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drugs. Along with the traditional as membrane-pathogenetic therapy administered alpha-tocopherol at a dose of 800 mg/day for 2 admission. Also, patients with comorbid pathology throughout the course of treatment prescribed gepatoprotektors. Doses of drugs consumed were determined taking into account biological factors: a daily dose of heroin, the duration of narcotization, the constitution and weight of the patient. To reduce the risk of complications and minimize the side effects of psychotropic drugs prescribed may lower doses in patients with comorbid pathology. At post abstinent disorders drugs ofchoice were antidepressants and neuroleptics. The study was conducted to compare the efficacy ofconventional therapy and optimize treatment with the antioxidant alpha-tocopherol. Excessive ROS during abstinence initiates the process of lipid peroxidation (LPO) in the blood of patients in both clinical groups, as evidenced by the increase in MDA level, depending on the duration of narcotization with respect to the norm. The most important role in the regulation of free-radical process belongs to the antioxidant enzyme catalase, which functions conjugate and inhibits lipid peroxidation in the step of activation of oxygen, the origin and the chain branching process.
A comparative study of two groups of drug users receiving different treatments — traditional and optimized in combination with alpha-tocopherol shows a more pronounced therapeutic effect bioreg-ularly antioxidant therapy. In the traditional method of treatment, the level ofMDA was significantly higher than before the treatment in the subgroup with the duration of narcotization over 1 year (2.94 ± 0.10**) and did not differ significantly from the index before treatment in the subgroup with the duration of narcotization to 1 year (1.24 ± 0.09**), indicating that the lack of effect of traditional therapy on the operating parameters. Moreover, in patients with liver damage, the operating system on the background of intensified conventional therapy.
When using the alpha-tocopherol in the composition optimized therapy lowering MDA levels observed in patients both subgroups, although its concentration is not reached control values. The catalase activity was restored to the control level in all patients and was not statistically different from the control group level. It is
also noteworthy that there were significant differences between the effectiveness of the optimized therapy with antioxidant relatively traditional in terms of MDA, SMP and catalase.
As in people, long-term opiate abusers and drug addicts with experience within a 1-year-optimized therapy including antioxi-dants have beneficial effects more pronounced in patients subgroup with duration of narcotization over 1 year. They noted a significant decrease from baseline in SMP (0.045 ± 0.012***) and MDA (1.33 ± 0.10***), which proves that the contribution of the liver in the system OS development with opiate addiction, as well as the fact that the recovery of the antioxidant capacity of the body leads to the relief of the OS (Note: * — Significant in relation to the traditional method of treatment, P < 0.05; ** — Significantly relative to controls (P < 0.05); *** — significantly relative to the treatment (P < 0.05)).
The study period of abstinence in patients receiving optimized treatment including an antioxidant, found that significantly reduced the duration ofwithdrawal symptoms, reduced craving for the drug, and the low intensity of the generation of ROS in the blood correlates with the effectiveness of therapy. Listing of alpha-tocopherol in the range of optimized therapy for opioid dependence contributes to sustainable and prolonged suppression of free radical oxidation in the blood, observed immediately after treatment.
Conclusion. Using optimized therapy helped achieve a significant reduction from baseline indicators of lipid peroxidation, which proves that the liver contribute to the development of the system operating in opium addiction, as well as the fact that the recovery of the antioxidant capacity of the body leads to the relief of the oxidative stress. The study period of abstinence in patients receiving optimized treatment including an antioxidant, found that significantly reduced the duration of withdrawal symptoms, reduced craving for the drug, and the low intensity of the generation of active forms of oxygen in the blood correlates with the effectiveness of therapy. Inclusion of alpha-tocopherol in the complex treatment of opioid addiction contributes to sustainable and prolonged suppression of free radical oxidation in the blood, observed immediately after treatment.
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Azizova Nigora Davlyatovna, senior staff scientist of Republican Specialized Scientific and Practical Medical Center of Pediatric, Republic of Uzbekistan
E-mail: [email protected]
A comprehensive assessment of the treatment effectiveness of bronchial asthma in children with metabolic syndrome
Abstract: It is installed the positive effect of metformin on clinical and metabolic parameters of insulin resistance syndrome. There was a positive trend in body weight, body mass index, total cholesterol, high density lipoprotein.
A comprehensive assessment of the treatment effectiveness of bronchial asthma in children with metabolic syndrome
Keywords: Bronchial asthma, metabolic syndrome, chilt
Actuality: In recent years, the attentions of scientists around the world are increasingly attracted to the problem of the combination of pathologies, which is one of the most difficult problems faced by doctors. Currently, the problem remains topical treatment of metabolic syndrome (MS) in children with asthma [1]. Among the younger generation over the past 10-15 years, in some extent was developed dietary and physical activity [2]. However, the above mentioned approach for the majority of children and adolescents are often ineffective. First of all, measures aimed at changing the image, the power of stereotypes and behavior require major modifications mentality of the patient, especially a child [3; 4]. The problem of drug correction of metabolic syndrome in children with bronchial asthma (BA) has been developed. It is well known that the progression of excess weight in childhood and adolescence in comorbidity is associated with significant metabolic disorders that may be a "trigger" link in MS development [4]. Given the available evidence about the role of insulin resistance in the mechanisms of formation and development of MS, the prospects for the pharmacotherapy it's a group of drugs that improve insulin sensitivity, which include drugs metformin group [5]. Metformin and its analogs (siofor) are widely used in the treatment of adult patients. Using in pediatric patients appeared only in the last 3-4 years. However, studies of metformin in children are isolated, not take into account the various forms of obesity, its stage, duration of the treatment and the side effects of[6].
Purpose of the study. To evaluate the effectiveness of complex treatment of bronchial asthma in children with metabolic syndrome.
Materials and methods. The criterion for selection of children and adolescents in the main group was the presence of BA with MS. Sampling was carried out in the comparison group by the criterion of normal body weight with BA.
Exclusion criteria were congenital endocrine pathology, secondary arterial hypertension (AH), long-term hormone therapy (more than 1 month) of the first type of diabetes, as well as the age of 3 years old. In our study to assess the efficacy of metformin in treatment of metabolic syndrome in children and adolescents with BA compared anthropometric, metabolic parameters and tools. The study involved 53 asthmatic children with MS, mean age — 10.44 ± 0.2 g. At the time of entry into the study the mean body mass index (BMI) was 26.79 ± 3.94, waist circumference/femur circumference — 09 ± 0.01. The comparison group consisted of 46 children aged 6 to 14 years (average 10.44 ± 0.2 g.) with normal weight. The first group of patients were on standard therapy (a combination of a reduced calorie diet with adequate exercise), the second — in addition to the basic treatment metformin. Basic therapy included: the use of antiinflammatory therapy, mucolytics, inhaled and systemic corticosteroids (Beklazon-eco 100 mcg.), specific immunotherapy, inhaled sympathomimetic (Salbutamol), oral methylxanthines (Theophilus 100 mg., aminophylline 0.2 %), humidified oxygen, antihistamines, breathing exercises, massage of the chest.
As a result of the treatment in the first and second group of 3-6 months was registered an increase mean values growth, but without significant differences (p > 0.05). No statistically significant changes in mean values of the growth registered between subgroups with BA and MS on background of standard treatment and during treatment with metformin.
In the study of indicators FEV1 and MEF 25 % in the BA group and indicators MEF 25 % MEF 50 % MEF 75 % in the group with comorbidity significantly lower than the corresponding figures RF patients with MS.
i, treatment.
Patients in acute disease revealed moderately expressed disturbances of RF in obstructive type, manifested primarily in reducing FEV1, MEF 25 % MEF 50 % MEF 75 % and the index Tiffno. Against the background of the therapy improvements were recorded in all the examined, but in BA patients with obesity more often than in the group with normal body weight, there is no full normalization of RF, mostly VC and FEVC (P > 0.05).
Overweight leads to changes in the mechanical properties of lungs, limiting respiratory excursion and thus reducing the VC index. And inflammation of the airways in BA produce an airway obstruction, reflected in the decline in FEV1 speed performance. The differences between the groups suggest, in our view, a significant role in shaping the nature of MS clinical course of BA, BA combined with MS have a more pronounced negative effect on the RF rather than separately BA. Before initiation of therapy in 28 patients (70 %) were fasting hyperglycemia (40 children was determined by IR). For the diagnosis of IR patients was calculated HOMA-R, as measured by the index of fasting glucose/fasting insulin. IR was diagnosed in 30 children (75 %). Initially, an elevated level of fasting insulin was detected in 24 children (60 %), and 2 hours after the load — in 28 children (70 %). After 12 months of therapy with metformin was showed a significant decrease in fasting glucose to 6.2 ± 0.15 mmol/l to 5.4 ± 0.1 mmol/l (P < 0.001). Children in this group baselines fasting immunoreactive insulin (IRI), as postprandial were above normal (N < 12.5 mcIU/ml) and accounted for, on average, 18.7 ± 6.98 mcIU/ml, 35.1 ± 1.083 mcIU/ml respectively. Against the background of 12 month metformin therapy tended to reduce the concentration offasting IRI to an average of13.1 ± 9.12 mcIU/ml and postprandial levels, on average, up to 31.62 ± 7.13 mcIU/ml. HOMA-IR index, which characterizes the level of IR, was not significantly changed.
In the analysis in 48 children (80 %) treated with metformin recorded by reduction as FG and postprandial glucose, moreover 42 children (70 %) of all patients with initially diagnosed fasting hyperglycemia achieved the target values of fasting glucose. The decrease in fasting insulin was found in 30 patients (50 %), and 2 hours after the load - in 36 patients (60 %). Reduced HOMAR was 16.2 (27 %) patients.
Thus, 70 % of children with metformin therapy led to the restoration target fasting glucose level (fasting glucose in plasma < 6.1 mmol/l).
On the background of12 month therapy with metformin on 41 children (68%) patients with high level occurred reliable reduction of IL-1p, IL-4, IL-8 and TNF-a levels. In group II, 12 months later, the observed immunological status of children, characterized by a significant reduction in levels of IL-1p — 200 ± 25 and 120.4 ± 23 respectively in relation to an indicator of group I, that is, almost close to the reference value. There was a significant positive dynamics on the part of IL-4, IL-6, IL-8 and TNF-a performance compared to children in group I (P of < 0.01 to < 0.001), but remained above the reference value.
One of the most important violations of risk factors for MS is the typical violation of lipid metabolism. To this end, we evaluated the following parameters of lipid transport system: the average concentration of total cholesterol (TC), triglycerides (TG), HDL cholesterol and LDL cholesterol; studied the dynamics of the above mentioned parameters and frequency variations, depending on the time and method of treatment.
The data showed a significant decrease in HDL levels in the group of BA children with MS. Increasing levels total cholesterol
was observed in 15 infants (75%) LDL - 17 (80%) and TG - in 13 children (60%) of the group. Reduction of HDL was found in 6 children (40%).
After 12 months of therapy with metformin was found a significant reduction in total cholesterol to 6.1 ± 0.28 mmol/l to 5.3 ± 0.22 mmol/l (P < 0.001), 6 months later these figures with 5.3 ± 0.22 mmol/l decreased to 4.2 ± 0.22 mmol/l. LDL before treatment averaged 2.8 ± 0.8 mmol/l, and after 3 months was 2.6 ± 0.2 mmol/l, and after 6 months 2.4 ± 0.2 mmol/l (P < 0.001). TG levels were also significantly decreased from 1.2 ± 0.7 mmol/l, after 6 months there was a significant decline in 1.1 ± 0.5 mmol/l.
Against the background of the treatment in 16 children (80%) decreased triglyceride levels, and 3 children (20%) managed to reach the target level.
The results of our work had a predominant influence on therapy with metformin, a standard treatment in the clinical and metabolic parameters in children with asthma. This effect is related to indicators, carbohydrate and fat metabolism, and had a statistically significant effect in children with MS.
Conclusions
1. Recommended treatment regimens that include reducing insulin resistance - metformin, the correction of body weight, recovery of carbohydrate and lipid metabolism, and normalization of all components of MS, advanced mode of physical activity, subcalorie diet bronchial asthma in school-age children have a positive effective lead in achieving long-term remission and improving prognosis of disease.
References:
1. Вавилова Н. Н. Способ восстановительного лечения больных бронхиальной астмой с избыточной массой тела//Бюллетень, Выпуск 35. - 2010. - С. 21-25.
2. Александров О. В., Алёхина Р. М., Григорьев С. П. Метаболический синдром//Российский медицинский журнал. - М., 2006. -№ 6. - С. 50-55.
3. Астафьева Н. Г., Гамова И. В., Удовиченко Е. Н., Перфилова И. А. Ожирение и бронхиальная астма//Лечащий врач. - 2014. -C. 63-68.
4. Балыкова Л. А., Солдатов О. М., Самошкина Е. С. Метаболический синдром у детей и подростков//Педиатрия. - М., 2010. -№ 3. - С. 127-134.
5. Ровда Ю. И., Миняйлова H. H., Сундукова Е. Л. Вопросы лечения и профилактики метаболического синдрома у детей и под-ростков/^Педиатрия. - 2010. - Том. 89, № 5. - С. 150-155.
6. Pervanidou P., Aralestos A., Bastaki D. Increased circulating concentrations in children and adolescents obesity and the metabolic syndrome: a marker for early cardiac damage//Metabolism. - 2013. - Том. 62. - Р. 527-531.
Azizov Miralim Mirabidovich, post-graduate researcher of neurosurgery of a Republican Research Center of Emergency Medicine, Tashkent, Republic of Uzbekistan. E-mail: [email protected]
Results of surgical treatment of patient with pituitary tumor apoplexy
Abstract:
Objective: Apoplexy in pituitary tumor, resulting from the acute hemorrhage or infarction mainly in pituitary adenomas, is a rare yet major clinical event with neurological, ophthalmological and hormonal urgent consequences. The authors describe their surgical experience with a series of 89 cases of pituitary apoplexy.
Methods: The 205 patients with pituitary tumor operated via transsphenoidal approach in our hospital between 20052015 and 89 cases with pituitary apoplexy were retrospectively analyzed. The indications for urgent transsphenoidal surgery were as follows: mental deterioration, rapid visual loss and pituitary insufficiency.
Results: The mean age of patients (39 male and 50 female) was 38 years. Pituitary apoplexy occurred as an initial manifestation of pituitary adenoma in all patients. Headache was the most common presenting symptom (88.7 %). Visual disturbance was found in 49.4 % of patients. 39.3 % of the patients had hypopituitarism. On magnetic resonance imaging (MRI), this catastrophic event accompanied with macroadenoma in a mean size of 26.5 mm. There was no specific complication in any of these patients.
Conclusion: The differential approach based on the account of features of a clinical case, possible increase already available pathologic infringements and high level of technics of operative intervention is a basis for favorable results of treatment at pituitary adenomas.
Keywords: pituitary adenoma, pituitary tumor apoplexy, transsphenoidal approach, hypothalamic syndrome.
Introduction meningism, and/or decreased level of consciousness, often with in-
Pituitary tumor apoplexy (PA) refers to the abrupt onset of volvement of optic nerves, chiasm and CN III, IV VI. The PA is po-a severe headache frequently accompanied with nausea, vertigo, tentially a life threatening pathology when the hemorrhage and/or
