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Section 5. Medical science
sorbents: dietary fibers, alginates, collagen, mucus, zeolites, chitin. They also enhance intestinal motility, reducing effective period of absorption of xenobiotics. Absorption of foreign substances in the gastro-intestinal tract and the extent of their receipt of the internal environment of the body depends on several factors: the residence time of food in the intestine, condition of membrane of enterocytes, the activity of the enzymatic digestion, the nature of the microbiota and the chemical composition of the diet. The latter implies the possibility of existence of different types of interaction between xenobiotics and nutrients: competitive, synergistic or neutral flowing in the cavity space and on biological membranes, in the cytosol of cells.
Conclusions
1. In the daily diet of workers at the enterprise for manufacture of quartz product, dairy products, meat, fish and chicken 12-50 % lower hygienic standards, particularly the significant deficiency noted in the relationship of essential amino acids (methionine, tryptophan, phenylalanine, lysine, leucine, tryptophan) at 40-55 % below normal.
2. The workers in the workshops for the production of glass of conditions by Norm and rule sanitary № 0141-03 class 2-3-4 degree of danger, in the shops of the RMC and ICC conditions 3.3 and 3.4 of class and severity.
3. The value of basal metabolism for men is 1665 kcal., for women 1580 kcal., specific dynamic action of food is 165.7 kcal. for men, to 158.5 kcal. for women, total energy value 4110 kcal. for men, for women 3941.
Protein 57 g., fat 51 g. carbohydrates: 170 g., calories 1200 kcal. It is proposed to enrich the composition of the diet on 2-categories meat, liver, fish, dairy, produktami, suzma and vegetables.
4. For glass production, blocking in some way the absorption of xenobiotics, primarily recommended natural non-specific sorbents: dietary fibers, alginates, collagen, mucus, zeolites, chitin. They also enhance intestinal motility, reducing effective period of absorption ofxenobiotics. Works in reducing the entry ofxenobiot-ics into the body.
References:
1. Guidelines for the assessment of the quantity of food consumed by method 24-hour recall. No. with 1-19. - M., 1996.
2. Tursunbaev To. Hygienic substantiation of preventive nutrition working on Almalinskogo mining and metallurgical combine (AGMK). Author. dis. ... candidate. honey. Sciences. - Tashkent, 2008. - 21 p.
3. Timokhin D. I., Istomin A. V., Shushkova T. S. and other. Questions of hygienic rationalization of medical-preventive nutrition of industrial workers//Zhurn. Gig and San. - 1997. - № 2. - S. 19-21.
4. Korolov A. Food Hygiene. - Moscow, 2008. - 568 p.
5. Grebneva O. V., Balaeva, E. A. Individual features of professional adaptation of women employed in industry//Hygiene and Sani. -Tarii, 2007. - No. 1. - P. 39-41.
6. Brennan P., Boffetta P. et al. Occupation and lung cancer risk in Central and Eastern Europe: the IARC multicentre case-control study// Cancer Causes Control. - 2007, Aug. - 18(6). - P. 645-654.
7. Richiardi L., Boffetta P., Simonato L., Forastiere F., Zambon P., Fortes C., Gaboricau V., Merletti F. Occupational risk factors for lung cancer in men and women: a population-based case-control study in Italy//Cancer Causes Control. - 2004, Apr. - 15(3). - P. 285-294.
8. Olsen R., Thorud S., Hersson M., Ovrebn S., Lundatics E., Greibrokk T., Ellingsen I. G., Thomassen V., Jvlolander P. J. Determination of the dialdehyde glyoxal in workroom air-development of personal sampling methodology//Environ Monit. - 2007, Jul. - 9(7). - P. 687-694.
9. Apostoli P., Sarnico M., Bavazzano P., Bartoii D. Arsenic and porphyrins//Am J Ind Med. - 2002, Sep. - 42(3). - P. 180-187.
Akhmedov Khalmurad, Tashkent Medical Academy, Candidate of Science, assistant professor, Independent researcher, the department of training of the general practitioner E-mail: khalmurad1968@mail.ru Rakhimova Matluba, Abdurakhimova Lola, Abdurakhmanova Nargiza, Khalmetova Feruza, Independent researchers, the department of training of the general practitioner
Influence of xenobiotics on the course of rheumatoid arthritis
Abstract: The results of disperse analysis indicated degree of contamination of air and soil by xenobiotics. It depended on the clinical, radiographic and sonographic signs of articular syndrome in RA.
Keywords: rheumatoid arthritis, articular syndrome, ecologic factors, climate geographic zone.
Climatic peculiarity of human habitat have always been the most important factor which affect to health. When marked effects of different environmental indicators to human health, it became clear that the priority of environmental factor composes — up to 30 %. Of these, pollution accounts about 20 % and climate geographic conditions — 10 % [1, 157-158]. Therefore, it is obvious that the problems associated with the disease can not be considered without debate and features of the environment.
Geographical factors, according to a study conducted under the auspices of the WHO are estimated as external risk factors that could adversely affect to functioning of all systems of the human body, as well as the to 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 and future features of rheumatoid arthritis with unfavorable environmental factors [3, 68]. RA is a multi factorial disease in which the interaction of genetic
Influence of xenobiotics on the course of rheumatoid arthritis
component and environmental factors determines not only the disease but also its pronounced clinical polymorphism [4, 2206]. Weighting of disease occurs under the simultaneous influence of environmental factors [5, 1747; 6, 7-8; 7, 86].
To date, Uzbekistan is the object of many investigations of medical and geographic directions, as Republic is distinctive by its geographical location, climate and nature of the development of industry and agriculture. Moreover, special attention should be paid to the environmental problem in certain areas of the Republic. As is known, deterioration of the nature does not occur immediately or instantly, this process is observed for a long time, in other words, the environmental situation gradually accumulates. The big environmental problem in Uzbekistan is the high degree of soil salinity. The real threat was extensive contamination of soil by various types of industrial and household wastes. One of the major problems is the quality of water resources, the problem of the disappearance of the Aral Sea and the threat of ecological safety in the country and contamination of air space. Our Republic of Uzbekistan is located in the arid zone and characterized by the presence of major natural sources of atmospheric dust as the Karakum and Kyzylkum deserts with frequent dust storms [8, 78]. Therefore, we believe that actual study in this field, particularly in matters of environmental rheumatology, in particular on the issues of RA in various climatic and geographical regions of Uzbekistan. We are interested in properties of development and duration of RA associated with environmental factors.
The aim of this study was evaluate the influence of environmental factors to articular syndrome in patients from various regions of Uzbekistan.
Material and Methods
The study is included 460 patients with a documented diagnosis of RA at the age of 50.6 ± 9.1 years, disease duration 9.9 ± 4.7 years:
1) I area, the northern region — Tashkent — 144 patients;
2) II region, the western region — Khorezm region — 112 patients;
3) III region, the eastern region — Namangan region — 104 patients;
4) IV area, the southern region — Surkhandarya region — 100 patients.
These hygienic assessment of environmental pollution, in particular xenobiotics in its three objects — air, soil and water (surface water and underground water sources) were obtained as a result of laboratory tests of sanitary stations, government offices of regional committees in the field of hydrometeorology, control of natural condition and environmental safety, as well as governmental Committee of Uzbekistan by protection of nature. Total emissions of air pollutants from stationary and mobile sources characterize the general anthropogenic load to the air. According to these data, the level for 5 years in the atmospheric emissions to the area of the experimental zones includes following:
- in the I area for the year was 302.76 ± 96.12 t/km2, to 1 patient with RA — 17.2 ± 29.16 kg.;
- in the II area of 81.2 ± 16.2 t/km2, to 1 patient with RA — 31.2 ± 1.8 kg.;
- in the III area 68.51 ± 11.4 t/km2, to 1 patient with RA — 9.1 ± 1.1 kg.;
- in the IV area of 90.5 ± 8.9 t/km2, to 1 patient with RA — 35.1 ± 3.4 kg.
Using of integral indicators of environmental burden to the atmosphere (y), water (ff) and soil (w), compared them with clinical signs of RA. (F) on the number of patients and with integral criterion in the study areas of Uzbekistan (G).
Statistical analysis of the results of research carried out by computer variations, correlation, one (ANOVA) and multivariate (ANOVA/MANOVA) dispersion analysis (programs «Microsoft Excel» and «Statistica-Stat-Soft», USA). We evaluated average values (M), their errors (m), the standard deviations (s), the correlation coefficients (r), the criteria of dispersion (D), the Student (t), Wil-coxon - Rao (WR), x2 McNemar - Fisher and reliability of statistical parameters (p).
Results and discussion
Among the studied patients predominance women — 336 (93.3 %). 85 (18.5 %) patients suffered from this disease less than 5 years, from 5 up to 10 years — 255 (55.4 %), and more than 10 years — 120 patients (26.1 %). Drug remission was determined in 80 patients (17.4 %), the activity is preserved — in 366 patients (79.6 %). Poly arthritis were in 440 patients (95.7 %). Systemic manifestations were detected in 269 patients (58.5 %). In addition to the articular syndrome, the most frequent complaints were general weakness (65.2 %), irritability, sleep and attention disorders (56.5 %), restlessness and anxiety (65.2 %), low-grade fever (39.1 %). Almost all RA patients had signs of anemia of chronic inflammation.
The results of our analysis establishes the impact of the degree of environmental pollution by xenobiotics air y to the w soil, as well as direct correlation w with integral parameter of contamination of groundwater and drinking water cr. There are significant positive correlations with the degree of w plant emissions of harmful substances into the atmosphere, with a level of accumulation in the regions of industrial waste and fluoride chloride (FH) load by xenobiotics, sulfates and phosphates in drinking water. At the same time the degree of dust y depends on w salinity (r = 0.76; p = 0.032).
It is known that the content of substances in the soil enters into the human body through the vegetable and animal food. In turn, plants and animals are supplied by micronutrients from the soil [9, 72]. Thus, the composition of minerals in the soil has a positive or negative effect to the human body, thereby specifically affects to duration of diseases, in particular to RA [3, 66]. Especially, human activity and anthropogenic impact influence to the composition of the soil. Thus parameters G influence to the levels in the soil zone of residence ofpatients with RA. as toxic microelements as nickel, aluminum and fluorine, and sulfates, which shown results from one factor dispersion analyses. Indicators G directly correlated with the content in the soil of nickel and aluminum fluoride (r = 0.69; r = 0.77; r = 0.71) and backwards — with concentrations of zinc (r = -0.66).
According to ANOVA integral indicator of soil contamination with nickel w significantly affect to the radiological stage of the disease and indexes Ritchie and Larsen. It should be noted that there is a significant direct correlation between the values of w and articular syndrome, however, high aluminum content of the soil was significantly affected to the localization of the articular syndrome. So, in figures G < 2 Aluminum G has a negative correlation (r=-0.44; r = -0.42; r = -0.32) with NPJ, NSJ and duration ofmorning stiffness, which become positive (r = 0.89; r = 0. 73; r = 0.79) in rates G > 2. It means that increasing of accumulation in the soil influences to pronounced degree of articular syndrome. As can be seen from fig. 1, area with high aluminum in the soil (IV area) is valid pronounced characters of above symptoms (p = 0.0042 & p = 0.033J).
It should be noted that on the background G > 2, the severity of air pollution by xenobiotics significantly influences (in the figure indicated in black) to the incidence of lesions of the elbow (p = 0.023), the shoulder (p = 0.052), knee (p = 0.049) and hip (p = 0.037).
Section Б. Medical science
Fig. 1. Articular syndrome depends on index G aluminum in soil. NPJ — the number of painful joints; NSJ — the number of swollen joints
Fig. 2. X-ray changes in the RA depend on index G aluminum in soil
It is noteworthy, as shown by one-factor disperse analysis to the functional index of HAQ affects w soil zinc (Zn). This performance is directly correlated with the G Ritchie index (r = 0.59) and back to the index HAQ (r = -0.67). Thus, by decreasing of w, i. e. decreasing of concentration of Zn in the soil degraded functionality of the joint, which reflect on the index of HAQ, in particular in zones II and IV and contrast with the increasing of concentration in the soil improved HAQ, in particular in the zone III (p = 0.0034$, p = 0.043J). It should be noted, according to the literature [10, 702], against changes in the level of Zn in the blood ofpatients with RA. in synovial environment increases the number of proteolytic activity of matrix metalloproteinases, which are involved in the implementation of preinflammatory and destructive action to the joint.
The important point, indicating the degree of progression of disease and complication of anatomical defects of joint in RA is radiological evidence of articular syndrome. As mentioned above, the rate of soil contamination w significantly affect to the radiological stage of the disease and the index of Larsen. As can be seen from fig. 2, in contrast from other zones in zone IV with increasing of accumulation of nickel (r = 0.089) will increase cases with ankylosis (IV radiographic stage of RA) and significantly increase Lars-en index (p = 0.0023$, p = 0.033J). At the same time multivariate
dispersion analysis also shows a high degree of impact on the overall У sonographic signs of RA. The degree of atmospheric pollution by xenobiotics significantly influences (in the figure indicated in black) to the frequency of sonographic and radiographic signs of RA.
It is noted the dependence of tendovaginitis, enthesopathies, ligamentosus, intra-articular calcifications, changes of horns of the menisci, Baker's cysts and bodies of Hoff on the parameters y. As the one-factor dispersion analysis to the frequency of sonographic and radiographic signs of RA affects to the degree of w salinity. Thus, in w salinity G > 2 (II zone) observed its direct strong correlation with indicators such as the tendovaginitis (r=0.84), ligamentosus (r=0.97), Baker's cyst (r=0.77) and body of Hoff (r = 0.91). It means that with increasing of salinity of the soil whereas increases above cases.
We should note that F articular syndrome in RA are not associated with the parameters of sulfates and phosphates in the drinking water (p > 0.05).
Thus, the results of disperse analysis indicate the degree of w and y depend on clinical, radiographic and sonographic signs of articular syndrome in RA.. It means that changes in the micro elementary composition of soil and air which depends on the zone of residence of patients with RA in Uzbekistan contributes rate of progression of joint syndrome.
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2. Rustamova 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/O. V. Sinyachenko//Ukr. revmatol. Zh. - 2007. - 30(4). - P. 64-68.
4. McInnes I. B. The pathogenesis ofrheumatoid arthritis//I. B. McInnes, G. Schett//New Engl.J. Med. - 2012. - Vol. 365. - P. 2205-2219.
Signs and surgical tactics in continued growth of gliomas of supratentorial localization in children
5. Dilaveris P., Synetos A., Giannopoulos G., et al.//Heart. - 2006. - Vol. 92, № 12. - P. 1747-1751.
6. Chashchin V. P., Gudkov A. B., Popov O. N. Characteristics of the main risk factors for health problems of people living in areas of active wildlife in the Arctic. - Human Ecology. - 2014. - S. 3-10.
7. Yanbaeva H. I. Sketches of Cardiology of hot climate II//Clinical and environmental aspects. - Tashkent: Publishing. Abu Ali Ibn Sina, 2003 - 86 p.
8. Otaboev S., Ergashev G., Kayumhodzhaev Y., Normatova S. Ecology of air and health problems. - Tashkent, 2008 - 78 p.
9. IvlevA. M. Evolution of soil. - Vladivostok, 2005. - 72 p.
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Ashrapov Jamshid Raufovich, Republican Scientific Center of Neurosurgery and Tashkent Medical Academy, Ministry of Public Health of the Republic of Uzbekistan E-mail: dr_jamshid@mail.ru
Signs and surgical tactics in continued growth of gliomas of supratentorial localization in children
Abstract: This work is devoted to pediatric neuro-oncology. The analysis of examination and treatment of 55 patients with continued growth of brain supratentorial gliomas is presented. Based on the study, diagnostic criteria and surgical treatment tactics for patients with continued growth of supratentorial gliomas have been determined. Keywords: continued growth, brain tumors, central nervous system, pediatric age.
Introduction. According to data from cancer registries in European countries and the USA, tumors of the central nervous system (CNS) occupy the second place among all cancers in children [1, 35-39]. Malignant types are the most frequent, like anaplastic astrocytomas, ependymomas, and glioblastomas [3, 53-63; 2, 30].
There are several studies devoted to continued growth of CNS tumors in children. In the literature over past 10-15 years, there is no consensus about the frequency of tumors of continued growth with different histostructure in children [6, 319-331; 4, 40-51].
According to several authors, in a group with tumor clinical manifestations, terms of continued growth were significantly shorter than in a group with radiographic (X-ray) signs. While identification early and late periods of the appearance of continued tumor growth, most of the early periods were determined clinically; this difference maintained even after the distribution of nosology, and there were no statistically significant differences between age, gender and race. Patients with large volume of surgical interventions prevailed in a group with radiographic (X-ray) detection of prolonged tumor growth [7, 4135-4140; 5, 1273-1280].
Macedoni-Luksic et al. (2003) in a retrospective long-term study of history cases of 61 patients, who underwent surgical treatment, could observe the nature of neurological abnormalities associated by continued growth or recurrence of hemispheric tumors [8, 89-101].
However, according to Minn et al. (2001), a factor of extent of surgical resection ofthe tumor becomes to be ofgreat importance for forecasting the possibility of further tumor growth [7, 4135-4140].
The most significant prognostic factor for survival is the extent of surgical resection. This factor can be changed unlike other factors, such as the differentiation of tumor cells, X-ray therapy, and age of the patient. Race and gender, according to the researchers, probably, do not play such a huge role, but, as has been reported, correlated with survival rate [10, 16-26; 9, 138-150].
Rozumenko et al. (2006) reported that surgical tactics plays the important role in life expectancy of patients and improving the quality of life [4, 40-51]. According to Butowski et al. (2006), clinical manifestation of hypertension syndrome with tendency to
progression, appearance and aggravation of focal neurological deficit, the pattern of tumor progression on brain CT and MRI in the form of mass-effect, displacement of structures in the midline, signs of decay and hemorrhage in the tumor are the indications for reoperation in hemispheric tumors with prolonged growth. Along with this, the absence of effect of conservative treatment is an indication for surgical intervention as well [5, 1273-1280].
The purpose of study was to analyze data of patients with assessment of the informative value of brain CT and MRI in determining surgical tactics for brain supratentorial gliomas with continued growth.
Materials and methods
In the Centre of Neurosurgery of Tashkent city, we carried out analysis of data of 55 patients (28 boys and 27 girls), who had been diagnosed and treated for glial tumors with continued growth of supratentorial localization during the period 2010-2014. The age of children ranged from 2 to 17 years. The diagnosis was made based on clinical-neurological and instrumental examinations. For determining and selecting surgical tactics for gliomas with continued growth, brain CT was used in 30 (54.5 %) patients and brain MRI with and without contrast enhancement was used in 25 (45.5 %) patients, respectively. The degree of radicality was assessed by the program "Calculation ofvolume of tumors".
Results and discussion
Re-appearance of intracranial hypertension (60 %) and/or increase of symptoms of epileptic syndrome (25 %) and focal neurological deficit (15 %) were clinical signs of continued tumor growth. Later on, further growth of tumor was confirmed by additional studies using different methods (brain CT or MRI).
A group of main risk factors for occurrence of continued growth ofbrain tumors of supratentorial localization in children included surgery radicality (total operation in 41.8 % of cases), malignancy grade of neoplasms (56.3 % were anaplastic), tumor localization, its location in the medial parts ofhemisphere and expansion to the neighboring lobe and subcortical structures (61.8 %). The totality of removal was calculated by the program "Calculation of tumor volume".
