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11after trauma we found increase of ceruloplasmin activity as manifestation of defense response. By the third day this level increases almost by 40% in comparison to control group, but then it significantly decreases. It has been proved that ceruloplasmin is the basic antioxidant of blood plasma both in normal and in pathology which prevents and inhibits lipid peroxidation by oxidation of bivalent iron. Antioxidant effect of ceruloplasmin depends on its feroxidase activity. We can assume that ceruloplasmin takes part in destruction of toxic free radicals of superoxide anion which is a product of aerobic metabolism.
On the first day we found significant increase of medium weight molecules. Moreover in 87% of patients there was an increase of their level within five days. Medium weight molecules are one of the objective markers of metabolic intoxication [4]. Increase of their level on the first day and in early posttraumatic period indicates that brain concussion is characterized with progressive metabolic disorders.
So we can make a conclusion that mobilization of protective antioxidant mechanisms in the brain softens primary activation of lipid peroxidation. However it is followed by their further exhaustion that leads to destructive changes of nervous cells. That is why early determination, prevention and correction of secondary brain injury largely determine the results of treatment.
Conclusions. 1. In patients with brain concussion activation of free radical oxidation is most pronounced in five days after traumatic brain injury.
2. On the first day of trauma there is expressed activation of protective antioxidant factors (increased activity of catalase, content of ceruloplasmin, SH-groups, glutathione). The dynamic observation has shown gradual decrease of antioxidant activity.
3. The most noticeable changes were shown in the level of medium weight molecules that may be considered as a sensitive criterion of metabolic intoxication in patients with brain concussion.
Attention is drawn to the need of the further study of biochemical processes that lead to irreversible changes in nervous tissue, as well as development and implementation of the drugs for correction of energetic metabolism and protection against secondary destruction of the cells.
References:
1. R.J. Swatzyna, The elusive nature of mild traumatic brain injury, Biofeedback, Vol. 37, Issue 3 (2009) 92-95.
2. M. Prins, T. Greco, D. Alexander, C.C. Giza, The pathophysiology of traumatic brain injury at a glance, Dis Model Mech, 6 (2013) 1307-1315.
3. A. Rodriguez-Rodriguez, J.J. Egea-Guerro, F. Murillo-Cabezas, A. Carillo-Vico, Oxidative stress in traumatic brain injury, Curr Med Chem, 21(10) (2014) 1201-11.
4. A.M. Arent, L.F. de Souza, R. Walz, A.L. Dafre, Rerspectives on molecular biomarkers of oxidative stress and antioxidant strategies in traumatic brain injury, BioMed Research International, 2014(2014), Article ID 723060, 18 pages, http://dx.doi.org/10.1155/2014/723060.
ASSESSMENT RESULT OF CATARACT STAGES DISTRIBUTION AND CONCOMITANT DISEASES STRUCTURE
Kovtun M.I.
Ph.D in Medicine
Chief medical officer Communal enterprise of health care «Kharkiv municipal clinical hospital №14 named by prof. L.L. Girshman»
ABSTRACT
The results of assessment of cataract stages distribution are provided. The research was carried out using case histories of 14911 patients (10409 men and 14502 women), who was operated during 2006-2011. It was shown that maximal number of patients with cataract of all stages is in age group of 71-80 years old and in average the same number is in age groups of 61-70 and in older than 80 years. Moreover, distribution of patients in accordance with cataract stages between gender groups has authentically no difference. In both gender groups 93% of patients had immature (53%) and mature (40%) cataract.
Based on the analysis of concomitant morbidity of 540 cataract patients it had been determined that more frequently met concomitant pathology was hypertensive disease ((34,6±2,1)% of tested) and coronary heart disease ((28,9±2,0)% of tested). Pancreatic diabetics were common for (12,8±1,5)% of cataract patients, moreover it was more frequently found among patients of young age, myopia alta, glaucoma and joint diseases was found only among 6-8% of tested patients.
Key words: cataract, cataract stages, glaucoma, myopia, pancreatic diabetics, hypertensive disease, coronary artery disease.
Formulation of the problem. According to modern data cataract is the reason of blindness of over 18 millions of people from different countries all around the world. Over the past few years in many countries a number of cataract patients grew significantly, this happened as a result of population ageing. Not looking at substantial progress of cataract surgery, a more considerable increase of morbidity rate is expected in near future. The number of blind because of cataract is predicted to be 40 millions of people until 2025. It was determined that
over 60 % of operations which carried out in ophthalmological establishments had been performed for cataract treatment [2,7].
Recent statistic shows that more than three millions of citizens' requests for medical help because of eye diseases registered in Ukraine each year. In the structure of eye morbidity in the past 10 years cataract takes the second place (11%) after conjunctive diseases (30,7%) [7,10].
Analysis of latest publications. Cataract is currently
diagnosed in different age groups; however it is more typical for elderly patients. These patients are in definite risk group since except of main eye disease they have significant number of concomitant diseases. This set of different diseases a man represents phenomena called polymorbidity or multimorbidity. During careful checkup of elderly patients with cataract, doctors found pathological changes in different organs and body systems, which can have age character. Mutual influence of diseases, involutory processes of natural aging and medical pathomorphism significantly change clinical picture and cataract course, and may worsen results of its surgical treatment [4,13]
As stated by number of authors the reasons of cataract appearance are different and it is complicated to determine them in each specific case. They may be connected with the presence of such diseases like hypertensive disease, coronary artery disease, diabetes, arthritis, gout, bronchial asthma. Often cataract occurs among patients with myopia alta and glaucoma. Moreover, cataract can be caused by long-term medical preparation (for example corticosteroids), direct contact with chemical toxic substances and radial energy [3,6-8,10,15,23].
Highlight unsolved aspects of the problem. The need of assessment of cataract stages prevalence in different age groups is caused by wide switch to outpatient treatment of these patients. It is known that the results of surgical treatment are better if cataract is in early stage. If the patient is operated on cataract on advanced stages of disease and has a lot of concomitant pathologies, the low clinical results can be received, as well as risk of complications development grows.
Continuous improvement of diagnostic and treatment technologies, creation of new equipment, conduction of minimally-invasive surgeries allows achieving high visual acuity, decreasing the risk of the post-operative complications, and reducing patients' rehabilitation term.
However, full transfer to out-patient treatment of cataract has a number of limitations, which we must take into account. First, most of cataract patients are elderly or old age people, who have a number of somatic diseases, which can become the reason of post-operational complications.
All listed above defines relevance of assessment of concurrent morbidity structure and prevalence of cataract stages in terms of age.
The aim of this work was assessment of concurrent morbidity structure and prevalence of cataract stages in terms of age.
Basic material statement. Assessment of cataract stages structure in different age groups was carried out with the use of case histories of 24911 of patients, who were operated in 2006-2011. Among patients there were 10409 male and 14502 female. Since gender groups of the same age were different in number of patients (n), for carrying out comparison they were standardized for general group volume (N), which allowed us to scale them.
On picture 1 the standardized division of female and male patients of different age depending on the cataract stage is shown.
Based on analysis of subdivision of gender groups (picture 1) we can point out that they are significantly different. Maximal number of patients with all cataract stages is in age group between 71 and 80 years and approximately the same number is in groups between 61 and 70 years and older than 80 years. Most patients who contacted hospital to get surgical treatment had immature cataract, which allowed us to achieve high results. The least favourable cataract stage for phacoemulsification is mature cataract; unfortunately there were a lot of such patients. According to the data shown on image 1 we can point out that in group of operated on early cataract patients is authentically rare (P<0,5) than for other stages.
(n/NlxlOOO
(n/XlxlOOO
jo 30 31-40 41-50 51-60 61-70 71
jo 30 31-40 41-50 51-60 61-70
Cataract type: * Immature
Mature ■*- Earlv
Age, years
Picture 1. Distribution of patients of different age depending on cataract stage.
From the other side patients older than 70 years are in risk group of the development of post-operational complications since they usually have a lot of concomitant diseases.
Assessment of concomitant morbidity structure of cataract patients was carried out among 540 patients, who are admitted to the ophthalmological hospital for cataract surgical treatment.
Among tested patients there were 193 male and 347 female.
Based on the analysis of the received results six most common concomitant diseases were chosen: pancreatic diabetics (PD), hypertensive disease (HD), coronary artery disease (CAD), myopia alta (MA), glaucoma (G), joint diseases (arthritis, gout - AG). Among male 20 % had not concomitant
diseases (WCD), in female group there were no such patients. The allocation of patients, depending on the diseases they have, is shown on picture 2.
It can be noted that three most widespread concomitant diseases are hypertensive disease, coronary artery disease and
pancreatic diabetics. By the frequency of concomitant diseases occurrence between men and women, there is authentically no difference found. We might only exclude hypertensive disease and joint diseases, where women were leading.
(P<0:001)-
O +
(?<0=02)
■ *
Male Female
PD HD CAD MA G A,G WCD
Picture 2. The allocation of patients depending on concomitant diseases presence. *- the differences between male and female by frequency of concomitant diseases are authentic.
The results of assessment of each of concomitant disease in age groups of man and women are shown in table 1.
One of metabolic and immune processes dysfunction symptoms among patients who have pancreatic diabetes (PD) is appearance and development of cataract. Cataract is on leading positions among blindness reasons during pancreatic diabetes [5,8,10,17,23]. During PD the risk of postoperational complications appearance in the form of exudative inflammatory reaction exists. Therefore it must be taken into account during out-patient treatment of such patients. In research group we have only detected (12,8±1,5)% of patients with PD, which doesn't allow us to talk about its significant role in cataract development in the background of general morbidity. During the analysis of age structure of patients' group with PD we found that the highest frequency of its occurrence is in group under 50 years old (about (27,3±13,4)% of male in this age group and (38,5±13,5)% of female). Thus among more than 30 % of people of young age, the cataract is observed in the background of PD. This can be an evidence of significant role of PD in the development of cataract, in particular for people of young age.
Table 1
Allocation of cataract patients with concomitant diseases
Age, years Diseases
PD HD CAD MA G A,G
Female
Under 50 (n=13) 5 (38,5±13,5) 2 (15,4±9,9) 1 (7,7±7,5) 2 (15,4±9,9) 0 0
51-60 (n=16) 0 5 (31,3±11,6) 1 (6,3±5,9) 2 (12,5±8,4) 3 (18,8±9,8) 0
61-70 (n=77) 7 (9,0±3,3) 27 (35±5,4) 22 (28,6±5,2) 7 (9,0±3,3) 4 (5,2±2,5) 6 (7,8±3,1)
71-80 (n=180) 33 (18,3±2,9) 79 (44±3,7) 64 (35,6±3,6) 11 (6,1±1,8) 8 (4,4±1,5) 14 (7,8±2,0)
81-90 (n=58) 3 (5,2±2,9) 23 (39,7±6,4) 18 (31±6,1) 1 (1,7±1,6) 8 (13,8±4,6) 9 (15,5±4,8)
Male
Under 50 (n=11) 3 (27,3±13,4) 0 0 1 (9±8,6) 0 0
51-60 (n=27) 3 (11±6,0) 3 (11±6,0) 1 (3,7±3,6) 1 (3,7±3,6) 1 (3,7±3,6) 1 (3,7±3,6)
61-70 (n=52) 9 (17,3±5,2) 12 (23±5,8) 12 (23±5,8) 1 (1,9±1,8) 2 (3,8±2,7) 3 (5,8±3,3)
71-80 (n=77) 4 (5,2±2,5) 22 (28,6±5,2) 23 (29,9±5,2) 5 (6,5±2,9) 12 (15,6±4,2) 2 (2,6±1,9)
81-90 (n=25) 2 (8±5,4) 13 (52±10,0) 13 (52±10,0) 0 3 (12±6,5) 1 (4±3,9)
We have not found essential gender difference in frequency of cataract morbidity in presence of PD. However, it is diagnosed more frequently in female group. The highlighting of PD presence before carrying out surgical treatment is a must. This happened because the activity of local inflammatory process and immune reaction is typical for these patients. These aspects may lead to the development of inflammatory post operational complications.
As modern literature analysis has shown, the recondition of cataract development can also be myopia alta [2,6]. Myopia is 1230% of all ophthalmology science [6,7]. Cataract development during myopia of medium and high degree happens on average 10 years earlier than during other refraction anomalies. In 70 % of cases these patients are of younger ages (from 20 to 40 years old). In myopia eyes cataract is found 45 times oftener, than during emmythropy and hyper emmithrophy, the combination of myopia and cataract is found in 7,3 % of cases [7,18].
Such peculiarities of cataract formation as increased thicknesses of lens, sub capsular opacity, intimately spliced with back capsule, weaken lens' Zinn's membrane govern high risk of intraoperative complications. Frequency of cataract surgery complications during complicated myopia alta is 1.5-2 times higher if cataract is senile [16, 19-22]
Analysis of data, provided in table 1, allowed us to establish that myopia alta was observed among (5,6±1,0)% of patients (among (4,1±1,4)% of male and (6,3±1,3)% of female), which can also be a strong reason of cataract development.
Glaucoma and cataract are the main reasons of blindness and low sight. They often have combined character - in 17-38% of cases [1, 9, 11]. It is also known, that after anti glaucoma operations cataract often appears and progresses, which can be in 15-81 % of cases [3].
Cataract in glaucoma eye, as a rule, has complicated character. At the same time pseudoexfoliations, back synechia, rigid pupil can be found. It is well known, that cataract complicates course of glaucoma in 17-76% of cases. And almost always in glaucoma eye lens subluxation of different levels takes place.
According to the data, provided in table 1, among tested by us patients we have found (7,8±1,2)% of patients who have cataract together with glaucoma, which is significantly lower than other authors reported. We can point out age group where cataract and glaucoma combination is met more often. Thus the frequency of glaucoma and cataract combination is highest among (15,6±4,2)% male in age group of 71-80 years old and (18,8±9,8)% of female in 51-60 years old age group.
In elderly age significant prevalence has joint diseases, treatment of which in the majority of cases is carried out with the use of glucocorticosteroid drugs. These drugs have powerful antiinflammatory effect. However, during intake especially for the long period of time, can encourage the development of serious complications, among which cataract is presented. Data analysis, provided in the table 1, allowed us to discover, that arthritis and gout was found among (6,7±1,1)% of patients, moreover authentically more frequently this pathology was observed among female, particulary in eldery age groups. Less distribution of joint diseases among tested patients and glucocorticosteroid drugs intake also doesn't allow us to think that this is essential reason of cataract appearance.
As it was demonstrated in table 1, the most widespread cataract patients' concomitant morbidity is hypertensive disease (found among (34,6±2,1)% of patients) and CAD (among (28,9±2,0)% of patients). Moreover HD authentically more frequent among female patients. Such dissemination of these diseases among cataract patients can be explained by the patients' age, since the basic mass of them is in age groups of 61-70 years old ((24±1,8)% of all patients) and 71-80 years old ((47,6±2,1)% of all patients), furthermore in second age group these authentically (P<0,001) more. From the other hand, HD and CAD further failure of normal flow of metabolic processes in organism and eye tissue, which can be the starting mechanism for accelerated cataract development.
The obtained in this article results can be a base of the prevention steps for post-operational complications among cataract patients, who has concomitant diseases.
Carried out by us analysis of cataract stages distribution and structure of concomitant morbidity of cataract patients allows us to make the following conclusions:
1. Maximal number of patients with all cataract stages is in age group of 71-80 years and in average the same number in groups of 61-70 and older than 80 years; moreover the distribution of patients based on cataract stages authentically has no difference. In both gender groups 93% of patients had immature (53%) and mature (40%) cataract.
2. The most common concomitant pathology of cataract patients is hypertensive disease ((34,6±2,1)% of tested) and coronary heart disease ((28,9±2,0)% of tested) which a result of patients' age condition. These diseases are followed by failure of normal flow of metabolic processes in the organism and can contribute the growth of cataract morbidity.
3. (12,8±1,5)% of researched cataract patients has pancreatic diabetics, moreover it was found among people of young age. This can be a cause of cataract development among patients of age group under 50.
4. Myopia alta, glaucoma and joint diseases were found among 7-8% of examined patients, which doesn't allow us to consider these concomitant diseases as the significant reason of cataract morbidity.
A prospect of future research is in the investigation of patients' professional activities influence features on the terms of cataract appearence and speed of its maturation.
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