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Respiratory diseases occupy one of the leading places in the structure of morbidity and mortality in children. Pneumonia plays an important role among them. This is due to both the high frequency of respiratory tract lesions in children and the severity of the prognosis of many late diagnosed and untreated pneumonia. The proportion of pneumonia, in which the clinical picture does not correspond to radiological data, has significantly increased, and the number of low-symptom forms of the disease has increased. There are also difficulties in the etiological diagnosis of pneumonia, since over time, the list of pathogens is expanded and modified. Community-acquired pneumonia has been associated primarily with Streptococcus pneumoniae. Currently, the etiology of the disease has expanded significantly, and in addition to bacteria, it can also be represented by atypical pathogens (Mycoplasma pneumoniae, Chlamydophila pneumoniae), fungi, as well as viruses (influenza, parainfluenza, metapneumoviruses, etc.), the role of the latter is especially great in children under 5 years old. In the last 10 years, pneumonia has taken the leading place among these diseases. Community-acquired pneumonia is an acute illness that arose in an out-of-hospital setting, accompanied by symptoms of lower respiratory tract infection and fresh focal infiltrative changes in the lungs. The aim of the study was to identify modern clinical and laboratory features of the protracted course of community-acquired pneumonia in children. We analyzed 853 case histories of children treated in Prospectively, 123 children were under our supervision, who were divided into group II. The 1st main group included 65 children (community-acquired pneumonia, prolonged course), the 2nd control group included 58 children (community-acquired pneumonia, acute course).
In the process of complex clinical and laboratory examination of children, biochemical, microbiological and immunological research methods were used. Enzyme immunoassay (determination of markers interleukin-4,6, tumor necrosis factor-alpha) was carried out in a private clinic INNOVA in the city of Samarkand, microbiological studies.
When studying the anamnesis of these children, a number of unfavorable factors were noted. Thus, 45.5% (56) of the mothers of the observed children had toxicosis in the first and second half of pregnancy, the threat of miscarriage in 42.3% (52), and grade I-II anemia in 84.6% (104). In the main group, 21.5% of children were born with asphyxiation, and in the comparison group, 2.5 times less (8.6%; P <0.05). When analyzing the medical history, it was noted that the premature birth of children among patients with community-acquired pneumonia was 4.9%: 6.2% in the main group and 3.4% in the comparison group. 57.5% (88) of mothers had acute respiratory infections during pregnancy,
The majority of mothers of children - 69.6% - had foci of chronic infection.
Laboratory data: The data showed that the level of interleukin-4 in children with community-acquired pneumonia was 2.3 times higher than the control, increasing to 10.8 0.9 pg / ml (P <0.01), in relation to the control group.
interleukin-6 was 13.4 0.3 pg / ml and was 2 times higher than in the control group (p <0.05).
Tumor necrosis factor-alpha up to 63.5 3.2 pg / ml compared with (P <0.01) control group.
In order to correct the revealed changes, differentiated treatment regimens for children with community-acquired pneumonia have been developed and recommended. In the acute period of the disease, Bronchomunal P (3.5 mg) was prescribed 1 capsule / day until the symptoms of the disease disappeared, but not less than 10 days.
With a protracted course of the disease, 1 capsule / day for 1 month. In the next 2 months, the use of the drug, 1 capsule for 10 days with a 20-day interval between courses.