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under the conditions of continuing therapy with NSAID or ASA the eradication therapy should be also performed. It is necessary to take into account, that in all situations the successful eradication of an infection H. pylori does not exclude necessity of the subsequent preventive application of PPI [12].
As symptomatic treatment the patients were prescribed the widely used in the gastroenterological practice non-absorbable antacids (almagel, Maalox or other). They, absorbing the hydrochloric acid, reduce proteolytic activity of gastric juice (by means of pepsin absorbtion, increase in pH of the environment), therefore pepsin has become inactive. Antacides have enveloping properties, binds lizoleci-tin and bilious acids having unfavoutable effect on the gastroduode-nal mucosa. Last years in the experimental and clinical researches it has been established, that cytoprotective effect of antacides is caused by increase in prostaglandins contents in the gastric wall, increase in bicarbonate secretion, and increase in glycoproteins in the gastric mucus. Their application has shown sufficient therapeutic efficiency as medical means for elimination of dyspeptic syndrome [10; 11].
Erosive changes in the gastroduodenal mucosa at absence of the symptoms of hemorrhage did not require stopping receiving of NSAID or ASA. In a case of identification of the ulcerative damages at any stage of NSAID-therapy their cancellation and prescription
of PPI appeared to be the most rational tactics. The same means were applied in the cases when it was impossible to stop receiving of NSAID because of high risk of thromboembolic complications of the ischemic heart diseases. The patients were recommended continuing treatment with PPI during 4 to 8 weeks with subsequent endoscopic control.
Conclusions:
1. The clinical features of NSAID-gastropathy and revealed at endoscopic examinations changes in the gastroduodenal mucosa in the patients with IHD do not meet, so endoscopic control, particularly at early time of treatment (the first 1-2 months) is an obligatory and adequate method of prevention of heavy complications.
2. At the patients with IHD at presence of gastroduodenal ulcers and erosion with a bleeding or its threat it is recommended to cancel NSAID, if this is impossible, it is necessary to lower a doze of a preparation and to prescribe PPI + antacids.
3. Strategy of treatment and prevention of NSAID-gastropa-thies should include prescription of gastroprotectors at presence of risk factors and symptoms of dyspepsia.
4. At revealing of H. pylori, according to the recommendations of Maastricht IV Consensus (2011) it is necessary to perform 10-day basic eradication therapy.
References:
1. Vertkin A. L., Aristarchova O. Yu., Adonina E. V et al. Safety and pharmacoeconomic efficacy of the use ofvarious preparations of the acetylsalicylic acid in the patients with IHD//Russ. med. Jurn. - 2009. - № 8: 15-20.
2. Drosdov V. N. Gatropathies induced by non-steroid anti-inflammatory drugs: pathogenesis, prevention and treatment. Gastroentero-logia//Application to the journal "Consilium medicum". - 2005. - 7, № 1: 29-33.
3. Lapina T. L. Treatment and prevention of gastropathies, induced by non-steroid anti-inflammatory drugs, in the therapeutist's prac-tice//Ross. jurn. gastroenterol., hepatol., coloproctol. - 2009. - 18, № 4: 13-18.
4. Pimanov S. I., Semenova E. V., Macarenko E. V. Risk factors and preventive maintenance of gastropathy at use of non-steroid antiinflammatory drugs (instruction on application). - Minsk, 2008. - 28 p.
5. Nasonov E. L., Karateev A. E. Gastric lesions connected with use of anti-inflammatory drugs (Part 1)//Klinicheskaya medicina. -2000. - 3: 4-10.
6. Tereschenko S. N., Djaiann N. A. Antithrombotic therapy as the basis for prevention of cardio-vascular complication. Focus for acetylsalicylic acid//Trudniy pacient. - 2008. - 11: 34-37.
7. Yarutovskiy M. B. Efficiency of application antisecretory preparations in the treatment of acute erosive-ulcerative lesions in the patients with acquired heart diseases//Ross. jurn. gastroenterol. hepatol. coloproctol. - 2004. -14, № 6: 33-39.
8. Dixon M. F., Genta R. M., Yardley J. H., Correa P. Classification and grading of gastritis. The updated Sydney system. International Workshop on the Histopathology of gastritis. - Houston, 1994//Am.J. Surg. Pathol. - 1996. - 20: 1161-1181.
9. Malfertheiner P., Megraud F., O'Morain C. A., Atherton J. Management of Helicobacter pylori infection. The Maastricht IV/Florence Consensus Report//Gut. - 2012. - 61: 646-664.
10. Peterson W. L. The role of acid in upper gastrointestinal haemorrhage due to ulcer and stress-related mucosal damage//Aliment. Pharmacol. Ther. - 1995. - № 1: 43-46.
11. Singh G., Rosen R. D. NSAID induced gastrointestinal complications: the ARAMIS perspective - 1997. Arthritis, Rheumatism, and Aging Medical Information System. Review//Rheumatol Suppl. - 1998. - Vol. 51. - P. 8-16.
12. Spirt M. J. Stress-related mucosal disease: risk factors and prophylactic therapy//ClinTher. - 2004 - Vol. 26(2). - P. 197-213.
Ahmadaliev Rustam Umaraliyevich, Fergana branch of Tashkent medical academy E-mail: arsif@mail.ru
A food the working enterprises glass products in the conditions adverse factors
Abstract:
Objective: Hygienic estimation of a condition a food of adverse factors manufacture glass products working in the conditions of influence. Methods: Hygienic estimation a condition a food of adverse factors of manufacture glass products working in the conditions of influence. For an estimation of condition TPF by means a method of questioning and poll method, learned
a daily true condition a food of the working. Results: In a daily food allowance of workers at the enterprise for manufacture of quartz glasses, dairy products, meat, fish and chicken meat on 12-50 % below hygienic norm, especially irreplaceable amino acids (methionine, Triptofan, Fenilalanin, lizig, leytsin) on 40-55 % below norm.
Conclusions: As a result in this analysis a daily diet of the squirrel, fats, carbohydrates, vitamins, microcells and considering harmful factors manufacture new food allowances are developed.
Keywords: days of diet, a food, the enterprise, glasses, dairy products.
Relevance
According to the UN the world produces up to 1 million names per year of previously existing products, including up to 100 thousand chemical compounds, from which about 15 thousand are potential toxicants. It is believed that up to 80 % of all chemical compounds emitted into the environment, sooner or later fall into natural water from industrial, domestic and storm water, in soil, and then in raw and processed food products. As a result in food and drinking water can be tens, and sometimes hundreds of toxic chemicals that can negatively affect the health of people [7; 8; 9].
For the organism as an open self-regulating biological system protection from external influences (protection of the internal environment of the organism) is implemented in the form of a number of universal mechanisms [3]. Food provides energy and substrate to support their functioning [2].
Research aim: hygienic assessment of the nutritional status working in conditions of influence adverse factors of production of glass products.
Material and methods
For the development of preventive nutrition, we used the recommendations of the San R and N No. 0184-05 "Hygienic norms of medical-prophylactic nutrition of workers employed in harmful working conditions". The study used the number of food products analysed depending on age and season (spring and winter). Nutritional status was studied in 100 workers, including 35 aged 16 to 29 years, 35 aged 30-49 years, and 30 aged 50-59 years. To assess
Meat and meat products a day working consumed on average; in an amount of 0.05 from 0.07 (beef) of up to 0.01-0.032 (lamb) and 0.001-0.005 kg. (pork). The total number of meat
the status of BOB by using the method of questionnaire and method of survey studied daily the true power status of employees. As a result of this analysis in the daily diet of proteins, fats, carbohydrates, vitamins, trace elements and taking into account the harmful production factors developed new rations of food [1; 4; 5].
Results and statistical processing
The true power status of workers manufacturing enterprise quartz product and the composition of the diet was studied using the method of questionnaire survey and measurement method. Information obtained from the questionnaires were analyzed by statistical methods. Data about the Composition of subsistence consumption of milk and dairy products operating LLC "Quartz", are shown in table 1.
The questionnaire assessed the consumption of milk and dairy products (milk, suzma, cheese, etc.); meat and meat products (beef, lamb and chicken meat, eggs); vegetables (potatoes, carrots, beets, tomatoes); fruits (apples, grapes, pomegranate, pears, persimmons, figs, peaches, citrus), cereal products (bread, flour, peas, rice). The power of men and women studied differenty. Taking into account the objectives of the study the questionnaire consisted of questions discussed and approved at the methodological meeting. It turned out that the day workers had used cow's milk in an amount of 0.03-0.05 kg., susimi 0.01-0.013 kg., cheese 0.01-0.02 kg., eggs 0.011-0.013 kg. In General, the amount of milk and dairy products amounted to 0.063-0.096, on average 0.078 kg. the Comparison data poluchennyh hygienic standards showed that the number of products was 1.5 times lower hygiene standards.
and meat products — 0.06-0.1 kg. 0.08 kg. on average According to hygienic norms (a day supposed to consume 176 g.), i. e., workers of meat and meat products 45.5 % less. The consumption
Table 1. - The composition of the daily consumption of milk and dairy products operating LLC "Quartz"
Product Milk Kefir Cheese Egg Total
Product amount (kg.) 0.03-0.05 0.01-0.013 0.01-0.02 0.011-0.013 0.063-0.096
Protein (gr.) 1.05 2.75 1.408 5.1
Triptophan (mg.) 0.0147 0.0049 0.0375 0.0232 0.07
Isoleicine 0.0669 0.0223 0.1853 0.0935 0.35
Leicine 0.1032 0.0344 0.2681 0.1239 0.52
Lizine 0.0816 0.0272 0.2017 0.0901 0.42
Metionine 0.0258 0.0086 0.0715 0.044 0.44
Cistyne 0.0093 0.0031 0.0155 0.0329 0.047
Fenilalanine 0.051 0.017 0.1474 0.0813 0.24
Amino isovaleric acid 0.072 0.024 0.1974 0.1056 0.30
Arginine 0.0384 0.0128 0.1004 0.0924 0.20
Fats ( %) 4 1.2 1.2 1.7 7
Vit A (mg %) 0.005 0.0005 0.00049 0.0016 0.0035
Vit B , (mg %) 0.005 0.0005 0.0005 0.0015 0.0035
Vit B 1 (mg %) 0.007 0.048 0.043 0.076 0.003
Vit B.2 (mg %) 0.0014 0.002 0.005 0.0095 0.066
Vit C (mg %) 0.008 0.04 0.03 0.034 0.15
Calcium 36.1 18.2 95.6 21.8 86.8
Magnesium 4.2 2.0 0.56 23.8 98.0
Phosphor 28.5 16.9 109.2 66.5
of grain and grain products per day averaged: 0.335 bread-and 0.750 kg. of rice 0.010-0.012 kg. of peas of 0.001-0.005 kg., wheat flour of 0.25-0.3 kg. the Total number of grains and grain products — 0.55-1.6 kg. the Comparison of obtained data with hygiene standards showed that consumption of grain and its products was 2.8 times more.
The consumption of vegetables and fruit during the day averaged: potatoes 0.15 to 0.20 g. carrots 0.12-0.16 g., cucumbers 0.10-0.11g., turnip 0.001-0.008 g., tomato is 0.18-0.22 g., onions of 0.10-0.15 g., greens of 0.01-0.05 g. the Total number of fruit and vegetables — 1.27g., i. e. workers received vegetables 1.6 times more hygienic norms. Table 2 shows data on the daily diet of workers of the enterprise for the production of kvartsevykh glasses.
In 0.079 kg. of milk and dairy products in contains of 5.75 g. of protein, 0.070 kg. of meat and meat products 10.4 g., 0.325 kg. of grain and grain products 0.8 g. of fruit and vegetables is 8.7 proteins. The total amount of protein is 1.27 g.
If the daily requirement of protein 80-100 g., the results of 29 % below normal. Common diet animal products 0.149 g., therefore, animal protein in total daily ration is 28 % (normally 55 %) with regard to the Analysis of amino acids in the food composition; methionine content of 1.13 mg, which is below the norm by 50 %, leucine 0.52 mg., i. e. Indispensable amino acids 20-38 % lower hygienic standards. The content ofvaline is equal to 3.0 mg., which is also 25 % lower hygienic requirements.
Amount of tryptophan in the daily diet is 0.71 mg., which is 29 % lower hygienic standards, threonine 2.05 mg. (the norm is 2-3 mg.),
phenylalanine 2.38 mg. (normal 2-4 mg.), arginine 3.23 mg., histi-dine 1.43 mg. Based on the survey revealed that the major amount of protein intake with beef, the average number is 10-11 g., the amount of fat in beef 13-16 g., 2-5 g. mutton Chicken meat and pork are eaten very rarely. A large number ofvitamins, macro-minerals in the organism enters through meat products. Study of the amount of grain products in the daily diet of the workers at the plant for the production of quartrous glasses showed that the body receives the bread in the amount of 24.5 g. of rice 0.76 g., peas 2.38 g. of flour 33.2, a large number of amino acids come from bread and flour. For example, as part flour products determined tryptophan (0.35 mg.), threonine (0.86 mg.), isoleucine (1.32 mg.), leucine (2.0 mg.), methionine (0.45 mg.), cystine (0.51 mg.), phenylalanine (0.51 mg.), valine (0.51 mg.). Fat intake from bread 5.25 g., rice 0.157 g., 0.002 g. peas, flour, or 0.42 g.
The carbohydrate intake of 175 g. bread, rice 13.3 g., 1.51 g. peas, flour, 163 g. In cereal products vitamin a is found in small quantity is 0.019-0.7 mg., vitamin B 1 0.002-1.27 mg., vitamin B 12 in cereal products is not defined (except peas). Using grain products on average are macro-minerals: calcium 2.9 to 10.2 g., magnesium 4.0-73.6 g., phosphorus 30 to 37 g.
In the daily diet of workers. Thus, in the daily diet, working at the enterprise for the production of glass, corvigo milk, meat, fish and chicken dishes on 12-50 % lower hygienic standards. Osobenni deficiency was noted in the essential aminokislot methionine, tryptophan, phenylanine, lysine, leucine 40-55 % below health standards.
Table 2. - The average need for food the workers at the plant for the production of glass
Product Demand into nutrition, g. Proposed norm (brutto)
Wheat bread 335-750 200
Black bread 70-80 250.0
Wheat flour 41-50 15.0
Noodles 55-60 40.0
Bob 35-45 70
Fabaceae (bean, soy-bean, pea) Rice 10-12 Peas 1-5 50
Sugar 40-45 50.0
Meat (beaf, mutton, chicken) beaf 50-70 mutton 10-32 150.0
Fish 2-4 20.0
Liver 3-5 25
Eggs pcs 0.5 0.5
Milk, kefir 30-505 500.0
Cheese 5-8 10.0
Curd 20-30 100
Beaf fat 7-8 10.0
Vegetable Oil 8-9 50.0
Potato 150-200 400
Vegetables 75-80 550
Fruits and juice 62-74 100.0
Energy value 1110.3 ± 17 1710.2 ± 13.0
Proteins 43 ± 0.5 57 ± 0.2
Lipids 49 ± 0.7 51 ± 0.3
Carbohydrates 230 ± 2.5 170 ± 1.2
In terms of environmental (alien) load power, in addition to traditional functions, should also provide:
• reduce the absorption ofxenobiotics in the GI tract;
• the weakening of the adverse effects of foreign substances and factors at the cellular and organ levels;
• reducing the level of deposition ofxenobiotics and their metabolites in the tissues of the tropic of accelerating their excretion from the body.
When developing BOB working in glass manufacture must be added to the daily diet primarily recommended natural non-specific
sorbents: dietary fibers, alginates, collagen, mucus, zeolites, chitin. They also enhance intestinal motility, reducing effective period of absorption of xenobiotics. Absorption of foreign substances in the gastro-intestinal tract and the extent of their receipt of the internal environment of the body depends on several factors: the residence time of food in the intestine, condition of membrane of enterocytes, the activity of the enzymatic digestion, the nature of the microbiota and the chemical composition of the diet. The latter implies the possibility of existence of different types of interaction between xenobiotics and nutrients: competitive, synergistic or neutral flowing in the cavity space and on biological membranes, in the cytosol of cells.
Conclusions
1. In the daily diet of workers at the enterprise for manufacture of quartz product, dairy products, meat, fish and chicken 12-50 % lower hygienic standards, particularly the significant deficiency noted in the relationship of essential amino acids (methionine, tryptophan, phenylalanine, lysine, leucine, tryptophan) at 40-55 % below normal.
2. The workers in the workshops for the production of glass of conditions by Norm and rule sanitary № 0141-03 class 2-3-4 degree of danger, in the shops of the RMC and ICC conditions 3.3 and 3.4 of class and severity.
3. The value of basal metabolism for men is 1665 kcal., for women 1580 kcal., specific dynamic action of food is 165.7 kcal. for men, to 158.5 kcal. for women, total energy value 4110 kcal. for men, for women 3941.
Protein 57 g., fat 51 g. carbohydrates: 170 g., calories 1200 kcal. It is proposed to enrich the composition of the diet on 2-categories meat, liver, fish, dairy, produktami, suzma and vegetables.
4. For glass production, blocking in some way the absorption of xenobiotics, primarily recommended natural non-specific sorbents: dietary fibers, alginates, collagen, mucus, zeolites, chitin. They also enhance intestinal motility, reducing effective period of absorption ofxenobiotics. Works in reducing the entry ofxenobiot-ics into the body.
References:
1. Guidelines for the assessment of the quantity of food consumed by method 24-hour recall. No. with 1-19. - M., 1996.
2. Tursunbaev To. Hygienic substantiation of preventive nutrition working on Almalinskogo mining and metallurgical combine (AGMK). Author. dis. ... candidate. honey. Sciences. - Tashkent, 2008. - 21 p.
3. Timokhin D. I., Istomin A. V., Shushkova T. S. and other. Questions of hygienic rationalization of medical-preventive nutrition of industrial workers//Zhurn. Gig and San. - 1997. - № 2. - S. 19-21.
4. Korolov A. Food Hygiene. - Moscow, 2008. - 568 p.
5. Grebneva O. V., Balaeva, E. A. Individual features of professional adaptation of women employed in industry//Hygiene and Sani. -Tarii, 2007. - No. 1. - P. 39-41.
6. Brennan P., Boffetta P. et al. Occupation and lung cancer risk in Central and Eastern Europe: the IARC multicentre case-control study// Cancer Causes Control. - 2007, Aug. - 18(6). - P. 645-654.
7. Richiardi L., Boffetta P., Simonato L., Forastiere F., Zambon P., Fortes C., Gaboricau V., Merletti F. Occupational risk factors for lung cancer in men and women: a population-based case-control study in Italy//Cancer Causes Control. - 2004, Apr. - 15(3). - P. 285-294.
8. Olsen R., Thorud S., Hersson M., Ovrebn S., Lundatics E., Greibrokk T., Ellingsen I. G., Thomassen V., Jvlolander P. J. Determination of the dialdehyde glyoxal in workroom air-development of personal sampling methodology//Environ Monit. - 2007, Jul. - 9(7). - P. 687-694.
9. Apostoli P., Sarnico M., Bavazzano P., Bartoii D. Arsenic and porphyrins//Am J Ind Med. - 2002, Sep. - 42(3). - P. 180-187.
Akhmedov Khalmurad, Tashkent Medical Academy, Candidate of Science, assistant professor, Independent researcher, the department of training of the general practitioner E-mail: khalmurad1968@mail.ru Rakhimova Matluba, Abdurakhimova Lola, Abdurakhmanova Nargiza, Khalmetova Feruza, Independent researchers, the department of training of the general practitioner
Influence of xenobiotics on the course of rheumatoid arthritis
Abstract: The results of disperse analysis indicated degree of contamination of air and soil by xenobiotics. It depended on the clinical, radiographic and sonographic signs of articular syndrome in RA.
Keywords: rheumatoid arthritis, articular syndrome, ecologic factors, climate geographic zone.
Climatic peculiarity of human habitat have always been the most important factor which affect to health. When marked effects of different environmental indicators to human health, it became clear that the priority of environmental factor composes — up to 30 %. Of these, pollution accounts about 20 % and climate geographic conditions — 10 % [1, 157-158]. Therefore, it is obvious that the problems associated with the disease can not be considered without debate and features of the environment.
Geographical factors, according to a study conducted under the auspices of the WHO are estimated as external risk factors that could adversely affect to functioning of all systems of the human body, as well as the to course and outcome of various diseases, including rheumatic diseases [2, 28-30]. In recent years, it began to discuss the possible connection of the current and future features of rheumatoid arthritis with unfavorable environmental factors [3, 68]. RA is a multi factorial disease in which the interaction of genetic
