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GENERAL CHARACTERISTICS OF PATIENTS WITH COMMUNITY- ACQUIRED
PNEUMONIA IN CHILDREN WITH MYOCARDITIS
Abdukarimova Mokhinur Abdalim kizi
student of 424
th
group of pediatric faculty Samarkand State Medical
University Samarkand Uzbekistan
Gaibullayev Javlon Shavkatovich
Scientific supervisor,
1- Assistant of the Department of Pediatrics and Neonatology
Samarkand State Medical University, Samarkand, Uzbekistan
https://doi.org/10.5281/zenodo.10694622
Abstract.
In the article, the anamnestic, clinical, traditional laboratory and special
examination methods of 80 out-of-hospital pneumonia children aged 1 to 6 years, emergency
pediatrics and child resuscitation II of the Samarkand branch of the Republican Emergency
Medical Research Center in 2020-2023 The results of 40 patients with myocarditis admitted to the
hospital are presented.
Key words:
pneumonia outside the hospital, children, myocarditis, ECG.
GENERAL CHARACTERISTICS OF PATIENTS WITH COMMUNITY- ACQUIRED
PNEUMONIA IN CHILDREN WITH MYOCARDITIS
Abstract.
In the article, the anamnestic, clinical, traditional laboratory and special
examination methods of 80 out-of-hospital pneumonia children aged 1 to 6 years, emergency
pediatrics and child resuscitation II of the Samarkand branch of the Republican Emergency
Medical Research Center in 2020- 2023 The results of 40 patients with myocarditis admitted to
the hospital are presented.
Key words:
pneumonia outside the hospital, children, myocarditis, ECG.
ОБЩАЯ ХАРАКТЕРИСТИКА БОЛЬНЫХ ВНЕБОЛЬНИЧНОЙ ПНЕВМОНИЕЙ У
ДЕТЕЙ С МИОКАРДИТОМ
Аннотация.
В статье рассмотрены анамнестические, клинические, традиционные
лабораторные и специальные методы обследования 80 детей с внебольничными
пневмониями в возрасте от 1 до 6 лет, экстренной педиатрии и детской реанимации II
Самаркандского филиала Республиканского научного центра скорой медицинской помощи
в г. 2020-2023 гг. Представлены результаты лечения 40 больных миокардитом,
поступивших в стационар.
Ключевые слова:
внебольничная пневмония, дети, миокардит, ЭКГ.
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Enter.
For several decades, severe bronchopulmonary diseases remain one of the urgent
problems of modern medicine, because despite the use of new principles and methods of treatment,
the number of patients increases and the death rate is constantly high [3 ,4]. The possible reason
for this is delayed diagnosis and, as a result, late initiation of treatment, as well as the inability to
adequately assess the effectiveness of therapy. Diagnosis of bronchopulmonary diseases in
children is often difficult, especially if symptoms of respiratory failure have developed against the
background of ARVI. The problem of acute myocarditis is related to its prevalence, especially in
childhood.
Myocarditis is an infectious, toxic-infectious, infectious-allergic, autoimmune and toxic
etiological inflammatory injury of the heart muscle. This disease mainly occurs in children and
young people, but the disease can develop at any age. Any viral or bacterial agent, as well as non-
infectious factors, can be the cause of myocarditis. The most common cause of the disease is
viruses. In 6-8% of cases, myocarditis develops during or shortly after various sporadic or
epidemic viral infections [1].
The purpose of the study. Determining the general characteristics of patients in the course
of pneumonia in children against the background of myocarditis.
Research materials and methods. The patients in the 1st stage of the study were divided
into 3 groups: 40 children without myocarditis, with community-acquired pneumonia, were
included in group I. 40 patients with mild to moderate severity of community-acquired pneumonia
against the background of myocarditis were included in group II. All patients traditional clinical,
laboratory and instrumental examinations, as well as special research methods were carried out. In
stage 2 (patients were taken from stage 1 of the study), patients were divided into 2 subgroups:
subgroup Ia (20) received traditional therapy. Subgroup Ib (20) received differential corrective
treatment in addition to traditional therapy. Control group consisted of 20 almost healthy children.
Exclusion criteria from the study were patients with chronic (hereditary) diseases of the
pulmonary bronchial system and congenital heart defects that naturally occur with changes in the
cardiovascular system.
Checking the diagnosis of pneumonia was carried out in accordance with the classification
of the main clinical forms of pulmonary-bronchial diseases in children approved at the meeting of
the XVIII National Congress on Respiratory Diseases [5].
We used the classification of myocarditis in children of the working group of the Russian
Association of Pediatric Cardiologists (2016) [2].
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Most patients are hospitalized 1 to 4 days after the onset of illness; after admission, all
patients were prescribed the same basic etiotropic, pathogenetic and symptomatic therapy for
pneumonia and myocarditis according to generally accepted treatment schemes [3].
Research results.
The discharge of sick children from the hospital was carried out in
accordance with the specifics of the work of the emergency medical service, which cannot be
delayed according to the standards of diagnosis and treatment, in which the recommended period
of inpatient treatment was 9 days for pneumonia outside the hospital. During the retrospective
analysis, observation and treatment of patients continued until the main symptoms of the disease
were resolved.
After recovery or improvement of the underlying disease, the children continued to be
followed up for 1 month to 3 years, which was terminated when all studied parameters normalized
or changes were noted that did not require continued therapy. In all children included in the study
the etiological diagnosis of the main disease was fully investigated by clinical analysis of blood
and urine. Analysis of patients by gender showed that boys (58.7%) were more affected than girls
(41.3%). Myocarditis and myocarditis were mostly diagnosed in boys, most often myocarditis
occurred against the background of myocarditis in children aged 1-3 years (68.3%), on the
contrary, most cases of myocarditis were observed in children under 1 year (87.0%).
Among the examined patients, the largest share was 3-4-year-old children - 81 (54.0%), 1-
2 years old - 47 (31.2%), and 5-year-old children - 22 (14.7%) less, which indicators can be
compared with literature data on the incidence of pneumonia.
A study of 80 children with pneumonia and myocarditis outside the hospital showed that
the clinical signs correspond to the main manifestations of the disease, and the clinical
manifestation of the disease is characterized not only by pathological changes in the lungs, but
also by other vital organs. It is also manifested by its frequent involvement in the pathological
process.
Table 2.1
Frequency of clinical signs in patients with pneumonia and myocarditis outside the
hospital
Clinical signs
Group I (n=40)
Group II (n=40)
abs
%
abs
%
General condition
Medium heavy
5
12,5
15
37,5
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Heavy
33
82,5
24
60
Very heavy
3
7,5
1
2,5
temperature 37.0-38.5oC
14
35
13
32,5
temperature >38.5oC
19
47,5
17
42,5
Fatigue quickly
22
55
5
12,5
Lack of appetite
29
72,5
19
47,5
hepatomegaly
10
25
3
7,5
Cyanosis of the skin and mucous membranes
Not available
4
10
9
22,5
Oral cyanosis
32
80
28
70
Acrocyanosis
11
27,5
3
7,5
Degree of shortness of breath
NYe I degree.
2
5,0
8
20
NYe II level.
33
82,5
31
77,5
NYe III degree.
5
12,5
1
2,5
Physical signs of the lungs
Lung sound dulling
33
82,5
32
80
Shortness of breath
27
67,5
25
62,5
Wheezing without crepitation
16
40
17
42,5
Wet wheezes
23
57,5
20
50
Heart activity
Muffled tones
27
67,5
27
67,5
Dull tones
2
5
0
0
Tachycardia
28
70
11
27,5
Bradycardia
4
10
1
2,5
Arrhythmia
9
22,5
3
7,5
Expansion of heart borders
20
50
4
10
Systolic murmur
14
35
7
17,5
The condition of hospitalized patients was graded from moderate to severe. Moderate
forms of the disease are less common (18.7%) and mainly observed in patients with pneumonia
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without myocarditis, severe course of the disease is the majority of children (77.3%). Severe forms
(4.0%) were mainly caused by children with pneumonia and myocarditis, who were hospitalized
late.
A comparative analysis of clinical symptoms and syndrome complexes showed that an
increase in div temperature was characteristic of 83.3% of patients with myocarditis, and in most
cases (48.3%) the temperature was higher than 38.5 ° C, Temperature reaction as a less
characteristic sign in children who came with STP - 76.6%, there were a number of cases (43.3%)
with a temperature higher than 38.5 °C. Complaints of fatigue (54.2%) and loss of appetite (73.3%)
were observed mainly in children with myocarditis and in patients with pneumonia outside the
hospital (13.3% and 46.7%).
Cyanosis of the skin and mucous membranes was observed more often in patients with
ShTP, therefore, the frequency of perioral cyanosis was almost the same in the observed groups -
79.2% and 70.0%, while the frequency of acrocyanosis in myocarditis with ShTP (26.7% and
6.7%) was 4 times more.
Patients with STP are characterized by mild respiratory disorders in the div, in this regard,
acute respiratory failure of the first degree (20.0%), while in patients with STP with myocarditis,
acute respiratory failure of the II degree (82.5) manifested and observed more than III degree
(12.5%).
Differences in the data of percussion and auscultation during the examination of respiratory
organs were almost not noted in the compared groups of patients.
Pneumonia in children is manifested not only by breathing, but also by cardiovascular
insufficiency, the cause of which is a pathogenetically determined blood circulation disorder, an
overload of blood circulation in the lungs that occurs when organs are damaged.
The analysis of the frequency of development of clinical signs reflecting the state of the
cardiovascular system showed that in the clinical presentation of pneumonia outside the hospital
in children, during auscultation of the heart, muffled heart sounds are heard in 66.7% of cases,
tachycardia is heard in 26.7% of cases. , bradycardia in 3.3% of cases and expansion of cardiac
boundaries was detected in 10.0% of cases.
The data in the group of patients who came on the background of myocarditis with STP
showed that tachycardia increased 2.6 times, bradycardia 3 times, arrhythmia 3.5 times, heart
limits increased 5 times and systolic noise increased 2 times, heart tones were muffled. the
frequency of heart failure was almost the same - 68.3% and 66.7%.
In an ECG study of all 80 hospitalized patients, sinus tachycardia - 29 (19.3.7%), sinus
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bradyarrhythmia - 10 (6.7%), extrasystole - 14 (7.3%), complete No blockade is detected. A
decrease in the amplitude of the QRS complex was observed in 12 (8.0%) and 23 (15.3%) patients
with right bundle branch block.
When analyzing the frequency of the above ECG changes depending on the nosological
form of the disease (in patients with pneumonia outside the hospital and patients with myocarditis),
a significant difference was found for almost all the studied parameters
Debate.
Studies have shown that at present, the criteria for early detection of heart
pathology in patients with bronchopulmonary diseases have not been developed sufficiently. Since
the number of cardiac pathologies at autopsy significantly exceeds its lifetime detection, the
problem of early diagnosis of cardiovascular pathology and risk factors for its development in
patients with bronchopulmonary diseases remains an urgent problem of clinical medicine [6] .
Among the pulmonary and extrapulmonary complications of bronchopulmonary diseases,
damage to the cardiovascular system takes an important place [7,8]. According to many authors
[9,10], the dysfunction of the cardiovascular system is an almost constant companion of broncho-
pulmonary diseases and develops from the first hours, while circulatory disorders are often
associated with broncho-pulmonary diseases. determines the prognosis and outcome.
Summary.
Thus, in patients with myocarditis, the frequency of sinus tachycardia
decreased by 3.4 times, sinus arrhythmia by 2 times, blockade of the right bundle of Hiss by 2.8
times, and the amplitude of the QRS complex by 5.5 times, and extrasystole by 11 times, compared
to patients with STP. It decreased by 7%, then this condition was not observed in the group of
patients with STP, respectively.
Determining the importance of electrocardiographic indicators in patients with
myocarditis compared with pneumonia outside the hospital revealed a number of indicators with
different degrees of reliability.
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