CC BY
28
Section б. Medical science
3. It has been determined that ASIT efficiency in patients with respiratory allergic diseases depends on initial ability of immune system to activation with low doses of allergen, rather
quick suppression of pro-inflammatory cytokines, induced thereby, as well as active functioning of the anti-inflammatory cytokines system.
References:
1. Аллергический ринит и его влияние на астму (ARIA): Руководство для врачей и мед. сестер. М., 2001, 24 с.
2. Гущин И. С. Аллергенспецифическая иммунотерапия атопических заболеваний: пособие для врачей. М., 2002, 32 с.
3. Гущин И. С. Физиология иммунитета и аллергия//Физиология и патология иммунной системы. 2004. - № 9. - C. 17-20.
4. Park H. S. Clinical and immunologic changes after allergen immunotherapy with Hop Japanese pollen. Ann Allergy, Asthma Immunol. 2001, v.86, No. 4. P. 444-448.
5. Akdis M., Akdis C. A. Mechanisms of allergen-specific immunotherapy. J. Allergology Clin. Immunol. 2007, v.119 (issue 4). P. 780-789.
6. Andersson T. N., Ekman G. J., Gronlund H. et al. A noveladjuvant-allergen complex, CBP — r Fel d 1, induces up-regulation of CD86 expression and enhances cytokine release by human dendritic cells in vitro. Immunology. 2004. v. 113 (2). P. 253-259.
7. Arshad S. H. Primary prevention of asthma and allergy. J. Allergy Clin. Immunol. 2005. v. 116. P. 3-144.
8. Canonica W., Baena-Cagna C. E., Bousquet J. et ак Recommendations for standardization of clinical trials with Allergen Specific Immunotherapy for respiratory allergy. Allergy 2007, v. 62. P. 317-324.
9. Ciprandi G., Marseglia G. L., Tosca M. A. Allergen-specific immunotherapy: an update on immunological mechanisms of action. Monaldi Arch. Chest. Dis. 2006, v.65 (1). P. 34-37.
10. Fujisawa T., Nagao M., Hosoki Yu. Et al. Biomarkers for allergen immunotherapy in cedar pollinosis. Allergology Int. 2009, v.58, No. 2. P. 163-170.
11. Grzela K., Grzela T., Lazarczyk M. et al. Influence of allergen-specific immunotherapy on IL-4-dependent IL-12 production by monocytes. Int. J. Mol.Med. 2002, v.10, №. P. 481-484.
12. Jacobi H., Poulsen L. K., Reimert C. M. etc. IL-8 and the activation of eosinophils and neutrophils following nasal allergen challenge. Int. Arch. Allergy Immunol. 1998, v. 116. P. 53-59.
13. Jutel M., Akdis M., Blaser K., Akdis C. A. Mechanisms of allergen specific immunotherapy — T- cell tolerance and more. Allergy. 2006, v. 61 (7). P. 796-807.
14. Moverare R. Allergen-specific increase in IL — and IL-5 secreation from peripheral blood mononuclear cells during brichpollen immunotherapy. Allergy. 2007, v. 53, Issue 3. P. 275-281.
15. Silny W. Effectiveness of specific immunotherapy in the treatment of children and youngsters suffering from atopic dermatitis. Part III. Serum concentrations of selected immunologic parameters. Wiadomosci lekarskie 2005, v.58 (5-6), P. 287-294.
16. Toshiyuki Tazaki, Kenji Minoguchi, Takuya Yokoe et al. Allergen rush immunotherapy increases interleukin (IL)-12 production and IL-12 receptor p2 chain expression in patients with allergic asthma. Cell Immunol. 2004, v.228 (1). P. 20-26.
Israilov Xikmatjon Tuygunovich, Republican Specialized Scientific-practical Medical Center of Dermatology and Venereology, Uzbekistan, Tashkent city
E-mail: mbshakur@mail.ru
The study of clinical manifestations and status of immune-interferon system in patients with recurrent genital Herpes
Abstract: The achieved results in the patients with recurrent genital Herpes indicate misbalance of cytokine and interferon systems of lymphocytes with disorders of differentiation of T-helpers and the way if signaling response.
Keywords: recurrent genital Herpes, immunological status.
Genital infection called Herpes Simplex virus (HSV) continues to stay constantly growing problem ofhealth care, spreading among people in the whole world and seriously affecting health status, es-
pecially young sexually active people [3; 6; 11]. It is mostly conditioned by wide spread of these viruses, long intra cellular persistence of the agents, their effect on the processes of immune genesis, often relapses, difficult diagnostics and therapy [7; 9; 10]. In the modern time in spite of remarkable success achieved in diagnostics and therapy of urogenital infections, morbidity rate stay high both in our country and abroad [1; 4]. Special importance in the structure of urogenital infections is occupied by the affect of HSV 1 and 2 types [5; 8]. The problems of epidemiology, causes of infection growth, often relapses, polymorphism of clinical manifest, the role of organism protection systems in the pathogenesis and clinical progress of
recurrent forms of herpetic infection require profound study of and condition the necessity of the improvement of therapy methods for patients with often recurrent genital Herpes which served the objective of our work.
Materials and methods. During 2008-2011 we observed 97 patients with often recurrent (from 4 to 10 and more relapses per year) genital Herpes (GH) who applied to anonymous testing and clinical departments of RSSPMC of DV of the MHC of the RUz. Among them there were 74 men and 23 women. Sick children were in the age from 18 to 58 years old. Term of the disease was from 1 to 5 years. At the moment of application all patients had stage of active manifestations of genital Herpes. In 12 (12.4%) patients the disease proceeded in combination with ITSW, including 4 patients with urogenital Chlamydia, 3 with ureo-mycoplasma in-
The study of clinical manifestations and status of immune-interferon system in patients with recurrent genital Herpes
fection, 5 patients with urogenital Candidosis and 2 combinations with bacterial vaginitis. Clinical checking included complaints, anamnesis, definition of objective status, study of clinical manifestations of the disease, laboratory tests for definition of syphilis, HIV, smear microscopy by Gram method and cultural tests using selective nutritious media for growing of mycoureaplasma, trycho-monades, Candida, IEA for Chlamydia trachomatis, PCR tests for HSV land 2 types from the foci, serological tests for the markers of acute and chronic infection of HSV land 2 types, amount of a- and y-IFN, IL — 2, 4, definition of the status of cell-mediated and humoral immunity. For the detection of urogenital infections we performed standard therapy in compliance with "Standards of diagnostics and therapy of dermatovenereology", confirmed by the Order of the MHC of the RUz № 377 dated 28.28.2006. For the therapy of genital Herpes we prescribed agents of acyclic nucleosides. Clinical-laboratory tests were performed in dynamics before and after the therapy, systematization of the results of clinical-laboratory tests and assessment of the efficacy of the therapy was performed by means of registration of the results in individual cards of the patients.
Results and discussion. Results of PCR test for HSV 1 and
2 types from the foci of damage showed that DNA of HSV 2 identified in 87 patients, HSV 1 in 7 patients, both types of the virus in
3 patients and that confirmed etiological relevance of the viral infection to Herpesviridae family. The achieved results testify prevailing of HSV 2 type in the genesis of the disease among the patients with genital Herpes (89.7% as mono infection and 3.1% in association with HSV ltype).
In the study of clinical manifestations of genital Herpes in men we revealed that injured foci in 32 (43.2%) patients located on skin of mons pubis at the root of penis. 37 patients (50%) had lesions of skin of penis with prevailing location of the elements in the area of frenulum or sulcus coronarius. In 5 (6.7%) cases there were various notable combinations offocal locations (sexual organs, skin of mons pubis, inner surface offemoral skin). In 15 (65.2%) women the elements of genital Herpes located on the skin of major labia pudendi, in 3 (13%) cases on the skin of mons pubis, and other 3 (13%) cases on mucous membrane of the inner surface of labia pudendi.
Combinations of foci of lesion on skin of labia pudendi major and inner surface of femoral skin were observed in 2 (8.7%) patients. In 8 (8.2%) cases clinical manifestations of genital Herpes were presented by erosion-ulcerous and ulcer elements of lesion. Subjectively in all cases the disease was accompanied by expressed pain syndrome at the places of lesions.
Clinical lesions of genital Herpes were presented by elements such multiple vesicular, erosive, ulcerous foci with exudation phenomena. Elements of GH were located on a little bit edematous hyperemic skin and mucous membranes of genitals, which were accompanied by subjective symptoms such as itching, pain, burning in the foci of lesions, and irradiation of pain to groin area and lower limbs (15.5% patients). 17 (17.5%) patients had complications such as pyodermia and unilateral inguinal lymphadenitis.
The study of prevalence of relapses of genital Herpes in the group of the examined patients showed that 47 (48.4%) patients had from 4 to 6 relapses per year, 29 (29.9%) patients up to 8 relapses per year. В 21 (21,6%) случаях рецидивы заболевания проявлялись от 1 до 2 раз в месяц, что соста-вило 10-12 и более рецидивов в год.
Change of location of the elements of lesion in GH relapses was noted in 32.9% patients, while in 67.1% cases of every new relapses of of genital Herpes rash located at the place of previous
focus of lesion. In 35% cases patients noticed exacerbation of GH after sexual intercourse, over-cooling, drinking alcohol; women noticed during every menstruation. Majority of the patients could not determine clear reasons. There was notable long-lasting progressing of the disease with slow epithelization among the patients with prevalence of erosive-ulcerous elements of lesion. While average epithelization in 91.8% patients occurred at the 6th — 8th days, the elements of erosive-ulcerous foci with exudation had average regression for two weeks.
Immunologic tests among the patients revealed decrease of relative amount of the total pull of lymphocytes and T-lym-phocytes (CD-3 average to 64%), T-helpers (CD-4) in comparison with the values of the patients of the control group. Ratio of CD4+/CD8+ decreased to 35% by means of diminishing of CD4+ amount and compensatory increase of CD8+ cells. The study of differential markers CD 16 revealed growth of its relative amount to 20%. These changes characterize disorders offunctions of T-cell part of immunity system with suppression of its function and prevailing of humoral type of immune response.
The level of CD4+ decreases in all forms of the disease, which were mostly expressed in the group of the patients with relapses of GH 8 times a year and more; the level of CD8+ increased in non-reliable limitsin 40% of the patients (mostly with the number of relapses from 4 to 6 times a year); reliable character of increase was observed in the group of patients with frequent relapses of GH (8 times a year and more). As a whole the results demonstrated a clear dependence of expression degree of impairments of immune system on the number of relapses.
The study of humoral immunity revealed non-reliable increase of the level of serum immunoglobulins class A, increased level of serum immunoglobulins class M in patients with genital Herpes respectively, and significant rise of serum immunoglobulins class G level in all checked groups.
Analysis of the achieved data relative number of B-lymphocytes (CD19+), responsible for the level of protection antibodies' production in the patients with GH increased average 1.3 fold, while the level of CIC increased average 1.5-2 fold in comparison with the control group, and it was characteristic for chronic long-lasting progress of infectious process. In the study of the values of cytokines and interferons in the patients with GH we determined that in the group of patients with the number of relapses up to 8 cases per a year the dynamics of cytokine amount changing (IL-2, IL-4, FNO-a) and interferons (a-TNF, y-TNF) was not significant. In this group of the patients there was notable increase of FNO-a to 17% and amount of y- TNF to 15% in comparison with the values of the control group.
In the group of patients with frequent relapses of genital Herpes we revealed decrease of IL-2 and y-TNF level to 85 -87%. Decrease of a — TNF level was more expressed and reached 65% different from the control. The level of IL-4 and FNO-a increased to 141% and 133% respectively.
Conclusion. Analysis of clinical material showed that among the patients with GH in 51.6% cases we observed quite often relapses of the disease from 8 to 10-12 times a year and more, with change of the location of the elements of lesion in 32.9% patients in the further relapses of the disease, and that can be the reason of immune control system failure in the group of the examined patients.
The achieved results among the patients with recurrent genital Herpes indicate misbalance of cytokine and interferon system of lymphocytes with disorders of T-helpers' differentiation and the way of signaling response (Th1, Th2, Th0).
Section 6. Medical science
The data reflect incompetence of anti-viral protection of an organism with background immunologic deficiency, and that decreases the capabilities of a micro organism in the control of virus replication and leads to persistence ofviral infection and reproduction of the virus, shortening of the period between relapses and the
number of relapses. That in its turn leads to the conclusion about mono therapy failure, including its suppressive scheme, and the necessity of complex therapy for the patients with recurrent genital Herpes taking into account peculiarities of the immunity system functioning in compliance with the literature data [2; 12].
References:
1. Alkeyeva A. B. Peculiarities of immunologic impairments in recurrent infection. Comparative assessment of the therapy efficacy: Abstract of Doct. Diss. - M, 1992. - 18 p.
2. Borisova A. M., Alkeyeva A.B, Saidov M. Z. The role of the system of natural cytotoxicity in immune pathogenesis of recurrent herpetic infection and the impact of immune modulators on the clinical-immunologic status//Immunology - 1991. - № 6. - P. 60-63.
3. Granitov V. M. Herpes viral infection. - M., 2001. - 88 p.
4. Drobisheva N. N. Problems of the diagnostics of genital Herpes//Bulletin of dermatology and venereology. - 2002. - № 5. - P. 21-23.
5. Kubanova A. A., Zudin A. B. Herpetic infection: characteristics of the progress, diagnostics, problems of medicine resistance//Bulletin of derm. and ven. - 2000. - № 3. - P. 10-16.
6. Polesko I. V., Butov U. S., Malinovskaya V. V., Khaldin A. A. Immunologic status in Herpes Simplex//Russian med. Jour.- 2001. - № 6. -P. 37-38.
7. Selkov S. A., Aylamazyan E. K. Genital Herpes: modern approaches to diagnostics and therapy. - SPb., 2000. - T 7. - № 1. - P. 34-41.
8. Sukhikh G. T., Marchenko L. A., Shurshalina A. V. Status of immune system in genital Herpes//Problems of reproduction - 2000. -№ 6. - P. 20-24.
9. Once-daily valaciclovir to reduce the risk of transmission of genital herpes/L. Corey, A. Wald, R. Patel et al.//N. Engl. J. Med. - 2004. - Vol. 350. - P. 11-20.
10. Patel R., Barton S. E., Brown D. European guideline for the management of geni tal herpes//Int. J. STD. & AIDS. - 2001. - N12. - Suppl 3. - P. 34-39.
11. Whi t l ey R. J. Optimizing the management of geni tal herpes//J. Round. Tabl e. Series. - 2000. - N 2. - P. 69.
12. Yu Z., Mani ckan E., Rouse B. T. Role of interferon-gamma in immunity to herpes simplex virus//J Leukoc Bi ol - 1996. - vol. 60 (4). - P. 28-32.
Israilova Nigora Amanullaevna, Tashkent Medical Academy, assistant of the department of GP pediatrics E-mail: nigora99@gmail.com
Possibilities of prediction of the development of cardio-vascular complications in acute pneumonia in young age children
Abstract: Elaboration of prognostic criteria of the development of cardio -vascular complications in acute pneumonia in young age children may promote detection of earliest signs of the disease, to choose the periods which is the most probable process of sanogenesis helps more deeply understand the pathogenesis of disease and according to timely prescription of adequate therapy.
Keywords: prediction complications, cardio-vascular system, acute pneumonia, children.
Topicality of problem. According to the requirement of life the number of researches on prediction in medicine has increased for the last decades [3,5]. On the basis of prediction there is knowledge, thinking and abilities of human brain to forestalling, anticipation, leading the reflection of reality. The main aim of medical prediction consists of decreasing uncertainty of future. The other important peculiarity of medical prediction is its active character which gives a possibility of indirect or direct influence to the object of prognosis [1; 2].
In the structure of morbidity and mortality of young age children, acute pneumonia takes the leading lace. According to WHO data children with pneumonia in developed countries of the world compose 3-4% from total number of patients, but in developing countries — 10-20%; lethality varies from 5,5 to 7,2%, children at the age from 1 to 6 months 15-20% [7]. In Uzbekistan (by the data of WHO, 2007) infantile mortality makes up 13,2%, in the structure of it where the portion of pneumonia is 40%.
In pneumonia in pathologic process of cardio-vascular system is involved, combination of infectious -inflammatory process in the lungs and heart is often observed [1; 4; 9]. Cardio — and hemodynamic disorders in pneumonia in young children, as an important team of pathogenesis of pneumonia, aggravates its course, worsen the prognoses and often become one of the cause of lethal outcomes [6; 8]. Elaboration of prognostic criteria of the development of cardio -vascular complications in acute pneumonia in young age children may promote detection of earliest signs of the disease, to choose the periods which is the most probable process of sanogenesis helps more deeply understand the pathogenesis of disease and according to timely prescription of adequate therapy.
Purpose of research. To elaborate prognostic criteria of the risk of development of cardio-vascular complications in young children with acute pneumonia.
