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8EFFECT OF BASIC THERAPY OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE IN COMBINATION WITH CORONARY HEART DISEASE ON PHYSICAL PARAMETERS OF THE ORAL
FLUID
Emelyanova N. Yu.
Candidate of medical sciences, dentist,senior research associate of the department of Chronic Non-communicable Disease Prevention GI «L.T. Malaya Therapy National Institute of the National Academy of Medical
Sciences of Ukraine», Ukraine, Kharkov
ABSTRACT
To assess changes in the physical properties of the oral fluid in COPD patients in combination with CHD, depending on the duration of basic therapy.
The most common complaints among patients were dryness and burning in the mouth, distortion of taste, hyperesthesia, and bad breath. The frequency of these complaints was significantly higher in group 3. It was noted that the salivary secretion rate (0.100 ml/min) was also significantly reduced, viscosity (6.500 units) and acidity (pH = 6.30) of mixed saliva was increased.
Keywords: chronic obstructive pulmonary disease, coronary heart disease, xerostomia, salivation rate, viscosity, hydrogen index
Introduction. To date, there is no doubt that the somatic pathology changes the course of many physiological and pathophysiological processes in the body, including oral cavity. In this regard, the study of the relationship between the patients somatic status and their dental health is an urgent task of modern dentistry [3].
One of the somatic diseases that have dental manifestations is chronic obstructive pulmonary disease (COPD), and often coronary heart disease (CHD) associated with it [11,12].
COPD is characterized by a persistent restriction of airway patency and is associated with increased chronic inflammatory response of respiratory tract to the action of harmful particles or gases [2].
The systematic influence of irritant factors in predisposed individuals leads to the development of abnormal inflammatory process with the infiltration of alveolar walls by alveolar macrophages, T-lymphocytes, neutrophils in the small bronchi resulting in fibrosis of the walls followed by their narrowing. Emerging changes in the epithelium, hypertrophy of submucosal glands with increased production of mucus, and violation of drainage function lead to the appearance of sputum with altered rheological properties. These changes lead to the development of obstruction of small bronchi, which is the main pathogenetic link. [2].
All pathological changes in the oral cavity have pathogenetic mechanisms similar to COPD - single immune-inflammatory character with a decrease of protective properties of oral tissues against development of systemic hypoxia [10].
Quite often COPD is complicated by CHD which combination occurs in more than 55% of cases complicating not only the relief of COPD symptoms, but also the diagnosis and treatment of dental manifestations [2].
Preference in the treatment of COPD is given to inhalation drugs. Standard treatment of COPD includes bronchodilators (short and long acting b2-agonists, an-ticholinergics (cholinolytics) and inhaled glucocorticoids (IGCS) [4].
Advantages of IGCS include high local anti-inflammatory activity, their affinity for lung receptors, and the possibility of small doses use (micrograms) minimizing the systemic effect.
According to a number of studies conducted, it is known that only 10-20% of the drug enters the respiratory tract, while 80-90% remains in the oral cavity, and as a result, changes due to negative effect on the tissues of the oral cavity could occur [1,7]. Reduction of salivation, and as a consequence, the subjective appearance of dryness in the oral cavity, is one of the manifestations of the side effect of IGCS.
Also, violations of salivation are observed in patients receiving inhalation therapy with agonists of p-adrenergic receptors. According to the studies, prolonged administration of beta-2-agonists affects the salivary gland receptors and inhibits the secretion of saliva by 20 to 35%. Decreased rate of salivation is accompanied by increase of its viscosity, and as a result, decrease of cleaning properties, changes of the composition of biologically active components, which leads to bacterial colonization and parallel decrease of the oral fluid pH [9].
In case of combined broncho-cardial pathology, patients in addition to basic therapy for COPD receive therapy for CHD.
It was noted that the majority of patients who take basic CHD therapy also noted drug-associated dryness in the oral cavity: angiotensin converting enzyme inhibitor (ACEi) cause a decrease of the activity of renin angiotensin converting enzyme, which in turn leads to inhibition of vasoconstrictive and sodium-retarding effects of angiotensin 2 (due to reduced formation of an-giotensin 1), inhibition of inactivation of bradykinin, which contributes to the excretion of sodium. The action of the drug causes xerostomia, increase of oral fluid viscosity, perversion of taste sensations.
p-adrenoblockers inhibit the passage of impulses through the conduction system of the heart and increase the period of action potential change. The block pi and
P2-adrenoreceptors, which is manifested by xerostomia, dysgeusia, increased viscosity of oral fluid, shifting of oral fluid pH to the acidic values [8].
In a number of cases, tissues of the oral cavity are subjected to uncontrolled exposure of drugs, which is associated with a violation of their reception regimen and may contribute to aggravation of pathological changes in the oral cavity. Nevertheless, the issue of prolonged intake effect of basic therapy on the character of changes in the physical parameters of the oral fluid remains insufficiently studied.
The purpose: To assess changes in the physical properties of the oral fluid in COPD patients in combination with CHD, depending on the duration of basic therapy.
Materials and methods: The study included 130 patients with verified diagnosis of COPD in combination with CHD. The diagnosis of COPD was established according to the order of the Ministry of Health
of Ukraine No. 555 of 27 Jun 2013 and the provisions set forth in GOLD (Global Initiative for Chronic Obstructive Lung Disease) document 2011-2015 [9,10]. According to the recommendations of the European Society of Cardiology, the diagnosis of CHD was verified on the basis of manifestation, tests with exercise, Holter monitoring, ECG and coronary angiography.
Exclusion criteria were: exacerbation of COPD, chronic heart failure of III-IV functional class, acute heart failure, hormonal thyroid dysfunction, history of tuberculosis, bronchial asthma, insulin-dependent diabetes mellitus, active inflammatory processes in the oral cavity.
All 130 patients were divided into groups depending on the duration of basic therapy: group 1 receives therapy lasting up to 3 years, group 2 receives drugs with a duration of 3 to 5 years, and group 3 receives therapy for more than 5 years (Fig1).
Fig1. Patient distribution by group depending on duration of basic therapy
Patient survey began with the clarification of the nature of dental complaints, their intensity, duration during the day.
Collection of unstimulated mixed saliva was performed on an empty stomach in the morning hours according to the standard procedure. For determination of physical parameters of the oral fluid (salivation rate, viscosity, pH) we used methods that were unified and adapted in dentistry.
Statistical processing was carried out with the help SPSS 13 software. Since, according to the Kolmogo-rov-Smirnov test the data distribution law did not correspond to the normal one, the median and interquartile range were calculated, Mann-Whitney criterion was used to compare the quantitative indicators, and %-square test was used to compare the qualitative ones.
Results of the research and and discussion: The
most common complaint of the vast majority (more than 87%) of all patients with COPD in combination with CHD was dryness in the oral cavity, which, in the respondents' opinion, was associated with the basic therapy of somatic disease (Fig. 2). It should be noted that the patients of group 3 (those that take drugs for more than 5 years), 100% noted pronounced dryness in the oral cavity. Survey found out that the sensation of saliva lack was eliminated by mouth rinsing with water, however, despite the fact that relief was immediate, its duration was no more than two hours.
150
%
100
50
92,5 100
90,2
69
dryness
43
505
58,5
65 61
77,5
93
29
24,5
49
47
60
71
burning tougue distortion of halitosis :: 1 group tastegroup ^3 group
hyperesthesiz dryness lipps
Fig 2. Nature and frequency ofpatient complaints during initial examination
In general, it should be noted that most often the main dental complaints were registered in patients of group 3, which in our opinion is associated with undesirable effects of long-term use of drugs for the underlying disease. For example, more than 77% of patients in group 2 and more than 90% of patients in group 3 experienced hypertensia, whereas patients who take therapy for less period of time reported this complaint in less than half of cases.
Presumably, the increased sensitivity of the teeth is associated with a violation of mineral metabolism due to a decrease of remineralizing properties of saliva and release of mineral components from the hard tissue of the teeth under the influence of IGCS.
Patients form each of the groups noted distortion of taste sensations, which were associated with the beginning drugs intake. It should be noted that the incidence of this complaint increased with the duration of therapy (more than 90% of patients in group 3).
Also, patients in groups 2 and 3 (65% and 61%, respectively) often noted the appearance of bad breath, which is probably due to the deterioration of the cleaning properties of the oral fluid due to a decreased salivation rate and retention of food remnants in the oral cavity.
The highest value of hygienic state index was registered in patients from group 3 -2,800 (2,200, 3,100), which is significantly (P = 0,001) different from the similar index of the other two groups (Fig. 3).
Fig 3. The values hygiene index in groups Note: * - the level of significance of significant difference compared with group 1; # - significance level of significant difference compared with group 2
According to the results of the oral fluid study, it was found that the greatest deviations were recorded in patients of group 3 (i.e., those who took basic therapy for COPD in combination with CHD for more than 5
years) (Table 1). It was noted that the rate of salivation in patients with COPD in combination with CHD ranged from 0.100 to 0.300 ml/min, with a minimal value in group 3.
Table 1
The values of physical indicators of mixed saliva of the subjects
Parameter Group 1 Group 2 Group 3
Salivation rate 0.300 (0.200; 0.400) p1=0.001 0.225 (0.200; 0.300) p=0.015 p1=0.001 0.100 (0.100; 0.1500) p=0.015
Viscosity 5.200 (4.550; 6.275) p1=0.001 5.800 (5.500; 7.000) p=0.011 6.500 (5.900; 7.150) p=0.001
pH 6.600 (6.350; 6.800) p1=0.001 6.400 (6.200; 6.675) p=0.014 6.300 (6.100; 6.600) p=0.001
Note: p - significance level of significant difference compared with group group 1, p1 - significance level of significant difference compared with group 3
0
Saliva is a natural liquid biological medium which neutralizing and mineralizing properties are largely due to the state of acid-base balance which objective parameter is pH. According to the received data, the lowest values of pH were also recorded in group 3 (6.3) which distinguished it not only from the accepted normative indices but also from parameters of group 1 where they also were less than normal.
Decreased salivation rate led to an increase of oral fluid viscosity which minimum value corresponded to group 1 and the maximum - group 3 which fully explained the significant complaints of patients of dryness and lack of saliva.
Conclusion: Thus, the study shows that more than 80% of patients with COPD in combination with CHD have dental complaints, which patients associate with the start of drug intake.
1.The most frequent complaints are dryness in the mouth, loss or distortion of taste sensations, burning tongue and dry lips, bad breath and increased sensitivity of teeth.
2. It was noted that the frequency of these complaints increases with the duration of basic therapy for somatic pathology.
3. Manifestations of COPD in combination with CHD against intake of basic therapy include changes in the physical properties of mixed saliva, expressed by a decrease in the secretion rate, as well as increased acidity and viscosity properties which directly depend on duration of drugs intake.
The perspectives of further scientific research - In this regard, the evaluation of the long-term side effect of drug therapy on the oral cavity in such patients is timely and relevant, and the polymorphism of subjective and clinical manifestations encourages the development of adequate integrated diagnostic and prophylactic methods.
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PATTERN OF CARDIAC RHYTHM VARIABILITY OF PREGNANT WOMEN DEPENDING ON THE FETUS SEX
Kalentyeva S.V.
Kemerovo State Medical University, professor
Kemerovo
ABSTRACT
The purpose of the research is to find out the pattern of a mother's cardiac rhythm variability depending on the fetus sex. Due to the high prevalence of neurohumoral control disturbances, especially of reproductive function, the women, who gestate male fetus, are in less conducive conditions to conception and gestation of male fetus, which is less resistant to disturbing factors. Under these circumstances there are more risks for perinatal sequelae.
Keywords: fetus sex, cardiac rhythm variability, perinatal sequelae.
Cardiorhythmography is a functional method of diagnosing the state of the vascular system, based on a spectral analysis of heart rate variability. The scope of the method has been expanding rapidly in recent years. In the field of clinical applications - this is neurology, therapy, occupational pathology, radiation injuries,
emergency conditions, narcology, oncology. In the field of labor physiology and ecology, cardiorhythmog-raphy is used to investigate the characteristics of the adverse effects of industrial and environmental conditions and biorhythmological effects.
