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«Наука через призму времени»
Май, 2023 / Международный научный журнал
«Наука через призму времени» №5 (74) 2023
Автор: Мамаризаев Иброхим Комилжонович, ассистент
Рубрика: Медицинские науки
Название статьи: Courses of acute pneumonia in children on the background of myocarditis
Дата публикации: 18.04.2023
COURSES OF ACUTE PNEUMONIA IN CHILDREN ON THE
BACKGROUND OF MYOCARDITIS
Rustamov Mardon Rustamovich
doctor
of medical sciences, professor
Mamarizaev Ibrokhim Komilzhonovich
assistant
of the department of the department of 1-pediatrics and neonatology, Samarkand
State Medical University. Samarkand, Uzbekistan
Annotation. Pneumonia
is an acute infectious disease, different in etiology (mainly bacterial),
characterized by focal lesions of the lungs with intraalveolar
exudation, which manifests itself in various degrees of intoxication,
respiratory disorders, local physical changes in the lungs and the presence of
an infiltrative shadow on the chest x-ray. Myocarditis
is an inflammatory lesion of the myocardium of an infectious, toxic-infectious,
infectious-allergic, autoimmune or toxic etiology. In this work, we studied the
course of community-acquired pneumonia in children with myocarditis.
Key words: pneumonia, myocarditis,
children, lungs, intoxication.
Relevance.
Currently, ideas about the etiology
of pneumonia in children vary significantly: for example, according to some
authors, the main causative agents of bacterial pneumonia are S. pneumoniae and H. influenzae b,
and it is indicated that the largest number of severe cases of pneumonia in
children is attributed to the disease caused by these etiological factors. [1,2].
In the etiological structure of CAP
in children, the most common infectious agents include Streptococcus pneumoniae, Mycoplasma pneumoniae, relatively infrequent Staphylococcus aureus, Clamydophylapneumoniae,
Chlamydia trachomatis, Bordetella
pertussis, and rarely Haemophilusinfluenzae,
Streptococcus pyogenes, Streptococcus agalactiae and Escherichia coli [2,3]
In the study of the etiological
structure of community-acquired pneumonia, it was revealed that it has
age-related features. Since the main causative agent of pneumonia is
Streptococcus pneumoniae, a certain role is assigned
to atypical pathogens, such as Mycoplasma pneumoniae and Chlamydophilapneumoniae,
the role of viruses is quite large in. The authors indicate that the
etiological agents of the development of community-acquired pneumonia in
children depend on the geographical region, the calendar of preventive
vaccinations, and antibiotic therapy of the disease. [1,3,5]
Most often, myocarditis
is of a viral nature. At the same time, if earlier the group of coxsackieviruses was in the first place in terms of the
frequency and severity of the lesion, now parvovirus B19, the group of herpes
virus type 6 and Ebstein-Barr are more often
determined [2,3,5].
Currently, cardiotropic
viruses include enteroviruses, adenoviruses,
poliomyelitis viruses, herpes viruses types 1 and 6, and some types of
influenza virus [2,4].
The most common cause of myocarditis in children are Coxsackie enteroviruses
and ECHO [2,3,4].
Currently, when using the polymerase
chain reaction, an increase in the frequency of parvovirus (PVC19), herpesvirus (HHV6) and also up to 25% of cases determine
the combination of two or more different pathogens (PVB19 and HHV6) in myocarditis [1,2,5].
Purpose of the
study: To
study the course of community-acquired pneumonia in children with myocarditis.
Materials and
methods of research:
To solve the set goal and task, we
plan to conduct research in the departments of emergency pediatrics and the
pediatric intensive care unit of the Samarkand branch
of the Republican Scientific Center for Emergency Medical Care. A survey of 80
children aged 1 to 5 years with community-acquired pneumonia will be conducted.
Of them:
Group I - 40 patients with severe
community-acquired pneumonia on the background of myocarditis.
Group II - 40 patients with mild and moderate course of community-acquired pneumonia
on the background of myocarditis.
The control group will consist of 20
practically healthy children.
Patients from both groups will be
collected anamnestic data, examination by
conventional clinical, laboratory and instrumental, as well as special methods.
Research results
and discussion:
A survey of 80 children with
community-acquired pneumonia and community-acquired pneumonia with myocarditis showed that the clinical symptoms basically
correspond to the main manifestations of the disease, while the clinical
manifestations of the diseases are characterized not only by pathological
changes in the lungs, but also by frequent involvement of other vital organs in
the pathological process. and systems.
Table 1. The frequency of
occurrence of clinical manifestations at admission in patients with
community-acquired pneumonia and community-acquired pneumonia with myocarditis.
Clinicalsigns |
GroupI
(n=40) |
Group II(n=40) |
||
абс. |
% |
абс. |
% |
|
Generalstate |
||||
medium-heavy |
5 |
12,5 |
15 |
37,5 |
heavy |
33 |
82,5 |
24 |
60 |
extremelydifficult |
3 |
7,5 |
1 |
2,5 |
temperature 37,0-38,5oС |
14 |
35 |
13 |
32,5 |
temperature>38,5oС |
19 |
47,5 |
17 |
42,5 |
fatigue |
22 |
55 |
5 |
12,5 |
lossofappetite |
29 |
72,5 |
19 |
47,5 |
hepatomegaly |
10 |
25 |
3 |
7,5 |
Cyanosis of the skin and mucous membranes |
||||
absent |
4 |
10 |
9 |
22,5 |
perioralcyanosis |
32 |
80 |
28 |
70 |
acrocyanosis |
11 |
27,5 |
3 |
7,5 |
Degreeofrespiratoryfailure |
||||
respiratoryfailureIdegree |
2 |
5,0 |
8 |
20 |
respiratoryfailureIIdegree |
33 |
82,5 |
31 |
77,5 |
respiratoryfailureIIIdegree |
5 |
12,5 |
1 |
2,5 |
The condition of patients upon
admission to the hospital (Figure 1) was assessed from moderate to extremely
severe condition. Moderate forms of the disease accounted for a smaller
proportion (18.7%) and were observed mainly in patients with pneumonia without myocarditis, the severe course of the disease accounted for
the bulk of the children (77.3%). Extremely severe forms (4.0%) were observed
predominantly met with late admission to the hospital of patients with
community-acquired pneumonia with myocarditis.A
comparative analysis of clinical symptoms and syndrocomplexes
showed that an increase in body temperature was characteristic of 83.3% of
patients with CAP with M, and in most cases (48.3%) the temperature was more
than 38.5 ° C, with CAP the temperature reaction was a less characteristic
sign. - 76.6%, there were a number of cases (43.3%) when the temperature
reached values above 38.5oC. Complaints of fatigue (54.2%) and loss of appetite
(73.3%) were mainly presented by children with CAP with M, compared with
patients with community-acquired pneumonia (13.3% and 46.7%).
Cyanosis of the skin and mucous
membranes was observed much more often in patients with SLM, so if the
frequency of perioral cyanosis was almost the same in
the observed groups - 79.2% and 70.0%, then there was a frequency of acrocyanosis 4 times more often observed with SLM (26.7%
and 6.7%).
Conclusions: Thus, the analysis of the data
showed that pneumonia in children is manifested not only by respiratory, but
also by cardiovascular insufficiency, which are caused by pathogenetically
caused circulatory disorders, overload of the pulmonary circulation that occurs
when organs are damaged.
References:
- Askarovna S. O. et al. Evaluation of physical development and bone mineral density in children with chronic bronchitis //International scientific review. – 2017. – №. 4 (35). – С. 102-104.
- Berdikulovna K. M. et al. Indicators of inflammatory markers in patients with chronic obstructive bronchitis and assessment of the effectiveness of immunocorrective and antioxidant therapy //Annals of the Romanian Society for Cell Biology. – 2021. – С. 13380-13387.
- Lim M.V., Shavazi N.M. "The combined use of acetylcysteine and 3% of sodium chloride in the nebulizer therapy of acute bronchiolitis" European science review. № 11-12, 2016. rp. 63-66.
- Shavazi N.M. and Lim M. V. "The effectiveness of nebulizer inhalations of acetylcysteine in the therapy of acute bronchiolitis in infants". Problems of Biology and Medicine. № 2, 2016: 87.
- Shavazi N.M. et al. "The assessment of the degree of bronchoobstruction in acute bronchiolitis in infants". Materials of III conference of the Association of Doctors of Emegency Medical Care of Uzbekistan. Tashkent, 2015.
- Chandima P. Karunanayake, Donna C. Rennie,and others «Bronchitis and Its Associated Risk Factors in First Nations Children» Children (Basel). 2017 Dec; 4(12): 103.
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