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8. Shepelenko A.F. Community-acquired pneumonia combined with cardiac pathology: peculiarities of clinics, diagnostics and treatment// Pulmonology. - 2010. - 1. - P. 87-92.
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Karabayeva Indira, research worker Republican specialized scientific — practical medical centre of dermatology and venereology, Uzbekistan E-mail: ikarabaeva.73@mail.ru
The state of immune reactivity in patients with microsporia
Abstract: The immunological investigations were performed in patients with different forms of microsporia in group of 4-14 year old children depending on the term of disease, remoteness of disease less than lmonth was registered in 55 patients, more than lmonths in 24 patients. In patients with microsporia the changes in the structure of circulating pool of lymphocytes as the decrease of functional activity of T -lymphocytes, T — helpers/inductors as well as indexes of nonspecific resistance, activization of humoral group of immunity were noted.
Keywords: zooanthroponosis microsporia, immunological investigations, children.
Nowadays zooanthroponosis microsporia with affection of skin coverlet and hair is one of the most common mycosis in children [1, 43-44]. In some countries microsporia makes up 60 to 97% of all dermatophytosis, but year-on-year increase of morbidity reaches 8% [3, 68-69;7, 8-12]. At present the increase of morbidity with microsporia caused by the changes of properties on the one hand, agents (appearance of the new types of fungi, increasing of their pathogenicity and contagiosity, disorders of structure and edges of nosoreals), — the host (decrease of natural resistance, the rate of immunodeficiency state, unfavorable epidemiological and social condition) on the other hand [5, 17].
The important place in pathogenesis of microsporia is due to different changes of immune status, in which clinical course of mycosis, its prognosis and the choice of rational therapy depend on them [1, 43-44;5].
Different authors note the various versions of deviation — from immunodeficiency until increased activity. Performed analysis of literary data allows to make a conclusion about the absence of single treatment of the character of immune changes in patients with microsporia. At present the disorders of system and local immunity were not studied fully, it was not revealed the role of nonspecific immune response [2, 25; 4,113; 6, 87-88].
The purpose of research.
The study of some immunological parameters in particular, T-lymphocytes and B- lymphocytes, subpopulation T- lymphocytes, humoral group of immunity as well as the factors of nonspecific protection in children — patients with microsporia.
Materials and methods
At the age of 4 to 14 years old 79patients with different clinical forms of microsporia with remoteness of disease from 1 week to 6 months were under the observation. The general number of patients predominated the person of male. The state of cellular and humoral immunity was determined by study of absolute and relative
number of leucocytes in 1 ml peripheral blood, relative content of T and B — lymphocytes and their subpopulation — T — helpers, T- suppressions and their ratio (by methodical recommendations of F.Yu.Garib with coauth., 1995). Indexes of humoral immunity were revealed by content in blood serum of immunoglobulins A, M, G (with method of radial immunodiffusion by Mancini G.) and circulating immune sets (CIS, method of M. Digeon and others (1977). Phagocytic index (Phi) and phagocytic number (PhN) were determined by incubation of mixture of leucocytes and particle of latex from indexes of nonspecific reactivity. According to the data of different investigators (V. N. Fedoseeva and coauthors., 1993) confidence bound inprobability 95% content T- and B-lymphocytes and immunoglobulins in children at the age from 4 to 14years old was practically the same, because of the analysis of results of immunological investigation was performed in all children who were in this age group.
Results and their discussion.
Immunological investigation were conducted in 79 patients with microsporia, among them 8 patients suffered from microsporia of smooth skin, on 39 -microsporia of fibrous part of the head and 32 -with combined lesions of fibrous part of the head and smooth skin.
Immunological indexes in general group ofpatients with microsporia were presented inTable 1.Evidiently, the changes of lymphocytes activity — the main immunocomponent cells is marked in patients with zoophilous microsporia, which expressed with increasing of leucocytes and general number of lymphocytes and decreasing of relative number of T- lymphocytes, T-helpers, decreasing of im-munoregulatory index and relative number of T-suppressors.
Increasing of B-lymphocytes, increasing of the content of serum immunoglobulins G, circulating of immune complexes was revealed at simultaneous decreasing of the number of immunoglobulins A and M in the indexes of humoral immunity.
Table 1. - Immunological indexes of patients with microsporia
Indexes Control, n=26 Patients, n=79
1 2 3
Leucocytes, abs 4,4 ± 0,11 5,7±0,09 ****
Lymphocytes,% 30,9 ± 0,62 37,2±0,72 ****
The state of immune reactivity in patients with microsporia
1 2 3
T-lymphocytes,% 58,8 ± 0,46 45,1±0,34 ****
T-helpers,% 37,2 ± 0,28 31,2±0,19 ****
T-suppressors,% 15,1 ± 0,19 14,2±0,12 ***
Th/Ts 2,5 ± 0,04 2,2 ± 0,02 ****
B — lymphocytes,% 20,5 ± 0,31 21,6±0,13 ***
Ig A, g/l 1,55 ± 0,06 1,15±0,02 ****
Ig M, g/l 1,91 ± 0,05 1,73±0,02 ***
Ig G, g/l 11,6 ± 0,44 15,5±0,27 ****
CIC 14,2 ± 0,78 24,1±0,22 ****
PhI,% 54,2 ± 1,08 35,4±0,27 ****
PhN 4,8 ± 0,11 3,6±0,03 ****
Note: hereandfurtherintablestheindexesuncertainlydifferentfromcontrol (healthy)) (P>0,05) was marked by sign *, indexes — different with low reliability (P<0,05) sign **, significant different (P<0,01) sign ***, high reliability (P<0,001) sign ****.
Thus in patients with microsporia the disorders of immune status was detected which is expressed in suppression of cellular group of immunity simultaneously increasing its humoral team activity. The disorders of nonspecific factors of protection appear in decreasing of functional activity of neutrophilous leucocytes which expresses with decreasing of the percent of phagocytosis and phagocytic number.
Table 2. - Immunological indexes of patients with microsporia according to the remoteness of disease
The analysis of evidence of immunological disorders was performed according to remoteness of the process. The state of immune system index inpatients who suffered from microsporia until 1 month (55 patients) and more than 1 month (24 children) were presented in Table 2.
Indexes Control Remoteness of disease
until 1 month, n=55 More than 1 month, n=24
Leucocytes, abs 4,4 ± 0,11 5,7±0,10 **** 5,7±0,20 ****
Lymphocytes,% 30,9 ± 0,62 37,3±0,83 **** 37,2±1,41 ****
T-lymphocytes,% 58,8 ± 0,46 46,0±0,35 **** 41,9±0,52 ****
T-helpers,% 37,2 ± 0,28 31,5±0,21 **** 29,8±0,36 ****
T-suppressors,% 15,1 ± 0,19 14,3±0,16 *** 13,8±0,17 ****
Th/Ts 2,5 ± 0,04 2,2 ± 0,03 **** 2,2 ± 0,03 ****
B-lymphocytes,% 20,5 ± 0,31 21,5±0,16 *** 22,2±0,27 ****
Ig A, g/l 1,55 ± 0,06 1,2±0,03 **** 1,1±0,03 ****
Ig M, g/l 1,91 ± 0,05 1,8±0,02 *** 1,7±0,02 ****
Ig G, g/l 11,6 ± 0,44 15,1±0,20 **** 17,5±0,28 ****
CIC 14,2 ± 0,78 23,8±0,26 **** 25,4±0,44 ****
PhI,% 54,2 ± 1,08 35,3±0,31 **** 36,3±0,46 ****
PhN 4,8 ± 0,11 3,6±0,04 **** 3,7±0,05 ****
It is clear the data from Table 2 that in patients with microsporia immunological disorders are detected already in the first month of disease included in decreasing of T- lymphocytes and T- helpers numbers concerning to control value of immunoglobulin A, increase of the content of circulatory immune complexes, sharp decrease of phagocytic reactions, which appears with expressed falling of phagocytic index and phagocytic number.
With remoteness of process more than 1 month proceeds with oppression of activity of cellular team of immunity, aggravation of detected disorders, reliable decreasing of content T-suppressors. At the same time the activity of humoral team of immunity begins
to increase gradually, that is expressed in increasing of the content of immunoglobulin G, with increasing of CIC, on the background of preservation the decreasing of content IgA. Phagocytic index and phagocytic number continue to decrease which reflects disorder of phagocytic reactions activity.
Thus, the structure of circulating pool of lymphocytes changes in patients with microsporia. The disorders as decreasing of functional activity of T-lymphocytes- helpers/inductors and indexes of nonspecific resistance, activation of humoral team of immunity has been revealed.
References:
1. Abidova Z. M., Karabayeva I. T. The state of cellular team of immunity in children with microsporia//Topical questions of dermatology and venereology: Collection of scientific works of scientific practice, conference, Tashkent, 2006..
2. Akhmetova A. K. «Clinical- immunological features of microsporia and trichophytosis and their therapy». Abstract. dissert. c. m.s. 1994. Almati.
3. Maksudova M. N. «Upto-dateclinical-epidemiological and immunological features of zooanthroponosis microsporia and improvement of its therapy». Abstract. dissert. c. m.s. 2002. Dushanbe.
4. Makushina Z. V. Determinationofclinical - immunological parallels in children with microsporia//Chronic dermatosis (collection of scientific works Anniversary scient. -practical conference., consecrating to 90-years of the department of skin and venereal diseases of treatment faculty of RSMU). - M., 2000. - P. 113.
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Karimov Shavkat Ibragimovich, Rector of Tashkent Medical Academy, Republic of Uzbekistan Berkinov Ulugbek Bozorbaevich, Professor in the department of faculty and hospital surgery of the Tashkent Medical Academy,
Republic of Uzbekistan Sakhiboev Dilshod Parpijalilovich, Assistant in the department of faculty and hospital surgery of the Tashkent Medical Academy,
Republic of Uzbekistan E-mail: doctorsd77@mail.ru
The results of treating of adrenal genesis hypertension through different surgical methods
Abstract: We would like to share our experience of treating 226 patients, sick with genesis of adrenal hypertension, who received inpatient care in the 2-clinic of Tashkent Medical Academy (TMA) within the period from 2000 to 2014, on whom were used the methods of treatment, which are mentioned above. Depending on the type of medical intervention, the patients were categorized into 3 groups. The first group comprised the patients, the process of intervention which was performed through traditional thorocofrenolumbotomic (TFL) access. These ways, for the shown period were performed 104 traditional adrenalectomies in patients at the age from 18 to 66. The second group constituted 47 patients in whom were performed endovascular destruction of adrenal gland (EDAG) for the above indicated period, at the age of 20 to 55.
The third group of patients made up 75 people who were operated through the method of laparoscopic adrenalectomy (LA). Indications to the performance of traditional adrenalectomies were considered hormonally active and non-active adrenal tumors. At that, the size of tumors reaching 1.5 centimeters, especially the ones located on the left side were subject to endovascular destruction of adrenal gland (EDAG). After the implementation of LA, the tumors of the size from 1 to 6 centimeters, were subject to be operated this way, and the traditional way was used only in big size tumors. LA nowadays is the preferred in most of the situations with adrenal gland tumors. Following the principles of adequate behavior of patients on all of the stages of treatment allows the reduction of risk of complications, which contributes to the safety and reliability of operations.
Keywords: tumor of adrenal glands, arterial hypertension, laparoscopic adrenalectomy.
According to different researchers, the frequency of arterial hypertension (AH) in general population is up to 30%, and at the same time, the genesis of adrenal hypertension causes from 8 to 14% of cases from all of its symptomatic forms [1]. The main way of treating AH of adrenal genesis, specifically when the origin contains variety of neoplasms, is considered the surgical method [2].
The surgery of adrenal gland is comparatively new branch of clinical medicine that has being developed from the end of XIX- and the beginning of XX century. The characteristics of the location of adrenal gland in the retroperitoneal space determined the difficulty of its search and removal. These difficulties were the main reasons of numerous complications, which in turn were the holding points of development in this sphere [2; 3].
One of the attempts of reducing the traumatic outcomes of operative interventions — is the implementation into the clinical practice the method of endovascular destruction of adrenal gland (EDAG) [4].
The injection of laparoscopic adrenalectomy (LA), performed first by Gagner in the year 1992, made it available to
avoid problems in traditional adrenalectomy and the number of such medical operations started to increase dramatically [6; 7]. Undoubtedly, another reason for increased number of medical interventions in adrenal gland is related with high detect-ability of adrenal tumors.
The material and methods. Depending on the type of medical intervention, the patients were categorized into 3 groups. The first group comprised the patients, the process of intervention which was performed through traditional thorocofrenolumbotomic (TFL) access. These ways, for the shown period were performed 104 traditional adrenalectomies in patients at the age from 18 to 66. The second group constituted 47 patients in whom were performed EDAG for the above indicated period, at the age of 20 to 55. The third group of patients made up 75 people who were operated through the method of LA. The method was first used in our clinic as well as in Uzbekistan in the year 2009. Patients were at the age of 22 to 72. The ratio of women and men were approximately the same (table 1).
