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Table 2. - Indicators of exercise testing in pregnant women with rheumatic heart diseases according to FC of CH
Parameters Group 1 (n = 12) P1 Group 2 (n = 24) P2 Group 3 (n = 34)
Passed distance in meters 474.17 ± 25.33 0.000 371.04 ± 30.24 0.000 261.03 ± 52.73
SBP before (mm Hg) 102.08 ± 11.17 > 0.05 100.42 ± 8.59 > 0.05 100.71 ± 7.87
SBP after (mm Hg) 123.75 ± 11.5 0.000 109.79 ± 8.29 0.000 108.86 ± 11.51
DBP before (mm Hg) 65 ± 6.74 > 0.05 64.37 ± 6.96 > 0.05 62 ± 6.66
SBP after (mm Hg) 70.83 ± 9.0 > 0.05 70.83 ± 8.29 > 0.05 69.71 ± 8.31
HRF before (beats/min) 92.4 ± 7.98 > 0.05 99.04 ± 15.47 0.025 102.2 ± 13.8
HRF after (beats/min) 122.5 ± 9.2 > 0.05 129.79 ± 13.3 0.021 132.4 ± 13.2
Breathlessness 7 (58.3 %) > 0.05 18 (75 %) X2 = 6.2; p = 0.01 32 (94.1 %)
Heartbeats 5 (41.7 %) > 0.05 11 (45.8 %) X2 = 5.3; p = 0.02 28 (82.3 %)
Tiredness 4 (33.3 %) > 0.05 10 (41.7 %) X2 = 5.6; p = 0.02 26 (76.5 %)
Note: P1 — the reliability of differences between groups 1 and 2; P2
During the test with a 6-minute walk, the distance covered was significantly greater in Group 1 compared to Groups 2 and 3. Thus, in Group 2 and 3 of there was a less marked increase in SBP levels, in response to physical strain compared with Group 1, in spite of the initial lack of these differences. Before the physical activity, the HRF was higher in Group 3 compared to Groups 1 and 2. The increase of HRF related to physical activity prevailed in Group 3. In this case, it is typical that a subjective exercise tolerance in Group 1 was better than in Group 3 of pregnant women (see table 2).
The analysis of hemogramindicated the prevalence of inflammatory blood indices in Group 3 compared to Group 1, so, the level ofleu-cocytes in Group 3 was 9.2 ± 2.22 -10 9/L, 7.34 ± 1.87 •109/L (p = 0.013) in Group 1, and 9.4 ± 3.84 -10 9/l in Group 2. Erythrocyte sedimentation rate (ESR) was also higher in Group 3: 4.28 ± 0.23 mm/h, 22.5 ± 7.37 mm/h in Group 1 (P = 0.034) and 24.33 ± 10.28 mm/h in Group 2. Blood hemoglobin levelinall groups was comparable. According to the results of rheumotest higher indicators of CRP and ASO was revealedin a group of pregnant women with FC III of HF, compared with the group ofpregnant women with FC I of HF. Thus, the CRP in
- reliability of differences between groups 1 and 3. Group 3 was 12.64 ± 16.64 mg/L, in Group 1 — 6.04 ± 2.58 mg/L (p = 0.008), and in Group 2—9.53 ± 7.22 mg/liter. ASO in Group 1 was 251.6 ± 139.53 IU/ml, in Group 3 — 347.2 ± 134.28 IU/ml (p = 0.041), and in Group 2 — 268.48 ± 118.5 IU/ml. The level of rheumatoid factor (RF) in subgroups did not differ: in Group 1 — 10 ± 0.94 IU/ml, in Group 2 — 10.2 ± 0.77 IU/ml, and in Group 3 — 10.88 ± 2.36 IU/ml.
The obtained data indicate that in pregnant women with rheumatic heart diseases the signs of heart failure, defined by exercise tolerance with a standard six-minute test, develop on the background of minimal changes of linear and volumetric parameters of the myocardium, which does not exceed the normal limits. However, in this case, a significant difference is observed between these parameters in groups of women with FCI and FC III. Reduction of myocardial contractility has reliably significant character as the increasing of physical activity of HF. Along with this, the hemodynamic parameters and their correlation with the PAT (physical activity tolerance) testify that the signs of inflammation, with comparable values of hemoglobin, have a significant impact on increase in HF.
References:
1. Baumgartner H., Bonhoeffer P., De Groot N. M. et all. ECS Guidelines for the management of grown-up congenital heart disease (new version 2010)//Eur Heart J. - 2010. - 31: 2915-2957.
2. Khairy P., Ionescu-Ittu R., Maskie A. S. et all. Changing mortality on congenital heart disease//J Am. Coll. Cardiol. - 2010. - 56:1149-1157.
3. Robson S. C., Dunlop W., Moore M. Et all. Combined Doppler end echocardiographic measurement of cardiac output: theory and application in pregnancy//Br. J ObstetGynaecol. - 1987. - 94: 1014-1027.
4. Siu S. C., Sermer M., Colman J. M. et all. Prospective multicenter study of pregnancy outcomes in women with heart disease//Circula-tion. - 2001. - 104: 515-521.
5. Stangl V. et all. Maternal heart disease and pregnancy outcome: a single-centre experience//Eur J Heart Fail. - 2008. - 10: 855-860.
6. Weiss B. M., von Segesser L. K., Seifert B., Turina M. I. Outcome of cardiovascular surgery and pregnancy: a systemic review of the period 1984-1996//Am J ObstetGynecol. - 1998. - 179: 1643-1653.
Indiaminov Sayit,
Samarkand State Medical Institute, doctor degree in medicine,
department of forensic medicine E-mail: davolash@mail.ru
Changes of the brain microcirculatory bed in different types of the blood loss and hemorrhagic shock
Abstract: The aim of the research was to determine thanatogenetic significance of blood filling degree of MCB vessels in the brain sections in different types of blood loss and in hemorrhagic shock. By means of by-stage method comparing the number of blood-filled vessels of microcirculatory bed in large hemispheres and in the brain trunk their different content has been estimated in acute, massive blood loss and hemorrhagic shock.
Keywords: premotor cortex, brain, neuroglia, blood loss, hemorrhagic shock.
Changes of the brain microcirculatory bed in different types of the blood loss and hemorrhagic shock
Introduction
Irreversible changes in the brain tissues occur before complete hemostasis takes place [2]. Most of vascular reactions in the brain are realized in short intervals of time — to 1 min [5]. Up to now information concerning the condition of the brain microcirculatory bed (MCB) vessels in blood loss and hemorrhagic shock (HSh) has not been systemized yet [4; 8; 9].
The aim of the research — to study the condition of the brain MCB vessels in different types of blood loss and HSh.
Material and methods of the research
The brain of 48 corpses underwent forensic medical expert examination for death caused by different types of blood loss and HSh as a result of cut-stab and incised wounds. Complex evaluation of the research results of corpses made it possible to determine the following types of blood loss: ABL (4 cases), MBL caused by single injury and by multiple (8) injuries of the heart and magistral vessels and also MBL caused by single (7) and multiple (13) injuries of peripheral vessels. HSh due to a single injury of the heart and magistral vessels (4 cases) and peripheral vessels - single (3) and multiple (5 cases).
The material for special study was taken from the large hemispheres of the brain (field 6, according to Brodman), the walls of ventricle III with hypothalamus area and fund of ventricle IV with the area of medulla oblongata. The material was fixed in 10 % of neutral formalin, poured over with paraffin and colored with hematoxilin and eosin according to Van-Gizon method, with resorcin-fuxin according to Veigert, with Shiff-reagent, by methods of Mallory, Nissle. The number ofblood filled vessels of MCB on the given area of section was determined by dotty method [1]. Each of the examined sections was studied on 2 topographic levels. In order to compare the number ofblood filled vessels ofMCB in different variants ofblood loss and HSh, the method of stage comparison was used [3; 6]. The digital method underwent statistic processing.
The results of the research and their discussion
The results of study concerning the number of blood filled vessels of MCB in the brain sections showed that in MBL their number in the cortex of large hemispheres is less numerous than in the white substance (P < 0.05). In MBL different blood filling of MCB vessels is observed in the cortex of large hemispheres depending on damage to the heart and magistral vessels or peripheral vessels. With this damage to the heart and magistral vesels is accompanied by sharper anemia of the cortex and white substance than in damage to peripheral vessels. Multiple injuries in both subgroups are accompanied by more marked anemia of white substance. In HSh the number of filled MCB vessels is larger than in fast death (P < 0.05).
In hypothalamus study it was determined that in MBL superficial layer (level 1) contains less number ofblood filled MCB vessels in comparison with its deeper layer (level 2). In damage to the heart and magistral vessels in MBL the number of blood filled MCB vessels does not significantly differ than MBL. In damage to peripheral vessels marked filling of these vessels both in single and multiple injuries is observed in both levels of ventricle III walls (P < 0.05). In HSh improvement of blood circulation in hypothalamus is not significant. On the contrary the number of blood filled MCB vessels is even less than in blood loss. Probably in damage to peripheral vessels compensatory reaction is observed not because of the vascular system of the body which produces centralized blood circulation but due to redistribution of blood inside the brain for more complete blood supply of hypothalamus. The decrease of blood supply in this brain area in hemorrhagic shock
proves insufficient degree of such compensation for normalization of blood circulation in hypothalamus in spite of providing transfusion therapy.
In study of medulla oblongata in MBL more marked anemia of its superficial layer in comparison with a deep one is determined (P < 0.05). In MBL there are more blood filled MCB vessels than in hypothalamus in the same trauma condition as a result of single and multiple impairments of the heart and magistral vessels (P < 0.05). It can be associated with higher adaptive abilities of the brain vascular system and its regulation of CNS vital part. In fatal injuries of peripheral vessels the number of both single and multiple blood filled MCB vessels is somewhat fewer in medulla oblongata as a whole than in hypothalamus. Besides, their number does not make significant difference from the subgroup with impairments of the heart and magistral vessels. These data confirm supposition that in the condition of fatal blood loss improvement of blood supply in medulla oblongata occurs due to redistribution of blood in the brain but not because of systemic circulation centralization. Comparison of the number of blood filled MCB vessels by stages made it possible to determine anemia presence in the structures of different brain sections in ABL, MBL and HSh in thanatogenesis. In ABL the most severe anemia is observed in superficial layer of medulla oblongata and it is also marked in its deep layer (P < 0.05). Weak blood filling is also determined in hypothalamus and white substance of the brain hemispheres. In MBL caused by a single impairment of the heart and magistral vessels the least number of blood filled vessels is determined in the cortex, subjacent white substance of hemispheres an in hypothalamus (P < 0.05). Blood supply of medulla oblongata is impaired in a less degree. The same participation in thanatogenesis of the studied brain sections is observed in multiple injuries with impairment of the heart and magistral vessels. In this type of trauma anemia of the brain hemispheres white substance is sharply marked. In MBL caused by impairment of peripheral vessels the same thanatogenesis is pbserved both in single and multiple injuries. It is first of associated with severe anemia of the brain hemispheres white substance. In multiple injuries clearly marked anemia of medulla oblongata superficial layer is added to it. In HSh caused by injuries of peripheral vessels the most number of blood filled MCB vessels is observed in the cortex of the brain hemispheres and white substance located under it. The least number of blood filled MCB vessels is determined in hypothalamus. In a single injury blood supply of medulla oblongata also decreases in comparison with similar trauma and MBL but in multiple injuries blood supply of medulla oblongata improves.
Thus, in ABL the mechanism of centralization ofblood circulation probably does not have time to begin operating and redistribution of blood in cerebral vessels between the brain sections is not considerable. In MBL with damage to the heart and magistral vessels in medulla oblongata the improvement of blood supply takes place due to the blood redistribution [7]. In MBL with impairment of peripheral vessels due to slower death outcome the mechanism of blood supply centralization probably begin to operate and it results in improvement of the cortex blood supply but anemia of blood substance persists. Blood supply in the hypothalamus also improves but it persists at the same level in medulla oblongata. In HSh caused by injury of the heart and magistral vessels transfusion therapy is not properly effective due to marked anemia of the brain sections. In peripheral vessels injuries and HSh blood supply of the cortex and white substance improves in transfusion therapy and blood supply of medulla oblongata becomes better. However with this marked anemia is observed in hypothalamus.
References:
1. Avtandilov G. G. Medical morphometry. Supervision. - M.: Medicine,1990. - P. 384.
2. Gannushkina I. V. Cerebral blood circulation in various types of circulatory hypoxyia of the brain//Herald. RAMS. - 2000. -№ 9. - P. 22-27.
3. Dobrovolsky G. A. Planning of medico-biological experiment. - Saratov: Pub. House of Saratov Univ., 1984. - P. 128.
4. Dolzhansky O. V., Borlakova B. U. Brain changes in acute blood loss and their forensic medical significance//Forensic med. expert exam. -2006. - V. 49, V. 5. - P. 39-40.
5. Moskalenko Yu. Ye. Problems of regulation of cerebral blood circulation and their connection with liquor dynamics//Regional blood circulation and microcirculation: scient. pract. journal. - Saint-Petersburg, 2002. - V. 1. - P. 78-82.
6. Stefanov S. B. Some possibilities of data synthesis of various nature in medicobiological studies//Phylosophic and social aspects of interaction of contemporary biology and medicine: Report theses ofAll-Union conf. - Moscow, 1982. - P. 66.
7. Chen R. Y., Fan F. C., Schuessler G. B., Simchon S., Kim S., Chien S. Regional cerebral blood flow and oxygen consumption of the canine brain during hemorrhagic hypotension//Stroke. - 1984. - Vol. 15, № 2. - P. 343-350.
8. Ince E., Kuloglu Z., Akinci Z. Hemorrhagic shock and encephalopathy syndrome: neurologic features//Pediatr. Emerg. Care. - 2000. -Vol. 16, № 4. - P. 260-264.
9. Thebaud B., Husson B., Navelet Y., Huault G., Landrieu P., Devictor D., Sebire G. Haemorrhagic shock and encephalopathy syndrome: neurological course and predictors of outcome//Intensive Care Med. - 1999. - Vol. 25, № 3. - P. 293-299.
Karimov Dilshod Madjitovich, Tashkent Pediatric Medical Institute, Researcher, the Department of Otorhinolaryngology and Pediatric Dentistry
E-mail: denta-plus@list.ru Gulyamov Surat Saidvaliyevich, Tashkent Pediatric Medical Institute, PhD Professor, the Department of Otorhinolaryngology and Pediatric Dentistry
E-mail: surat1977@mail.ru Pulatov Oybek Abdumutalovich, Tashkent Pediatric Medical Institute, Researcher, the Department of Otorhinolaryngology and Pediatric Dentistry
E-mail: dr.oybek@mail.ru Mahkamova Feruza Tashtemirovna, Tashkent Pediatric Medical Institute, Researcher, the Department of Otorhinolaryngology and Pediatric Dentistry
E-mail: timur2001123@mail.ru
Increase in psychosocial status of school age children with dentomaxillary deformities
Abstract: Most people have problems with their appearance, are ashamed of their external view and that has negative effect on their life. To avoid such cases it should be begin from childhood. As a rule, correction of these states is a mission of orthodontist and intervention of children's psychologist. Fifty children with occlusion deformities have been examined. Keywords: psychosocial status, orthodontics, dentomaxillary deformities, orthodontic treatment, smile.
Introduction
Face of person has the greatest effect from viewpoint of attrac-tivity. Smile is the second feature of face after eyes to which people pay their attention while estimating attractivity of humans. It is exactly that beautiful look and smile became an important part of a successful person because we express our emotions and attract persons to us. Influence of self-appraisal on personality is very great. In his (her) low self-appraisal person has not faith in herself, possibilities, and he (she) does not like himself. They experience self-dissatisfaction stable or very often. Person works, achieves aims, defines new goals, but his negative relation to himself remains. Besides, human' low self-appraisal, without fail, reflects on his appearance. One of the psychosocial tasks of person is to have present look that requires present society [1; 3].
Attractiveness plays an enormous importance both in professional and social society. How it was noted in the University of the North Caroline the patients often appeal Orthodontist: 84 % cases for uneven teeth, 52 % cases according to Dentist advice and 41 % cases for unpleasant look. Nice look indicates that person presents a good, honest and happy man. It is exactly that unpleasant look of person sets thinking receive orthodontic treatment that leads him to success in social life. After orthodontic treatment and perfection of esthetic appearance children become less shy and emotionally more sure and feel themselves more attractive among their friends and social surroundings [2; 7; 9.].
Most children have crowded teeth and occlusion deformities and require orthodontic aid. From year to year rate of bite deformities pathology is stably increasing. It is related with food consumed
