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

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

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.

scholarly journals SPECIFIC FEATURES OF DENTAL STATUS OF CHILDREN WITH CONGENITAL LIP AND PALATE IN A REGION WITH PETROCHEMICAL ECOTOXICANTS

2021 ◽  
Vol 16 (4) ◽  
pp. 147-154
Author(s):  
Sergey Chuykin ◽  
Galina AKATYEVA ◽  
Natal'ya Makusheva ◽  
Oleg Chuykin ◽  
Elena Egorova ◽  
...  
Keyword(s):  
Dental Caries ◽  
Oral Cavity ◽  
Petrochemical Industry ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Periodontal Diseases ◽  
Dental Status ◽  
Dental Tissues ◽  
Dental Examination ◽  
Congenital Cleft

Subject. Dental examination and identification of the features of the dental status of children with congenital cleft lip and palate, born and living in the region with industrial ecotoxicants. Objectives. To study the dental morbidity in children with congenital cleft lip and palate living in a region with industrial ecotoxicants, compare the data with a group of children with congenital cleft lip and palate from an ecologically safe region. Methods. The article presents the results of a dental examination of 195 children with congenital cleft lip and palate, including 108 children aged 3 years, 87 children aged 6 years. Children were divided into two groups depending on the place of birth and residence: 113 children were born and lived in regions with a developed petrochemical industry, 82 children from relatively ecologically safe regions. In the examined children, the prevalence and intensity of dental caries, malformations of hard dental tissues, periodontal diseases, dentoalveolar anomalies, and the hygienic state of the oral cavity were assessed. To determine the intensity of dental caries in children of 3 years old, the index "KPU" was used, in children of 6 years old - the index "KPU+kp". The hygienic state of the oral cavity was assessed by the Fedorov-Volodkina index (1968), the periodontal condition in children of 6 years old was assessed by the KPI index (Leus P.A., 1988). Results. Our data indicate that children from regions with the petrochemical industry have higher rates of dental caries intensity in the age groups of 3 and 6 years, there is a decrease in the resistance of the tooth enamel, and periodontal diseases are more common. Conclusions. The results of the study made it possible to obtain clinical and dental data characterizing the negative impact of industrial petrochemical ecotoxicants on the condition of the dentition in children with congenital cleft lip and palate, which is the rationale for the development of methods for optimizing and increasing the effectiveness of therapeutic and prophylactic measures in this group of patients.

Impact of cleft palate repair on speech and development of dentoalveolar deformities

2021 ◽  
Vol 16 (3) ◽  
pp. 47-53
Author(s):  
Yu.V. Stebeleva ◽  
◽  
Ad.A. Mamedov ◽  
Yu.O. Volkov ◽  
A.B. McLennan ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Surgical Techniques ◽  
Normal Functioning ◽  
Primary Surgery ◽  
Cleft Palate Repair ◽  
Congenital Cleft ◽  
Palate Repair ◽  
Late Postoperative Period

Surgical repair of cleft palate is quite difficult because it aims not only to eliminate the anatomical defect of the palate, but also to ensure normal functioning, including speech. Moreover, successful surgery implies no or minimal deformation of the middle face that can be corrected in the late postoperative period. No doubt that primary surgery (both in terms of technique and time) is crucial for further growth and development of the maxilla. However, surgical techniques and the age of primary cleft palate repair vary between different clinics, which makes this literature review highly relevant. Key words: cleft palate repair, cleft palate, congenital cleft lip and palate

scholarly journals MOLECULAR GENETIC STUDY OF THE IMPACT OF SNP C677T OF THE GENE MTHFR IN THE DEVELOPMENT OF CONGENITAL ISOLATED CLEFT LIP AND PALATE

2018 ◽  
Vol 25 (5) ◽  
pp. 104-110
Author(s):  
V. S. Uchaeva ◽  
Yu. A. Vasiliev ◽  
A. S. Gracheva ◽  
O. V. Gulenko ◽  
I. G. Udina
Keyword(s):  
Genetic Study ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Control Group ◽  
Population Genetic Study ◽  
Molecular Genetic Study ◽  
Increased Risk ◽  
Significant Difference ◽  
Congenital Cleft ◽  
The Impact

Aim. This research was designed to conduct an associative population genetic study for the consideration of the impact of SNP C677T of the gene MTHFR in the congenital maxillofacial developmental anomalies (CMDA): congenital cleft lip (CCL), congenital cleft palate (CCP), congenital cleft lip and palate (CCLP) in the Krasnodar territory. The aim of the study is to establish the associations between SNP C677T of the gene MTHFR and the development of congenital cleft lip and/ or palate.Materials and methods. In this research, the peculiarities of distribution of SNP C667T of the gene MTHFR in children with congenital cleft lip and/or palate (n=223) and their mothers (n=78) in comparison with the control group (n=124) were studied in the Krasnodar territory. The genetic demographic questionnaires were gathered for children with CMDA, the information about diagnosis was obtained from the medical records. The biological samples, including blood or scrapings of oral mucosa, were collected from children with the pathology and their mothers. The DNA was extracted from the samples by the standard method. The study of the peculiarities of distribution of alleles of SNP C677T of the gene MTHFR was performed by PCR-PFLP with endonuclease Hinf I or by tetra-primer ARMS-PCR method in children with CCL, CCP, CCLP, their mothers and the control group. Statistical processing of the obtained data was performed by the algorithms of the “Statistica” program.Results. While comparing the profiles of frequencies of SNP C677T in children with CCL, CCP and CCLP with the control group, there were identified no significant differences in the frequency of this SNP and no peculiarities of genotypes distribution. There was identified a significant difference in the peculiarities of genotypes distribution with the control group (G=19,5232, d.f.=1, p<0,001) as well as united genotypes (С/C и С/T) in accordance to T/T (G=10,4657, d.f.=1; p<0,001) and united genotypes (C/T и T/T) in accordance to C/C (G=15,1896, d.f.=1, p<0,001) for the mothers of children with CCL, CCP and CCLP.Conclusion. As a result of the study, we established the association of SNP C677T of the MTHFR gene with the development of congenital cleft lip and/or palate: mothers’ T/T genotype is associated with the increased risk of giving birth to a child with CCL, CCP and CCLP (in comparison with mothers with C/C+C/T genotype): odds ratio [OR]=16,63, 95% CI: 3,86-71,71; p=0,0003 and also for mothers with genotypes (C/T+T/T) in comparison with mothers with genotypes C/C: OR=3,22, CI:1,71-6,08; p=0,0002. The amount of risk is not significant in children with CMDA for T/T genotype. So it is possible to make a conclusion about the impact of C677T of the gene MTHFR in the development of CCL, CCP and CCLP only in mother’s genotype. 

scholarly journals Congenital cleft lip and palate in children from Tajikistan in 2009–2019

2020 ◽  
Vol 20 (1-2) ◽  
pp. 75-79
Author(s):  
Abdugafor Z. Abdurahmonov
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Medical Center ◽  
Archival Data ◽  
Number Of Children ◽  
National Medical ◽  
Outpatient Visits ◽  
Congenital Cleft ◽  
The Republic

We analyzed the dynamics of congenital cleft lip and palate in children and studied the archival data of the National Medical Center Shifobakhsh (Dushanbe) of the Republic of Tajikistan on the incidence of outpatient visits due to this abnormality in the Republic of Tajikistan over the period from 2009 to 2019. The number of children born with congenital cleft has been increasing for the last ten years. We found out this pathology to develop in families with in-and-in marriage, it also depends upon the sex of a child. Boys are more prone to maxillofacial anomalies.

scholarly journals The local interferon-corrective therapy in children with congenital cleft lip and palate, suffering from the recurrent respiratory infections

2020 ◽  
Vol 10 (2) ◽  
pp. 368-374
Author(s):  
I. V. Nesterova ◽  
M. N. Mitropanova ◽  
G. A. Chudilova ◽  
S. V. Kovaleva ◽  
E. O. Khalturina
Keyword(s):  
Oral Fluid ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Viral Infections ◽  
Respiratory Infections ◽  
Control Group ◽  
Recurrent Respiratory Infections ◽  
Congenital Cleft ◽  
Group 2 ◽  
Group 1

It is known that children with congenital cleft lip and palate are suffering from recurrent respiratory infections, which worsen the state of their health, and also complicate the results of reconstructive surgical treatment. The aim of the study was to detect defects of mucosal immunity in children with congenital cleft lip and palate, suffering from recurrent respiratory infections, and to create the program of local interferon corrective therapy with an assessment of its effectiveness. The studies included 56 children from the age of 1 to 3 years. Three groups of children were formed: group 1 – 26 children with congenital cleft lip and palate (antibiotic therapy); group 2 — 30 children with congenital cleft lip and palate (antibiotic therapy + local interferon therapy), group 3 — the control group. The clinical examination included a medical history, an assessment of the symptoms of recurrent episodes of acute respiratory infections and exacerbations of chronic infections. Microbiological studies were performed using standard methods. The status of local immunity was detected: the concentrations of secretory IgA, cytokines IL-17, IL-4, IL-6, IL-1β, IFNγ in the oral fluid were tested by ELISA. Results of the study established that in group 1 and group 2 clinical criteria of immunodeficiency with an infectious syndrome were revealed: repeated acute respiratory viral infections from 10 or more times a year, complicated by frequent exacerbations of chronic bacterial infection (up to 10 or more per year). Assessment of the state of local immunity in children with congenital cleft lip and palate revealed a lack of sIgA compared with the control group. Before treatment in group 2 oral fluid level of IL-17, IL-6 were statistically significant increase (p < 0.05); the results of the study also established increase in the level of IL-1β and a decrease in anti-inflammatory IL-4 and regulatory IFNγ relative to the control group (p > 0.05). After complex treatment with the inclusion of local interferon therapy in group 2 the appearance of sIgA, increase in the concentration of IL-4, IL-1β and a decrease IL-17 in oral fluid were observed (p > 0.05). The concentrations of IL-6, IFNγ did not change (p > 0.05). After treatment in group 2 there were a decrease in exacerbations of chronic upper respiratory tract infection and in frequency of acute respiratory viral infections compared with group 1 (p < 0.05). Positive clinical efficacy of local interferon therapy (the gel of recombinant IFNα2b in combination with oxidants — Viferon gel) in the process of staged rehabilitation of children with congenital cleft lip and palate has a protective clinical effect in reducing the frequency of acute respiratory viral infections, reducing the number of postoperative complications, reducing hospital stay, duration of antibacterial therapy and the number of exacerbations of chronic bacterial infection.

scholarly journals THE MAIN DIRECTIONS IN THE COMPLEX REHABILITATION OF CHILDREN WITH CLEFT LIP AND PALATE

2013 ◽  
Vol 1 (1) ◽  
pp. 36-43 ◽  
Author(s):  
Yulia Vladimirovna Stepanova ◽  
Margarita Sergeevna Tsyplakova
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Social Adaptation ◽  
Psychological Help ◽  
Complex Treatment ◽  
Upper Lip ◽  
Orthopedic Treatment ◽  
Professional Psychological Help ◽  
Specialized Center ◽  
Congenital Cleft

Complex treatment of children with cleft lip and palate is complicated and multi-step. Treatment is conducted by high-skilled specialists. The organization and execution of this complex are possible only at the large specialized center. Coordinator of this work is the maxillofacial surgeon. The performance of rehabilitation circuits includes preoperative orthodontic and orthopedic treatment, operative intervention (reconstructive and plastic surgery), orthodontic and orthopedic treatment after operation. Post-operative conservative treatment prevents the development of secondary deformities of the nose and upper lip. Professional psychological help and long supervision promote the achievement of good social adaptation of patients with congenital cleft lip and palate, improvement of their health.

Breast Feeding for Cleft Lip and Palate Patients, Using the Hotz-Type Plate

1997 ◽  
Vol 34 (4) ◽  
pp. 351-353 ◽  
Author(s):  
Mikihiko Kogo ◽  
Gen Okada ◽  
Shouichirou Ishii ◽  
Megumi Shikata ◽  
Seiji Iida ◽  
...  
Keyword(s):  
Oral Cavity ◽  
Outcome Measures ◽  
Breast Feeding ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Lateral View ◽  
Bottle Feeding ◽  
Oral Airway

Objective: Oral-cavity feeding movements were analyzed during sucking and used to modify a Hotz-type plate to facilitate sucking in infants with cleft lip and palate. Design: Sucking movements were analyzed using lateral view cine radiography as three adults fed from a bottle. A Hotz-type plate was then modified to better isolate the oral cavity and to occlude the oral airway. The plate was then utilized indirect breast feeding by 10 babies. Outcome Measures: Sucking rate, amount of milk taken, and duration of use of the plate were assessed. Results: Wearing this plate, four babies with cleft lip and palate could suck their mother's breast, drinking about 22 g/trial. Conclusions: Although supplemental bottle feeding was required to provide enough nourishment, this is the first step to reaching ideal breast feeding situation for these patients.

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