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0the oral cavity and elaboration of therapeutic-preventive programs for children suffering from type I diabetes mellitus.
Conflicts of Interest: authors have no conflict of interest to declare.
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СОВРЕМЕННЫЕ ВОЗМОЖНОСТИ УВЕЛИЧЕНИЯ КОНТРОЛЯ БРОНХИАЛЬНОЙ АСТМЫ В
ШКОЛЬНИКОВ
Марусык У.И.
Высшее учебное заведение Украины «Буковинский государственный медицинский университет», г., Черновцы, Украина, доцент кафедры педиатрии и детских инфекционных болезней, кандидат
медицинских наук
THE MODERN OPPORTUNITIES FOR INCREASING THE CONTROL OF BRONCHIAL ASTHMA
IN SCHOOL-AGE CHILDREN
Marusyk U.I.
Higher education institution Ukraine "Bukovinan State Medical University", c. Chernivtsi, Ukraine, Assistant professor, Department of pediatrics and children's infectious diseases, PhD
Аннотация
Актуальность. Бронхиальная астма - одно из самых распространенных заболеваний в мире, количество больных которого постоянно увеличивается, особенно среди детей. Недостаточная эффективность контролирующей терапии астмы обусловила необходимость применения у детей новых медикаментов, способствующих улучшению течения данного заболевания.
Цель исследования. Повысить контроль астмы у детей школьного возраста с использованием Нук-леината в качестве компонента комплексной терапии.
Материал и методы. 45 детей школьного возраста с астмой в период ремиссии были обследованы в пульмонологическом отделении Черновицкой областной детской клинической больницы. Нуклеинат принимали в дозе 0,25 г в день в течение 21 дня в комплексе базовой терапии, в соответствии с Международным консенсусом по лечению астмы у детей.
Все дети прошли бальную оценку контроля над астмой с помощью обследования до и после курса противовоспалительной терапии.
Эффективность контролирующей терапии анализировалась в соответствии к сумме балов клинических симптомов и динамикой спирографического исследования таким образом, что, при ухудшение контроля БА, балы увеличивались.
Результаты. Использование Нуклеината в комплексной противовоспалительной терапией у детей уменьшало часть пациентов, которым необходимо частое употребление р2-агонистов короткого действия (в среднем 4-7 доз в неделю). Таким образом, до начала лечения потребность выявлена у 46,6% пациентов и только у 22,2% пациентов (Р <0,05) после.
После лечения у детей выявлено снижение бронхиальной гиперчувствительности в виде увеличения провокационных и кумулятивных доз гистамина в 2,6 раза.
Abstract
Introduction. Bronchial asthma is one of the most common diseases in the world, the number of patient with an ever increasing, especially among children. Inadequate efficiency of controlling asthma therapy necessitated the application of new drugs in children which have improved the course of the disease.
Objective. To increase the controllability of asthma in school-age children by using Nucleinate as a component in the complex therapy.
Materials and Methods. 45 school-age children with asthma in the remission period were comprehensively examined in the pulmonology department of the Chernivtsi Regional Children's Clinical Hospital. Nucleinat was taken at a dose of 0.25 g in day for 21 days in the complex of basic therapy prepared in accordance with the International Consensus for the treatment of asthma in children.
All children underwent a baseline assessment of asthma control with the help of a survey before and after the course of anti-inflammatory therapy.
The effectiveness of the control therapy was analyzed according to the sum of the points of the children's clinical state 12 and the dynamics of the spirographic examination, in such a way that, given the deterioration in the control of the BA, the score increased.
Results. The using of Nucleinat with basic anti-inflammatory therapy in children decreased a part of children who needed frequent use of short-acting p2-agonists (an average of 4-7 doses per week). So, before the start of treatment, the need was indicated in 46.6% of patients, and after only 22.2% of patients (P <0.05).
After treatment in children, a decrease in the bronchial hypersensitivity in the form of an increase in the provoking and cumulative doses of histamine by 2.6 times was revealed.
Ключевые слова: бронхиальная астма; дети; Нуклеинат; гиперчувствительность бронхов; контролирующая терапия.
Keywords: asthma; children; Nucleinat; bronchial hypersensitivity; control therapy.
Introduction. Asthma is the most common chronic disease of childhood and the leading cause of childhood morbidity from chronic disease as measured by school absences, emergency department visits and hospitalizations [4,8,9]. Asthma often begins in early childhood; in up to half of people with asthma, symptoms commence during childhood.2 Onset of asthma is earlier in males than females [3,12]. Atopy is present in the majority of children with asthma who are over 3 years old, and allergen-specific sensitization is one of the most important risk factors for the development of asthma. However, no intervention has yet been shown to prevent the development of asthma, or modify its long-term natural course.
Symptoms and airflow limitation may resolve spontaneously or in response to medication, and may sometimes be absent for weeks or months at a time. On the other hand, patients can experience episodic flare-ups (exacerbations) of asthma that may be life-threatening and carry a significant burden to patients and the community. Asthma is usually associated with airway hyperresponsiveness to direct or indirect stimuli, and with chronic airway inflammation. These features usually persist, even when symptoms are absent or lung function is normal, but may normalize with treatment.
Long-term using of inhaled glucocorticosteroids, as the main component of anti-inflammatory therapy of bronchial asthma (BA) in children, in some cases is ineffective, possibly due to the phenotypic features of the disease [1,5,6]. The determination of the BA phenotype is a laborious and rather expensive process that's why it is not available in most clinics. In this situation it is very important to use new medications which are able to enhance the action of anti-inflammatory drugs in the complex of basic BA therapy and are effective in its various phenotypes. From this perspective, the drug Nucleinat [1], whose use in adults significantly increased the controllability of asthma, should be considered promising.
Purpose of the study. To increase the controllability of asthma in school-age children by using Nu-cleinate as a component in the complex therapy.
Material and methods. 45 school-age children with asthma in the remission period were comprehensively examined in the pulmonology department of the Chernivtsi Regional Children's Clinical Hospital. Nu-cleinat was taken at a dose of 0.25 g in day for 21 days in the complex of basic therapy prepared in accordance with the International Consensus for the treatment of asthma in children. This clinical group included 31 boys (68.8%) and 14 girls (31.1%), and the average age of patients was 11.8 ± 0.5 years. Mild asthma was observed in 4 patients (8,9 ± 4,2%), moderate asthma in 26 children (66,7 ± 7,4%) and severe - in 15 patients (33,3 ± 7,0%).
All children underwent a baseline assessment of asthma control with the help of a survey before and after the course of anti-inflammatory therapy. The questionnaire [11] consisted of clinical signs of bronchial asthma, which were assessed on a 4-point scale (the sum of scores I, maximum - 28) and the dynamics of spirographic data (the sum of scores II, maximum - 8). The function of external respiration was assessed according to the indices of FEV1 (forced expiratory volume for the first second) and PEF (peak expiratory flow rate). At the same time, the above indicators were estimated as follows: if the FEV1 and the PEF were more than 90% of the norm - 0, 80-89% - 1, 70-79% - 2, 6069% - 3 and less than 60% - 4 points.
The effectiveness of the control therapy was analyzed according to the sum of the points of the children's clinical state 12 and the dynamics of the spirographic examination, in such a way that, given the deterioration in the control of the BA, the score increased. All patients were assessed by hypersensitivity of the respiratory tract using the MicroLab portable calibration spirograph from Micro Medical. Hypersensitivity of the bronchi was assessed according to the provoking dose of histamine, which reduces the forced expiratory volume in the first second by 20% (PC20H), and the cumulative dose (PD20H) using serial dilutions of his-tamine.
The obtained results were analyzed by variational statistics methods using statistical software StatSoft Statistica v5.0.
Results of the study and their discussion. It was
found that after the course of treatment in children, the level of asthma control increased (Table 1).
Table 1
Score assessment of the bronchial asthma control before and after treatment in children (M ± m).
Clinical symptoms of the dis- Before treatment After treatment Р, no difference
ease (N=45) (N=45) (ND)
Daytime asthma symptoms 2,3±0,15 1,6±0,16 р<0,05
Nighttime asthma symptoms 1,2±0,17 0,7±0,13 р<0,05
P2-agonists as needed 1,9±0,15 1,3±0,15 р<0,05
Physical activity - limited 2,4±0,14 1,8±0,14 р<0,05
Frequency of hospitalizations 2,1±0,13 2±0,12 HD
The frequency of exacerbations 2,8±0,11 2,6±0,12 HD
Unscheduled visit to the allergist 2±0,17 1,8±0,4 HD
The sum of scores I 15±0,8 11,1±0,8 р<0,05
FEV1 0,8±0,15 0,8±0,16 HD
PEF 2,4±0,19 2,1±0,19 HD
The sum of scores II 3,9±0,6 3±0,3 HD
The total score 17±0,9 14,6±0,9 р<0,05
Improvement of the clinical course of bronchial asthma in children using Nucleinates in the complex of control therapy was explained by a possible decrease in the inflammatory process in the bronchi. This was manifested by positive changes in the clinical and paraclin-ical signs of the asthma controllability. At the same time, it was noted that after treatment a part of children who needed frequent use of short-acting p2-agonists (an average of 4-7 doses per week) decreased. So, before the start of treatment, the need was indicated in 46.6% of patients, and after only 22.2% of patients (P <0.05). At the same time, school-age children had a significant decrease in the score of the clinical state of children (from 15 ± 0.8 points before treatment to 11.1 ± 0.8 points after (p <0.05)).
In our opinion, the results indicated that the introduction of Nucleinate [6] into the complex of anti-inflammatory therapy of asthma caused an increase in the level of disease control.
After treatment in children, a decrease in the bronchial hypersensitivity in the form of an increase in the provoking and cumulative doses of histamine by 2.6 times was revealed. So, before using the drug, provoking and cumulative doses of histamine were 1.02 ± 0.2 mg / ml and 0.22 ± 0.04 mg, and after treatment - 3.6 ± 1.3 mg / ml and 0.8 ± 0.3 mg, respectively (p <0.05). Simultaneously after treatment, the hypersensitivity of the respiratory tract decreased in 57.8% of patients. In our opinion, the results can be explained by a decrease in the inflammatory component of bronchial hypersensitivity under the influence of complex treatment.
Conclusions: 1. The use of Nucleinate in the complex of anti-inflammatory therapy reliably allows to achieve a better level of bronchial asthma control in school-age children. 2. The use of Nucleinate in the complex of basic therapy of bronchial asthma in children can reliably reduce bronchial hypersensitivity due to a likely decrease in the activity of the inflammatory process of the respiratory tract.
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ЗАБОЛЕВАЕМОСТЬ И СМЕРТНОСТЬ СЕЛЬСКОГО НАСЕЛЕНИЯ ОТ БОЛЕЗНЕЙ СИСТЕМЫ
КРОВООБРАЩЕНИЯ
Навчук И.В.,
доцент кафедры социальной медицины и организации здравоохранения Высшего государственного учебного заведения «Буковинский государственный медицинский университет»
Навчук Г.В.,
кандидат филологических наук, доцент кафедры общественных наук и украиноведения Высшего государственного учебного заведения «Буковинский государственный медицинский университет»
Собко Д.1. Врач-терапевт
MORBIDITY AND MORTALITY OF RURAL POPULATION WITH CIRCULATORY DISEASES
Navchuk I. V.,
PhD, Associate Professor of the Department of Social Medicine and the Organization of Health Care of
Higher State Educational Establishment of Ukraine «Bukovinian State Medical University»
Navchuk H.I.,
PhD, Associate Professor of Social Sciences of Higher State Educational Establishment of Ukraine
«Bukovina State Medical University» Sobko D.I. Physician
Аннотация
Изучено и проанализировано связь между показателями заболеваемости и смертности от болезней системы кровообращения у сельского населения. Доказано, что смертность взрослого населения от острого инфаркта миокарда и инсульта напрямую зависти от показателей их распространенности и заболеваемости.
Abstract
An association between the morbidity and mortality rates of the rural population with circulatory diseases has been studied and analyzed. And it has been proved that the mortality rate of the adult population from acute myocardial infarction and stroke is the higher, the higher is their prevalence and the morbidity rate.
Ключевые слова: заболеваемость, распространенность, смертность, болезни системы кровообращения, сельское население.
Keywords: morbidity, prevalence, mortality, circulatory diseases, rural population.
In contrast to the countries of the European region, circulatory diseases (CD) in Ukraine have their own characteristics: increased mortality, disability (especially among the rural population (RP); northeast prevalence vector; rejuvenation of patient contingents; a significant incidence of morbidity with temporary disability in men of working age.
Due to these peculiarities, the medical and social importance of CD in Ukraine is constantly growing, they belong to the first places among the causes of death, disability, which leads to significant economic losses for the family and the state from premature death, especially at working age; as well as to large financial costs for the diagnosis, treatment and rehabilitation of patients.
The fight against CD and, in particular, with arterial hypertension, is most effective, and in some cases -the only possible only in the preventive plane.
To study and analyze the relationship between the rates of prevalence, morbidity and mortality from CD in the adult population of the rural region.
For the analysis, statistical data of the Ministry of Health of Ukraine on morbidity and mortality of the population of Ukraine from CD processed using analytical, sociological and mathematical-statistical methods were used.
Calculation of the correlation coefficient (r) was carried out according to the formula:
