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Hygienic assessment of long-term dynamics of the quality of water supplied to the population with centralized...
Proposed revisions in the organization of care for patients with of treatment and reduce the cost and improve the quality of life of
stenosing carotid artery will significantly increase the effectiveness patients.
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1. Karimov S. I., Ghazanchian P. O., and others. The results of the reconstruction of the carotid arteries in patients with ischemic stroke//Jour. Problems of Biology and Medicine № 3 (49) 2007 3.
2. Belousov Y. B., Belousov D. Y., Afanasyev E. V. and others. Predicting the effect of statins on direct medical costs for secondary prevention in patients at high risk for cardiovascular disease. Qualified clinical practice in 2011; 1: 97-115.
3. Parfenov V. A., Verbitskaya S. V. International recommendations for the secondary prevention of ischemic stroke and their implementation in outpatient practice. Neurology, neuropsychiatry, psihosomatology. 2011 (1), 16-21.
4. Kucherenko S. S. Carotid endarterectomy and carotid stenting: the pros and cons. Bulletin of Russian Military Medical Academy. 2011; 3 (35): 220-5.
5. Kulikov A. Y. Practical aspects of quality oflife assessment. Report on V congress with international participation pharmacoeconomics and pharmacoepidemiology «Razvitie in RF », 1 March 2011, Samara.
6. Gavrilenko A. V., Sandrikov V. A., Ivanov V. A.and others. Carotid endarterectomy or carotid stenting: the choice of optimal treatment of patients with carotid stenosis. Angiology and vascular surgery. 2011; 17 (2) 70-7.
7. Kavteladze Z. A., Bylov KV, Drozdov S. A.and others. Carotid stenting or endarterectomy. International Journal of interventional cardiology. 2011; 24: 53-4.
8. Brott T. G., Co-Chair, Halperrin J. L. et al. ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients WithExtracranial Carotid and Vertebral Artery Disease. Circulation, 2011; 124: 489-532.
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11. Brott T. G., Hobson R. W. 2nd, Howard G. et al. Stenting versus endarterectomy for treatment of carotid-artery stenosis. CREST. N Engl J Med 2010; 363 (1): 11-23.
Atakhanova Dilbar, Nukus branch of the Tashkent Pediatric Medical Institute, teacher E-mail: dilbar.atahanova@mail.ru
Hygienic assessment of long-term dynamics of the quality of water supplied to the population with centralized and decentralized water supply
Abstract: On the basis of long-term dynamics of the quality of water supplied to the population with centralized and decentralized water supply of the Republic of Karakalpakstan, in assessing the levels of water pollution by chemical parameters as a risk factor for the population as a priority indicator index in terms of Karakalpakstan, can use the amount of total hardness of drinking water 7.0 or 10.0 mEq/l (depending on the presence or absence of structures for special treatment of tap water).
Keywords: water quality, water supply utilities, departmental water supply, sources of decentralized water supply.
The analysis of materials of many literary sources revealed that the majority of the authors of works devoted to the study and assessment of the sanitary conditions ofwater population of Karakalpakstan (RK), notes serious shortcomings of domestic water supply and often inadequate O'zDST 950-2011 quality of drinking water used by the population, which leads to higher levels of morbidity. At the same time it noted the insufficient coverage of the population (especially in rural areas), centralized water supply systems [1, 15-17; 2, 76; 3, 19; 4, 81].
According Madreimova A. et al. [5, 229-231; 6, 17-19; 7, 227229], the overall security of the population of the RK tap water is 60% (in urban areas — 72%, in rural areas — 47%). These figures indicate that about 40% of the RK use water from open reservoirs and wells (respectively 28% in the cities, rural areas — up to 59%).
Sanitary situation is complicated by the fact that, according to the same authors, Specific gravity of non-standard water samples in all of these sources — 44.8%, in open water — 49.7%; wells —
76.8%. Bacteriological quality of the water is much better — the proportion of non-standard water samples are respectively 3,8-9,85,2%.
These numbers suggest that the sanitary evaluation of the quality of water used by the population of RK, priority have chemical pollution of water, which are major risk factors for the population because of the possibility of occurrence of diseases such as fluorosis and dental caries, cholelithiasis and urolithiasis, some other nosological forms of non-infectious diseases.
In the study of conditions and the state of the water supply of Karakalpakstan should be considered division of its territory into 4 zones with different population densities.
In the southern zone of the RK (Turtkul, Biruniy, Amudarya and Ellikkala district) population density is more than 3 times higher than the republican level. For the coastal zone (Muinak district) is characterized by an absolute and relative decrease in population. In the northern zone (Kungrad, Kegeyli, Chimbay, Karauzyak,
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Takhtakupyr and Qonlikol district) population density is also significantly lower than the national level (3 times). Most constantly increasing population densities observed in the central zone (Nukus, Hodzheyli, Shumanay areas, and the city of Nukus and Takhiatash), which for the past 10 years has increased by almost 2 times [10, 84].
According to A. Madreimov et al [8, 30-35; 9, 107-108] the population density was along the southern zone — 33.3; at center — 201.1; for the northern zone — 4.0; by Muinak area (Maritime Zone) — 0.7 people per 1 sq.km. area. Moreover, in these zones, respectively, resides 38,7-34,1-26,3-1,8% of the population. The above data is largely defined the main directions and study the characteristics of our research in the analysis and evaluation of sanitary data reporting forms № 18 Republican Centre of state the sanitary-epidemiological inspection (RCSSEI) for 2005-2010. The divisions of water hygiene and public water supply, sanitary protection of water sources, morbidity.
Objective: hygienic assessment of long-term dynamics of the quality of water supplied to the population with centralized and decentralized water supply RK.
Materials and methods: The subjects ofresearch were studied following characteristics: the degree of water pollution open reservoirs, including Tuyamuyun reservoir; sanitation water consumption of the population; the quality of tap water on the population; the quality of groundwater and the main water sources of decentralized water supply (wells);
All studied sanitary characteristics studied in the long-term dynamics of the time series of at least 5 years (2005-2010).
Research methods varied depending on the task, and was based on the study, generalization and analysis of emerging sanitary and epidemiological materials, their statistical and mathematical processing.
Studies have been conducted at the Department of “Hygiene and Epidemiology" Nukus branch of the Tashkent Pediatric Medical Institute.
When analyzing the data on the hygienic characteristics of the water source of centralized water supply (open reservoirs and wells) were evaluated data characterizing the odor, color and turbidity of the water, pH, iron, fluorine and manganese, permanganate oxidation, the number of coliform bacteria in 1 liter water. Assessment of the degree ofwater pollution ofwater sources with the division into 3 classes are conducted in accordance with O'zDST 951-2011 [11]. In assessing the data on drinking water quality of municipal and departmental water supply systems specified in the reporting material of RCSSEI, took into account the standards O'zDST 950-2011 [12]. Hygienic assessment of water quality of wells, the water is not supplied to the water system, also taken into account the requirements of Sanitary norms and rules (SanNandR) of Uzbekistan № 0182-05 [13]. In the study and assessment of water supply have been used performance proportion of the population receiving drinking water from centralized and decentralized economic drinking water supply, as well as the proportion of non-standard water samples (in percent) from different water sources.
In order to ensure the simultaneous complex hygienic assess-
ment of pollution levels of the above objects of the environment in different territorial areas of Karakalpakstan were selected 4 test (pilot) areas: Chimbay (North Zone), Nukus (central zone), Beruni (southern zone) and Muinak (Maritime Zone).
The development had taken the records on the activities of the RCSSEI in form № 18 for 2009-2014yy.; statistical data on the activities of health institutions of the Republic of Uzbekistan (2002, 2009, 2014yy.), demographic data of the State Statistics Committee of Uzbekistan and RK and newsletters of hygiene, ecology and health of the population for 2010, 2011, 2012yy.
Research methods varied depending on the task, mainly included the analysis and generalization of the above sanitary and epidemiological materials, their statistical processing and hygienic assessment with the requirements of SanNandR, guidance documents approved by the Ministry of Health of Uzbekistan since 1991.
Data obtained in the study were subjected to statistical analysis on a PC Pentium IV processor with a software package Microsoft Office Excel 2003, including the use of built-in functions of statistical processing [14, 201-205; 15, 143].
Results: In the study, and sanitary assessment of drinking-water supply of the population in Karakalpakstan, we found it necessary to distinguish three main types of water use: municipal water supply, departmental water supply and sources of decentralized water supply.
In the study period in the territory of RK functioning 1617 public water, mostly on surface water sources of which are 4-6 water pipes did not meet sanitary requirements.
As can be seen from the data presented in Table 1 below, in the public water located on surface water sources, Specific gravity of non-standard drinking water samples for chemical indicators fluctuated quite considerably over the years, from 23.23% in 2006 to 45.27% in 2008 (Annual average over 5 years was 32.6 + 4.72%). Specific gravity of non-standard samples for bacteriological parameters was, on the contrary, quite stable: from 2.26 to 2.92%, and 5 years was at 2.03 + 0.14%.
On a single public water that uses underground water sources, Specific gravity of non-standard samples was lower for chemical and bacteriological: 19,13-23,15%, respectively (for 5 years 21.17 ± 0.9%) and 0.42 -5.45% (for 5 years 1.74 ± 0.1%).
In the study period on the territory of Karakalpakstan functioned in different years from 35 to 41 departmental water supply systems on surface water sources and from 65 to 89 on groundwater. At the same time, the quality of drinking water supplied by public water pipes departmental differed in terms of the proportion of nonstandard samples of water quality public water slightly both chemical and bacteriological.
In particular, departmental water supply systems on surface water bodies, the figure for the year ranged from 18.36 to 55.68% according to the results of chemical analyzes, and from 0.7% to 6.07% — for bacteriological analysis. At the departmental water supply systems in underground waters, the figure was, respectively, from 22.6 to 38.59% and from 2.3 to 5.12% (Table. 1).
Table 1. - Sanitary-hygienic characteristics of public water RK on non-standard specific gravity of samples Percentage calculated on the reporting form № 18 for the 2006-2010 yy.
№ Name of indices 2006y. 2007y. 2008y. 2009y. 2010y. М+m for 5 years
1. Water su pplies in surface sources
1.1. Total number 16 16 16 17 17 -
1.2. Does not meet the sanitary requirements 6 5 4 6 1 -
1.3. Number of samples research for chemical performance 5755 6334 7867 8122 7013 35091
1.4. Of these, does not meet hygienic standards 1337 2000 3562 2755 1789 11443
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Hygienic assessment of long-term dynamics of the quality of water supplied to the population with centralized...
1.5. Specific gravity of non-standard samples% 23,23 31,57 45,27 33,92 25,50 32,60+4,72
1.6. Number of samples research for bacteriological performance 4596 5535 7314 7378 6218 41172
1.7. Of these, does not meet hygienic standards 104 155 214 197 166 836
1.8. Specific gravity of non-standard samples% 2,26 2,80 2,92 2,67 2,66 2,03+0,14
2. Water supplies in underground sources:
2.1. Total number 1 1 1 0 1 -
2..2. Does not meet the sanitary requirements 0 0 0 0 0 -
2.3. Number of samples research for chemical performance 602 533 628 0 570 2333
2.4. Of these, does not meet hygienic standards 125 102 135 0 132 494
2.5. Specific gravity of non-standard samples% 20,76 19,13 21,49 0 23,15 21,17+0,90
2.6. Number of samples research for bacteriological performance 638 468 495 0 576 2177
2.7. Of these, does not meet hygienic standards 6 2 27 0 3 38
2.8. Specific gravity of non-standard samples% 0,94 0,42 5,45 0 0,52 1,74+0,1
These data show that the proportion of non-standard parameters of drinking water samples in the departmental water supply systems that use surface and underground water sources, were almost identical for both chemical parameters (average over 5 years 34.0 + 8.80% and 27.31 +3, 43%) and bacteriological (average over 5 years 3.14 + 1.15 and 3.53 + 0.60%).
Research has shown that the quality of water obtained from the public water supply systems, decentralized, using both surface water reservoirs 1 and 2 categories, as well as underground water, on such an important indicator of the indicating Specific gravity of
non-standard samples is significantly worse than in the municipal and departmental running water.
Thus, the average rate for 5 years when microbiological studies with non-centralized water used by people from surface water reservoirs 1 category reached 21.26 + 2.45% from surface water reservoirs 2 categories 29.30 + 18.81% from underground water sources (wells) 5.39 + 0.70%. When chemical research, these figures were large, accounting for 40.52 + 3.02%, 49.26% and 4.12 + 67.31 + 3.37% (Table. 2).
Table 2. - Sanitary-hygienic characteristics of departmental water supply systems of RK to the specific gravity of non-standard samples as a percentage calculated by form № 18 for 2006-2010.
№ Name of indices 2006y. 2007y. 2008y. 2009y. 2010y. М+m for 5 years
1. Water supplies in surface sources
1.1. Total number 35 35 41 39 39 -
1.2. Does not meet the sanitary requirements 1 0 0 0 0
1.3. Number of samples research for chemical performance 719 896 704 705 914 3938
1.4. Of these, does not meet hygienic standards 215 350 392 243 177 1339
1.5. Specific gravity of non-standard samples% 29,9 39,06 55,68 34,46 18,36 34,0+8,80
1.6. Number of samples research for bacteriological performance 682 1105 788 1115 796 4486
1.7. Of these, does not meet hygienic standards 5 33 55 16 32 141836
1.8. Specific gravity of non-standard samples% 0,7 2,98 6,07 1,43 4,02 3,14+1,15
2. Water supplies in underground sources:
2.1. Total number 65 65 82 89 85 -
2.2. Does not meet the sanitary requirements 1 2 3 3 2 -
2.3. Number of samples research for chemical performance 1129 1362 1306 1335 1274 6406
2.4. Of these, does not meet hygienic standards 259 344 504 355 288 1750
2.5. Specific gravity of non-standard samples% 22,9 25,25 38,59 26,59 22,60 27,31+3,43
2.6. Number of samples research for bacteriological performance 1171 1325 1405 1333 1156 6390
2.7. Of these, does not meet hygienic standards 27 50 72 46 31 226
2.8. Specific gravity of non-standard samples% 2,3 3,77 5,12 3,45 2,68 3,53+0,60
Thus, our studies related to the analysis of the data reporting forms № 18 RCSSEI and the calculation of indicators Specific gravity of non-standard drinking water samples obtained populations from different water systems, allow us to consider the risk factors for the health of the population the following indicators: on the municipal and departmental water supply systems, as well as water use from wells — the deterioration of the chemical quality of the water; if water use from surface water reservoirs 1 and 2 category — the deterioration of the chemical and microbiological quality of water.
To confirm this conclusion in the chosen areas experienced in 2013, studies were carried out of water used by the population of the municipal and departmental water pipes and wells, with a total hardness of the water and its content of chlorides.
The results showed that we used measure the chemical quality of drinking water (total hardness) is a priority indicator value in terms of Karakalpakstan, as even the average value of this indicator in Beruni district exceeded the norm OzDST 950-2011.
In the same area has been exceeded the permissible norm the content of chlorides in the water, as the average value of this indi-
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cator amounted to municipal water and departmental water pipes 367.2 + 22.4 mg/l (with a special weight of non-standard water samples 80.0 and 60.0%), and water wells — 367.6 + 30.4 mg/l (with weight of non-standard samples of 60.0%).
In the Muinak district the magnitude of total hardness of the water in the wells studied ranged from 8.1 to 13.1 mEq/L, and the
average value was 11.66 + 1.07 mEq/L (with a special weight of non-standard water samples on this indicator at 80.0%).
Thus, in assessing the levels of water pollution by chemical parameters as a risk factor for the population as a priority indicator index in terms of Karakalpakstan, you can use the value of the total hardness of drinking water at 7.0 or 10.0 mEq/L (based on availability or lack of facilities for the special treatment of tap water).
Table 3. - Sanitary-hygienic characteristics of the water sources of decentralized water supply of the population of RK to the Specific gravity of non-standard samples as a percentage calculated by 18/0 reporting forms for 2009-2013
№ Name of indices 2009 y. 2010 y. 2011 y. 2012 y. 2013 y. М+m for 5 years
1. Surface waters 1 category:
1.1. Number of samples research for microbiological performance 952 2446 1372 2227 2209 9206
1.2. Of these, does not meet hygienic standards 144 451 268 591 504 1958
1.3. Specific gravity of non-standard samples% 15,1 18,43 19,53 26,53 21,82 21,26+2,45
1.4. Number of samples research for chemical performance 1410 1372 1255 1550 1302 6889
1.5. Of these, does not meet hygienic standards 516 661 624 540 451 2792
1.6. Specific gravity of non-standard samples% 36,55 48,17 48,72 34,83 34,63 40,52+3,02
2. Surface waters 2 category:
2.1. Number of samples research for microbiological performance 2459 1235 711 1414 1130 6949
2.2. Of these, does not meet hygienic standards 256 426 104 570 687 2043
2.3. Specific gravity of non-standard samples% 10,4 34,49 14,62 40,31 60,79 29,39+18,81
2.4. Number of samples research for chemical performance 387 532 393 345 507 2164
2.5. Of these, does not meet hygienic standards 223 231 218 199 195 1066
2.6. Specific gravity of non-standard samples% 57,6 43,42 55,47 57,68 38,46 49,26+4,12
3. Groundwater sources (wells, springs):
3.1 Number of samples research for microbiological performance 2763 2838 3055 2999 2536 14192
3.2. Of these, does not meet hygienic standards 166 210 163 123 104 766
3.3. Specific gravity of non-standard samples% 6,0 7,39 5,33 4,10 4,10 5,39+0,70
3.4. Number of samples research for chemical performance 3844 2734 2747 3279 2910 155,4
3.5. Of these, does not meet hygienic standards 2675 1901 2097 2068 1763 10444
3.6. Specific gravity of non-standard samples% 69,5 69,53 76,33 63,06 60,58 67,31+3,37
Table 4. - Water quality used by population in experimental areas and Specific gravity of nonstandard samples (as a percentage) of the different systems of water supply (2010 y.)
№ Name of water supply systems and the study of quality indicators Beruni (southern zone) Chimbay (north Zone) Muinak (Maritime Zone)
1 2 3 4 1 2 3 4 1 2 3 4
1. Municipal water pipes:
1.1. Total hardness, mg-eq/L 6,5 15,2 12,7+0,9 90,0 6,6 10,5 9,93+1,07 80,0 7,6 7,9 7,76+0,06 0
1.2. Chloride, mg/L 226,0 439,0 367,2+22,4 80,0 219,0 325,0 301,9+22,7 0 253,0 280,0 266,6+5,79 0
2. Departmental water pipes:
2.1. Total hardness, mg-eq/L 4,5 16,0 10,6+1,2 60,0 7,4 8,6 7,07+0,1 0 - - - -
2.2. Chloride, mg/L 134,0 421,0 259,6+31,0 0 240,0 298,0 265,2+4,6 0 - - - -
3. Wells:
3.1. Total hardness, mg-eq/L 14,1 15,5 14,7±0,2 100,0 7,9 8,3 8,18+0,08 0 8,1 13,1 11,66+1,07 80,0
3.2. Chloride, mg/L 287,0 429,0 367,6+30,4 60,0 250,0 270,0 258,4+4,29 0 255,0 304,0 290,2+1,05 0
Note: 1-minimum figures; 2-maximum figures; 3-averages from investigated samples; 4-Specific gravity of non-standard samples (as a percentage)
Conclusions:
The main risk factor for the population is the deterioration of the chemical and, if water use from surface water reservoirs 1 and 2 category — further deterioration of the microbiological quality of water;
Given the high rates of Specific gravity of non-standard drinking water samples on the population of Kazakhstan, even when using municipal and departmental water pipes, as a priority indicator should be used, respectively, the overall performance and if the water hardness index ofvalues O'zDST950: 2011 “Drinking water"
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Anti-remodeling efficiency of preparations such as perindopril, veroshpiron and bisoprol applied to patients,..t
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Atakhodzhaeva Gulchekhra Abdunabievna, PhD, the assistant of department of faculty therapy of Tashkent Pediatric Medical Institute, Uzbekistan, E-mail: atakhodzhaeva@list.ru. Rakhimov Shukhrat Malicovich, PhD, professor of department of faculty therapy of Tashkent Pediatric Medical Institute, Uzbekistan.
Anti-remodeling efficiency of preparations such as perindopril, veroshpiron and bisoprol applied to patients with chronic heart failure and metabolic syndrome
Abstract: The aim ofthis work is to study the anti-remodeling efficiency of complex pharmacotherapy of CHF by use of perindopril, veroshpiron and bisoprolol in patients with MS. The study involved 76 male patients with chronic heart failure (CHF) II-III FC, with post infarction cardiosclerosis. Depending on the components of MS the patients were divided into 3 groups: Ist group (n=27), patients without MS; Group II (n=24), patients with a combination of dyslipidemia (DLP) with abdominal obesity (AO) and arterial hypertension (AH); Group III (n=25), patients with a combination of AD, AH and DLP with diabetes 2 types. A three-month treatment with an implement of the Perindopril, Bisoprolol and Veroshpiron combination in patients suffering from CHF without MS promotes regression of non-adaptive remodeling of myocardium and improvement of systolic and diastolic function of the heart. The MS in patients with chronic heart failure reduces the anti-remodeling effectiveness of the combined application of Perindopril, Bisoprolol and Veroshpiron, which depends on the representation of its components. The most marked resistance against therapy exists, when there is a combination of AO, AH and DLP with diabetes of 2 types.
Keyworlds: chronic heart failure, metabolic syndrome, systolic and diastolic left ventricular dysfunction.
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