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a disease of 29 (39,7)%, at the same time 27 (36,9%) patients 2 (2,7%) for 7-8 days, 2 (2,7%) for the 10th day were hospitalized for 3-4 days from the beginning of a disease, 10 (13,5%) for 5-6 days, and more than put from the beginning of a disease and 3 (4,1%) patients considered themselves patients during the long time. The acute beginning of a disease at the main contingent of patients will completely be compounded with literature data (1-2).
It is necessary to notice that at patients with the EVI intestinal form the general state was in most cases regarded as moderately severe 50 (68,4%), but in the comparative analysis it was taped that the number of cases with a serious current of this form prevailed in group with a positive PCR result on an EV (19 (25,7%) at EVI and 20 (21,05%) at patients with negative result).
The intoxication syndrome became perceptible at all patients from the first day of illness and lasted on average 3,72±0,46 days. High temperature of febrile character was observed at 11 (15,06%) patients whereas the subfebrile condition occurred at the majority 49 (67,1%) patients from AII, normal body temperature was diagnosed at only 13 (17,8%) patients. It is compounded with data of literature (1-2) where it is indicated the relative mild current of the EVI intestinal form, with moderate intoxication.
The specific gastrointestinal tract disease at patients with the EVI intestinal form in 100% of cases was characterized by a loss of appetite, at a part of patients 7 (9,5%) the anorexia was observed. At 17 patients (23,2%) abdominal pains were observed. Often the diarrhea was followed by nausea — at 18 (24,6%), vomiting — at 14 (19,1%). Almost at all patients the liquid chair without pathological impurity from 5-6 at 32 (43,8%) patients, and till 10-12 once a day — at 13 was observed (17,8%). At only 2 patients (2,7%) of the studied selection it was observed impurity of slime, pus and a blood in a chair. At the same time at 12 (16,4%) patients the condi-
tion of a serious dehydration of which the main part was made by children of early age of10 children (83,3%) developed.
It is necessary to notice that at 16 of 21 (76,1%) sick adult age with EVI the accompanying pathology in the form of chronic cholecystitis, chronic pyelonephritis, chronic gastritis, chronic hepatitis and a helminthic invasion became perceptible. We consider that this chronic pathology in a GIT promotes dysfunction mucous an intestine and as a result to a larger susceptibility of an organism as to EVI and other intestinal infections. In group of comparison with negative result of the PCR at 11 of 31 (35,4%) adults the accompanying chronic pathology of a GIT was observed.
From background diseases the larger frequency of anemia of serious degree at patients with the EVI intestinal form attracts attention. Perhaps, this fact is one of EVI provoking for more mild perception as anemia promotes depression of immunobiological properties of an organism. So anemia frequency degrees 3 made a half of cases of observations 37 (50,6%), at the same time there were 24 patients with the 2nd degree of anemia (32,8%), only 11 (15%) cases patients with mild degree of anemia made and at only 1 (1,3%) the patient a hemoglobin within norm was observed. When comparing with group with negative result of the PCR it was taped that the number of patients with serious anemia made in this selection 35 (36,8%), moderately severe anemias of42 (44,2%), mild degree 15 (15,7%) and at 3 (3,1%) a hemoglobin was within norm.
Conclusions: In structure of patients from AII at 43% positive takes of the PCR on existence of an EV were taped, at the same time children till 1 year prevailed. The major causal factor of distribution of EVI were giving raw unboiled water from open reservoirs in rural areas that speaks about a possible water factor of transfer of an EV. The disease was characterized by an acute current and moderate severity against the background of anemia of serious degree.
References:
1. Lukashev A. N., Ivanova O. E., Khudyakova L. V. The social and economic importance of an enteroviral infection and its role in structure of infectious pathology in the world//Journal of microbiology, epidemiology and immunobiology - 2010. - No 5 - P. 113-120. (In Rus.).
2. Musabayev E. I., Nazarova R. P., Bayzhanov A. K., Kasimova R. I. Enteroviral infections etiology, clinic, diagnostics, treatment. Methodical Recommendations Tashkent. - 2010. - (In Rus.).
3. Poklonskaya N. V. et al. Use of various modifications of a method of a polymerase chain reaction at diagnostics of enteroviral infec-tions//Medical news, - 2004. - No. 1, - P. 13-16. (In Rus.).
DOI: http://dx.doi.org/10.20534/ESR-16-11.12-107-110
Erkaboev Shokhrukh Muidinovich, Amirkulov Bakhtiyor Dzhumaevich, Kurbanov Ravshanbek Davlatovich, Republican specialized center of cardiology, Tashkent, Uzbekistan E-mail: [email protected]
The impact of the radio-frequency catheter ablation on the emotional status of the patients with AV nodal reentrant tachycardia
Abstract: The evaluation of the level of anxiety and depression in patients with AV nodal reentrant tachycardia after radio-frequency catheter ablation was performed. The study included 33 patients with AV nodal reentrant tachycardia (AVNRT). The expressiveness of the anxiety and depression level was assessed with the help of the Hospital anxiety and depression scale. The majority of patients with AVNRT had clinically expressed anxiety (63,6%) and sub-clinical depression (66,7%) before treatment. Against the background of RFA application, normalization of psychical status of the patients (reduction of the feeling of anxiety/depression in 84,8%/93,9% respectively) was observed.
Keywords: AV nodal reentrant tachycardia, anxiety, depression, radio-frequency catheter ablation.
AV nodal reentrant catheter ablation (AVNRT) is a supraventricular tachyarrhythmia characterized by a coordinated electrical activation of auricles and ventricles appearing as result of realization of the reentry mechanism in the AVC area. The share of AVNRT accounts for 85% of all supra-ventricular arrhythmias provided the exclusion of fibrillation of auricles [2; 10]. The correlation of men and women is 2:3. Despite the fact that AVNRT occurs in all age groups, there are certain age period that play important role in the clinical course of AVNRT. In children, most frequently, tachycardia manifests itself at the age of 7-12, and the frequency of attacks increases during the age of 12-13. The decrease of the frequency of attacks is often observed at the age of14-16 [6]. In adults, clinically expressed manifestations are, as rule, observed in the group aged from 28 to 40 [13; 15].
According to Ardashev V. N. [3], in 18% of patients with AVNRT, the reason initiating the arrhythmia is physical or emotional stress. During the study of the quality of life of patients with AVNRT, we found that 48,8% had emotional changes related to the attacks of tachycardia. During the analysis of the psychological component of health, the decrease of the indicator of life activity (by 26,1%) that reflects the feeling of cheerfulness was observed. The decreased level of the indicator of the emotional-role functioning (by 31,5% lower compared with the clinical control) certifies about the presence of problems in patients (concern about health, decrease of mood), which have significant negative impact on their social activity and daily role activity [14].
Epidemiological data of the last decades shows a high occurrence of depressive, anxiety disorders in general medical and cardiology practice. The interrelation of stress, anxiety and depression in patients with cardio-vascular diseases has been known to researchers for long, but only in the recent years, this interrelation started being proved from the position of evidence-based medicine, where it is indicated that such disorders are one of the reasons of significant deterioration of QL of the patients, reduce the patients' adherence to treatment and affect their working and labor capacity[1; 5; 8; 11].
We did not find information about anxiety-depression states in patients with AVNRT in available literature sources.
The goal of the research is to assess the level of anxiety and depression in patients with AVNRT after radio-frequency catheter ablation.
Materials and methods. The study included 33 patients with AVNRT. Among them, there are 6 (18,2%) men, 27 (81,8%) women. The mean age was 38,6±13,2 (Me 37 years old; IQR 30,0-49,0). The arrhythmic anamnesis was 6,1±3,6 years (Me 6,5 years; IQR 2,8-9,0).
The control group included 24 almost healthy people (men — 7 (29,2%); women — 17 (70,8%)) aged 39,4±3,1 years (Me 40,5 years old; IQR 28,0-51,8) without structural pathology from the side of cardio-vascular system. The groups of the examined people were comparable by age and sex.
The procedures of IC EPS (intra-cardiac electrophysiological study) and RFA were conducted according to standard method. All stages of the research were performed consistently in the course of one operational session with the use of electrophysiological complex «Elkart II» (by «Elektropuls», Tomsk, Russia). Under local anesthesia Sol.Novocaini 0,5% — 40,0 ml and according to the Seldinger technique, the right jugular vein and the left femoral vein were punctuated, through which, with the help of introducers, 2 electrodes for EPS and RFA conduct in the position of CS and RVa were inserted in the cardiac cavity.
Initially, the sinus rhythm is registered on ECG. Them EPS was performed. Then, there was puncture of the right femoral vein, through which, ablation catheter was inserted into cardiac cavity and was installed in the area of slow passages of AVC. In this zone, the RF effects with the following parameters (T=50-55 C; P=25 Wt; electrode resistance I= 100-110 Ohm) were performed. During the conduct of RFA, slow nodal rhythm was registered. Then, control standard EPS was performed.
The presence and degree ofexpressiveness of anxiety-depression disorders was assessed with the help of the Hospital anxiety and depression scale. During the interpretation, the total indicator for every sub-scale was taken into account, defining three areas of its values: 0-7 — norm (absence of significantly expressed symptoms of anxiety and depression); 8-10 — sub-clinically expressed anxiety/depression; 11 and higher — clinically expressed anxiety/depression.
Statistical processing of changes of the evaluations of the QL was done with the help of computer programs STATISTICA 6 and Biostat. The quantitative indicators were presented in the form of M±SD, as well as the median (Me) and 25 and 75 percentiles (IQR). The differences between the groups were considered statistically significant at P<0,05.
Results and discussion. During the analysis of complaints, it was established that during the paroxysm, patients felt weakness (33,3%), uncontrolled attacks of anxiety (27,3%), vertigo (21,2%), feeling ofbaseless fear (18,2%), strong urges to urinate (6,1%), feeling of pulsation in the vessels of the neck (6,1%), unconsciousness (3,0%).
In more than half (54,5%) of patients, the factors causing the appearance of arrhythmia were not established; in 8 (24,2%) patients, the reason was physical stress (intensive activity, lifting and moving of heavy objects during construction and renovation works), herewith, half (50,0%) of them were young men ofworking age (from 21 to 50). 7 (21,2%) had stress and nervous overloads that cause arrhythmia.
The significant part of patients suffered from cardio-vascular system diseases: hypertonic disease was diagnosed in 13 (39,4%) patients, ischemic heart disease — in 6 (18,2%), chronic focal myocarditis — in 4 (12,1%); prolapse of mitral valve and chronic rheumatic heart disease were verified in 9,1% and 6,1% of patients respectively.
According to the data of the hospital anxiety and depression scale, the absence of anxiety state (clinical norm) before RFA was established only in 1 (3,0%) patient (Table 1.).
Clinically expressed anxiety was observed in significantly bigger number of patients (63,6%), than subclinical anxiety (33,3%; OR 3,64; 95% CI 1,30-10,2; p=0,02). The total indicator of the level of anxiety was 11,1±2,4 points and corresponded to clinically expressed anxiety.
The majority (66,7%) of patients had subclinical variant of depression. 8 (24,2%) patients had clinically expressed depression with insignificantly expressed reduction of mood and anxious concerns. The absence of the depressive symptoms was established in 3 (9,1%) patients. The total value of the level of depression accounted for 9,8±1,8 points and corresponded to the indicator of the sub-clinically expressed disorders.
The significant part (75,8%) of patients connects the state of anxiety with the attacks of heart-beating and interruptions in the heart operation, feeling of heart stop, with the need to self-limit in alcohol, coffee, strong tea, smoking as well as difficulties in realization of usual rest, house work, sport activities and hobby.
According to different authors, the presence of the anxiety establish the diagnosis of anxiety or depression disorder, but also and depression is an unfavorable factor in terms of prognostics in maximally fully reveal all psychopathological symptoms in every patients with cardio-vascular diseases. It is important to not only concrete patient [7; 8].
Table 1. - The expressiveness of anxiety and depression in patients with AVNRT
Parameters Before RFA, n=33 After 6 months, n=33 12 months, n=33
Abs. % Abs. % Abs. %
Clinical norm 1 3,0 28 84,8 33 100
Sub-clinical anxiety 11 33,4 5 15,2 - -
Expressed anxiety 21 63,6 - - - -
Total points 11,1±2,4 5,7±1,7 2,8±1,1
Clinical norm 3 9,1 31 93,9 33 100
Sub-clinical depression 22 66,7 2 6,1 - -
Expressed depression 8 24,2 - - - -
Total points 9,8±1,8 4,9±1,8 2,4±1,4
The disruptions of the rhythm of heart often limit the professional suitability and working ability of young patients without organic heart diseases [4; 9; 12].
Radio-frequency ablation (RFA) has been used for many years to treat various disorders of heart rhythm and has proved to be a highly effective and safe method. The advantage of this method of treatment is obvious, because in the successful ablation of the source of arrhythmia, the patient is cured from the disease for good [12].
During the conduct of the analysis of the psychological status of the patients after 6 months post RFA, we established the absence of the patients with clinically expressed anxiety and depression. Insignificant reduction of the number of patients with sub-clinical anxiety (15,2%; OR 0,36; 95% CI 0,11-1,18; p=0,15), and significant reduction of the share of patients with sub-clinical depression (6,1%; OR 0,03; 95% CI 0,01-0,16; p<0,0001) was registered. The total points of anxiety (up to 5,7±1,7 points; p<0,0001) and depression (up to 4,9±1,8 points; p<0,0001) decreased. The nor-
Thus, the application of RFA in AVNRT contributes to complete recovery and the patient does not have the need to continue anti-arrhythmia medicine, which leads to normalization of psychical
malization of psychical status was established in the majority of patients (anxiety in 84,8%; depression — 93,9%).
The test in accordance with the hospital anxiety and depression scale after 12 months showed that all patients had no significant symptoms of anxiety and depression. The total points of anxiety accounted for 2,8±1,1 points (p<0,0001), depression — 2,4±1,4 (p<0,0001).
In the course of the research, the frequency of occurrence of manifestations related to anxiety-depressive states was evaluated. The most frequently occurred symptoms of anxiety and depression included fear, anxiety. Inability to relax (Table 2.). The reduction of emotional well-being is related to the absence of pleasure from previous entertainments. Over the fourth of the patients noted inability to appropriately react to certain life situations. After 6 months post the conduct of RFA, the significant reduction of patients with the symptoms of anxiety and depression was observed.
status of patients (decrease of the feeling of anxiety/depression in 84,8%/93,9% respectively).
Table 2. - Frequency of occurrence of anxiety-depressive symptoms in patients with AVNRT
Parameters Before RFA, n=33 After 6 months, n=33 р
Abs. % Abs. %
Feeling of tension, fear and anxiety 31 93,9 22 66,7 0,01
Absence of vigor, inability to relax 30 90,9 20 60,6 0,01
Absence of pleasure from previous entertainments 29 87,9 16 48,5 0,002
Inability to appropriately react to any events and circumstances 9 27,3 2 6,1 0,05
Decrease of personal qualities 26 78,8 17 51,5 0,04
References:
1. Абдуллаева Т. И. Психологическая реабилитация инвалидов, больных ишемической болезнью сердца//Медико-социальная экспертиза и реабилитация. - 2001. - № 3. - С. - 13-17.
2. Ардашев А. В. Клиническая аритмология. - М., - 2009. - С 742-794.
3. Ардашев В. Н., Ардашев А. В., Лечение нарушений сердечного ритма. - М.: Медпрактика, - 2005. - 240 с.
4. Бокерия Л. А., Ревишвили А. Ш., Ардашев А. В. и др. Желудочковые аритмии. - Москва: Медпрактика. - 2002. - С. 272.
5. Гоштаутас А., Шинкарева Л., Густайнене Л.И др. Эффективность мероприятий по ранней психологической реабилитации больных ишемической болезнью сердца//Кардиология. - 2004. - № 7. - С. 35-39.
6. Кручина Т. К., Егоров Д. Ф., Татарский Б. А. Феномен и синдром Вольфа - Паркинсона - Уайта у детей: клинико-электрофизиологические различия//Вестник аритмологии. - 2011. - № 66. - С. 13-18.
7. Погосова Г. В. Признание значимости психоэмоционального стресса в качестве сердечно-сосудистого фактора риска первого порядка//Кардиология. - 2007. - № 2. - С. 65-72.
8. Скурихина О. Н., Миллер О. Н. Уровень тревоги и депрессии у пациентов с пароксизмальной и постоянной формами фибрилляции предсердий//Вестник аритмологии. - 2009. - № 55. - С. 14-18.
9. Стеклов В. И. Тахиаритмии сердца: стратегия диагностики, лечения и новые подходы к военно-врачебной экспертизе после радиочастотной аблации: автореф. дис. ... докт. мед. наук. - 2015. - 47 с.
10. Химий О. В., Желяков Е. Г., Конев А. В., Ардашев А. В. Рецидив типичной атриовентрикулярной узловой реципрокной тахикардии через 8 лет после радиочастотной катетерной абляции медленной части атриовентрикулярного соединения//Клиническая практика. - 2013. - № 3. - С. 44-48.
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DOI: http://dx.doi.org/10.20534/ESR-16-11.12-110-112
Yuldasheva Mokhigul Turdialievna, Tashkent Medical Academy, Uzbekistan E-mail: [email protected]
Effect on the experimental hypothyroidism morphological and morphometric parameters of thymus
Abstract: The aim of the work was to study the morphological and morphometric characteristics of the thymus at experimental hypothyroidism in adolescencerats. Experiments were carried out on rats weighing 70-80 g, hypothyroidism caused by adding food merkazolil in dose 0.5 mg/100 gbody weight for 14 days. Then the animals received during the month maintenance dose of the drug 0.25 mg/100 g body weight. Thymus was examined using morphological and morphometric techniques. It was found that long-term hypothyroidism contributes to a significant reduction in the area of cortical areas and a decrease in the density and ofthe mitotic activity of thymocytes. The degree of destruction of thymocytes significantly increases. Conclusion: Experimental hypothyroidism in the adolescence rats leads to inhibition of proliferation of thymocytes and increases their death in the thymus. Therefore, thyroid hormones play a key role in maintaining tissue homeostasis in the thymus in a postnatal ontogenesis.
Keywords: thymus, thyroid gland, Mercazolilum, thymocytes.
The urgency of the problem. In the process of evolutionary development of the organism there are new coordination mechanisms, leading to the formation of structural and functional relationships. These relationships enable the integration of the various organs and systems. The close relationship between the immune and endocrine systems is shown in several studies [1]. It has been established that various endocrine organs lesions are accompanied by certain immune changes in the body and, in turn, certain immune disorders lead to disturbances of the endocrine functions of the body [2; 3]. In this regard, the relationship of the thyroid with the immune system are particularly noteworthy. Clinical observations suggest that at the diseases of the thyroid gland in patients with various immune disorders develop, the severity of which depends on the level of thyroid hormones [4].
It was revealed that in patients with autoimmune thyroiditis in combination with hypothyroidism secondary immunode ficiencies are observed to varying degrees [5]. The change in the immune system generally correspond to the level of serum thyroid hormones. Reducing the level of thyroxine (T4) and triiodothyronine (T3),
often accompanied by a decrease in the total amount of co-lymphocytes change in the ratio of T-suppressor/helper, a violation of antibody processes and the emergence ofhigh-titer auto-antibodies [6; 7]. '
Objective. Identification of morphological and morphometric characteristics of the thymus in rats with experimental hypothyroid-ism caused in the prepubescent period.
Material and methods. The experiments were conducted on rats — males weighing 70-80 grams, which corresponded to the period of prepubescent or adolescent development. Rats were divided into three groups. Two groups of animals received the experimental diet Mercazolilum together with a dose of 0.5 mg. 100 gr. of body weight during the 14 days, then received within a month merkazolila maintenance dose of 0.25 mg. Per 100 g body weight. Further experimental groups of animals were divided into two subgroups. The first subgroup continued to receive merkozolil (short-term hypothyroidism). This class was used for the study of the natural regression of hypothyroidism in the juvenile period. Animals with similar body weight merkozolila instead received sterile
