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ANALYSIS OF BLOOD INFLAMMATORY MARKERS FOR DETECTION OF ACUTE APPENDICITIS IN CHILDREN
Ovechkin D.V., Zaitsev I.E, Agyiri B.N., student of 6th course
Sumy State University, chair of surgery with children surgery and course of oncology
This study was performed prospectively with 210 consecutive patients admitted for suspected AA between 2005 and 2010 at Sumy Region Children Clinical Hospital. 117 (56%) of them were boys. Included were all children between 4 and 16 years of age presenting with right lower abdominal pain highly suspicious for acute appendicitis.
39 (19%) patients whose abdominal pain could not be attributed to any specific cause were categorized as having nonsurgical abdominal pain (NSAP) - group 1. Altogether 171 (81%) patients underwent appendectomy during the study period. All removed appendices were examined histologically. According to the histopathological results, patients were classified into the following groups: absent or early appendicitis (mucosal ulceration, focal appendicitis) - group 2; phlegmonous or gangrenous appendicitis (diffuse infiltration of granulocytes or areas of necrosis extending through the wall) - group 3; and perforated appendicitis - group 4. Furthermore, children of the groups 1 and 2 were subsummized as non severe cases, and groups 3 and 4 were considered together as a category "severe appendicitis" requiring immediate surgery. The mean age of the children as well as gender distribution in the investigated groups differed not significantly.
White blood cell count (WBC), serum C-reactive protein (CRP), interleukin-6 (IL-6), and erythrocyte sedimentation reaction (ESR) were estimated ad the time of admission. The diagnostic performance was analyzed using receiver operating characteristic curves (ROC).
ESR showed a poor or satisfactory correlation to the type of appendiceal inflammation and were excluded from further statistical analysis. Significant differences between all investigated groups for CRP, IL-6, and WBC count were confirmed. Differences between singular groups were mostly significant. It should be noted that early appendicitis and NSAP cannot be distinguished significantly at all. However, differences between children with NSAP or early appendicitis and children with phlegmonous and perforative appendicitis (groups 3 and 4) were very impressive for all 3 parameters. Furthermore, a criterion for discrimination between phlegmonous and perforated appendicitis could be found not for leukocytes, but for IL-6 and mostly impressive for CRP.
To investigate diagnostic value of these parameters, ROC curves were calculated. Significantly best parameters are shown bold (p < 0.05 or smaller). In fact, using ROC curves non of the parameters was able to identify children with phlegmonous appendicitis (groups 3 vs. 1 and 3 vs. 2) on a statistically significant level. Measurement of IL-6 or CRP but not WBC had additional diagnostic value on the diagnosis of advanced or perforated appendicitis (groups 3 and 4). Between IL-6 and CRP, there are no significant differences in diagnostic use, but some insignificant trends as visible in ROC curves: CRP is superior when describing acuity of clinical appendicitis by better sensitivity, but IL-6 gives the best help in deciding for immediate surgery by its superior specifity.
It has been shown, that WBC count, serum CRP, and IL-6 are helpful tools to support the clinical diagnosis of phlegmonous and perforated appendicitis in childhood. However, early stages of appendicitis do not strongly correlate with elevated inflammatory markes. In this cases physical examination, ultrasound investigation and clinical suspicion remain necessary to establish the correct diagnosis preoperatively.
SURGICAL LAPAROSCOPIC METHOD OF POSTOPERATIVE VENTRAL HERNIA
Alex Magufwa, student of 5th course
Supervisor - Ph.D. Sergei Zhdanov
Sumy State University, Department of Surgery
Hernia is simply defined as the protrusion of an organ or the fascia of an organ through the wall of the cavity that normally contains it, or a sac formed by the lining of the abdominal cavity (peritoneum).
Ventral hernia occurs in the abdomen and is a fragment of intestines or other organs that push through the abdomen muscle wall. These most often are called incisional hernias because they usually develop along an area where an incision (cut) for surgery has occurred. Some people have ventral hernias that result right after a surgery on the abdomen has taken place and others may develop them years after a surgery.
Types of hernia: there can be classified according to their location within the body, such as:-abdominal hernias, pelvic hernias, and diaphragm related hernias i.e. Hiatus hernia.
Further classification of hernia is as follows: hiatus hernia, inguinal hernia, femoral hernia, umbilical hernia, incisional hernia, epigastric hernia, spigelian hernia, and sport hernia.
These are the most commonly known group of hernias. However, a hernia can develop as a result of a protrusion of any internal organ or tissue and not just through the abdominal wall. There are types of less well known hernias which include: - sciatic hernia, scrotal hernia, vaginal hernia (vaginocele), ovarian hernia, perineal hernia.
Causes of the hernia: heavy lifting is one of the most common causes of hernia, but there are factors as well which include:- excessive coughing, excessive vomiting, excessive exercise, e.g. power lifting, constipation/straining on the toilet, old age poorly healed scar tissue/wound following an injury, accident or surgery, also pregnancy, obesity and genetic
Management using polypropylene mesh: advantages of application of polypropylene mesh grafts in repairing: significant reduction in frequency of recurrence of hernia; reduction of postoperative mortality; can view the giant hernia as inoperable.
Complications arising from the use of polypropylene mesh grafts: early complications; - seroma; hematoma; suppuration; necrosis of dermal-fat graft;; and the separation of the grid; long-term complications: - The formation of skin-subcutaneous fistula; intestinal fistula; chronic infection; adhesive disease ; biomechanical functional complications:-foreign body sensation; chronic pain; restriction of the anterior abdominal wall.
In order to avoid the complications of retention (i.e. Seroma and hematoma) one should: minimally traumatizing tissue; mobilizing the subcutaneous layer; careful implementation of homeostasis;drainage with active aspiration.
Conclusions: applying alloplasty in the anterior abdominal wall with linear polypropylene allograft is a good but not perfect way to cure; the main reason is the occurrence of complications such as negative properties of polypropylene mesh as the ability to cause local inflammatory reaction, the formation of connective tissue and coarse wrinkling.
RENAL REGULATION OF MICROELEMENT STATUS OF THE NEWBORNS WITH INTRAUTERINE GROWTH RETARDATION
Okafor James, 5th-year student
Scientific supervisor - Associate Professor A.M. Loboda
Sumy State University, Department of Pediatrics with Medical Genetics
It is known that the most susceptible to diseases related to violation of mineral metabolism are pregnant women and children. Among the latter group of high risk of development of microelementosis are newborns with intrauterine growth retardation (IUGR).
Kidneys are one of the principal organs of system of support homeostasis of the human body. Kidney is one of the main ways of eliminating microelements from the human body. But the peculiarities of renal excretion of trace elements in infants with intrauterinegrowth retardation are unknown.
Research purpose – to explore features of renal regulation of microelement balance in infants with different variants of intrauterine growth retardation.
Under supervision there were 80 full-term newborns with IUGR (30 children with hypotrophic variant, 30 children with hypoplastic variant and 20 children with dysplastic variant of IUGR). Comparison group include 30 healthy full-term newborns.
To determine the content of trace elements in urine we used the method of atomsc absorption spectrophotometry.
Infants with intrauterine growth retardation were characterized by high loss with urine of iron and cobalt, which could lead to their deficiency and imbalances and require correction.
Low amount of chrome in urine of newborns with intrauterine growth retardation may be negative because of chrome overload.
Parameters of content of trace elements in urine and their daily excretion during the neonatal period in infants with different variants of intrauterine growth retardation and healthy full-term children can be used as normative.
OPTIMIZATION OF ZINC BALANCE AT NEWBORNS WITH INTRAUTERINE GROWTH RETARDATION
L. Turova; T. Yaschenko, 6th- year student
Scientific supervisor – M.D. Markevich
Sumy State University, Department of Pediatrics with Medical Genetics
Today the problem of intrauterine growth retardation is very important. Various factors, including level of microelements cause this pathology. Zinc is one of most important microelements of the human body which deficiency during pregnancy negatively affects fetus.
The zinc disbalance in a fetus organism comes owing to infringement of its absorption in a digestive system and as at its raised deducing with urine.
Infringement of level of zinc along with increase of metabolic processes and functional immaturity of organs and systems of newborns with intrauterine growth retardation (IUGR) demands search of correction of that problem.
In this research influence of medicine, called «Drops of Beresh plus» on newborns with IUGR which had a zinc disbalance has been studied.
Peripheral venous blood of children with IUGR taken in the morning on an empty stomach was used as the material for research. After centrifugation the content of Zn was investigated separately in serum and erythrocytes. The content of Zn was defined by the method of atomic absorbed spectrophotometry on C115M1 spectrophotometer produced by JSC "Selmi" (Ukraine) and equipped with a computer program for automatic identification of the content items in samples. The level of zinc was controlled at the beginning and the end of treatment.
The research was carried out according to the international bioethical standards as for the parents’ agreement for their child to be examined.
Analysis of the obtained results was performed by means of the program called “Statistics 6.0”. Methods of varied statistics suitable for medical biological research were used. An average (M) and arithmetic average error (m) were defined. Reliable index of R was estimated by means of Student’s criterion (t).
It should be noted that introduction of “Beresh Drops Plus” into the course of rehabilitation therapy for infants with IUGR contributed to the positive dynamics of weight increase during the first months of life. The results of questioning of mothers showed that due to the use of the drug positive changes in behavioral reactions and more rapid restoration of sucking reflex appeared. The majority of children were observed to have improved the general state; they demonstrated reduced syndrome of nervous and reflexive excitability, and sleep resetting. None of the complications and side effects was observed during the course of using “Beresh Drops Plus”.
We identified that loss of zinc in the urine depended on gestational age and maturity of the newborn - the lower the indices were, the higher was the level of zinc in the urine which was likely to be related with functional immaturity of the urinary system. The proposed method of correction positively influenced the excretion of zinc – its (р<0,01) decrease in particular. The defined features seem to be a manifestation of zinc saving effect under the influence of the medication mentioned above.
So, usage of "Beresh Drops Plus” contributed to the increase of zinc level in serum and erythrocytes (p<0,001), and its decrease in urine on the contrary (р<0,001). Therefore, we consider this method of correction to be of great importance as it provides an optimal absorption of zinc by newborns with IUGR.
CHANGES IN MICROBIOCENOSIS AT CHILDREN WITH SHIGELLOSIS
Daniel Puriti Iruchi, 2nd-year student
Scientific adviser - candidate of biological science V.V.Lipovskaya
Sumy State University, infectious diseases and epidemiology department
Disease Shigellosis is characterized by a high and unstable level of social and economic, ecological and epidemiological factors essentially influence, therefore: there is a question of epidemiological monitoring behind activators of Shigellosis, caused by Shigella flexneri 2a, their influences on microbial ecosystem a gastro enteric path and forecasting of disease Shigellosis for future and the remote prospect.
Change of qualitative and quantitative structure contents of the microflora of intestines under influence Shigella flexneri 2a and antibiotic therapy on 98 children Sumy in the age 2 months till 8 years is investigated. The contents of microflora in excrements was investigated according to methodical recommendations “Laboratory diagnostics of dysbacteriosis”.
Such statistically authentic changes autochthonous microflorae of intestines at children. Have been revealed: Bifidobacterium spp. at all surveyed children their amount changed within the limits of 105-107 CFU/g feces, that considerably below norm. 55,1 % of children the contents Bifidobacteria has made 106 CFU/g feces and only 22.4 % of patients their amount reached some 107 CFU/g feces. Decrease in the contents of Lactobacteria up to a parameter of 103-106 CFU/g feces is revealed also. 46.9 % of children the amount Lactobacteria has made 103 CFU/g feces and 34.7 % of children their contents reached some 105 CFU/g feces. The contents Bacteriodes at all patients has been lowered, did not exceed a parameter of 106 CFU/g feces. Significant changes have been revealed in qualitative and quantitative structure of contents Escherichia coli. At 72.2 % of patients dysbiotic changes were characterized by total high-grade decrease in fermentation attitude of E. coli. Its contents was less than 106 CFU/g feces. 28.6 % of patients are revealed lactose negative serotypes Escherichia and 41.9 % of patients – serotype E. coli with lowered fermentation activity. The quantity of lactose negative E. coli has made 107 CFU/g feces, and the contents E. coli with lowered fermentation activity made 105 CFU/g feces. Of all serotypes of E. coli 68% serotype showed lytic and hemolytic effect on donor specific bacteriophage MS2. It is found out, that Bifidobacteria and Lactobacteria deficiency was connected with 100 % hemolytic activity of E. coli. The contents of conditional-pathogenic bacteria has been raised and also bacteria formed associations.
Analyzing the received results, it is possible to approve powerful influences of Shigella flexneri 2a and antibiotic therapy on qualitative and the quantitative structural contents of children intestinal microflorae.
THE ANALYSIS OF THE FREQUENCY OF PARENTERAL INTERVENTIONS
IN PATIENTS WITH VIRAL HEPATITIS B AND C
Khilko A.S., Chemych O.M.
Scientific supervisor - doctor of medicine, professor M.D Chemych
Sumy State University, infectious diseases and epidemiology department
Chronic viral hepatitis (CVH) remains one of the most actual problems of the public health nowadays. The main reasons are: the considerable spread of CVH among the population of all age groups; the great percentage of the subclinic and non-jaundice forms, which are not diagnosed; the development of the irreversible changes in liver, which lead to the malignant neoplasms; mixed-hepatitis are often for last years and they have unfavorable influence on the clinical course and the prognosis of the disease. There are no reliable etiotropic drugs for the treatment and no universal methods of the specific prophylaxis of viral hepatitis. The high percentage of not in time diagnosed cases, high virus capability to mutations, unfavorable social conditions (drug-addiction, prostitution) and also the widespread usage of the invasive methods of diagnostics and treatment, the usage of blood preparations lead to the spread of the viral hepatitis among the population.
The aim of this study is to determine the number of cases of invasive interventions in patients with CVH with parenteral ways of transmission (B, C, mixed). To study the epidemiological features of chronic viral hepatitis B and C in Sumy region. We have analyzed the data of Sumy regional clinical infectious hospital named after Z.Y. Krasovytskiy in the period from 2005 to 2009.
The total chronic hepatitis (CH) – 650 cases (100 %), non-differentiated – 235 (36,2 %), parenteral viral – 415 (63,8 %). In the result of the study we have found out that patients with parenteral CVH had in anamnesis medical invasive interventions in 47 % of cases, and patients with non-differentiated CH – 10 %. Among the invasive interventions, the major attention was given to the operative interventions, endoscopic methods of diagnostics, blood transfusions, donating blood, teeth extraction, ISD of wounds, piercing and tattoo. There is no reliable information about the invasive interventions in the anamnesis of the patients with the parenteral CVH in 13,8 % of cases, in patients with non-differentiated CH – 34 %. (The absence of the reliable information may testify that patients didn’t have any parenteral and invasive interventions in the anamnesis, but it is also may testify that the anamnesis was not collected properly).
So, after the analysis of the obtained data, we may suggest that among the patients with chronic viral hepatitis men prevailed, 2/3 of patients had chronic viral hepatitis C. One of the most common ways of transmission of hepatitis B and C were iatrogenic (operations, transfusions of blood and its components, endoscopic methods of diagnostic, etc.). Only 1 patient out of 10 with chronic viral hepatitis C was vaccinated against VHB. The most of the examined patients did not know of close relatives infected with viral hepatitis.
EFFECTS OF NANOSILVER ON CLINICAL COURSE OF ACUTE INTESTINAL INFECTIONS, INTESTINAL MICROFLORA AND CYTOKINES
Lufunyo Edson Lihweuli, 5th year student
Scientific adviser – assist. K.S. Polov’yan
Sumy State University, infectious diseases and epidemiology department
The incidence of acute intestinal infections (AII), caused by conditionally pathogenic microorganisms has increased nowadays in Ukraine. As a result, widely used antibacterial drugs are forming resistance in microorganisms that needs to be reviewed etiotropic priority treatment at AII.
The purpose of research is to study clinical course, levels of cytokines and condition of intestinal microflora at AII caused by conditionally pathogenic microorganisms by using colloidal citrate of nanosilver.
40 patients hospitalized in Sumy regional infectious clinical hospital named after Z.Y. Krasovytskiy were examined, average age of (35,11±2,93) years. Men and women were under 20. Patients were hospitalized at (1,26±0,07) day of onset. Patients were divided into two groups of 20 persons each depending on the medical purpose. First group of patients received basic therapy – gastric and/or intestine lavage, diet, rehydration, enzymes and sorbents. The second – colloidal citrate of nanosilver 10 mg/l 100 ml three times a day for 5 days on the background of basic therapy. Intestinal microflora, cytokines IL-1β, IL 4, sIg A at hospitalization and on (5,94±0,18) day of disease were examined.
At the beginning of treatment group of patients were comparable for frequency of defecation (first group (8,13±1,74) and second (5,74±1,12) times a day, p>0,05), the body temperature rose (37,49±0,12) 0C and other clinical symptoms. After the therapy of 2nd group patients rather than 1st one abdominal pain disappeared, the (3,79±0,24) and (5,38±0,31) days respectively, p<0,001. Also, patients receiving colloidal citrate of nanosilver had earlier terms of normalization of defecation (1st and 2nd group (4,05±0,26) and (5,06±0,34) days respecticely, p<0,05), decreased patient length of stay in hospital ((5,53±0,18) and (6,44±0,3) days, p<0,01 respectively).
In the beginning of therapy all patients’ growth was established compared with the norm of sIg A (1st, 2nd and norm group (20,10±1,55), (19,62±1,57) respectively and (4,05±0,36) mg/l, p<0,001), IL-1β ((3,67±0,40), (3,22±0,26) respectively and (1,81±0,03) pg/l, p<0,001), IL 4 ((8,26±0,52), (8,24±0,53) respectively and (0,97±0,13) pg/l, p<0,001). In the early recovery period two groups IL-1β declined to normal (1,80±0,10) and (1,97±0,09) pg/l, p<0,001; IL 4 was less in dynamics (p<0,001), but higher then normal (1st group – (5,36±0,43), 2nd – (4,03±0,46), p<0,001). Lower concentrations of IL 4 in 2nd group in the early recovery period (p<0,05) points to reduce the risk of inflammatory response to normal flora and possible chronization of pathological process in the colon compared to the patients of 1st group. After discharge from hospital the level of sIg A of 1st and 2nd groups did not reach the norm ((19,62±1,57) and (14,38±1,16) respectively, p<0,001), but differed significantly between groups (p<0,05).
In the study of intestinal microflora on (5,94±0,18) day of disease decrease in the number of Bifidobacterium and Lactobacillus in both groups of patients were detected (in the 1st (3,50±1,02) and (4,13±0,94 ) in 2nd (4,89±0,88) respectively and (4,95±0,89) against normal (7,90±0,07) and (7,75±0,1) lg CFU/g p<0,001). In 2nd group, compared with 1st one the level of total E. coli was below ((7,47±0,06) and (7,66±0,07) lg CFU/g respectively, p<0,05), other members of the conditionally pathogenic microorganisms ((0,52±0,36) and (2,77±0,93) lg CFU/g respectively, p<0,05), indicating less severity of dysbacteriosis. The number of fungi Candida did not differ from normal in dynamics.
Thus, the use of colloidal citrate of nanosilver at AII leads to faster normalization of defecation, reduction of the pain syndrome duration and length of staying in the hospital; reduces the risk of inflammatory response to normal flora and progression of intestinal dysbacteriosis.