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Factors of nonspecific resistance and their clinical value at patients with recurrent aphthous stomatitis
Alimova Dono Mirjamalovna, Tashkent State Dental Institute teacher assistant of department of faculty therapeutic dentistry E-mail: stom_81@bk.ru Kamilov Khaydar Pozilovich, Tashkent State Dental Institute head of department hospital therapeutic dentistry, professor, d. m. s. (PhD) E-mail: Khaydar.Kamilov.@mail.ru
Factors of nonspecific resistance and their clinical value at patients with recurrent aphthous stomatitis
Abstract: indicators of nonspecific resistance in RAS are objective criteria of severity of its clinical course. In patients with mild and severe clinical course progressive decrease of IgA, sIgA, lysozyme and phagocytosis is accompanied increase of IgA, sIgA, IgG and IgM which is evidence of suppression organism and oralmucosa is resistance.
Keywords: recurrent aphthous stomatitis, immunoglobulins A, M, G, lisozyme, phagocytosis.
The recurrent aphthous stomatitis (RAS) remains an actual problem of stomatology, keeping the leading positions in structure of diseases of the mucous membrane of oral cavity (MMOC).
The topical antimicrobial preparations and antibiotics of a wide range, which are applied to treatment of patients, promote development of a dysbiosis of the main biotopes of an organism, have immunosuppressive effect and become an additional adverse pathogenetic factor at RAS [4, 23-25; 6, 20-22; 7, 14-17].
Key links of pathogenesis of RAS make local provocative factors and reactivity of a microorganism, which in modern conditions is affected by adverse factors [1, 636-642; 3, 368].
Thus wellbeing of a clinical course and outcomes of diseases of oral mucosa depends on the adequate answer of nonspecific factors of resistance.
In recent years convincing evidences of participation of specific and nonspecific links of protection at RAS are received [6, 20-22; 7, 14-17; 9, 271-273].
However the questions of a solvency of nonspecific protection of organism in RAS of different severity are little-investigated aspect of this problem. It causes difficulties with adoption of the reasonable decision on indicators to correction of the revealed deviations.
Purpose of research: to estimate a condition of nonspecific factors of resistance in patients with various severities of RAS and to determine their clinical course.
Materials and methods. Material for the analysis and conclusions were results of 116 patients with RA.S, which were on out-patient treatment in clinic of dental therapeutics of Tashkent medical academy during the period from 2012 year till 2015 year.
The clinical assessment of RAS severity was carried out according to methodical instructions of Kh. P. Kamilov and U. A. Shuku-rova (2008) and concluded assessment of severity of clinical course by the index of the total severity (ITS) representing an average score of the basic clinical symptoms and manifestations of a disease [2, 16]. The assessment of RAS on the ITS index is presented by: 0.5-1.0 points — mild RAS; 1.1-2.0 — medium RAS and 2.1-3.0 points — severe RAS.
Among all the patients with RAS there were 72 (62.07 %) patients with medium severity ofdisease; 32 (27.59 %) patients with mild RAS and 12 (10.34 %) patients with severe form.
Patients received the standard complex of treatment and preventive actions including prescription of the full-fledged sparing diet, anesthesia of erosive and ulcer surfaces with Lidocaine spray
or Sinetidin, desensibilizing and vitamin therapy, course of immunomodulators (T-aktivin, Imunomodulin) according to indications, and probiotics (Lakto-and Byfidobacterin).
During remission period dental readjustment of oral cavity, elimination of agents of chronic infection, treatment of organ pathology were carried out.
The assessment of efficiency of treatment of RAS was carried out on the basis of studying local (oral liquid) and system (blood serum) indicators of nonspecific resistance.
Concentration of Immunoglobulins A, G, M was studied by method of simple radial immunodiffusion in an agar by G. Man-chini and A. Garbonava (1965) in modification of E. V. Cher-nokhvostova and S. I. Golderman (1975). Activity of lysozyme was studied by nephelometryby V. G. Dorofeychuk (1968), and phagocyte activity neutrophilic leukocytes was studied according to M. A. Temirbayev (1989).
The data obtained in the course of clinical and laboratory research was exposed to statistical processing with the use of Excel program. Statistically reliable distinctions between indicators were defined by Student's T-criterion with the standard degree of reliability P < 0.01.
Results and discussion. In patients with RAS in the acute period of a disease there was disturbance of indicators of nonspecific reactivity, which nature of change was defined by severity of a clinical course, established.
In patients with mild RAS in the acute period of a disease in both studied environments there was decrease of the activity of a lysozyme, phagocytosis and increase of IgA, IgG, IgM established. So, in oral liquid activity of lysozyme was lowered by 11.92 % (P > 0.05); phagocytosis was by 24.46 % (P < 0.01); and concentration of IgA, IgG and IgM increased by 18.42 % (P < 0.05); 19.61 % (P < 0.05) and 27.27 % (P < 0.05)respectively. ^he corresponding dynamics in blood serum decreased in lysozyme by 16.43 % (P < 0.05); in phagocytosis — by 14.84 % (P < 0,05) and increase in IgA, IgG and IgM for 19.0 % (P < 0,05); 23.69 % (P < 0.05) and 17.90 % (P < 0.05) respectively (table 1).
The analysis of the quantity of IgA in both studied biological liquids revealed authentically low (P < 0.05) value of this indicator in patients with medium RAS and severe RAS that testified to oppression of local immunity in the acute period of a disease. Besides reliable oppression of phagocytal function of neutrophils and lysozyme, reliable growth of IgG and IgM, decrease of the activity of lysozyme and phagocytosis were noted.
Section 4. Medical science
The revealed changes progressed with increase of RAS severity. So, In patients with medium RAS lysozyme activity was lowered on 34.59 % (P < 0.01); phagocytosis was on 36.18 % (P < 0.01); IgA was lowered on 31.56 % (P < 0.01); and IgG
In patients with severe RA.S these changes were even more expressed. So, in oral liquid lysozyme activity was lowered on 46.36 % (P < 0.01); phagocytosis was on 46.14 % (P < 0.01); IgA was on 44.74 % (P < 0.01); and IgG and IgM increased by 67.65 % (P < 0.01) and 79.73 % (P < 0.01)respectively; the corresponding dynamics of these indicators in blood serum decreased by 42.62 % (P < 0.01); 48.27 % (P < 0.01); 36.76 % (P < 0.01) and increased by 65.74 % (P < 0.01) and 57.17 % (P < 0.01) (table 1).
Thus, indicators of nonspecific resistance in RAS are objective criteria of severity of its clinical course.
The main function serum IgA is neutralization of infectious agents on mucosa. SIgA-function is protection against an infection. Serum antibodies possess the expressed anti-sorption properties: they interfere with an attachment of bacteria to a surface the epithelial cells, prevent adhesion without which bacterial damage becomes impossible. Together with other nonspecific factors provide protection of mucous membranes against microbes and viruses [5, 112-116; 8, 752]. It is possible to explain with high IgA and sIgA level benign course and low frequency of recurrence or mild RAS.
Emergence of IgM and its increase with increase of weight of RAS testifies to progressing of inflammatory process.
Antibodies of IgG class play a fundamental role in providing the long humoral answer. The IgG level increases in response to a chronic infection or an autoimmune disease. The main IgG function is formation of the anti-gene — antibody complex [3, 368; 5, 112-116; 8, 752].
The increase in IGM and IgG with increase ofclinical symptoms of RAS and decrease in IgA reflect progressing of the system and local inflammatory answer and decrease in antibacterial protection.
and IgM were raised on 39.22 % (P < 0.01) and 54.55 % (P < 0.01); the corresponding dynamics of these indicators in blood serum were 28.20 % (P < 0.01); 22.23 % of 18.07 % (P < 0.05); 44.75 % (P < 0.01) and 35.80 % (P < 0.01).
In the period of convalescence in patients with RAS there were noted reliable (P < 0.05) changes of the studied indicators. Extent of normalization of the studied indicators was defined by initial disease severity.
So, in mild RAS in oral liquid and blood serum the studied indicators of nonspecific resistance had no considerable distinctions with control (P < 0.05); in patients with a medium RAS only the part of indicators had no significant distinctions with control; and in severe RA.S their value differed in the adverse party from control indicators (P < 0.05) (table 1).
In patients in the acute period disorder of nonspecific resistance is noted. Thus dynamics of the studied indicators is interconnected with a clinical course of RAS.
- In patients with mild RAS the adequate answer of factors of nonspecific resistance is formed. High level of immunoglobulin A in serum of blood and oral liquid during RAS of an easy current testifies to a solvency of resistance of an organism and oral mucosa that reflects clinical symptoms. Normalization of indicators in the period of convalescence determines the minimum frequency of recurrence.
- The progressing decrease of concentration of IgA, sIgA, ly-sozymes, phagocytes was followed by increase of IgA, sIgA, IgG and IgM, testifying about lowered antibacterial protection, suppression of resistance of an organism and oral mucosa, progressing of system and local inflammatory and autoimmune processes, in patients with medium and severe RAS.
- After carried out treatment of medium and severe RAS according to the standard scheme all the shifts in studied links of immune system have remained with, testifying about low efficiency of treatment and need of development of the treatment schemes, adapted for severity of a clinical course of a disease.
Table 1. - Indicators of nonspecific resistance at patients with various RAS severity depending on the disease period
Group Liz, % Phagocytosis, % IgA, g/l IgG, g/l IgM, g/l
Oral liquid
Control 46.25 ± 2.11 49.6 ± 2.38 0.38 ± 0.01 1.02 ± 0.04 0.11 ± 0.02
Patients with RAS Acute period
1 Mild 36.11 37.21 ± 1.25 0.45 ± 0.02 1.22 ± 0.06 0.14 ± 0.06
2 Medium 30.25 31.42 ± 1.02 0.26 ± 2.01 1.42 ± 0.07 0.17 ± 0.007
3 Severe 24.81 26.53 ± 0.96 0.21 ± 0.06 1.71 ± 0.08 0.19 ± 0.08
Convalescence period
1 Mild 45.32 ± 2.4 47.32 ± 2.08 0.40 ± 0.07 1.08 ± 0.04 0.12 ± 0.05
2 Medium 40.81 ± 1.97 39.41 ± 1.52 0.32 ± 0.01 1.22 ± 0.05 0.13 ± 0.006
3 Severe 35.44 ± 1.62 33.62 ± 1.44 0.25 ± 0.01 1.41 ± 0.06 0.14 ± 0.007
Blood serum
Control 42.37 47.37 ± 2.14 3.21 ± 0.10 15.62 ± 0.81 1.62 ± 0.06
Patients with RAS Acute period
1 Mild 35.41 ± 1.52 40.35 ± 2.03 3.82 ± 0.12 19.32 ± 0.85 1.91 ± 0.08
2 Medium 30.42 ± 1.29 32.11 ± 1.44 26.30 ± 0.07 22.61 ± 0.92 2.22 ± 0.05
3 Severe 24.31 ± 1.02 24.52 ± 1.03 2.03 ± 0.04 25.81 ± 1.03 2.53 ± 0.07
Convalescence period
1 Mild 41.03 ± 1.62 46.92 ± 2.06 3.31 ± 0.12 16.01 ± 0.71 1.66 ± 0.07
2 Medium 39.61 ± 1.38 38.11 ± 1.42 2.91 ± 0.08 19.81 ± 0.62 1.91 ± 0.06
3 Severe 31.25 ± 1.44 32.61 ± 1.53 2.51 ± 0.11 23.11 ± 0.88 2.02 ± 0.08
Note: * — P < 0.05 concerning norm; ° — P < 0.05 concerning acute period; X — P < 0.05 concerning mild clinical course; A — P < 0.05 concerning medium clinical course.
Evaluation of medical and preventive care of patients with diabetes mellitus according to the register in Fergana region
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Alikhanova Nadira Mirshavkatovna, PhD in Medicine, Academic Secretary of RSSPMC of Endocrinology MH of Uzbekistan E-mail: nodi200468@mail.ru Ismailov Said Ibragimovich, MD (DMSc.), Professor, Director of RSSPMC of Endocrinology MH of Uzbekistan E-mail: endocrin@uzsci.net Akbarov Zairkhodja Sobirovich, MD (DMSc.), Professor, Head of Diabetology Laboratory
Evaluation of medical and preventive care of patients with diabetes mellitus according to the register in Fergana region
Аbstract: Clinical courses of DM 1 and 2 were analyzed from of 10 436 register-cards in Fergana region. It was established that most of the patients were in decompensation stage that result from poor management of diabetes and increases rate of diabetic complications. Based on the results, conclusions were made about the necessity of reviewing current treatment modalities and on increasing general awareness among healthcare personnel.
Keywords: diabetes mellitus, register, cards, decompensation, treatment.
Urgency. At present, cardiovascular diseases, cancer and make it possible to solve both the practical problems faced by the other diseases of non-infectious origin became major causes of healthcare authorities and carry out a scientific analysis of the pecu-morbidity, disability and early mortality. The problem of diabetes liarities of clinical course and manifestation of DM in Uzbekistan. mellitus (DM) is acquiring ever-increasing importance among The study was aimed at analyzing the clinical course of type 1
them. According to the World Health Organization, that global prevalence of DM increased during the last decade more than twofold, reaching some 387 million to the end of 2014 and it was estimated to affect 9 % of adults aged 18 and over. WHO projects that diabetes will be the 7th leading cause of death in 2030 [14]. In the absence of a well-organized health and social care to patients, DM leads to early disability, increased mortality and reduced life expectancy of affected individuals. Uzbekistan encounters a sharp growth in the prevalence of DM, like many other countries. Currently, the number of registered patients with diabetes in Uzbekistan has exceeded 157 000 people. However, epidemiological studies of the prevalence of diabetes suggest that actual prevalence is several times greater than the officially registered and, by estimates comprises 5.2-9.1 % of population [2; 7; 8; 13].
Establishment of a national registry is an essential step towards optimization of care provided to diabetic patients. The data of register
and type 2 diabetes in the last 12 months (2007) in Fergana region.
Materials and methods of research. Analysis Clinical course of DM was studied with aid of register-cards in Fergana region. The register-cards were unified forms of national register, elaborated by employees of the center with account taken ofEASD recommendations and experience of other countries [1; 4; 5; 9; 10].
10 436 register-cards of same numbered patients, including 9 384 patients with type 2 DM, 1 052 of type 1 DM and 1 — gestational diabetes, were filled in Fergana region; the data of clinical course and treatment were processed with aid of computer.
The age of patients with 1 type DM ranged mainly from 1 to 14, up to 80 and included 560 men, 492 women.
The age of patients with type 2 DM was 14 to 80 years, 4 086 men and 5 297 women. The number of patients who were on constant follow-up or what is called dispensary observation comprised 11 659, filling in of register-cards comprised 89.51 %.
