Allergic rhinitis is a disease that is based on IgE-mediated inflammation of the nasal mucosa (caused by allergens), characterized by at least two of the following symptoms daily: nasal congestion, nasal discharge (rhinorrhea), sneezing, itching in the nasal cavity. Allergic rhinitis is often combined with other allergic diseases, such as bronchial asthma, allergic conjunctivitis, atopic dermatitis, and certainly is a global medical and social problem. Although allergic rhinitis is a serious, lifethreatening disease, nevertheless, its medical and social significance is due to its high prevalence among children, adolescents and adults, especially in combination with acute and chronic sinusitis, otitis media and bronchial asthma
Topicality and demand of the subject of dissertation. Bronchial asthma (BA) is one of the most common and serious diseases, which in the world suffer from 3 to 12% of the child population of the globe. Proportion of adolescents with asthma, is one third of all children with this disease. High prevalence of asthma in the numbers of teenagers, characteristics of the disease, age-related aspects of the functioning of the endocrine and immune systems of teenagers that cause difficulties which arise in the course of the diagnostic process, highlight the need to find innovative approaches to diagnosis and treatment of this disease.
It is known that the key immune mechanisms in the pathogenesis of the vast majority of AD cases is real and indisputable fact. Currently, considerable interest to researchers involved in the pathogenesis of positions of allergic diseases, especially asthma, along with IL-4 and IL-13 causes a number of other (IL-6, IL-8, IL-10, IL-5, INF-a and INF-y) immunoregulatory cytokines.
Genetic predisposition plays an important role in the development of allergic diseases. Currently available data on the relationship with asthma and associated with disease symptoms polymorphism approximately 150 genes. Important role as the main contender for the predisposition to asthma gene is a gene encoding flchain of high affinity receptor IgE. Interaction elevated levels of antigen-specific IgE with FceRip plays a central role in the pathogenesis of allergic asthma. Particularly attractive candidate gene asthma is also one of the enzyme genes biotransformation - GSTirl, encoding glutathione S-transferase and л1 express almost exclusively in the pulmonary tissue. This gene is located at the locus 11 ql 3, for which repeatedly shown clutch with atopic symptoms. Accumulated in the literature say about the relationship of gene polymorphism FceRI, GSTnl with different allergic diseases.
From this perspective, the study of immunological and genetic mechanisms of the pathogenesis of this disease for the construction of rational treatment and prevention emphasizes the relevance of this thesis research.
From the earliest days of independence, the country has successfully implemented state programs aimed at reforming the health care system. As a result, the targeted implementation of organizational health and research activities aimed at effective diagnosis, prevention and treatment of asthma among adolescents, with some success in the treatment of this disease in the country. However, now the problem of early diagnosis and the development of effective programs for treatment and prevention among adolescents with asthma remain one of the most important issues of modern health care. This research work was carried out in the framework of the tasks set by the Resolution of the Cabinet of Ministers of the Republic of Uzbekistan "On additional measures to improve the health of women and the younger generation," dated 25.01.2002 for the №32. In this regard, the need to deepen the information received about the state of cellular and humoral immunity among adolescents, asking pathogenetic informative immunogcnctic studies in asthma arc one of the important criteria demand the dissertation topic.
Purpose of research is study the immunological and genetic mechanisms of the pathogenesis of asthma in adolescents and form the basis of this plan rational diagnostic and therapeutic measures in this pathology.
In To achieve this goal the following tasks of research is solved:
to establish the clinical course of asthma in the population of adolescents living in the Samarkand region, in the early stages of the pathological process in the bronchopulmonary system.
explore the features of the state of cellular and humoral immunity, as well as activation markers in asthma in adolescence by determining the immunophenotype of lymphocytes in the peripheral blood.
to examine the level of production of immunorcgulatory cytokine interleukin-6 and interfcron-y and install them pathogenetic informative in asthma among adolescents.
to determine the features of distribution of allele and genotype frequencies of polymorphic variants of genes and FceRip GSTnl population Uzbek people with asthma, compared with the healthy part of the population.
examine the clinical and immunological aspects effectiveness of therapies using drugs and polioksidony tsikloferon in patients with asthma in adolescence.
on the basis of studies to develop a multivariate model of formation of bronchial asthma and develop an optimal algorithm for the diagnosis, treatment, prevention in adolescents with this pathological condition.
Scientific novelty of dissertational research consists in the following:
proposed introduction to the work of doctors teen clinics layered approach testing can significantly improve the detection rate of asthma in adolescence and optimize treatment and preventive measures in high-risk groups;
first defined the peculiar characteristics of the quantitative parameters of the immune status of patients with asthma in the cohort of adolescence and the corresponding proposed regulations and guidance documents for the healthy part of the adolescent population;
for the first time presents a comprehensive assessment of the cytokine profile of blood serum in bronchial asthma in adolescents. Specific features of products immunorcgulatory cytokines IL-6 and INF-y and their pathogenetic and regulatory information content in asthma among adolescents;
first analyzed the distribution of alleles and genotypes of polymorphic gene variants and gene FceRip GSTirl among patients with different phenotypic variants of AD and healthy individuals of Uzbek nationality, which resulted in the identified markers of increased risk or, conversely, resistance to the development of asthma in adolescents Uzbek ethnicity;
algorithms for phase diagnosis, treatment and prevention of asthma in adolescence in terms of disclosure of important moments of the pathogenesis of the disease, allowing to build a rational sequence of diagnostic search, aimed at verifying the diagnosis and expedient construction of preventive measures.
Conclusion
1. Set the frequency of occurrence of the disease and the structure of "asthma" in the arid zone among teens. Said pathology is recorded in 9,6% of the population surveyed adolescents, while the disease is more common among females. In the structure of the disease prevails periodical exposure and mild persistent form.
2. Identified by clinical features of asthma among adolescents living in the arid zone, indicate a high frequency of lesions of the bronchial tree association with allergic processes in other organs and tissues: in 73,9% of the AR, 53,7% with AK. 16,6% with BA and 14% with urticaria/angiocdcma.
3. Found that in the study population of patients with asthma adolescence occur expressed disturbances of the immune status, manifested deficit indicators as cell (CD3‘, CD4+, CD8 , CD16+), and humoral immunity (CD19 , IgA, IgG, IgM) and activation markers (CD23+, CD95). The immune status of patients with asthma in young people, adolescence has distinctive features, the depth of detected violations immunoreactivity was most pronounced in the younger age group.
4. In patients with bronchial asthma in adolescence revealed distinct changes in cell-cell interactions in the immune system: a significant increase in the content of Th2-cclls secreted IL-6 is a regulator of maturation of antibodies and immunoglobulin production itself, and vice versa reducing regulator activity of Th 1-cell cytokine INF-y.
5. It was found that the contents of cytokines IL-6, INF-y and in the peripheral blood is in communication with one pathogenic disease. It is shown that the lowest level of INF-y production in the scrum is characteristic of allergic clinical pathogenic variant asthma in adolescence. Adolescents suffering from predominantly infectious form of asthma, there is a sharp trend towards increased production of IL-6 in peripheral blood.
6. Revealed that markers of increased risk of allergic forms of asthma in adolescents Uzbek ethnicity arc genotype FceRip-109T/T allele FceRip-109T, low-risk markers - FcsRip-109C/C and allele Fc£Rip-109C. A high degree of cohesion genotype FcsRip-109T/T allele and FcsRip-109T with hereditary burden of asthma in the Uzbek population.
7. Among females ethnic Uzbek Association revealed lie-105 allele and genotype Ilc-105/Ilc-105 polymorphic gene locus GSTkI at high risk for asthma. Revealed that the genotype associated with the development Ilc-105/Ilc-105 allergic form of asthma in adolescents Uzbek population.
8. Complex therapy with adolescents’ patients with asthma ciklofcron and polyoxidonium, providing immunocorrective effect, enhances the clinical efficacy of basic therapy. In the study of prophylactic efficacy of immunomodulators positive indicators prevailed in the group of patients receiving polioksidony, necessitating its inclusion in the priority scheme of integrated treatment and prevention of asthma in adolescents.
Purpose: to study the efficacy and tolerability of the domestic drug cromoviz in the treatment of allergic conjunctivitis.
The state of the organ of vision in 60 patients (120 eyes) with allergic conjunctivitis was studied. Depending on the therapy, the patients were divided into two groups of homogeneous clinical manifestations. At the same time, the patients of the main group (30 patients) were instilled with the drug Cromoviz (Uzbekistan), 2 drops 4 times a day for 4 weeks. Patients of the control group (30 patients) were instilled with Aycrol according to the same scheme.
The obtained research results showed that the use of the domestic drug cromoviz against the background of basic treatment is expressed in a decrease in subjective complaints of patients and a significant clinical effect in 95.9% of cases. The revealed economic efficiency of the drug action indicates the achievement of the maximum level of therapeutic result at an acceptable price for the patient and therapeutic-prophylactic institution. Cases of side effects and intolerance to the domestic drug cromoviz were not identified in our studies.
Adenoviral conjunctivitis is an inflammatory disease of the conjunctiva that spreads at the epidemic level, the main reason for which is explained by the fact that it is rapidly spread by airborne and domestic routes and has a high degree of contagiousness. In clinical practice, viral eye pathologies develop the background of upper and lower respiratory (especially rhinitis, sinusitis, tonsillitis, bronchitis) and antibiotics are often used to treat bacterial complications in this category of patients. As a result, the balance of the immunomicrobiological environment in the intestines of some patients is disturbed [1,2,7] In this contingent of patients, eye pathologies of viral etiology persist for a long time. In modern practice, an integrated approach is used to increase the effectiveness of the prevention and treatment of adenoviral conjunctivitis. In addition, complex treatment of adenoviral conjunctivitis is required that the adequate use of antiviral and immunomodulatory drugs, as well as the inclusion new group of drugs in the treatment algorithm for increasing effectiveness and eliminate symptoms of this disease [3,5]. Probiotics stimulate the body's specific (antibody and immune system) and non-specific (skin, mucous membranes and tears) immunity by restoring the normal intestinal microflora balance, resulting in activation of cellular and humoral immune processes. The use of modern probiotics during treatment period decreased the production of cytokines in the patient's body in the same time increased of endogenous interferon’s concentration in the blood [1,3,4,6]. Even during an epidemic of adinoviral conjunctivitis, the inclusion of multi-component probiotics such as Bifolak Zincum + C + D3 in the complex treatment plan is effective and safe.
Respiratory allergosis includes diseases in the pathogenesis of which allergies play a decisive role, and in the clinical picture, symptoms of respiratory damage come to the fore. Allergic lesions of the respiratory system are quite common in children, especially early and preschool age. It is believed that allergic diseases of the nose, pharynx and ear account for 50-60% of all cases of diseases of these organs in children [1, 5, 7]. In recent years, the doctrine of the reactivity of the organism has been successfully developed [2, 4]. Allergic reactivity is understood as the development of a specific hypersensitivity of the body to the effects of genetically alien substances - allergens. Determination of the allergic reactivity of the organism of patients is of great practical importance [3, 6]. In this regard, there is a need for detailed studies related to clarifying the features of the allergic reactivity of the body in various diseases.
As a result, the study found that allergic diseases in children with hereditary burden, and the clinical manifestations of allergies in children do not always coincide with the allergic disease in the mother. Children born to mothers with bronchial asthma and pollinosis have hypersensitization, polysensitization, meteorological stability, and a frequent combination of the underlying disease with other allergic reactions.
The study involved 76 patients with children (46 boys and 30 girls) aged from 9 to 15 years, 34 of them - with allergic conjunctivitis and rhinosinusitis, 24 - with chronic recurrent obstructive bronchitis (preasthma), 18 - with asthma. Duration of illness ranged from a few months to 5 years examination. To clarify the rheological properties of blood there were determined electrical breakdown of the membrane, the electrophoretic mobility, the zeta potential of the membrane of erythrocytes and blood viscosity. The extent and intensity of the rheological properties of blood disorders in association with other clinical and laboratory data has prognostic significance in the development of respiratory allergies in children.
Allergy occupies a special place in medicine, and therefore, our work reflects aspects of the prevention of allergic diseases in children born to mothers with allergic diseases based on literary analysis.
To investigate predisposing factors in children with allergic rhinitis
The article includes data from a literature review on aspects of the study of the clinical manifestations of allergic diseases in children born to mothers suffering from allergic pathology, which are important for physicians, especially pediatricians, and the study of this problem remains an open question.
The article presents an analysis of the examination of children with allergic rhinitis at the age of 7-14 years. Based on the data of rhinoscopy and indicators of nasal function, it was found that the violation of the main functions of the nasal mucosa (respiratory, protective, pH of nasal secretions) is more pronounced in children with combined forms of AR than in CAR and SAR. When studying the cytological picture of nasal secretions, it was found that the allergic and inflammatory process in the nasal cavity and paranasal sinuses is accompanied by increased destruction of ciliated epithelial cells. In parallel with the growth of epithelial cell destruction, the number of granulocytes in smearsprints increases, which is evidence of infiltration of the nasal mucosa by neutrophilic leukocytes. The degree of neutrophil destruction increases with CAR and with combined forms of AR.
In the complex treatment of inflammatory eye diseases, anti-inflammatory therapy takes the leading place. The use of glucocortico steroids, which have powerful anti-inflammatory and antiallergic effects, carries the risk of serious side effects. Therefore, it was quite logical to develop and introduce into ophthalmological practice non-steroidal anti-inflammatory drugs, which are only slightly inferior to them in their anti-inflammatory activity. On the basis of a cytological analysis of the state of the conjunctiva, to assess the effectiveness of a new domestic ophthalmic drug "0.5% benzketozone ointment" in the treatment of conjunctivitis and blepharitis of infectious etiology. Materials and methods. To assess the effectiveness of 0.5% benzketozone ophthalmic ointment (Registration certificate No. 06-07.), A study was carried out on 134 (218 eyes) patients. In the control group, patients received traditional treatment, in the main group, 0.5% benzketozone ointment was additionally prescribed to the traditional treatment. Cytological examination was carried out by the method of modified impression cytology. Results. The data of modified impression cytology showed that the inclusion of benzketozone ointment in the traditional treatment significantly reduces the phenomena of exudation and proliferation, which at the subcellular level is manifested by a decrease in the number of basophils and eosinophils, restoration of the structure of epithelial cells and normalization of the nuclear-cytoplasmic ratio at an earlier time than in control groups, a faster decrease in the preparations of protein and tissue detritus. Conclusion. The inclusion of benzketozone eye ointment in the complex of traditional therapy increases regenerative activity, improves metabolic processes and alleviates the symptoms of inflammatory eye lesions
The problem of treating inflammatory diseases of the anterior segment of the eye, in particular chronic allergic conjunctivitis, blepharoconjunctivitis , continues to be relevant. In addition to the pronounced subjective discomfort, cosmetic defect, these diseases pose a danger to the cornea. Our study was aimed at studying the effectiveness of Floxal antibacterial ophthalmic ointment - in the treatment of acute and chronic diseases of the eyelids and conjunctiva.