75%) and inflammatory and regenerator (25%). Against treatment for the 5th days in control, the cytogram type at 25 patients was replaced with regenerator and inflammatory, remaining inflam-
matory and regenerator at 8 (22,8%) and inflammatory at 2 (2,5%) patients. At the same time in group of comparison against RLAT the inflammatory and regenerator type of the cytogram is noted at 2 (6,6%) the patient, at 10 (33,3%) — regenerator and inflammatory and at 18 (60%) regenerator and inflammatory with an autoimmune component.
For the 4th days at 23 (76.6%) the patients who received a regional lymphatic antibioticotherapia the expressed active cuticular-ization opposite to 15 (42.8%) control became perceptible.
Suppuration of wounds was observed in 2 (6.5%) primary and 5 (14.2%) of the control groups.
Thus, the regional lymphatic antibioticotherapia in complex treatment of victims of combustions referred on prophylaxis and treatments of complications burn wounds significantly influences the current and the result of inflammatory process in a wound, a bacterial contamination, reduces the frequency of complications. As a result of use of RLAT depression of an edema, refocal inflammation becomes perceptible, terms of restoration of an integument decrease. Besides RLAT it: a possibility of more aim administration of medicines to the lesion center (achievement of high concentration of antibiotics), ease and a possibility of use at all stages of treatment, economic efficiency.
References:
1. Alekseev A. A., Krutikov M. G., Yakovlev V. P. Burn infection. Etiology, pathogenesis, diagnostics, prophylaxis and treatment. - the Monograph - M. Vuzovskaya the book, 2010-416 p.
2. Borodin Yu. I., Sapin M. R., Etingen L. E. and other//General anatomy of lymphatic system. Novosibirsk.: nauka of Sib.otd.1990, 243 p.
3. Nechepelenko G. V.//Segmentary theory of lymphatic system. - M.: khimiya, 1990, 160 p.
4. Sapin M. R., Borzyak E. I.//Extra organ ways of transport of a lymph. - M of a.: meditsin, 1982, 264 p.
5. Kaye ET. Curr Clin Top Infect Dis. 2000; 20: 43-62.
6. Pruitt BA. In: Infection and the surgical patient. Polk HC. (Ed.) Churchill Livingstone. 1982; 4: 113.
Navruzova Shakar Istamovna, MD, Associate Professor, Head of Department of Childhood Diseases and Neonatology of the Bukhara State Medical Institute, Bukhara, Uzbekistan.
Sa'dulloeva Iroda Kurbonovna, Senior scientific employee-researcher, Assistent of Department of Childhood Diseases and Neonatology of the Bukhara State Medical Institute, Bukhara, Uzbekistan.
E-mail: [email protected]
State of neuro-humoral regulation in congenital heart defects in children
Abstract: Authors examined 160 patients of children with congenital heart disease (CHD). We studied the cellular and humoral immunity, cytokine, and thyroid status in patients with corticoid children with congenital heart disease in the periods before and after surgery. The authors argue that the state of neuro-humoral regulation (NHR) of the body determines the course of CHD. Natural and after operating for CHD accompanied by dysfunction of the endocrine glands. Operational correction CHD partial or complete removal of the thymus further reduces the innate.
Keywords: congenital heart disease, immune system, timic-cortical status, neuro-hu-moral regulation.
Congenital heart defects (CHD) — one of the most common congenital anomalies in children. In recent years there has been an increase in the frequency of CHD due, probably, the use of more
advanced methods of functional diagnosis and the increased interest in the issue of the CHD other physicians [1-3].
According to various authors, in the United States are born each year to 30-35 thousand children with CHD, in the Russia 20-22 thousand Children [14; 15].
Natural mortality for all CHD is about 40%, and most patients die in the first year of life and 70% of them — in the first month of life [15]. In the age structure of mortality from CHD and anomalies of the great vessels 91% were children of the first year of life. Among them, about 50% — children up to 28 days of life (neonatal period) [6-9].
According to research L. A. Bokeria and collaborators (2010), children with CHD and low concentrations of total immunoglobulin
Section 7. Medical science
A and G in the preoperative period are at risk to develop infectious postoperative complications [7].
Among the dead was diagnosed with congenital pathology of the thymus [4; 5; 10; 11; 13]. In children with the natural course of disease may occur spontaneous reduction of the defect with its almost complete leveling.
According to various authors, the spontaneous obliteration of the ventricular septal defect (VSD) is observed in 15-60% of patients; atrial septal defect (ASD) — from 3-27%; patient ductus arteriosus (PDA) in 3%, i. e. in 0.6% ofpatients annually. A separate group ofpatients with small defects do not show random or conservative treatment. Surgical treatment of CHD, in most cases carried out with a cut sternum causing performed partial or total removal of the thymus [12, 14].
The purpose of the work: to study the state of NHR of CHD in children.
Materials and methods: The study involved 160 children with CHD. Of these, 88 boys and 72 girls between the ages of 1 month to 18 years. Sick children with CHD were in the pe-diatric cardiology Bukhara regional diversified children's medical center (Bukhara) in the pe-riods 2010-2015.
The control group consisted of 60 healthy children (34 boys and 26 girls). Verification CHD conducted by the WHO requirements, classified according to the International Classifi-cation of Diseases (ICD-10).
All patients underwent clinical, immunological, biochemical, laboratory and functional studies. Studied the cellular and humoral immunity, cytokine (IL-8, IL-10, TNF-^), thyroid (T3, T4, TSH) and corticoid status (cortisol).
The method of mathematical modeling (2000) developed the CHD flow forecasting program for children (Certificate № DGU02417, 15.02.2012).
Results and discussion. Patients with CHD children were distributed by M. F. Zinkovs-kaya into 3 groups:
Group 1 patients with CHD. Surgical intervention in these children should be carried out in the first hours or days of life — 3 (6.8%);
Group 2 patients, who underwent early operative correction of the CHD is not shown due to minor violations of circulatory dynamics — 18 (40.9%);
3 group of patients with inoperable or unrespectable CHD patients by somatic condition — 23 (52.3%).
The observed group consisted of the remaining 116 patients with children with CHD. Among these patients, which is a planned operation, 79 (68.2%), which operative correction of CHD — 37 (31.8%) was carried out.
The structure of the CHD observed group was: VSD — 47 (40.5%), ASD — 12 (10.3%), TGV — 15 (13.0%), tetralogy of Fallot, 25 (21.5%), the PDA — 11 (9.5%).
Indicators immunogram children to the operational period depending on the type of CHD were varied. When VSD and ASD there is a shortage of T-lymphocytes-helper, enhancing killer activity and the level of CD23+ cells, of IgA (P<0.05). In transposition of the great vessels (TGV) there is a deep deficiency of T-lymphocytes and T-helper cells, increasing the suppressor and killer activity. Lev-
els of the proliferative activity of the cells (CD23 and CD95, CIC) also increased. In tetralogy of Fallot — deficiency T cell/helper, increased TNF-a, IgM and IgA.
Postoperatively, during the first 6 months of the period: the ASD observed increase in the index of immune (CD4/CD8); increase in VSD-relative content of NK-cells 2.4-fold (P<0.01) and a 4-fold increase in titer of IL-10 and TNF-a; in the TGV and tetrad Fallo deficiency of T-lymphocytes with an increase suppressor (CD8) and especially killer (CD16) activity. The level of apoptosis of cells with a molecule (CD95) and IL-8 increased.
Study concentrations of immunoglobulins G, A and M shown IgA reduction in all kinds of CHD.
Analysis of cytokine status of pediatric patients showed a 4-fold increase in titer of IL-10 and TNF-a, which indicates the strengthening of proliferative processes and coagulation at the VSD. Therefore, the results indicate a complex immunomodulatory effects of TNF-a, which is the only cytokine that causes high levels of IL-10. Described more Wanidworanum C., the existence of a unique self-regulation of TNF-a on the basis of feedback from the IL-10 is due to mul-tidirectional immunomodulatory effects of TNF-alpha, which is manifested in CHD, particularly in the VSD. Timic-cortical status to the operational period showed: when ASD — decline in both total and free T3, free T4 increase; with VSD, decrease in total T3 and total and free T4; nibble at Fallo — decrease in total T3, free T4 increase; TGV with reductions in both total and free T3 and cortisol. In the postoperative period for all types of CHD observed reduction in both total and free T3 and T4- (secondary hypothyroidism), and for the typical TGV also transient hypoco-rticism.
Conclusion: 1. The state regulation of immunity in children with CHD is characterized by activation of the B-cell level against the backdrop of an imbalance in the population ofT — lymphocytes.
2. At the CHD, in particular, is characterized by multidirectional VSD immunomodula-tory effects of TNF-a. The immune status at the same time aims at enhancing the proliferative processes and coagulation.
3. The state of NHR of the body determines the course of the CHD. At the same time as the children to the operational and post-operational period for CHD accompanied by a dysfu-nction of the thyroid and thymus, as well as hypofunction of adrenal glands: there is secondary hypothyroidism, and TGV for typical transient hypocorticism.
4. Forecast of the natural history of the CHD depends on the type and size of the defect, as well as the state of the NHR. For small defects, ASD, VSD with normal NHR of the natural process ends closing.
5. For complex types of CHD patients with age is characterized by the formation of a vi-cious circle. The presence of heart disease and blood vessels contributes to tissue hypoxia, which in turn contributes to the common ARD. Frequent ARD lead to reduced immunity and formation of foci of chronic infection and delay the physical development. The latter in turn is one of the reasons for surgical correction of late, causing a high risk of postoperative complications, reducing mortality and quality of life.
References:
1. Beshlyaga V. M., Lazoryshynets V. V. Echocardiography in Cardiovascular Surgery of new-borns//Doctor. 2005; 2: 52-5. (In Russia).
2. Vernovskiy G., Rubenstayn S. D. Research in Perinatology. Cardiovascular disease in newborns//K.: "Molod' ". 2004. 5-96 p. (In Ukrainian).
3. Vinogradov K. V. Congenital heart defects in children: incidence and the current state of problem//Journal of "Child Health". 2007; 6 (9): 13-9. (In Russia).
Correction of respiratory disorders in patients with ARDS on the background of having obesity
4. Degtyaryova E. A. Immunological failure and immunorehabilitation in pediatric kardiologi.//M. - 2003. http://medvuz. com/med1808/t4/15.php
5. Dudarev I. V. Immunological and hemodynamic characteristics of children with congenital " heart defects blue and white types//Im-munology (Moscow). 2002; 3: 167-70. (In Russia).
6. Zinkovskiy M. Lazoryshynets V., Rudenko N. Principles of treatment of children with conge-nital heart defect//Doctor. 2003; 2: 23-5. (In Russia).
7. Kim A. I., Bokeria L. A., Podzolkov V. P. et al. Cardiovascular diseases in the newborn: cardiology and surgical problems//Bulletin of the Russian Academy of Medical Sciences. 2003; 12: 77-80. (In Russia).
8. Knyshov G. V. Cardiac surgery: problems and prospects//Doctor. 2003; 2: 9-11. (In Russia).
9. Knyshov G. V. Cardiac surgery in Ukraine: Past, Present and Future//Heart and blood vessels. 2003; 1: 8-14. (In Russia).
10. Kovalchuk L. V. Problems of Clinical Immunology in the light of new ideas about the innate immunity. Lectures on Pediatrics//Im-munology (Moscow) 2010; 9: 18-33. (In Russia).
11. Lukyanova I. S., Sopko Y. O. Congenital heart defects in the fetus: the basic aspects of etio-logy and risk factors//Perinatology and pediatrics. 2004; 2: 47-50. (In Russia).
12. Mutafian O. A. Congenital heart defects in children. - M.: BINON publishers, 2002; 11-21 p.
13. Nagornaya N. V., Vinogradov K. V. Clinical manifestations of congenital heart defects in children//Journal of "Child Health". 2009; 5 (20): 5-11. (In Russia).
14. Osokina G. G., Abdulatipova I. V., Korsun A. A. The structure of morbidity and mortality in infants in the first year of life//Physiol-ogy and pathology of the cardiovascular system in infants in the first year of life/Edited by M. A. Shkolnikova, L. A. Kravtsova - M.: Publishing House "Medpraktika", 2002; 146-160 p.
15. Cardiology childhood/Edited by A. D. Tsaregorodtseva, Yu. M. Belozerova, L. V. Bregel. - M.: GEOTAR Media. 2014; 784 p.
Sviatlitskaya Volha Ivanovna, MD, Associate professor of Belarusian Medical Academy of Post-Graduate Education E-mail: [email protected]
Correction of respiratory disorders in patients with ARDS on the background of having obesity
Abstract: Obesity significantly alters lung mechanics, and creates the conditions for rapid decompensation of work of respiratory organs at infectious damage of lungs. Early transfer of patients with community-acquired pneumonia with diffuse bilateral infiltration and obesity in the ICU, the use of non-invasive ventilation and early transfer of mechanical ventilation with mandatory implementation of maneuver 'Recruitment' can effectively prosthesis lung function in these patients, helping to reduce the duration of mechanical ventilation and decrease mortality.
Keywords: community-acquired pneumonia, acute respiratory distress syndrome, obesity, respiratory support.
Relevance of the topic
In recent years the tendency to the serious course of community-acquired virus and bacterial pneumonia becomes perceptible [1; 2]. Reproduction of viruses' of influenza and a parainfluenza II type in an cells of epithelium of respiratory tracts and alveoluses leads to destruction of an respiratory epithelium of the lower respiratory tracts and disturbance of production of surfactant. The considerable part of pulmonary tissue damaged. Alveoli's are fallen down and multiple atelectasis develop, that is followed by a resistant hypoxia. Such pneumonia is characterized by the expressed intoxication syndrome, hemodynamic disturbances, a serious respiratory failure with development of the acute respiratory distress syndrome (ARDS). Despite development of medical technologies the mortality at ARDS remains high, making from 24 to 75% and more at development of a syndrome of multiple organ failure [3; 4].
For effective prophylaxis of development and treatment of ARDS it is necessary to consider the specific risk factors which promote development of this syndrome. It is noticed that patients with the overweight and an obesity have the heavy course of the community-acquired pneumonia which was complicated by development of ARDS, and demanded transfer to intensive care unit (ICU) and a long-term mechanical ventilation [1; 5].
Obesity significantly alters lung mechanics, and creates the conditions for rapid decompensation of work of respiratory organs at infectious damage oflungs. Obesity combines two mechanism of respiratory function disorders: lung volume reduction (restriction) and distal airway narrowing (obstruction), which causes predisposition of patients with obesity to development of ARDS.
In this context, the aim of our study was to improve the results of treatment of ARDS with community-acquired viral and bacterial pneumonia in obese patients by optimizing respiratory support.
Materials and methods
We analyzed the results of treatment of 251 patients with severe community-acquired viral and bacterial pneumonia, complicated by the development of ARDS who were treated in the ICU of City clinical hospital of emergency medical care of Minsk.
The study included patients who meet the following criteria: acute onset ofthe disease; time of onset (fervescence > 38 °C) prior to the development ofARDS is not more than 7 days; diffuse bilateral infiltration on radiographs; respiratory index (RI, PaO2/FiO2) < 300 mm Hg; no signs of cardiogenic pulmonary edema; the need for respiratory support.
Hypoxemia has been quantified by the PaO2/FiO2 ratio (the ratio of pulmonary arterial oxygen tension to the fraction of inspired oxygen con-
