CC BY
26
DOI: http://dx.doi.org/10.20534/ESR-17-1.2-145-147
Khudaybergenov Ulugbek Ataullaevich, Tashkent Medical Academy, PhD in Medical Sciences, Faculty of Treatment E-mail: [email protected] Akilov Farkhad Ataullaevich, Republican Specialized Center of Urology, Doctor of Sciences in Medicine, Professor, Tashkent, Uzbekistan
E-mail: [email protected] Makhmudov Azamjon Talatovich, Tashkent Medical Academy, Doctor of Sciences in Medicine, Faculty of Treatment E-mail: [email protected]
Epidemiology and clinical manifestations of benign prostatic hyperplasia in the Khorezm region
Abstract: Epidemiologic studies are becoming relevant solution for efficient prophylactic tactics in urological disease treatment and prognosis. This paper is an attempt to highlight regional basis epidemiology of benign prostatic hyperplasia (BPH), particularly in Khorezm Region of Central Asia. This study focused preventive measurements of preventive therapy for the early detection of BPH and reduce the incidence of complications. Output of this study concludes that prevalence of symptoms of BPH increases progressively with age.
Keywords: Epidemiology, benign prostatic hyperplasia (BPH), urine flow data.
Introduction
Benign prostatic hyperplasia (BPH) — is one of the most common diseases in elderly men. In spite that during the last 20 years has been conducted many epidemiological and clinical researches all over the world, it is difficult to determine the prevalence of BPH.
Kim, Larson and Andriole determined age-related changes associated with metabolic disturbances, changes in hormone balance, and chronic inflammation may cause BPH development [9, 137-151]. About 8% of men aged 31-40 years have histological signs of BHP, to 6th decade this level will increase till 50% and reaches till 90% at 80 years [4, 864-875]. Several studies indicated that period prevalences, incidence rates, waiting time distributions and Lorenz curves were important factors to identify BHP prevalence. For instance, the results of a paper showed that 295,620 men had approximately 3 million dispensing events of the four Nordic countries. The period prevalence was markedly higher in Finland and Sweden than in Denmark and Norway. In 2009, period prevalences were 18.2/1000 males in Finland and 12.0/1000 males in Sweden compared to 6.7/1000 males in Norway and 4.9/1000 males in Denmark [8, 220-227]. An argument by Egan highlighted that cultural, psychosocial, economic, and/or disease awareness and diagnosis factors may influence medical care access, symptom reporting and help-seeking behaviors among men with BPH/LUTS. However, these factors and their epidemiologic association with BPH/LUTS have not been thoroughly investigated [5, 289-297]. Research conducted in different Asian countries showed that age percentage relationship in men with severe and average symptoms of BHP were higher than in American [6, 40-46; 10, 391-395]. Prevalence varies from 18% in men aged 40 years to 56% in men aged 70 years [6, 40-46]. Research conducted in 30 cities of Iran, enveloped 8466 men aged 40 years and older. The overall morbidity rate was 23.8%. The incidence of BPH increases with age, from 1.2% among men 40-49 years to 36% over the age of 70 years [7, 78-81].
An epidemiological survey undertaken by R. B. Nurullayev in Khiva district of Khorezm region in Uzbekistan, showed that wide-
spread of BHP signs among population 50 years and older was: SLUT (IPSS, BS) — 100%, Qmax<15 ml/sec- 60.9%, residual urine-21.5%, V>30.0 ml-61.9% [2, 36-37].
An epidemiological survey of the population in risk group of certain regions of the Republic of Uzbekistan, showed that the prevalence rate of the disease in the age range 50-59 years was 22.7%, 60-69 years — 63.4%, 70-79 years — 49.7% and at the age of 80 years and older the proportion of patients with BPH reached 63.2%. This prevalence of BPH according to negotiability, in most regions of the country amounted to 7.6%, It was lower than that determined in the course of screening in 57.2 times [3, 7-17].
At the moment modern tactics of treatment of early stages of BPH helps huge amount of patients recover from symptoms of disease through drugs or mini-invasive interventions, cause of that modern diagnostics of disease becoming more actual [1, 33-42].
At the stage of health care reform in Uzbekistan more substantial and indisputable becomes the role of institutions such as rural medical centers (RMC) and territorial polyclinics, as well as professionals (general practitioners) primary care. In this aspect of the definition of actual values of primary health care in the recognition and treatment of urological diseases.
To assess the situation related to the incidence of urinary tract, requires modern information about it, as according to official statistical reports, as well as on the results of epidemiological studies conducted specifically among the population. Lack of completeness and detail of such information at the moment does not allow to present a complete picture of the status of the issue incidence of BPH. Another aspect of the problem is the involvement of primary care (general practice) in the control of urological disease, which is shown, again, as an example only individual disease entities.
The scientific value of the proposed research is to obtain data on the prevalence of BPH and associated diseases, based on population surveys focused on a special method of epidemiological survey. This allows to obtain reliable results of morbidity needed in public health activities, as well as for expert assessment of causal relationships that
determine the prevalence of BPH and associated factors with her. The social value of the work is reflected in the direct influence on disease through the development of preventive measures, medical examination of groups, special monitoring, patient care, prevention of complications and thus improve the quality of life ofpatients suffering from BPH.
The purpose of the study
Epidemiological evaluation of the prevalence of BPH, the development of therapeutic and preventive measures for the early detection of BPH and reduce the incidence of complications in the Khorezm region.
Materials and methods
The present study was carried out by employees of the Tashkent Medical Academy (TMA) and doctors of primary health care through local health authorities, in the framework of an integrated epidemiological survey of urological diseases of the population of ecologically unfavorable regions of Khorezm region. For epidemiological survey of the population selected RMC "Avaz Utar" ofYangiarik area and RMC "Uygur" ofYangibazar district of Khorezm region.
Continuous population survey of selected therapeutic areas justified the systematic approach of an integrated and comprehensive study is the most holistic method, which is important in light of the stated purpose of the precinct and the traditional territorial principle of health. For an accurate analysis of the situation is needed examples of deep survey when the specific physician of primary care is responsible for the health of the population.
In the period from February to July 2010, by staff of the Department of Urology TMA and physicians had selected RMC where were 3991 respondents surveyed. From them were selected men 50 years and older, for further examination for signs of BPH.
Department staff of Urology TMA took part in the preparation and planning, as well as in the implementation of research and perform quality control of the latter. Provided standardization of procedures was intended to ensure the quality of consistent implementation of sections of the program to all staff, adherence of continuity as well as the comparability of results.
For a survey of the population used a specially designed at the Republican Specialized Urology Center universal questionnaire designed to identify symptoms of urological diseases. The purpose of the development of the present study was the need for a simple, compact and universal "urological" questionnaire, suitable for both epidemiologic and clinical (general medical and urological) practice in the examination of both genders and all age groups. The questionnaire consists of 33 questions. This includes issues related to the symptoms of the lower urinary tract, urinary tract infections, incontinence, male genital diseases. The information is documented by means of a specially designed survey maps, which were made to
the data of objective examination, the results of the ultrasound scan and analysis of urine using test strips.
To screen for BPH used the following methods: survey ofrespon-dents according to special universal questionnaire, including questions of questionnaire of international prostate symptom evaluation system (I-PSS) and quality oflife (Bs); physical examination, including a digital rectal prostate examination; ultrasound of the kidneys, urinary tract and prostate with the assessment of the presence and volume of residual urine, determination of prostate volume; determination of the average urinary flow rate; urine analysis using test strips (indication performed microscopy of urine sediment by prescription).
In research used ultrasound scanner "Kransbuhler" (Germany) with sensor Convex 3,5 Mhz, operating in real time. As a sound-conducting medium used contact gel brand "Scanogel" and others. For the urine test used Urine-10 test strips of the company "Cypress Diagnostics". If it was necessary, then a microscopy of urine sediment would be tested.
All respondents identified with signs of BPH were included in the group for therapeutic and preventive measures. As a means of conservative therapy used tamsulozin, which belongs to alpha 1-blockers, which by blocking alpha-1-adrenergic receptors hyper-plastic prostate, bladder neck and prostatic urethra, "eliminates" a dynamic component of bladder outlet obstruction, thereby greatly reducing the severity of irritative symptoms. At the same time significantly reduced symptoms of the disease and obstructive voiding. Dose was 2 mg per day for 6 months.
Results and discussion
Total number of examined were 235 men older than 50 years. From them 126 were men aged 50-59 years (53.6%), 53 were 60-69 years — (22.6%), 50 were 70-79 years — (21.3%), 6 were 80 years and older than (2.6%) patients.
Analysis of the survey results showed that 158 (67.2%) patients showed signs of symptoms of lower urinary tract. At the same time there was a trend of increasing the severity of symptoms in a group of surveyed men with increasing age. According prostate ultrasound in 120 (51.1%) of the men showed an increase in prostate size. Prostate volume increases depending on the age of the 30,0ml to 62ml. Residual urine volume with age and depending on the volume of the prostate naturally increased, on average, from 20 to 160ml.
Urine flow data also showed a corresponding pattern. In increase of age and prostate volume average urinary flow rate decreased from 15.2 to 8.7 ml/sec. In 14.3% of patients it was more than 15 ml/sec, was at 60.0% in the range of10 to 15 ml/sec, lower than 10 ml/sec — at 25.7%.
BPH is diagnosed in 120 patients, accounting for 51.1% of the surveyed men. They were divided according to age group to followings (Table 1):
Table 1. - The prevalence of BPH in men of different age groups
Age (years) Yangiarik district Yangibazar district In two districts
Number of surveyed men Number of men with BPH % Number of surveyed men Number of men with BPH % Number of surveyed men Number of men with BPH %
50-59 Years 69 18 26,1 57 25 43,9 126 43 34,1
60-69 Years 20 18 90,0 33 19 57,6 53 37 69,8
70-79 Years 20 13 65,0 30 22 73,3 50 35 70,0
80 Years and older 3 2 66,7 3 3 100,0 6 5 83,3
Total 112 51 45,5 123 69 56,1 235 120 51,1
In 4 men according to ultrasound scan were revealed secondary bladder stones. These patients were sent to the urology department for specialized care.
Most patients had SLUT (65%) perceived their state optimistic and generally satisfactory, considering their age-related and only 35% had a negative attitude to the prospect of having these symptoms in the future. This shows that, even when expressed forms of the disease, some number of the patients neglect or consider this state natural and as a consequence do not go to the doctor.
All men with signs SLUT included in the group of follow-up and preventive treatment. Respondents identified with concomitant diseases (urinary tract infection, kidney stones, hypertension, diabetes and others.) are taken on dispensary registration with the issuance of the related recommendations of the diagnostic, therapeutic and preventive nature.
The effectiveness of therapeutic and preventive measures evaluated as they were completed, the results of re-examination by the same parameters and using the same methods as for the initial examination.
Medication held 104 (86.7%) patients with symptoms of BPH, the remaining 16 (13.3%) for various reasons, refused to receive the drug. For the treatment were used tamsulozin from the group of alpha-adrenergic blockers. The course was 6 months. Already 5-6 days after taking the remedy, patients began to notice a decrease in the severity of the symptoms, especially the urgency and
frequency of urination at night, had also improved the quality of urination. Control survey showed that in patients after initiation of treatment increased urine flow rate, residual urine volume decreased. Analyzing the efficiency of the treatment in general was found that it was successful in 85% of men. These results are consistent with the literature, according to which tamsulozin caused a rapid decrease in the severity of symptoms of BPH to 20-50%, increases urinary flow rate to 20-30% and improves the quality of life of patients [2]. The ineffectiveness of treatment in the remaining 15 (14.4%) patients may be due to the large size of the prostate and the prevalence of obstructive symptoms.
Conclusion
Results of an epidemiological study of BPH indicate the need for more in-depth survey of men aged 50 years and older. Prevalence of symptoms of BPH increases progressively with age. Epidemiological study of men at risk in the surveyed region fully complies with the laws of propagation of BPH and its development observed in other countries. Using a simple, mandatory method of diagnosis of BPH in primary health care, making possible the early detection of this disease, which ultimately will avoid various complications.
Use of Tamsulozin during the 6 month, decreases intensity of symptoms of disease, especially imperative urging and rate of nictu-ria, improving quality of urine (increase of urine flow rate, decrease of residual urine).
References:
1. Винаров А. З., Асламазов Э. Г. Гиперплазия предстательной железы. Современное лечение//10 Росс. съезд урологов, материалы. -М., - 2002. - С. 33-42.
2. Нуруллаев Р. Б. Эпидемиологические аспекты, лечение и профилактика наиболее значимых урологических заболеваний. Автореф. дисс. д. м.н. - Т., - 2005. - 37 с.
3. Тарасенко Б. В., Клёпов Ю. Ю., Нуруллаев Р. Б. Доброкачественная гиперплазия простаты: распространенность и естественное развитие заболевания//Проблемы биологии и медицины. - Самарканд, - 2001. - № 4. - С. 7-17.
4. Alcaraz A. et al. Is there evidence of a relation between benign prostatic hyperplasia and prostate cancer?//Eur. Urol. - 2009. - 55: 864-875.
5. Egan K. B. "The Epidemiology of Benign Prostatic Hyperplasia Associated with Lower Urinary Tract Symptoms: Prevalence and Incident Rates". Urol Clin North Am - 2016. - 43 (3): - P. 289-297.
6. Homma Y., Kawabe K., Tsukamoto T., Yamanaka H., Okada K., Okajima E., Yoshida O., Kumazawa J., Gu F. L., Lee C., Hsu T. C., de la Cruz R. C., Tantiwang A., Lim P. H., Sheikh M. A., Bapast S. D., Marshall V. R., Tajima K., Aso Y. Epidemiologic survey of lower urinarytract symptoms in Asia and Australia using the International Prostate Symptom Score//Int Urol - 1997. - P. 40-46.
7. Mohammad R. S. Prevalence of benign prostatic hyperplasia in a population-based study in Iranian men 40 years old or older. Urology and Nephrology Research center, Shaheed Beheshti University of Medical Sciences, P. O. Box 19395-1849, Tehran, Iran.
8. Kjaerulff T. M., A. K. Ersboll, A. Green M. Emneus E. Pukkala K. Bolin K. Stavem P. Iversen K. Brasso J. Hallas and L. C. Thygesen. "Patterns of finasteride use in the male populations of four Nordic countries: A cross-national drug utilization study". Scand J Urol -2016. - 50 (3): - P. 220-227.
9. Kim E. H., Larson J. A. and Andriole G. L. "Management of Benign Prostatic Hyperplasia". Annu Rev Med - 2016. - 67: 137-151.
10. Tsukamoto T., Kumamoto Y., Masumori N., Miyakr H., Rhodes T., Girman G. J., Guess H. A., Jacobsen H. J., Lieber M. M. Prevalence of prostatism in Japanese men in a population based study with comparison to a similar American study//J. Urol - 1995. - 154. - P. 391-395.
DOI: http://dx.doi.org/10.20534/ESR-17-1.2-148-150
Shadiev Sadulla Samekhjanovich, Samarkand State Medical Institute Senior Staff Scientist of the Department of Maxillofacial Surgery
E-mail: [email protected] Fazilova Dilshoda Ulugbekovna, Samarkand State Medical Institute Master of 3d Year of Study, Department of Maxillofacial Surgery
E-mail: [email protected]
The effectiveness of ozone therapy in treatment of acute osteomyelitis of jaws in children
Abstract: 29 children aged from 7 to 16 years old have involved to investigation and analyses of fatty acids have carried out by gas-fluid chromatography. Markers of endogenic intoxication molecules of average mass (MAM) — MAM254, MAM280, malone dialdehyte (MDA), activity of antioxidant enzyme of catalase (CA), coefficient ofMDA/CA and MAM280/MAM254 — coefficient of protein resistance (CPR) have determined in plasma of venous blood. Ozone therapy consisted in performing procedures of the local and general action. It is established that ozone therapy in children with acute osteomyelitis of jaws respectively reduces concentrations of MDA, MAM254, MAM280, proportion of MDA/CA and increases activity of catalase and coefficient of protein resistance (CPR), it is also established a reliably reduction the concentration palmitinic and palmi-tolien acids and increase of oleic acid.
Keywords: osteomyelitis of jaw, gas-fluid chromatography, endogenic intoxication, fatty acids, ozone therapy.
Introduction. In spite of the preventive measures for the last years frequency of inflammation processes of maxillofacial area in children steadily increases, most often rapid progressive types of disease course is observed [1; 5]. Odontogenic infection is become the cause of purulent-inflammatory processes in the soft tissues of maxillofacial area (MFA) in 65-70% of patients. Patients with inflammatory processes of maxillofacial area are from 40 to 60% of all hospitalized patients. From all inflammatory processes of maxillofacial area in children osteomyelitis of jaws is 15-33% [1; 5; 7].
In 65,7-74,3% of patients chronic osteomyelitis of jaws lasts from 6 months to several years and provides prolonged treatment including repeated performing of surgical interventions. Chronic course of the process very often leads to such dangerous complications as chronic generalized sepsis, disseminating of the process to neighboring areas, mediastenitis, deformation of jaws, ankyloses of temporal-mandibular joint and so on [1; 5; 9]. One of the basic causes of failure of mechanisms of specific and unspecific resistance in purulent-inflammatory diseases are oxidative stress characterizing by decompensating of antioxidant activities, accumulation of lipid peroxide products, intensification of free-radicial oxidation which lead to the disorders of metabolic processes. Basic areas promoting to the solve of this problem are elaboration and improvement, and also realization in the clinical practice the new more effective methods of diagnostic, treatment and prediction of osteomyelitis of jaws [5; 7; 9].
The most acceptable and widely used in the practical medicine methods and remedies of treatment have unilateral action, causes side effects. In the last years big interest attends to non-pharma-cologic methods of general and local treatment, since they do not cause allergic reactions and tolerance. Ozone therapy possessing antihypoxic, antibacterial, immune-corrected, indirect antioxidant, disintoxicated, anti-aggregate and other actions in the last years has widely disseminated in many fields of medicine [2; 7]. From the literary sources it is known that ozone entering into connection with polyunsaturated fatty acids (PUFA) of membranes of erythrocytes is generated peroxides and ozonizes. Besides membrane is
become elastic which gives possibility to the newly generated peroxides on the one hand better entered to the cell, and on the other hand deformability of erythrocytes is improved. Increase ability of erythrocytes to change its forms gives them the possibility to enter into the most hard to reach areas of bloodstream which promotes the improvement of microcirculation [2]. That is why optimization of using ozone in the treatment of osteomyelitis of jaws is become the actual objective.
The aim of this investigation was the assessment of the effectiveness of ozone therapy in the complex treatment of acute osteomyelitis of jaws in children.
Materials and methods of investigation. 29 children aged from 7 to 16 years old with phlegmons of MFA who were in the hospital treatment in the Department of Maxillofacial Surgery of District Multidisciplinary Medical Center of Samarkand city (head doctor PhD M. K. Azizov) and 15 healthy children (control group) of the same age in the period from 2014 to 2016 have involved to investigation.
Patients were divided into 2 groups: 15 patients getting traditional treatment were included in the 1 group and 14 patients getting in the complex treatment ozone therapy were included in the
2 group.
Gas-chromatographic analyses of fatty acids from blood urea have been carried out by the method described N. K. Mukham-madiev and Sh. M. Ibadova [6]. Markers of endogenic intoxication — molecules of average mass (MAM) — MAM254, MAM280, malone dialdehyte (MDA) and activity of antioxidant enzyme of catalase (CA) have determined in plasma of venous blood. Coefficient of MDA/CA and MAM280/MAM254 — coefficient of protein resistance (CPR) has been calculated [3; 4; 8].
Ozone therapy consisted in performing procedures of the local and general manipulations. Local manipulations were consisted in realization of sequesterectomy before surgical operation, oral-baths with ozonized distilled water barbotaged with concentration of ozone-oxygen gas mixture 4-6 mg/l no more than
3 times per day, washing-out of sinus tract on the skin by ozonized
