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Comparative characteristics of clinical and functional parameters of rheumatoid arthritis, depending on the zone of residence
decrease in the shortening degree of the anterior-posterior size of the left ventricle into systole by 19.2% (p<0.01). Patients with MS differ by more severe manifestations of diastolic dysfunction as well, which as evident by the significant increase of RA in 2nd group (p<0.05) and the third group (p<0.01) patients within the slight decrease in PE, as well as a decrease in E/A ratio by 7.6% (p<0.05) and 19.5% (p<0.01), respectively. The disturbance of transmitral blood flow is associated with the increasing ofleft ventricular isovolemic relaxation time by 8.6% (p<0.05); 15.9% (p<0.01), as well as the deceleration time of early diastolic filling by13.4% (p<0.05) and 21.7% (p<0.01) in the 2nd and 3rd groups, respectively. The disorder of systolic and diastolic function of LV leads to strained work of the LA. The received data indicates that the changes revealed by the LV in patients without MS are not reflected on LA condition, while in patients with MS has an increase in its size. Herewith, if this figure in the second group is increased by 6.2% (p<0.05) in the third group the difference reached by 12.1% (p<0.01), which is out of range.
Thus, all patients with heart failure show the signs of structural and functional changes in the left ventricle and left atrium of the heart, the severity of which depends on the presence and severity of MS. The next stage of this work was to study the anti-remodeling efficiency of complex pharmacotherapy using the main set ofprepa-rations for the treatment of heart failure.
Conclusions:
1. The presence of metabolic syndrome in patients with chronic heart failure is an important factor reinforcing the pathological cardiac remodeling of LV.
2. The presence of metabolic syndrome in patients with chronic heart failure is an important factor progression of systolic and diastolic dysfunction of LV,
3. More pronounced changes in echocardiographic parameters are most manifested within the combination of DLP, AO and diabetes of 2 types.
References:
1. Laaksc M., Ronnemaa T., Mykkonen L. Insulin resistence syndrome in Finland. Cardiovascular Risk Faktors 1993; 344: 1: 44-50.
2. De Simone G., Paganisi F., Contaldo F. Link of non hemodynamic factors to hemodynamic determinants of left ventricular hypertrophy. Hipertention 2001; 38: 13-18.
3. Konradi А. О., Jukova А. V., Vinnik Т. А., Shlyakhto Е. V. Structural and functional parameters of the myocardium in patients with hypertension, depending on body weight, such as obesity and the state of carbohydrate metabolism. Arter. Hyper. 2002; 8: 1: 12-17.
4. Didenko V. А., Simonov Д. B.//Clinic. medicine. 1999; 6: 28-32.
5. Messery F. H. Left ventricular hypertrophy as a coronary risk factor.//Blood 1992;1: 28-30
6. Levy D. et al./New Engl. J. Med. 1990; 332: 1561-1566.
7. Oh J. et al. J. Amer. Society of Ehocardiograph. 1977; 10: 246-270.
8. Teicholz L. E., Kruelen T., Herman M. V. et al. Problems in echocardiographic volum determination.//Am. J. of Cardiol.1976;37:7-11.
9. Devereux R. B., Lunas E. M., Kasale P. M. et al. Standartization of M-mode echocardiographic left ventricular anatomic measurements. J. Amer. Col Cardiol. 1984; 4: 1222-1230.
10. Glebovskaya Т. D., Burova Kh.Kh., Soloveva Kh. V. The role of diastolic myocardial function in heart failure patients with metabolic syndrome, undergoing myocardial infarction-segment elevation ST.//Art. hypertension 2010; 2: 170-174.
11. Kamilova U. К., Rasulova Z. D., Ibabaekova Sh. R., Nurmamatova D. B. Effect of lisinopril and losartan on the processes of cardiovascular remodeling and renal function in patients with chronic heart failure.//Cardiology Uzbekistan. 2014; 3: 18-22.
Akhmedov Khalmurad, Tashkent Medical Academy Candidate of Science, assistant professor, Independent researcher, the department of training of the general practitioner
E-mail: khalmurad@rambler.ru Rakhimova Matluba, Tashkent Medical Academy Independent researcher, the department of training of the general practitioner Nargiza Abdurakhmanova, Tashkent Medical Academy Independent researcher, the department of training of the general practitioner Feruza Khalmetova, Tashkent Medical Academy Independent researcher, the department of training of the general practitioner
Comparative characteristics of clinical and functional parameters of rheumatoid arthritis, depending on the zone of residence
Abstract: Retrospective analysis shows that clinical and functional parameters of RA differs in four areas of Uzbekistan, which does not exclude the probability of the impact of climatic and geographical factors of the environment in the course of the disease. Keywords: rheumatoid arthritis, geographic zone.
Introduction. Climatic features of human habitat have always been the most important factor affecting to their health. If we detect any marked effect on human health among different environmental indicators, it became clear that the priority is the environmental factor —
up to 30%. Of these, pollution accounts for 20% and climatogeograph-ic conditions — 10% [1, 157-158]. Therefore, in this days it is obvious that the problems associated with the disease can not be considered without debate and without the features of the environment.
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Section 6. Medical science
Climatic factors, according to a study conducted under the auspices of the WHO, are treated as external risk factors that could adversely affect the functioning of all systems of the human body, as well as the 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 course of the rheumatic arthritis with adverse environmental factors [3, 68]. RA is a multifactorial disease in which the interaction of genetic component and environmental factors determines not only the disease but also its pronounced clinical polymorphism [4, 2206]. Worsening of disease occurs under the simultaneous influence of many climatic factors: solar radiation, atmospheric circulation and the number of local features of climate [5, 1747; 6, 7-8; 7, 86].
Till the now, Uzbekistan is the object of many works of medical and geographic focus, as Republic distinctive of its geographical location, climate and nature of the development of industry and agriculture. However, most of them studied separate group of diseases or separate regions or separate populations.
Thus, the problem of complex medical and geographical research, according to the different areas of our republic is not resolved, that determines the urgency of the problem.
The aim of this study was in example of RA to conduct a comparative analysis of the manifestations of the disease in various climatic and geographical regions of Uzbekistan.
Materials and methods. The comparative analysis was based on a retrospective study of outpatient's card and case record of patients. A total of 2013 patients with documented data in Khorezm with RA (n = 550), Surhandarinsoy (n = 498) and Namangan (n = 504), as well as the city of Tashkent (n = 461). In this work, an attempt was made to form conclusions about characteristics of the disease, depending on the place of residence of patients, using documentary evidence, which reflects the results of follow-up a large enough group of patients. Radiological evaluation was based only on x-ray images.
Statistical processing of the results of research carried out by methods of parametric statistics with calculation of the arithmetic mean value (M) and the mean square error (m). The significance of differences was assessed by Student's t test with Bonferroni correction.
Results and discussion of the data. The study of the dynamics of the main indicators of the disease in patients with RA. which based on retrospective analysis has shown that the disease can be characterized by two parallel operating factors: disease activity and progression of destructive changes in the joints. So, dynamics of disease activity over time, between the zones can be traced significant differences in the severity of articular syndrome. Thus, in the first year of the disease regions of different initial manifestations, zone III patients were significantly different (p <0.05) from other areas mostly original lesions of the proximal interphalangeal and wrist joints (82.5%), whereas patients zone IV differed significantly (p <0.05), mainly affecting the knee and hip joints (62.4%).
Retrospective evaluation of the dynamics of the joint changes on the basis of studying the rate of progression of radiographic changes carried out in the presence of X-rays images (n = 686). The average erosion in the small joints have appeared in patients of all zones an average of 1,53 ± 0,42 years from the onset of the disease. Formation of the radiological stage III occurred after an average of 3,1 ± 0,71 years, and stage IV — after 5,43 ± 0,53 years from the onset of the disease. If the patient at the end of 3rd year of follow-up was III or IV radiographic stage RA. or erosion in the joints have been detected within the first 1.5 years of onset (earlier than the average for the whole area), — progression considered fastly. In the absence of these signs it was considered a slow progression. As a result, from Fig. 1. shows that the group with rapid radiographic progression was II (63,5%; p <0.05) and IV zones (78.7%; p <0.05). At the same time patients zone III in 67.7% of cases there is a significant (p <0.05) slower radiographic progression.
Fig. 1. Levels of radiographic progression in RA patients
The combination of assessments of the dynamics of disease activity and radiographic progression has allowed distinguish the difference in the studied region (Table 1). In principle, patients can be released depending on the evaluation of these two factors; the activity can be assessed as a low and high and progression — slow and fast. According to the study documentation in patients who had initially low disease activity (1st degree), it is usually kept in the surveys over time (25.1%). For patients with 3rd degree activity has also been characterized by stability of this parameter: 76.8% high disease activity persisted, and only 23.2% activity has decreased. Among patients with 2nd degree of activity 59.4% of patients in the dynamics remained the same degree of activity, or it is periodically reduced to 1st degree, 40.6% of patients remained predominantly 2nd
degree of activity with the periodic rising up to 3rd degree.
In this regard, the dynamics of disease activity has been divided in two categories of patients:
1) patients with 1st degree of RA activity at baseline or with 2nd degree of activity without tendency to increase;
2) high (3rd degree) the activity of RA. or with 2nd degree of activity with its periodic increase to 3rd degree.
Thus, in evaluating the dynamics ofdisease activity and radiographic progression zone II and IV significantly, unlike other different “high or recurrent" activity with rapid radiographic progression (50.3% and 74.8%, respectively; p <0.05). As can be seen from Table 1, in 55.1% of patients zone III (p <0.05), there is activity as “low or moderate, with a tendency to reduce “ with slow radiographic progression.
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Creation of the informational model of toxic myocarditis occurred under the influence of pesticides
Table 1. - Dynamics of disease activity and radiographic progression of RA, depending on the zone of residence
Activity Regions X-ray progression
slow rapid
Low to moderate with a tendency to decrease (%) I zone (n=226) 44,2 *& 41,2*&
II zone (n=159) 10,7*$ 13,2*$
III zone (n=198) 55,1$ 26,7$
IV zone (n=103) 5,8& 3,9&
High or recurrent (%) I zone (n=226) 9,7*& 4,9*&
II zone (n=159) 25,8*$ 50,3*$
III zone (n=198) 12,6$ 5,6$
IV zone (n=103) 15,5& 74,8& J
Note: p <0.05 — significant differences of statistically significant indicators of the study: * — when comparing the I and II zones; # — when compared zones I and III; $ — when compared zones II and III; &- the comparison zones I and IV; ® — when compared zones II and IV; J — when compared zones III and IV.
In addition, a retrospective study allowed us to estimate the difference between the areas of extra-articular manifestations of rheumatoid arthritis. Thus, the frequency of occurrence of visceral forms zone II was 49%, and IV-zone — 56.5%, and the indicators for the presence of seropositive resulting composition in the same areas — 67% and 75%, respectively.
Human adaptation to the new conditions of the environment is characterized by stress regulatory mechanisms, that is, in particular, changes in the structure of biological rhythms of different functional systems ofthe body. From a number ofhuman physiological systems, which shows the particular laws of development of adaptive responses, least studied is the reproductive system. In the context of the general adaptive mechanisms to assume that changes in the functions of the reproductive system are secondary. No exception is that the climatic and geographical uniqueness ofvarious regions of Uzbekistan is also apparent in the adaptive changes in the reproductive system reproductive homeostasis. Therefore, in estimating the quality of the genetic health of the population under the influence of the negative effects of environmental pollution recently used indicators of reproductive
function. A retrospective analysis showed that in the zone IV dominated cases with reproductive disorders in 70.3% of cases opposite to 53.1% in the I zone (compared to the I zone p = 0.002) and 44.6% of the cases in zone III (in compared to III zone p = 0.0011). According to data recorded in the outpatient's card, the main among disorders of the reproductive system have been changes in the menstrual cycle, particularly algomenorrhea, oligomenorrhea, dysmenorrhea, metrorrhagia, and spontaneous abortion.
By studying certain indicators, it was found that among patients with II and IV areas dominated incidence with the need for treatment (39.7% and 42.4%, respectively) in one year, and among the patients I and III zones opposite dominated the event with longterm remission (41.7% and 61.2% respectively). In turn, patients of zone IV of significantly (p <0.05) is often consulted a doctor about the problem in the past 3 years, in average of 8,02 ± 2,4 times a year.
Conclusions: Retrospective analysis shows that clinical and functional parameters of RA differs in four areas of Uzbekistan, which does not exclude the probability of the impact of climatic and geographical factors of the environment in the course of the disease.
References:
1. Kelin N. Y., Bezruchko N. V. Assessing the impact of chemical pollution as a risk factor for human health. - Herald TSPU, 2010. № 3 (93). P. 156-161.
2. Rustamov N. M. Environmental indicators for monitoring the state of the environment in Uzbekistan//Environmental Indicators for Uzbekistan. Tashkent. 2006. P. 24-37.
3. Sinyachenko O. V Rheumatic diseases and environment//Ukr. revmatol. j. - 2007 30 (4). P. 64-68.
4. McInnes I. B. The pathogenesis of rheumatoid arthritis//I. B. McInnes, G. Schett//New Engl. J. Med. - 2012. - Vol. 365. - P. 2205-19.
5. Dilaveris P., Synetos A.//Heart. - 2006. - Vol.92, № 12. - P. 1747-51.
6. Savin V. P., Gudkov A. B., Popov ON. Characteristics of the main risk factors for health problems of people living in areas of active wildlife in the Arctic. - Human Ecology. 2014. P. 3-10.
7. Yanbaeva H. I. Sketches of Cardiology hot climate II//Clinical and environmental aspects. - Tashkent: Publishing. Abu Ali Ibn Sina. 2003. - 86 p.
Akhmedova Sayora Muhamadovna, Senior researcher Department of Human Anatomi, Faculty of Pediatrics, Samarkand State Medical Institute, Uzbekistan, E-mail: sayyora-76@mail.ru
Creation of the informational model of toxic myocarditis occurred under the influence of pesticides
Abstract: Creation of productive knowledge is important whereas on the base of this knowledge we can diagnose morphologic and morphometric properties of vascular stromal tissues of myocardium under toxic myocarditis on the bases of clinical symptoms. Consequence of this is a proper therapeutic strategy that will have a life importance for the patients.
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