The article presents the features of the clinical course of tonsillitis caused by hemolytic streptococcus in children infected with human herpes simplex virus type 6 (HHV 6). It was revealed that tonsillitis in children with background infection with HHV 6 is characterized by a prolonged course, prolonged maintenance of fever, impaired general condition, the presence of signs of hepatomegaly and regional lymphadenitis, and as a result, a longer stay of such patients in the hospital. The characteristic clinical and laboratory features of tonsillitis in children infected with HHV 6 include the presence in the debut of the disease subfebrile body temperature, regional lymphadenopathy, hepatomegaly, thrombocytopenia, signs of a parenchymal reaction of the liver and mesadenitis. Latent HHV 6 infection in children affects the frequency of registration and the duration of certain symptoms of tonsillitis.

Currently, the incidence of tonsillitis in children is very common and represents a serious medical and social problem. In young children, viral tonsillitis predominates, while bacterial tonsillitis is more common between the ages of 5–15. The frequency of registration of infection with viruses of the herpes group, including the human herpes virus (HHV) type 6, is increasing. The healing processes in infectious pathology are primarily due to the balanced work of the cellular and humoral links of the body’s immune response, the state of which can be influenced by concomitant infection with herpes viruses. The aim of the work was to study the cellular immune response of children with tonsillitis infected with HHV-6 type. The study of the influence of HHV-6 infection on the state of the cellular component of the immune response in 74 children with tonsillitis in the acute period and in the period of convalescence was carried out. All patients were diagnosed with a moderate form of tonsillitis; the etiological factor was hemolytic streptococcus group A. It was revealed that in children with mono-infection at the onset of the disease, there is a moderate response of cellular immunity (t = 2.76), while the presence of HHV-6 infection leads to more pronounced changes in the parameters of CD lymphocytes (t = 4.06). We found a significant increase in the content of CD16+-lymphocytes in tonsillitis of streptococcal etiology, but the maximum growth was recorded in patients with mono-infection (p < 0.05). By the time of convalescence, complete recovery of T-lymphocytes in infected HHV-6 patients does not occur. The degree of deviation from the standard for the entire complex of CD-lymphocytes during the period of convalescence was more pronounced in patients with co-infection (t = 2.83). The obtained data indicate the suppression of the cellular component of the immune response in patients with tonsillitis against the background of HHV-6 infection, which requires a differentiated approach to treatment and medical supervision of such patients.

Modern obstetrics is characterized with a loyal approach to surgical delivery, which has significantly affected the activity of maternity hospitals: the number of complications in childbirth from both the mother and fetus has decreased. The formed scar on the uterus is determined differently when examining the women in the postoperative period. Isthmocele is a hypogenic area in the myometrium within the site of postoperative scar in the form of a "niche", diverticulum or sac after cesarean section. It can lead to the development of diseases: abnormal uterine bleeding, dysmenorrhea, chronic pelvic pain, dyspareunia, infertility, adenomyosis, bladder dysfunction, as well as be the cause of ectopic pregnancy, uterine rupture, abnormalities in the placenta attachment of. Risk factors for isthmocele include low uterine incisions, a history of cervical removal, cervical dilatation of more than 5 cm, more than five hours of delivery, etc. For the first time the diagnosis of "isthmocele" is made at ultrasonic research, more often transvaginal one. The diagnosis is confirmed by hysteroscopy or constructive surgery. An important criterion for ismocele is the degree of deficiency, i.e. the ratio between the the biometry thickness on the scar and adjacent to the scar the myometrium area. Depending on the woman's reproductive plans, conservative or surgical treatment of isthmocele is recommended, using autologous stem cells to regenerate muscle tissue. Conservative treatment involves taking oral contraceptives. Surgical treatment includes the imposition of a two−row single−wing suture. The use of stem cells in the postoperative period allows a rise in the frequency of pregnancies in women with a scar on the uterus in the case of the isthmocele formation. Key words: isthmocele, cesarean section, myometrium, autocells.

У статті представлено огляд іноземної та вітчизняної літератури з теми відновлення фертильності у жінок репродуктивного віку з ендометріоїдними кістами яєчників. Одним із шляхів вирішення даної проблеми є використання малоінвазивних технологій при лапароскопічному видаленні ендометріоїдних кіст (аргоноплазменої коагуляції або лігатурного гемостазу), застосування інтраопераційно противоспайкових засобів та реабілітації у післяопераційний період, що включає застосування кріоекстракту плаценти та аутомезенхімальних стовбурових клітин. Ключові слова: Ендометріоїдні кісти яєчників, аргоноплазмена коагуляція яєчників, фертильність, мезенхімальні стовбурові клітини, кріоекстракт плаценти, противоспайкові препарати.

The aim of the work was to study the characteristics of the response of non-specific protective factors in tonsillitis of streptococcal etiology in children infected and uninfected with HHV-6 infection at different periods of the disease. Materials and research methods. In 78 children aged 3–15 years, inflammation markers and phagocytic activity of peripheral blood neutrophils (PAN) were determined using the nitroblue tetrazolium reduction test. The studies were carried out in the acute period and in the period of convalescence. Mathematical and statistical processing of the data obtained was carried out using Microsoft Excel 2003 and Statistica 6.0 programs. The significance of differences between the mean values was determined using the Student's test (t). Results. It was found that infection of children with HHV-6 leads to a decrease in the functional activity of neutrophils in the onset of streptococcal tonsillitis compared with uninfected patients (p<0.05). Also, the acute period of streptococcal tonsillitis in patients with co-infection is accompanied by a violation of the functional reserve of the oxygen-dependent mechanism of bactericidal neutrophils: minimal opportunities were found in tonsillitis on the background of HHV-6 infection (p<0.05). By the period of convalescence, a decrease in the indicators of the functional activity of neutrophils, increased in the acute period, was recorded, but in children infected with HHV-6, a complete recovery of indicators to the physiological norm did not occur. One of the features of streptococcal tonsillitis in children with HHV-6 infection is an increase in serum gamma globulin level (p˂0.05), lack of significant dynamics of decrease in the ASL-O indicator. Conclusions. The presence of VHL-6t infection in a child with streptococcal tonsillitis adversely affects the state of nonspecific protective factors, in particular PAN. The obtained data must be used to optimize the management of patients at different periods of the disease, including at the stages of dispensary observation