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Conclusions.
1. Conservative therapy of colostasis in young children with inclusion of preparations having immunomodulating properties (duphalac, linex, detoxicants, vitamins) revealed significant increase in parameters of T-cellular immunity (CD3+, CD4+, CD8+, lymphocytes) with normalization of immunoregulating index, reduction of expression of apoptosis markers and NKC.
2. The early postoperative period in children of young age was characterized by monocytopenia, lymphopenia, neutrophilia, some reducing of the immunoglobulin concentration, growth of apop-
tosis marker expression, but it was accompanied by improvement of parameters of T-cellular immunity at the expense of growth of
CD4+ and CD8+--lymphocytes. These data reflect tendency to
restoration of the damaged parameters of immunity in children of young age after surgery performed.
3. In the children with chronic colostasis immune system id differed by marked cellular and humoral deficit on the background of immaturity of immune system, characterized for these patients that requires inclusion of immunomodulating therapy into the complex of treatment.
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DOI: http://dx.doi.org/10.20534/ESR-16-9.10-60-63
Alimova DonoMirjamalovna, Tashkent State Dental Institute, Uzbekistan teacher assistant of department of faculty therapeutic dentistry
E-mail: [email protected]
Effect of lipid peroxidation on severity of clinical course and recurrence of aphthous stomatitis
Abstract: A study to assess lipid peroxidation oral fluid and blood serum in 110 patients with recurrent aphthous stomatitis of varying severity in the periods of exacerbation and remission.
The period of convalescence in patients with RAS clinical course of moderate and severe saved local and systemic imbalance in the system POL-AOS, which is a factor in determining the severity of the clinical course and risk of recurrence.
The research results indicate the need for antirecurrent treatment of patients with RAS in the period of remission of clinical manifestations in the mucous.
Keywords: recurrent aphthous stomatitis; peroxide oxidation of lipid; antioxidant; malondialdehyde; superoxide dis-mutase.
In everyday clinical practice patients with diseases of oral mucous membrane (OMM) represent one of the most difficult problems in dentistry due to diagnostics and treatment difficulties [1,485-491].
Recurrent aphthous stomatitis (RAS) currently represents one of the most urgent issues of modern dentistry due to the prevalence, both in Uzbekistan and around the world. Increase in the proportion of severe forms, absence of tendency to decrease the frequency of relapses were noted [5, 30-33; 11, 76-79; 9, 229-232; 18, 12861287].
Recurrent aphthous stomatitis is one of the common diseases of OMM. According to Rybakov A. I. and Banchenko G. V. (1978), it was 5% of all the diseases of oral mucosa. According to other researches, 20% of population suffer from aphtae in that or another life period. It was found that the age of most ofpatients ranged from 20 to 40 years. Persons of both genders suffer equally before puberty, but females predominate among adults [4, 9-11].
Etiology and pathogenesis of RAS have not been clarified till the end. It was found that state of microbiocenosis of oral mucosa play significant role in the pathogenesis of inflammatory processes [10, 225-
Effect of lipid peroxidation on severity of clinical course and recurrence of aphthous stomatitis
231;12, 49-58]. It was proved its involvement in metabolism, vitamin synthesis, formation of the immune status and nonspecific resistance. Clinical and experiment are evidence of role of gastrointestinal pathology and liver diseases in pathogenesis of RAS [15; 16, 8601-8612]. Question ofallergic genesis ofdiseases is widely discussed. At the same time problem of free-radical processes and antioxidant protection in the saliva remains less studied. It is known that the immunological and free-radical disorders may affect clinical course and prognosis of chronic diseases of oral mucosa [14, 826-831; 17, 316-321].
It is known that RAS is characterized by failure of cellular and humoral immunity, enhanced sensitization, chronic clinical current of the disease [5, 30-33; 11, 76-79].
In the pathogenesis of RAS immune mechanisms caused by an abnormal accumulation of aggressive inflammatory mediators play big role [5, 30-33; 7, 22; 11, 76-79].
Any pathological process takes place against the background of the formation of reactive oxygen species (ROS) and the activation of free radical oxidation of biological substrates. Oxidative stress develops in the presence of a serious imbalance in production of free radicals and antioxidant protection attenuation, which leads to degradation of the cellular, tissue and organism level. Free radicals are the part of complex reasons for the origin ofvarious diseases [2, 42-45; 3, 24-28, 6, 20-25].
Free radical oxidation level of unsaturated fatty acids in the form of lipid peroxidation (LPO) is one of universal metabolic control mechanisms in the organism under physiological conditions, and non-specific cellular damage pathogenic factor in pathological conditions where there is a development of oxidative stress [2, 42-45; 3, 24-28, 7, 22; 6, 45-55].
Therefore, laboratory data on the content of lipid peroxidation products in biological fluids may carry information about the depth and severity of the pathological process. The study of the state of lipid peroxidation and antioxidant system (AOS) is highly informative in assessing the severity and the effectiveness of the treatment of many inflammatory oral diseases [2, 42-45, 7, 22].
The problem of RA.S treatment is to achieve long-term resistant remission. In this regard research of pathgenetic mechanisms of RA.S recurrence and development of differentiate treatment principles is the urgent task.
Promising in this respect are targeted study to assess the nature of the violations of free-radical processes of the oral cavity and the blood serum in different periods of the disease, their role in the formation of clinical manifestations of RAS relapses.
The object of research was to compare rates of lipid peroxidation and anti-oxidant system of oral liquid and blood serum in patients with RAS of different severity in exacerbation and remission periods.
Table 1. - LPO-AOS process in patients with different
Materials and methods. According to variety of the clinical picture, which characterizes the erosive and ulcerative lesions of the oral mucosa, the lack of clear differential diagnostic criteria between different variants of the clinical course of RA.S, the severity of the clinical manifestations of the disease was evaluated on a point system developed. We took into account the main symptoms and signs of the disease: the general condition of patients, body temperature, state of the regional lymph nodes, the size and number of the AFL, the state of the edges and the bottom of the AFL, the degree ofpain, recurrence frequency. Index of disease severity (IDS) was taken into account as the average score of the selected indices. IDS in the range of 0.5 to 1.0 was taken as a mild course of the disease; IDS equal to 1.1-2.0 and 2,1-3,0, were assessed as medium and severe RAS respectively [8, 16].
From a total of 110 patients with RAS 68 patients were diagnosed with medium RAS; 32 patients were estimated as mild RAS and 10 patients had severe RAS.
The mean duration of disease was 5,82 ± 0,44 years. In patients with different clinical forms, in both men and women, these figures did not have significant differences.
Evaluation of peroxidation and antioxidant system of blood serum and oral fluid was carried out on a level of malonic dialdehyde (MDA) and activity of superoxide dismutase (SOD), determined by the spectrophotometric method (L. P. Andreeva et al, 1988;. Dubinin B. B. et al, 1983).To assess the state of free radical oxidation and antioxidant system we used MDA/SOD ratio 1000 (Kichenko E. M., 2004). Anti-peroxide activity (APA) of studied biological fluids was determined by chemiluminescence method (A. H. Kogan et al., 1996).
To estimate the pathogenic mechanisms of disease recurrence, these figures were assessed at the height of the disease in remission.
Statistical processing of the results of studies was determined by the software Microsoft Excel Statistika 6.0 software. By comparing the data obtained during the study we used a t-coefficient.
Results and discussion. In patients with RAS indicators, characterizing the intensity of lipid peroxidation processes in the acute phase of the disease, were within the above standard values (P <0.05), with a significant decrease in performance counter AOS systems (P <0.05). The greatest changes were observed in patients with medium to severe clinical current.
At the period of convalescence LPO-AOS levels were determined by the severity of the clinical course of RARAC: at mild RARAS they were restored to the levels of control values (P> 0.05); at medium and severe clinical course in oral fluid and blood serum the normalization of lipid peroxidation-AOS process did not occur (table).
severity of RAS in dependence on disease period
Group MDA, micromoles/ml SOD, au/ml MDA/SOD • 1000 APA
1 2 3 4 5 6
Oral liquid
Control, without RARAS 0,22±0,01 71,8±3,32 2,65±0,11 5,62±0,25
Patients with RAS: Acute period
1 Mild 0,44±0,02^ 57,1±2,65- 6,60±0,22^ 7,22±0,35^
2 Medium 0,63±0,03-'° 44,32±1,88-'° 14,32±0,62^° 11,32±0,50-'°
3 Severe 0,81±0,03-'°' x 37,2±1,55-'°' x 21,90±0,87-'° x 14,69±0,67-'°' x
Decubation period
1 Mild 0,24±0,01A 69,81±2,95A 2,89±0,4A 6,02±0,28A
2 Medium 0,32±0,02-'°'A 53,26±2,48-'°'A 5,81±0,23-'°'A 8,53±0,35-'°'A
3 Severe 0,41±0,02-'°' X'A 48,32±2,03-'°' *>A 9,11±0,41-'°' X'A 11,32±0,42-'°' X'A
1 2 3 4 5 6
Blood serum
Control, without RA.S 0,16±0,01 63,21±2,32 2,53±0,07 4,83±0,11
Patients with RAS: Acute period
1 Mild 0,22±0,0T 56,21±2,14- 3,80±0,2T 5,62±0,24^
2 Medium 0,32±0,02^° 40,82±1,83-'° 8,18±0,42-'° 7,11±0,27-'°
3 Severe 0,42±0,02^'°' x 36,44±1,14-'°' x 11,27±0,6P'°' x 8,32±0,37-'°- x
Decubation period
1 Mild 0,17±0,01A 61,31±3,11A 2,63±0,06A 5,11±0,23-
2 Medium 0,21±0,0P'A 52,11±2,51-'° 4,25±0,1P'°'A 5,81±0,27-'°'A
3 Severe 0,30±0,01- 44,32±2,1T' *>A 7,81±0,25-'° X'A 6,62±0,3P'°' X'A
Note: • — P <0.05 compared to control;
° — P <0.05 in relation to mild clinical current;
x — p <0.05 relative to medium clinical current;
A — P <0.05 in relation to the acute period
Thus, in patients with mild RAS in the period of convalescence MDA value in the oral fluid was only 9.09% (P> 0.05) higher than control indicators; SOD has been below the reference value by 2.77% (P> 0.05); MDA/SOD ratio 1000 was higher than the control values at 9.06% (P> 0.05); APA and oral liquid increased by 7.11% (P> 0.05); corresponding dynamics at medium and severe amounted to 45.45% (p <0.01); 2.8% (P <0.01); 119.25% (P <0.01); 51.78% (P <0.01) and 86.36% (P <0.01); 32.70% (P <0.01); 243.77% (P <0.01) and 101.42% (P <0.01) (Table).
As the results of research, the formation of recurrent course RAS occurs in the interaction of exogenous and endogenous factors, while an imbalance in the system of LPO-AOC in serum satisfactorily coincide with the state of these processes in the oral fluid.
Thus, in the convalescence period of patients with mild RAS MDA serum had no significant difference with the control group: index exceeding 6.25% (P> 0.05); SOD reduced by 3,0№ (P> 0.05); ratio ofMD A/SOD 1000 was higher by 3.95% (P> 0.05);, and the value of APA exceeded control values at 5.80% (P> 0.05); similar relations with the PAC of average weight amounted to 31.25% (P <0.01); 17.5% (P <0.05); 67.98% (P <0.01) and 20.30% (P <0.01); corresponding dynamics in severe PAC was already 87.50% (P <0.01); 29.88% (P <0.05); 208.70% (P <0.01) and 37.07% (P <0.01) (Table).
Continued imbalances in the LPO-AOC system indicate the activity of the biochemical and pathophysiological disorders in severe
RAS. It is obvious that the constant presence of high levels of lipid peroxidation in the body's environment plays a role in maintaining the activity of the process and determines the severity and frequency of relapses of RAS.
Studies have established the importance of lipid peroxidation-AOS processes at the local and systemic levels in the pathogenesis of the formation ofvarious severity of clinical forms of RA.S, verified a group of patients at high risk for recurrence.
Conclusions:
1. The development of severe forms of aphthous stomatitis with frequent relapses occurs in the interaction of exogenous and endogenous factors, an imbalance in the LPO-AOS system.
The clinical course of the RAS with a pronounced imbalance in the system of LPO-AOS local manifestations of the pathological process most pronounced reconstructed moderate and severe forms of disease, increasing the number of relapses.
2. The period of convalescence in patients with medium to severe RAS saved local and systemic imbalance of LPO-AOS, indicating the severity of the clinical course and exposure to extreme risk of relapse.
3. The high level of activity of LPO in remission is an important diagnostic sign, indicating the necessity of anti-treatment, and whether to include antioxidant therapy in the complex treatment.
References:
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The program of cochlear implantation in children with profound hearing loss in the republic of Uzbekistan («Uzbek model»)
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DOI: http://dx.doi.org/10.20534/ESR-16-9.10-63-65
Amonov Shavkat Ergashevich, Professor, Head of the department of otorhinolaryngology, child otorhinolaryngology and stomatology, Tashkent Pediatric Medical Institute, Tashkent, Uzbekistan Inoyatova Flora Ilyasovna, Professor, Head of the department of hepatology under the Republic specialized scientific research medical center for pediatrics of the Ministry
of Healthcare of the Republic of Uzbekistan, Tashkent, Uzbekistan Akhmedova Diloram Ilkhamovna, Professor, Director of the Republic specialized scientific research medical center for pediatrics of the Ministry of Healthcare of the Republic of Uzbekistan, Tashkent, Uzbekistan E-Mail: [email protected]
The program of cochlear implantation in children with profound hearing loss in the republic of Uzbekistan («Uzbek model»)
Abstract: The «Uzbek model» of cochlear implantation, developed and implemented at the Republic specialized scientific research medical center for pediatrics of the Ministry of Healthcare of the Republic of Uzbekistan, showed high efficiency of hearing and speech rehabilitation in children with profound hearing loss and deafness, expressed reduction of the indicator of hearing disability in Uzbekistan, increase of the quality of life and integration of the children of the given cohort in the process of studying and society.
Keywords: hearing disorder, cochlear implantation in children, «Uzbek model», efficiency of treatment.
According to the data of the World Health Organization (WHO), hearing loss, in worldwide scale, is one of the six leading factors deteriorating the quality of life. 360 million people suffer from hearing function disorder, which forms 5,3% of the population of the world, out of which, 328 million are adults and 32 million are children (WHO, 2012). Among patients with hearing disorder, the hearing loss in 80% is determined by the damage of sound-perceiving apparatus. Out of every 1000 newborns, one is born with sensorineural hearing loss of 3-4 degree. WHO stated that by 2020, the number of people with hearing disorder would increase by not less than 30% [1-3].
30 years ago, the diagnosis of «Deafness» was nearly a verdict and, today, provided early diagnosis with further cochlear implantation and rehabilitation measures, it is a quite solvable problem.
Cochlear implantation is a highly effective means of rehabilitation of children with profound hearing disorders that allows achieving significant results in the pre-lingual period and in people with profound hearing loss occurred at mature age. There are over 450 thousand users of the systems of cochlear implantation in the world today.
Until 2014, only technical means — hearing devices, were used in Uzbekistan for the rehabilitation of children and adults with light and medium degree of hearing loss. Hearing devices transfer only signals allowing hearing to some degree, and are not efficient in the rehabilitation of the patients with profound hearing loss or deafness. In this respect, patients with this pathology had to go to other countries for the operation of cochlear implantation, which required a lot of expenses. This, in turn, also didn't solve the problem com-
