Pathogenetic justification for the use of immunotherapy for the treatment of recurrent co-infections of the upper respiratory tract in children with congenital cleft lip and palate

2020 ◽  
Vol 18 (4) ◽  
pp. 117-126
Author(s):  
I.V.Nesterova I.V.Nesterova ◽  
◽  
M.N.Mitropanova M.N.Mitropanova ◽  
G.A.Chudilova G.A.Chudilova ◽  
S.V.Kovaleva S.V.Kovaleva ◽  
...  
Keyword(s):  
Oral Cavity ◽  
Respiratory Tract ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Inflammatory Diseases ◽  
Clinical Manifestations ◽  
Microbiological Analysis ◽  
Upper Respiratory Tract ◽  
Congenital Cleft ◽  
Upper Respiratory

The synergism of the action of co-infecting microorganisms contributes to their overcoming the epithelial barrier, modification of the function of cells of the immune system (IS) and evading the immune response. In children with congenital cleft lip and palate (CCLP), despite elimination of the anatomical defect at an earlier age, the frequency of infectious and inflammatory diseases of the respiratory tract and oral cavity involving pathogen associations increases as they get older, at the same time defects in the functioning of IS are preserved. Objective. To develop immunotherapy program for children with CCLP, suffering from recurrent co-infections of the upper respiratory tract and oral cavity, based on the study of the dynamics of the microbial landscape transformation, IS dysfunction, clinical manifestations of infectious and inflammatory diseases of the upper respiratory tract and oral cavity in children with CCLP at different ages. Patients and methods. The study included 120 children from 1 to 12 years of age with CCLP at different stages of surgical treatment. The study was carried out: T and B lymphocytes, natural killer cells (FC500 "Beckman Coulter", USA), phagocytic and microbicidal functions of neutrophilic granulocytes (NG), serum IgA, IgM, IgG and sIgA levels in the oral fluid (ELISA), detection of microbial pathogens (microbiological analysis, ELISA) and viral (PCR). Results. Comprehensive examination of children with CCLP at different age periods, including characteristics of the clinical manifestations of infectious and inflammatory diseases, assessment of the microbial landscape of the oral cavity and upper respiratory tract with the identification of co-infection features, clarification of the variants of IS dysfunction, made it possible to reveal children with the most severe clinical manifestations of recurrent co-infections and to optimize treatment. Conclusion. The developed program of combined local interferon and systemic immunotherapy for immunocompromised children with CCLP contributes to the restoration of IS functions, anti-infective resistance and achievement of positive clinical effects in the form of regression of clinical signs of immunocompromise in patients with recurrent co-infections, which allows to obtain a protective effect and provide timely surgical care, to avoid complications in the postoperative period and at the stage of recovery, and by improving anti-infective immunity to enhance the quality of life of children with CCLP. Key words: children, congenital cleft lip and palate, co-infection, systemic immunity, microbiocenosis, immunotherapy

своеDifferentiated immunotherapy in the integration program for the rehabilitation of immunocompromised children with congenital cleft lip and palate

2020 ◽  
Vol 15 (6) ◽  
pp. 7-17
Author(s):  
I.V. Nesterova ◽  
◽  
M.N. Mitropanova ◽  
S.V. Kovaleva ◽  
G.A. Chudilova ◽  
...  
Keyword(s):  
Oral Cavity ◽  
Respiratory Tract ◽  
High Frequency ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Inflammatory Diseases ◽  
Clinical Status ◽  
Integration Program ◽  
Different Ages ◽  
Congenital Cleft

One of the development directions of osteoimmunology is the search for new therapeutic approaches in the pathology of bone tissue, in the pathogenesis of which the interaction between the immune and bone systems plays an essential role. In children with congenital cleft lip and palate (CCLP), the physiological deficiency of the immune system (IS) and its anatomical disorders lead to intense tension in the immature mechanism for maintaining immune homeostasis, which is accompanied by clinical features of immunodeficiency in the form of recurrent viral, bacterial and fungal infectious and inflammatory diseases of the respiratory tract, ENT organs and oral cavity. Objective. To develop an integration program for the rehabilitation of children with CCLP, which includes not only traditional complex rehabilitation, but also measures aimed at restoration of the normal functioning of IS with the use of new approaches to conduct differentiated immunotherapy for each age period. Patients and methods. The study included 210 children of different ages: 150 children with CCLP and 60 conditionally healthy children without CCLP. Immunophenotyping of lymphocytes was conducted by flow cytometry; testing of phagocytic activity of neutrophilic granulocytes (NG), spontaneous and induced production of reactive oxygen species in the NBT test, determination of the level of serum IgA, IgM, IgG and sIgA in oral fluid. Results. Common for all age groups of children with CCLP, NG dysfunctions of different severity were found: defects of phagocytosis, an increase of spontaneous activity of NADPH oxidase and dysfunction of adequate response in the form of partial or complete blockade of NADPH oxidase activity during additional antigenic bacterial load in the system in vitro. Taking into account revealed defects in the functioning of IS and peculiarities of the clinical status of immunocompromised children of different ages with CCLP who suffer from a high frequency of infectious and inflammatory diseases of the respiratory tract, ENT organs and oral cavity, we have developed programs of differentiated immunotropic therapy for children of different ages with CCLP. Considering revealed defects in the functioning of IS and peculiarities of the clinical status of immunocompromised children of different ages with CCLP who suffer from a high frequency of infectious and inflammatory diseases of the respiratory tract, we have developed and used an integration program of immunorehabilitation with a positive clinical and immunological effect. Conclusion. The developed integration program for the rehabilitation of immunocompromised children with CCLP with a high frequency of infectious and inflammatory diseases of the respiratory tract, ENT organs and oral cavity, organically including differentiated immunotherapy along with methods of surgical, orthodontic and social rehabilitation and speech therapy, optimizes the treatment of patients with this pathology. The principles of differentiated immunotherapy are based on the revealed clinical and immunological peculiarities of immunodeficiency, which have both common features and differences depending on age, infectious and inflammatory manifestations and the stage of surgical treatment of children with CCLP. Key words: congenital cleft lip and palate, immunocompromised children, immunotropic therapy, rehabilitation

scholarly journals DYSFUNCTIONS OF NEUTROPHILIC GRANULOCYTES IN CHILDREN WITH CONGENITAL CLEFT LIP AND PALATE

2019 ◽  
Vol 21 (5) ◽  
pp. 885-894
Author(s):  
M. N. Mitropanova ◽  
G. A. Chudilova ◽  
I. V. Nesterova ◽  
S. V. Kovaleva
Keyword(s):  
Respiratory Tract ◽  
Bacterial Infections ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Age Groups ◽  
Healthy Children ◽  
Upper Respiratory Tract ◽  
Control Groups ◽  
Congenital Cleft ◽  
The Impact

The problem of rehabilitation of children with congenital cleft lip and palate (CCLP) is a difficult task and doesn’t lose its relevance. Children with CCLP often suffer from repeated acute viral and bacterial infections of the respiratory tract and upper respiratory tract, which leads to a forced delay in surgical, orthodontic treatment, adequate speech therapy and complications after staged surgical operations. The development of inflammatory processes in children with CCLP is associated with anatomical and topographic features that facilitate the penetration of pathogenic microflora in oral and nose mucosa and, consequently, negative changes in the immune system (IS). The key cells of IS in maintaining homeostasis and ensuring oral health are neutrophil granulocytes (NG). NG dysfunctions in CCLP interfere with the elimination of pathogens and support their persistence. This can occur against the background of previously existing defects in the functioning of the NG system and is aggravated by the significant pathogenicity and massiveness of the impact of various infectious agents. Full diagnostics of NG dysfunctions is necessary for the further implementation of their timely immune correction and prevention of the development of pathological chronic inflammation in response to the pathogenic microflora long-term on the mucous membrane of the mouth and nose. For this purpose study was conducted of the functional activity and phenotypic characteristics of NG in children with CCLP at different stages of complex rehabilitation. Blood samples of 56 children with CCLP 1-3 years (n = 20, group 1), 4-6 years (n = 20, group 2), and 7-12 years (n = 20, group 3) at different stages of complex rehabilitation and 30 conditionally healthy children (control groups) of the corresponding age was studied. A violation of the microbiocenosis of the mucous membranes of the oral and nasal cavities was revealed, which may be a cause or a consequence of a decrease in antibacterial immunity, first of all NG dysfunctions. Common for all age groups children with CCLP NG dysfunction was found: the appearance of NG expressing CD14 receptors that are absent in children of all three control groups, which indicates the presence of viral and bacterial load; defects of phagocytosis associated with a decrease in the number of actively phagocytic NG, impaired NG capture functions; impaired NADPH oxidase release with partial or complete blockade of the response to additional antigenic load, even in the absence of acute clinical manifestations. Comparative analysis of the studied indicators of the expression level of the receptors CD64, CD16, CD32, CD14 NG in children with CCLP demonstrates different equipment, which determines the inconsistency of the phagocytic and microbicidal function of NG in different age periods. Thus, an increase in the expression of these membrane markers, especially CD64 and CD14, in older age groups is accompanied by more significant defects in phagocytic and killing functions of NG, which is associated not only with recurrent viral respiratory infections, but also with a high frequency of associated bacterial infections of the respiratory system and ENT – organs. Revealed NG dysfunctions in children with CCLP of various age groups indicate their inability to implement adequate anti-infective protection, which can lead to atypically occurring viral – bacterial infections and the occurrence of various, including purulent complications in the postoperative period, which requires the development of targeted immunotherapy, included in the program of comprehensive rehabilitation in children with CCLP and aimed at restoring impaired NG functions.

Cultural "latrogenic" Cleft Palate

PEDIATRICS ◽  
1986 ◽  
Vol 78 (3) ◽  
pp. 511-511
Author(s):  
AMIN Y. BARAKAT ◽  
USAMA ITANI ◽  
GEORGE M. ZAYTOUN
Keyword(s):  
Tract Infection ◽  
Respiratory Tract ◽  
Respiratory Distress ◽  
Cleft Palate ◽  
Respiratory Tract Infection ◽  
Upper Respiratory Tract ◽  
Difficulty Breathing ◽  
Congenital Cleft ◽  
Upper Respiratory ◽  
Feeding Difficulty

Pediatricians are familiar with congenital cleft palates and those occurring as a part of a multisystem abnormality. We have encountered a child with a cultural "iatrogenic" cleft palate. The patient is a 5-year-old girl who appeared normal until 4 months of age, at which time she became febrile and had difficulty breathing as a result of an upper respiratory tract infection. She was not attended to by a physician, but a uvulectomy, supposedly to prevent respiratory distress, was performed by a laywoman considered by the villagers to be a "specialist" in the procedure. Following the uvulectomy, the infant experienced feeding difficulty, choking on solid and liquid foods.

scholarly journals Experience in treatment and prevention of respiratory diseases relapses in children with the use of the phytotherapeutic complex «Alpicol»: feedback of doctors in Ukraine

2021 ◽  
pp. 12-22
Author(s):  
О.К. Koloskova ◽  
◽  
A.L. Kosakovskyi ◽  
T.M. Bilous ◽  
I.B. Horbatiuk ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Therapeutic Efficacy ◽  
Respiratory Diseases ◽  
Conflicts Of Interest ◽  
Inflammatory Diseases ◽  
Clinical Manifestations ◽  
Herbal Medicines ◽  
Upper Respiratory Tract ◽  
Treatment And Prevention ◽  
Parents And Children

Infectious and inflammatory diseases of the respiratory tract in children are the «leaders» among all pathologies of childhood. Optimization of therapeutic and prophylactic approaches for infectious and inflammatory pathologies of the respiratory system by reducing the frequency of unreasonable antibiotic therapy and eliminating polypragmatic use is a relevant problem of modern pediatrics and otolaryngology. According to WHO guidelines, modern standardized herbal medicines are not inferior in efficiency to synthetic ones. The aim — to analyze the results of assessment by doctors of the preventive and therapeutic efficacy of the remedy «Alpicol» on the basis of a questionnaire, as well as clinical examination of patients before using the medication and after completion of the course of treatment. Materials and methods. The advantages of «Alpicol» were analyzed through a questionnaire offered by first contact practitioners to children in order to receive feedback on the assessment of the preventive and therapeutic efficacy of this medication. Doctors from 9 regions of Ukraine were involved, and 6,093 questionnaires of children of different ages were analyzed. Results. The frequency of registration of a pronounced paediatric pain (3 scores) with the use of the «Alpicol» medication significantly decreased (23.7 times), a moderate manifestation of the disease (2 scores), was 17 times less at the same time, mild manifestations of paediatric pain remained at the same level. Patients with a comorbid pathology of the respiratory tract in the form of recurrent lesions of the upper and lower airways during the 2nd visit received a zero score (no symptoms) significantly less frequently than children with pathology of the upper respiratory tract with 62.6% of cases versus 72.2% of observations, respectively (p<0.05). As a result of the use of the course of «Alpicol» medication, a statistically significant decrease in the severity of the catarrhal symptom complex was achieved, since the proportion of the course of disease, assessed by the maximum number of scores, decreased by 29.6 times, moderate (score 2) — 13.3 times, and zero scores appeared 5.7 times more often. At the same time, the proportion of patients with a mild course of catarrh practically did not change. Conclusions. «Alpicol» has a multi;vector efficacy against the complex of symptoms that accompany infectious and inflammatory exacerbations of recurrent respiratory diseases. This is manifested by a decrease in the severity of clinical manifestations of the disease, as well as in an increase in cases of clinical stabilization of the patient's condition, which demonstrates the therapeutic and prophylactic effect of the drug «Alpicol» on the course of recurrent respiratory diseases in children. The study was carried out in accordance with the principles of the Declaration of Helsinki. The study protocol was adopted by the Local Ethics Committee of all institutions indicated in this research. The informed consent of parents and children was obtained. The authors declare that they have no conflicts of interest. Key words: ecurrent respiratory diseases, treatment and prevention, children, phytocomplexes.

scholarly journals New prospects for local etiotropic treatment of acute respiratory viral infections

2019 ◽  
pp. 105-108
Author(s):  
A. A. Krivopalov ◽  
V. A. Shatalov ◽  
S. V. Shervashidze
Keyword(s):  
Respiratory Tract ◽  
Respiratory System ◽  
Safety Profile ◽  
Viral Infections ◽  
Inflammatory Diseases ◽  
Upper Respiratory Tract ◽  
Positive Experience ◽  
High Efficacy ◽  
Upper Respiratory ◽  
Respiratory Viral Infections

According to WHO, the respiratory system diseases are currently inside the ten most common pathologies. The modern strategy for treating influenza and ARVI gives priority to the antiviral and immunostimulating agents, but the symptomatic drugs, which include preparations based on silver and its compounds, also play an important role. The large positive experience in using silver preparations supported by numerous clinical studies shows their high efficacy and satisfactory safety profile in the treatment of infectious and inflammatory diseases of the nose and upper respiratory tract in children and adults.

scholarly journals Modern possibilities of herbal medicine in the treatment of acute inflammatory diseases of the upper respiratory tract

2021 ◽  
pp. 127-133
Author(s):  
A. V. Gurov ◽  
A. V. Muzhichkova
Keyword(s):  
Phenolic Compounds ◽  
Respiratory Tract ◽  
Inflammatory Diseases ◽  
The Body ◽  
Upper Respiratory Tract ◽  
Plant Materials ◽  
Pelargonium Sidoides ◽  
Medicinal Substances ◽  
Upper Respiratory ◽  
Tract Infections

The article provides data on the effectiveness of the use of the drug in the treatment of acute, chronic and recurrent diseases of the respiratory tract and ENT organs. The drug is an extract of Pelargonium sidoides. From the standpoint of modern pharmacology, it is known that the use of natural products based on plant materials ensures safety and the absence of pronounced side effects. The main active ingredients of pelargonium are phenolic compounds: coumarins, flavonoids and phenolic acids. The article details the biochemical and pharmacological properties of each of the above groups of compounds. It has been shown that the presence of several classes of phenolic compounds simultaneously contributes to the potentiation of the pharmacological effects of each group separately. Therefore, drug has a pronounced polytropic effect: antiviral, antibacterial, immunomodulatory, mucolytic, anti-inflammatory, antioxidant, cytoprotective. The article presents the results of numerous domestic and foreign randomized, placebo-controlled studies demonstrating its high efficacy and safety in the treatment of ENT diseases, upper respiratory tract infections and bronchitis, not only in adults, but also in children over 1 year old. On the basis of the analyzed and presented material, the authors concluded that the use of a natural-based drug in the treatment of acute respiratory infection is effective and safe, both as monotherapy and in combination with other medicinal substances. He is able to quickly eliminate not only the symptoms of inflammation, but also to support the body with any ailments of this type.

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