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Efficacy assessment of the activities for prophylaxis of micro nutrients deficit in children
to ipochondric neurosis (F45.2). Ipochondric symptoms in the observed patients differed by expressed polymorphism. Raised anxiety, concentration on body feelings and own emotional status in these patients provoked non-satisfaction with these sensations and desire to its improvement and demanding additional medicines from doctors. In the discussion of their status with each other these patients soon got notions about bad feeling, uselessness of the performed therapeutic measures. All these were accompanied by worsening of mood and intensification of pain feeling.
Asthenic-depressive symptoms reliably prevailed in the 1st group (19.3% and 57.8%; p<0.01); (26.3% and 62.2%; p<0.05). They complained about fatigue, unpleasant feeling in the area of heart. Depressive symptoms were characterized by little depth and instability. Often complaints were about bad mood.
Quantification of the components ofpathologic inclination for drugs (PID) was performed according to the scale worked out by M. A. Vinnikova (2004).
Periodic thoughts about narcotic drug appeared rarer in the 1st group than in the 2nd one (22.8% and 48.8%; p<0.01), and constant thoughts about drug — more in the 2nd group (45.6% and 20.0%; p<0.05). Some patients of the 2nd group associated memories about narcotic intoxication with possible application of "the right of golden injection", i. e. leave this life.
Specific weight of the expressed depression with anguish was higher in the 2nd group (35.0% and 20.0%). First of all there were complaints about feeling everything gray around, no perspective for future, no will to communicate with anybody. The result according to anxiety demand attention, as there are differences in all expression degrees: slight — 14.0% and 2.2% (p<0.05); middle — 29.8% and
17.7% (p=0.05); severe — 38.5% and 11.1%; p<0.01). Dysphoria state with prevailing in the 2nd group was expressed in increased conflict making, malignancy (49.1% and 28.8%; p<0.05). Specific weight of the patients with dysphoria was 82.3% in group 2 and 53.1% in group 1.
We revealed high level of sleeping disorders in the 2nd group (43.8% and 33.3%; p>0.05). Qualitative characteristics of dyssom-nia was change of its day rhythms. Specificity of dreams in the patients of the 2nd group was that besides dreams with narcotic theme these patients had fearful dreams, including aggressive ones. Dreams repeating for several times (31.5% and 13.3%; p<0.05) conditioned the decrease of mood, exacerbation of vegetative symptoms. It should be noted that maximally expressed disorders of behavior were registered in the patients of the 2nd group (29.8% and 17.7%; p=0.05).
Formal and formal-forced programming for the therapy as met less in the 1st group (33.3% and 62.2%; p<0.05), while negative programming was higher in the 2nd one (52.6 and 31.1%; p<0.05). The patients of both groups were aware of their disease (59.6% and 71.1%).
Conclusion. The established affective impairments have certain interrelation with personal characteristics of the examined patients. Results of the study widen the capabilities of diagnostics of suicidal behavior patterns in the patients with addictive impairments and provide prognosis of readaptation and re-socialization ways. The obtained results of clinical, structural and dynamic peculiarities of deviant behavior in addictive patients provide the possibility for scientific basis and design of complex differentiated therapeutic-rehabilitation programs.
References:
1. Keselman L. E., Matskevich M. G. Social space of narcotism. - SPb.: Medical press, 2001.
2. Mendelevich V. D. Psychology of deviant behavoir. - M.: "MEDpress", 2001.
3. Khanzian E. D. Vulnerance of self-regulation sphere in addictive patients: possible therapy methods./Psychology and therapy of addictive behavior./Edited by S. Dawling. - M.: Independent company "Class", 2000. P. 29.
4. McArdle P. & est. International variations in youth drug use: the effect of individual behaviours, peer and family influences, and geographical location//European Addiction Research. Karger, 2000. P. 163-169.
Ashurova Dilfuza Tashpulatovna, CMS, Chief of the Department of Propaedeutics of Children's Diseases,
Tashkent Pediatric medical institute E-mail: mbshakur@mail.ru
Efficacy assessment of the activities for prophylaxis of micro nutrients deficit in children
Abstract: Programs in the field of nutrition implemented in Uzbekistan, such as supplementation of children from 6 to 59 months old with vitamin A, rational nutrition and consumption of fortified flour promote the improvement of immunity indicators and normalization of serum retinol. It conditions the prophylaxis and liquidation of nutrition disorders and harmonic development of children during initial 5 years of life.
Keywords: supplementation of vitamin A, nutrition disorders, physical development, children.
The notion of vitamin deficit being one of the important reasons of children's health deterioration occupies a stable place in the modern pediatrics and children's nutriology. At the same time many aspects ofthat problem, and particularly causes of appearance ofvi-tal micro nutrients deficiency, forms of that deficiency and various approaches to its prevention, did not find sufficient reflection in the modern literature. In our opinion it is linked especially with pro-
phylaxis of vitamin deficiency in children during initial 5 years of life [4; 5; 8].
Though subnormal supply ofvitamins is not accompanied with expressed clinical impairments, it significantly diminishes resistance of children to the impact of infectious and toxic factors, physical and mental workability; it slows down the terms of recovery in children with various pathologies including children with severe trauma,
Section 6. Medical science
burns, postoperative patients; it promotes exacerbation of chronic diseases of the upper respiratory ways, gastric intestinal system, and hepatic-billiary system [2; 4; 7].
Deficit of vitamin A is considered to be a global problem. According to WHO data every year 140 million school age children and 7 million pregnant women suffer vitamin A deficit in the world. 4.4 million children and 6.2 million women suffer xerophthalmia. 1.2-3 million children die as a result ofvitamin A deficit [9].
Prophylaxis of vitamin deficit should be targeted to provision of complete compliance between the children's demand ofvitamins and vitamins supply with food [3]. Studies performed during recent years showed that none of herbal or animal products cannot compensate vitamin A deficit, that's why additional supply of it is necessary [6; 7].
A program proposed by UNICEF "Supplementation ofvitamin A" was performed in 2003 in Uzbekistan. Main branches in the improvement of nutrition are widening of the spectrum and covering of population by supplementation of fortified food products, widening of target groups of children's population for supplementation of micro elements and vitamins, and formation of the skills of rational feeding of children and nutrition of adults [1].
The objective: is to evaluate the efficacy of the actions for prophylaxis of micro nutrients' deficit among children in the Republic of Uzbekistan.
Materials and methods of the research: For the definition of the efficacy of the implemented measures we selected 513 children under 5 years old, among which we performed supplementation ofvitamin A starting from 6months (in compliance with WHO recommendations these children got 1 capsule ofvitamin A100000 Units in 6 months, and starting from 12 months 1 capsule 200000 Units once every 6 months, I. e. totally they got 6 capsules ofvitamin A). Besides that, families of these children had explanatory work for healthy nutrition, and these families used fortified flour in their ration.
The control group involved 227 children who did not get vitamin A due to any reason in all recommended ages (who received from 1 to 3 capsules).
Immunologic studies were performed in 84 children, among them 64 frequently sick children (FSC) and 20 actually healthy ones who composed the comparison group.
Results of the research: Comparative analysis showed that the children of the main group grew and developed better and met the demands of WHO standards. The analysis of antropometric values showed that average value of the weight in relation to the age in children receiving vitamin A was 15.2±1.4 kg in girls and 14.8±1.6 kg in boys and that corresponded to the interval "mediana (0) +1 CO» WHO standards, while in the group of children who did not get vitamin A that value was 11.8+0.9 kg in girls and that corresponded to
the interval «-2 CO--1 CO», which wad the risk of low weight,
and 10.2+1.5 kg in boys corresponded to the interval «-3 CO — -2 CO», considered to be decreased weight. The analysis of individual development showed that the percentage of children with decreased weight in the group of children receiving vitamin A was 1.9%, and in children who did not receive vitamin A 7.2%.
The impact of vitamin A on the development and growth of
children once again was proved by the results achieved in the measurement of the height of 5 years old children. So the average value of girls' height was 97.2±2.4 cm, and boys — 94.5±1.5 cm. In the group of children receiving vitamin A these values in girls were 90.4±3.4 cm, and in boys — 89.2±2.4cm. Individual analysis showed that among the children receiving vitamin A retardation of growth was observed in 2.2% of the children; and in children who did not receive vitamin A 14.2%.
Vitamin A also promoted harmonic development of the children. Body weight index both in girls and boys corresponded to mediana (0) and was equal to 16.7±1.1 kg/sq.m in girls and 16.4±1.5 kg/sq.m in boys. In the group of the children who did not receive vitamin A these values were respectively 14.75±1.6 and 12.75±1.2 kg/sq.m and testified light degree protein-energetic deficiency in girls, medial degree in boys.
In the analysis of immunogram of 64 frequently sick children we revealed relative leucopenia compared with the children from the control group 5599.7± 332.7 in 1mkl versus 7300±370 in 1 mkl respectively (P<0.05), and also we observed lymphopenia (46.7±2.1%, P<0.05, versus 48.1±1.4%). Similar tendency was observed in the amount of CD 3+ cells; that value was 40.4±1.2, and that was reliably lower the values of the control group (48.3±1.98; P<0.05). a little bit decreased volume of subpopulation of CD8+ (16.5±1.0% versus 17.4±0.6% (P<0.05)) with background depressive pull of CD4+, it led to significant decrease of the correlation of CD4+/CD8+ (1.58± 0.08 versus 1.7 ± 0.1 respectively). Activation of B-system of immunity displayed not only by increase of B-cells amount, but also significant alteration in the amount of immunoglobulins. All children had notable hyper globulinemia G (16.8±0.62 versus 11.6±0.35; P<0.01) and A (2.95±0.15 versus 1.99±0.13; P<0.01). There was significant change of non-specific protection factors: phagocyte number had remarkable decrease (41.2±2.1 versus 48.2±2.5%; P<0.05).
After vitaminization it was determined among FSC that supplementation by vitamin A could promote normalization of immune system functioning in FSC. Vitamin A had favorable effect on the population of T-lymphocytes. So the children had increased amount of CD3+ (after supplementation — 44.5±1.5 versus 48.3±1.98; P<0.05) and CD4+ (after supplementation — 28.9±1.2 versus 29.6±1.1; P>0.05) lymphocytes after supplementation in comparison with the control group. Supplementation of vitamin A had expressed impact on the values of humoral immunity. In FS children after vitamin supplementation there was reliable increase of B-lymphocytes amount both compared with the original level (P<0,05) and the values in healthy children (P<0.05). All children had notable stimulation of IgM synthesis (P<0.05). It should be noted, that the level of serum IgG in FSC decreased, though did not reach the control values (13.4±0.85%, versus 11.6±0.35; P>0.05).
Conclusion. Thus, programs in the field of nutrition such as supplementation of vitamin A to children in the age from 6 to 59 months, rational nutrition and consumption of fortified flour promoted harmonic development and correction of nutrition disorders in the children within initial 5 years of life independently of the sex and place of living.
References:
1. Alimov A. V., Akhmedova D. I. Main branches in the provision of birth of healthy children and formation of harmonic developed generation in Uzbekistan: results and perspectives.//Republican scientific-practical conference "Basic branches in the formation of harmonic developed generation in the Republic of Uzbekistan". - Tashkent, 2010. - P. 23-25.
2. Bistrova N. A. Immune modulating effect ofvitamin A and E.//7th Russian national congress "Human and drugs". 10-14 April 2000. -P. 394.
Role of G308A polymorphism of TNF-a gene in the formation of rosacea
3. Vitamins and minerals for the health of children (educational manual). - M.: SPR-OF «Healthy child"; SCCH RAMS, 2003. - 28 p.
4. Gromova O. A., Krasnikh L. M., Limanova O. A., Kutuzova N. A. Correction of vitamin status in attention deficiency and hyper activity syndrome//Probl. Of modern Pediatric. - 2003. - V.2. - № 4. - P. 33-39.
5. Kon I. Y. Deficit ofvitamins in children: main reasons, forms and ways ofprevention among young and school age children.//Problems of modern pediatrics - 2002. - V. 1. - № 2. - P. 62-66.
6. Narbayeva T. K., Akhmedova D. I. Strategy of nutrition improvement - essential condition of health and harmonic development of new generation/Thesis: VI Congress of Pediatricians of Uzbekistan. Tashkent, 5-6th November 2009. - P. 42-43.
7. De Onis M., Garza C, Victora C. G. et all. For the WHO Multicentre Growth Reference Study Group. The WHO Multicentre Growth Reference Study: Planning, studydizighn and methodology. Food Nutr Bull 2004;25 Supl 1: S. 15-26.
8. De Onis M., Garza C., Victora C. G. et all. WHO Multicentre Growth Reference Study (MGRS): Rationale, planning and implementation. Food Nutr Bull 2004;25 Supl 1: SI-89.
9. WHO Multicentre Growth Reference Study Group. WHO Child Growth Standarts based on length/height, weight and age. Acta Padiatrica, 2006; Supl 450: 76-85.
Babadjanov Oyibek Abdujabbarovich, Assistant of the Department dermatology Tashkent Pediatric Medical Institute Arifov Saidkosim Saidazimovich MD, professor of dermatology head of the department of the Tashkent Institute of Advanced Medical E-mail: mbshakur@mail.ru
Role of G308A polymorphism of TNF-a gene in the formation of rosacea
Abstract: The results obtained by the research reliably demonstrate the presence of association of carrying rs1800629*G allele and rs1800629*G/A genotype of TNF-a gene with the risk of rosacea development. Keywords: rosacea, polymorphism rs1800629, TNF-a gene, cytokines.
Rosacea — a chronic relapsing skin disease with multifactorial nature, characterized by lesions of facial skin in the form erythema and papulo-pustular elements [8, 11]. According to the authors, the prevalence of rosacea is 10% of the world's population and holds 7th place in frequency among all dermatoses [6]. The disease mainly occurs in 30% ofpatients aged 50 years and comparably common in fair-skinned Europeans [9, 13]. In Uzbekistan, the share of rosacea among all skin diseases is 10%.
According to the classification of the National Rosacea Society (NRS) proposed in 2002 [13], there are four subtypes and one variant ofrosacea: subtype 1-erythematous-teleangiectatic rosacea; subtype 2 — papulo-pustular rosacea; subtype 3 — phymatous rosacea; subtype 4 — ocular rosacea; the variant — granulomatous rosacea.
Modern concepts of rosacea suggest that in the majority of cases the disease develops due to congenital disorders of the immune response associated with genetic defects in one or more components of the immune system [14]. This is supported by studies of some authors: 1/3 of the rosacea cases among northern Europeans is hereditary [4]. At the same time, it shows the special role of genetically mediated dysfunction of cytokine system at the core of the disease [5]. In connection with this, there has recently been notes an increased interest to the study of genetic polymorphisms ofcytokines functionally responsible for changing their protein products and the contribution ofgenotypic variants of these polymorphisms in the development and progression of rosacea.
Since the proinflammatory cytokine TNF-a plays a leading role in cellular immunity, not only promotes chemotaxis but cell proliferation, amplifying inflammation [7, 12], we considered it appropriate investigate the role of G308A polymorphism (rs1800629) of gene TNF-a in the formation of rosacea at Uzbek people. This polymorphism increases the expression of the gene and accordingly the production of the cytokine [3].
Purpose of work — study of the role of polymorphism rs1800629 of gene TNF-a in the pathogenesis of rosacea and evaluation of the prognostic value of certain genotypic variants in the development and clinical characteristics of the disease.
Methods of the research. The object of research served as the sampling of unrelated patients with "rosacea", living in different regions of the country, the total number is 140 people. The diagnosis was based on the diagnostic criteria, taking into account the major and minor signs of rosacea.
All examined patients were divided into 2 groups: I subgroup — patients with erythematous form "rosacea"; Subgroup II — patients with papulo-pustular form of "rosacea."
The control group consisted of 145 healthy unrelated individes (Uzbeks) who corresponded on the sex and age of the studied patients, and did not have in anamnesis skin disease. Genomic DNA from leucocytes of peripheral blood samples (Vacutainer Becton Dickinson International with EDTA) was isolated using the kits "QIAamp DNA Blood Mini Kit", Qiagen (Germany) and "the RNA/DNA-sorb" LLC "InterLabService" (Russia), in accordance with instruction.
Amplification of polymorphism rs1800629 of TNF-a gene was performed using thermal cyclers GeneAmp PCR-system 2720 (Applied Biosystems, USA) and Corbett Palm Cycler (Corbett Research, Australia CG1-96 model) using a commercial kit of LLC SMF Liteh (Moscow).
For genotyping of rs1800629 polymorphism of TNF-a gene specific oligonucleotide primers are used: F: 5'AATAGGTTTT-GAGGGCCATG-3'$ R: 5ATCTGGAGGAAGCGGTAGTG-3'.
Amplification was performed under the following original conditions: to pre-denature — 94 ° C (1 min. 1 cycle), 35 cycles of amplification: 94 ° C (10 sec) — denaturation, 66 ° C (20 sec) — an-
