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2330 East European Scientific Journal #1(65), 2021 ...2;...,..
y^K: 612.17:616.839:796.071
Zubaydullaeva M. T., Karimova M. T.
Tashkent Medical A cademy
FUNCTIONAL CONDITION AND ADAPTATION POSSIBILITIES OF THE ORGANISM OF SPORTSMEN
Resume. The article presents data from the literature of recent years usages of rhythmocardiography to assess the success of sports activities. The study of the variability of the heart rate variability provides important information for assessing the functional reserves of an athlete and, accordingly, adaptive abilities and predicting his success. The processes of economization - mobilization - recovery, determining the effectiveness of sports training, are fully reflected in the heart rate variability. According to the RCU, one can judge the level of adaptation of the organism to the conditions of sports activity.
Key words: heart rate variability.sportsmens, autonomic nervous system, neurohumoral regulation of the heart
Athletes are a special professional group with regular increased loads on the cardiovascular system and accordingly, the risk of cardiac complications, the most formidable of which is Sudden cardiac death (SCD). The incidence of SCD in high-level athletes is 0.35 per 100,000 athletes, and in individual active sports 0.46 per 100,000 per year for men and 0.77 per 100,000 per year - among women. [22]
Achieving high athletic performance is inextricably linked to the effectiveness of managing the training of athletes. One of the most important principles of building the training process is the correspondence of the loads to the current functional state. [32,37]
Objective criteria for assessing the current functional state and physical fitness of athletes are physiological indicators, primarily reflecting the state of the mechanisms of regulation of the autonomic nervous system (ANS) [7] As you know, ANS manages the energy and metabolic processes of the body, mobilizes functional reserves under stress, ensuring their recovery and accumulation. The mechanisms of autonomic regulation play a leading role in the adaptive reactions of the body and in maintaining the homeostasis of its basic systems under changing environmental conditions.[4] A high degree of adaptation to physical activity is manifested not so much in increasing the functional capabilities of individual organs and systems as in improving their regulatory mechanisms, that is, in the integration of motor and autonomic functions.[37]
The body's adaptation to the effects of various environmental factors (including physical exertion) is largely associated with the reactions of the cardiovascular system and its regulatory mechanisms. The heart is a very sensitive indicator of all events occurring in the body. The rhythm of its contractions, regulated through the sympathetic and parasympathetic sections of the autonomic nervous system (ANS), responds to any stressful effects[41]
To assess the functional reserves of the body and the regulatory features currently in applied physiology, sports medicine and clinical practice, a technique is actively used to study heart rate variability (HRV) [5,24,42]. HRV research is used in sports practice to
assess the current functional state and adaptive potential of the body, early detection of maladaptation and overtraining state, exercise urgent control over the process of physical training in order to optimize it. The success of sports activity depends not only on the effectiveness of the training process, but also largely physiological reserves of the athlete.[19,24]
The concept of cardiac regulation.
Automatism of the heart and the influence of neurohumoral factors on the function of the sinus node. The rhythm of the heart is determined by the property of automatism, i.e. the ability of the cells of the conduction system of the heart to spontaneously activate and cause contraction of the myocardium. Heart rate regulation is carried out by the autonomic, central nervous system, a number of humoral influences, and also due to impulses arising in response to irritation of various inter- and exteroreceptors.[38,17]. The heart is innervated by the autonomic nervous system, consisting of sympathetic and parasympathetic nerves. Under the influence of the sympathetic nerve, heart rate increases. Sympathetic nerves, stimulating beta-adrenergic receptors of the sinus node, displace pacemakers to cells with the highest automatic activity. Irritation of the vagus nerve, in turn, stimulates the M-cholinergic receptors of the sinus node, resulting in the development of bradycardia. The sinus and atrioventricular nodes are mainly influenced by the vagus nerve and, to a lesser extent, the sympathetic, while the ventricles are controlled by the sympathetic nerve.
The activity of the autonomic nervous system is influenced by the central nervous system and a number of humoral influences. In the medulla oblongata there is a cardiovascular center uniting the parasympathetic, sympathetic and vasomotor centers. The regulation of these centers is carried out by subcortical nodes and the cerebral cortex. The rhythmic activity of the heart is also affected by impulses emanating from the cardio-aortic, sinocarotid and other plexuses. In addition, among the factors affecting the cardiovascular center, one can distinguish humoral changes in the blood (changes in the partial pressure of carbon dioxide and oxygen, changes in the acid-base state) and hemoreceptor reflex. (15)
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1. The activity of the ANS is on the one hand under the influence of the central nervous system (CNS), and on the other hand depends on the humoral and reflex effects. All regulatory systems of the body prof. R.M. Baevsky proposed dividing into two circuits: the highest - the central and the lowest - an autonomous (or local) circuit (two-circuit regulation model). [5]
2 The structures of the autonomous regulation loop include: the sinus node, vagus nerves and their nuclei in the medulla oblongata. The central circuit of regulation of the heart rhythm in the framework of this concept is a complex multilevel system of neurohumoral regulation of physiological functions, which includes numerous links from the subcortical centers of the medulla oblongata hypothalamic-pituitary level of autonomic regulation of the cerebral cortex.
3 .Level 1 is characterized by ensuring the organization of the interaction of the body with the external
4 . environment (adaptation of the body to external influences). The central nervous system, including cortical regulation mechanisms, coordinating the functional activity of all body systems, depending on the nature of the influence of environmental factors, belongs to it.
5 .The 2nd level is responsible for the balance of various body systems among themselves and provides intersystem homeostasis. A significant role at this level belongs to the higher vegetative centers (including the hypothalamic-pituitary system), providing hormonalvegetative homeostasis.
6.Level 3 provides intrasystemic homeostasis, in particular in the cardiorespiratory system (while the cardiovascular and respiratory systems are considered as a single functional system). The leading role is played, in particular, by the vasomotor center as part of the subcortical cardiovascular center, which has a multidirectional effect on the heart through the fibers of the sympathetic nerve. [25]
The effect on the tone of the arteries occurs with the obligatory participation of all levels of autonomic regulation, starting with its cortical representation in the temporal lobe of the cortex and the limbic-reticular complex in the midbrain structures and ending with the pathologically altered synaptic interaction of sympathetic parasympathetic terminals and smooth muscle cells (SMC) of blood vessels.
Thus, the number of heart contractions is an integrated indicator of the interaction of 3 factors regulating the heart rhythm: sympathetic reflex, parasympathetic reflex and humoral-metabolic-mediating environment and heart rhythm is the body's response to various irritations of the external and internal environment. Heart rate variability as an indicator of the quality of the functions of the regulatory systems of the body. The universal operative reaction of the whole organism in response to any environmental impact is a change in the rhythm of the heart. To a certain extent, it characterizes the balance between the tone of the sympathetic and parasympathetic departments. With optimal regulation,
East European Scientific Journal #1(65), 2021 31 control takes place with minimal involvement of higher (central) levels. The optimal activity of the lower levels "liberates" the higher ones from the need for constant participation in local regulatory processes. In the case when the lower ones do not cope with their functions, when coordination of the activity of several subsystems is necessary, balancing the body with the environment is due to the tension of the regulatory mechanisms. The higher the centralization of heart rhythm control, the greater the tension of regulatory mechanisms, the higher the "physiological price" of adaptation; [2]
Heart rate variability (HRV) is an informative method for assessing the overall activity of regulatory mechanisms, neurohumoral regulation of the heart, the relationship between the sympathetic and parasympathetic divisions of the ANS and allows you to obtain both integral indicators that reflect the functional state of the cardiovascular system and identify systemic relationships, including cardiocerebral and cardiovascular.[3]
Active study of HRV by cardiologists around the world has led to the need for standardization of terminology, the development of optimal methods for measuring HRV, as well as a description of HRV indicators and their characteristics in normal and pathological conditions. To this end, in May 1994, a working group of the European Society of Cardiology and the North American Society of Cardiac Stimulation and Electrophysiology held a meeting at which a report was prepared describing measurement standards, physiological interpretation and clinical use of heart rate variability. [6,33]
Spectral analysis of HRV. The main parameters of spectral analysis are the high-frequency component (HF), which reflects the activity of the parasympathetic component of the autonomic nervous system; low-frequency component (LF), which characterizes the activity of both the sympathetic and parasympathetic parts of the autonomic nervous system, their ratio (LF / HF) and total spectrum power (TP) According to currently prevailing notions, the power in the HF spectrum is determined by vagal activity, in the spectrum LF - indicates the severity of sympathetic modulation of HRV; in the VLF spectrum - it is associated with the influence of suprasegmental structures and reflects the state of neurohumoral and metabolic levels of regulation[(38]
There is also an opinion that LF waves can be associated with activity of both the sympathetic and parasympathetic nervous systems, and VLF waves can be associated with sympathetic and parasympathetic activity, plasma catecholamines, renin-angiotensin-aldosterone system, etc. LF / HF may reflect an established vagosympathetic balance [23,24.]. It should be noted that the information content of the spectral analysis indicators is ambiguous and is still being discussed. [23]
The central control of the autonomic function, the interaction between the central nervous system and the autonomic nervous system is largely determined by the ratio of the activity of the sympathetic and parasympathetic subsystems.[32]
32 East European Scientific Journal #1(65), 2021 APPLICATION OF HRV ANALYSIS METHODS IN SPORTS MEDICINE.
HRV can also be used as a control over the course of physical rehabilitation, assessing the effectiveness of physical training. A criterion for the positive effect of physical training is an increase in the high-frequency component (increase in parasympathetic activity) and a decrease in the amplitude of low-frequency oscillations (sympathetic activity). [14,15]
Currently, the athlete's success is determined by the ability to pronouncedly economize body functions at rest, maximize their mobilization during exercise and full recovery after it. In other words, the result of sports activity is determined by the dynamism and efficiency of the processes of economization, mobilization and restoration of the body, that is, the ability to variability (in Latin - variability) of body functions. [12]
Thus, the study of heart rate variability provides important information for assessing the athlete's functional reserves and, accordingly, adaptive abilities and predicting its success. According to the works of V.V. Parina and R.M. Baevsky [2], a system with relatively autonomous connections due to the independence of its elements is more flexible, which facilitates its adaptation to changing environmental conditions, including physical stress. And an increase in these "degrees of freedom" and a decrease in the control of central systems ultimately contribute to the achievement of a functional optimum when performing a load. Adaptation processes in such systems proceed with high efficiency. To a greater extent, this applies to athletes training the quality of endurance. [ 11,26] In the case when the lower levels do not cope with their functions, central coordination of the activity of individual systems is necessary for the coordinated work of the body and balancing it with the external environment. Such regulation is already taking place due to the stress of all its mechanisms. Thus, the higher the centralization of function control, the higher the physiological "price" of adaptation. The lower the level of regulation, the greater the chances of successful adaptation even under severe stresses [29, 31]
The processes of economization - mobilization -recovery, which determine the effectiveness of sports training, are fully reflected in the heart rate variability. According to the RCG, one can judge the level of adaptation of the body to the conditions of sports activity. When an athlete's skill is honed to automatism, that is, with minimal participation from the central regulatory systems, this gives maximum results in sports activities. At the training stage, the role of autonomous regulation of body functions is high. For the success of sports activities, the potential of the body must constantly increase, which helps to expand the boundaries of the functioning of the systems most involved in the training process, that is, the boundaries of the variability of the functioning of these systems and the body as a whole must expand. [29] Thus, the athlete's best functional state at the training (preparatory) stage implies the following changes: high autonomy and variability of functioning, as well as a decrease in the centralization of function control. This
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is achieved by structural and functional restructuring of the athlete's body regulation under the influence of the training process, which is reflected in a change in the RCG indices. [29,30]
In a healthy athlete without signs of overstrain in a state of relative rest, including in the absence of a competitive period of the training cycle, an increase in fitness and successful adaptation to the conditions of sports activity are accompanied by an increase in the parasympathetic nervous system and a decrease in the sympathetic nervous system. [29]
It is known that a high sports result can be achieved only with optimal functioning of the body in extreme conditions of competitive activity. In this case, on the contrary, a pronounced centralization of body control is already required. During the competitive period, one can often trace the transition from the pronounced predominance of autonomous to central regulation. Professor D.I. Zhemaitite [32] while studying the RCG of endurance athletes, found a significant part of them, as they approached the peak of the sports "form", had a decrease in the amplitude of the respiratory waves amid a slowdown in rhythm. This is a kind of reflection of extreme coherence, harmonious conjugation of all rhythmic processes. According to D.I. The same type of RCH reflects the high functional capabilities of the body. This option occurs, according to the author, mainly in successful athletes. This is accompanied, as a rule, by good hemodynamics, reactivity and tolerance of loads, high working capacity. This thesis was also confirmed by spectral methods for analyzing the rhythmograms of athletes in a state of sports "form" [41]. A decrease in rhythm variability and its centralization in the competitive period of the training cycle is shown in a number of works. So, I.A. Kuznetsova and S.I. Kudinova [33] examined 19 male athlete-styers during two winter competitive seasons. Data analysis was carried out taking into account the performance of athletes in competitions. The success criterion was the compliance of the planned result at the competition with the actual one. It was shown that for successful athletes on the eve of the competition, the total wave spectrum was significantly lower in comparison with less successful ones. Sympathetic regulation prevailed: the LF / HF ratio was 3.01 for successful versus 0.86 for unsuccessful. [20] C.P. Earnest and collegues [34], analyzing the change in HRV during a multi-day cycling race in Spain, showed that between the level of voltage increase and parameters of rhythm variability (TP, SDNN, HF) negative correlation relationships were established (p <0.01), which indicated a decrease in HRV and a shift in the sympathovagal balance towards sympathetic activity during an increase in physical stress. [10] F. D'Ascenzi et al. [35] conducted a study of HRV in elite volleyball players before and directly during the competition. The authors showed that approaching the decisive match was accompanied by a significant decrease in the autonomous (HF) and an increase in the central (VLF) regulation loop. The authors also believe that there is a close correlation between sympathetic activity and the success of
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competitive activity in volleyball, and HRV research can be a useful tool for assessing the competitiveness of athletes. Based on the decrease in variability, one can predict the success of the performance immediately before the start. [9] Similar dynamics of HRV was noted during the training of military personnel in the USA [36]. During the intensive training of fighters, more successful subjects had the lowest level of rhythm variability. According to the authors, at the time of testing, the best fighters showed the strongest sympathetic reaction. On the other hand, fighters with the highest heart rate variability during training showed the highest exhaustion of physical and mental forces and at the same time the lowest results in combat training. Researchers concluded that these participants had the lowest potential for successful warfare. [36,37] The most important quality for the successful implementation of sports activities is not only the economization of function at rest and a healthy powerful reaction to stress, but also the ability to quickly recover from stress. The method of rhythmocardiography allows you to evaluate this ability. In particular, to assess the athlete's recovery, a Scandinavian method of continuous (night) rhythmogram recording was proposed and is successfully used. The uniqueness of Firstbeat technology is that it can be used to collect round-the-clock information on the state of the rhythm regulation loop and simultaneously measure the training load in real time. The system quickly gained the confidence of national teams around the world. Analysis of the training process helps to make sure that the athlete has achieved the task in this training session. Recovery assessment is carried out using nightly measurements of heart rate variability indicators [18,35 ]. In athletes with impaired recovery after awakening, a decrease in HRV and an increase in the sympathetic tone of the autonomic nervous system are noted. Firstbeat technology makes it possible to measure the so-called recovery ratio. An increase in this indicator characterizes a better recovery. In contrast, its decline indicates the accumulation of underreduction and exit into overtraining. For each athlete, these figures are individual. [38, 39]
Monitoring recovery helps to prevent the occurrence of overwork and build the training process in the most optimal way on an individual basis for each athlete. The use of monitoring HRV indicators to monitor the progress of the training process has recently been noted by a number of authors [29,37] It should be noted that each sport has its own specific "vegetative portrait". O.A. Butova et al. [42] when examining 95 athletes with different orientations of the training process, it was revealed that fundamentally different regulatory mechanisms lie in mobilizing the reserve capabilities of the body of professional athletes. So, for athletes involved in high-speed power sports, the central one dominates, and for athletes who train endurance, an autonomous circuit of heart rhythm regulation [8].Rhythm variability is more pronounced in dynamic training in comparison with static training [28]. Carrying out longitudinal rhythmic
East European Scientific Journal #1(65), 2021 33 rhythmocardio-graphic studies makes it possible to identify an individual portrait of an athlete's HRV and evaluate its functional readiness for competition. According to I.V. Gushturova and V.N. Telepova [17], the study of an individual portrait of HRV in an athlete in dynamics in preparation for the competition can provide the trainer with valuable information and help predict the results of athletes. Also according to D.J. Plews et al. [45], even the dynamics of the RCG within one week provides fairly reliable information about the course of adaptation of the body to the training process. [21] Only a small part of the information can be obtained by the method of rhythmocardiography at rest. The reserve of athletes, its reactivity, including response to stress, conditions of pathological and pre-pathological deviations, is revealed by conducting functional tests, such as orthostatic, respiratory and physical exercise tests [13] Thus, a study of heart rate variability is carried out to determine the success of sports activities of athletes. This makes it possible to identify the state of physical overstrain and overtraining, and also conducts dynamic control of training and the speed of recovery processes.
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Akhmedova M.D., Niyazova T.A., Karimova M. T.
Tashkent Medical A cademy, Uzbekistan
JOINT CLINICAL TRANSMISSION OF INTERNAL PARASITOSIS WITH ACUTE INFECTION
IN KARAKALPAKSTAN
Relevance of the topic. According to the WHO, developing countries in Asia, Africa, Latin America, and other countries spend 100 million dollars a year for the patient suffers from acute intestinal disease. Of these, the under-five mortality rate is 23%. Acute intestinal infection is the leading cause of death in children, followed by salmonellosis and shigellosis. Salmonellosis and shigellosis are common in the world, and salmonellosis has increased 5-7 times in the last 2025 years compared to 1990. The reason for this should be sought in the process of centralization of food production and food supply to the population, as well as in the process of violating the shelf life of food exported or imported [4,5]. In economically developed countries, the increase in shigellosis, especially Shigella Zonne, is explained by the high degree of centralization of food supply to the population and the fact that the population mainly uses public places to eat [1,4,5].
The clinical course of salmonellosis and shigellosis in patients is also associated with the presence of other related diseases. In particular, it can be associated with severe complications when combined with intestinal parasitosis [2,3]. In patients with bacterial intestinal infections, several organs are injured against the background of general intoxication. In this case, when intestinal parasitosis is added as a co-morbid disease, the patient is observed anemia, decreased immunity. As a result, the recovery of the underlying disease is prolonged or complicated. Intestinal parasitosis and intestinal bacterial infection play an important role mainly in the fecal-oral
mechanism of transmission. For this reason, we aimed to study the level of the clinical course of these mixed infections in the Republic of Karakalpakstan.
The purpose of the study. To study the clinical course of acute intestinal infection and intestinal parasitosis in Karakalpakstan.
Materials and methods. Clinical-laboratory, bacteriological, parasitological, and statistical methods were used in the research. There were 60 patients with acute intestinal diseases (mainly bacteriologically confirmed salmonellosis and shigellosis) + parasitosis in the follow-up, who were mainly treated at the Infectious Diseases Hospital of the Republic of Karakalpakstan in 2017-2019 and controlled as a result of outpatient treatment. Patients with mixed infections were divided into 2 groups as follows: the first group included 40 patients (main group) and the second group included 20 patients (control group). In the main group there were 12 (30.0%) giardiasis on the background of salmonellosis, 8 (20.0%) enterobiasis and 11 (27.5%) giardiasis on the background of shigellosis, 9 (22.5%) enterobiasis. Patients in the control group had only salmonellosis 11 (55.0%) and shigellosis 9 (45.0%). The obtained results were statistically processed on a special computer Pentium-IV using Microsoft Office Excel-2003.
The results obtained and their discussion. Of
the patients under observation, 38 (63.3%) were boys, men and 22 (36.7%) were girls and women. The mean age of the patients was 18.5 ± 2.4%. The clinical symptoms reported in the follow-up patients are listed in Table 1.
Table 1.
Clinical when referring patientssymptoms (M ± m)%
№ Clinical symptoms The main group Control group P <0,05
n=40 n=20
1. Fever 100,0±0 95,6±2,3 >0,05
2. General intoxication 98,5±2,8 93,7±3,1 >0,05
3. Diarrhea 100,0±0 95,8±2,7 >0,05
4. Headache 88,2±3,2 85,0±2,5 >0,05
5. Nausea 89,7±3,7 72,8±1,9 <0,05
6. To return 85,4±3,5 67,9±2,8 <0,05
7. General weakness 100,0±0 92,7±2,5 >0,05
8. Pain in the abdomen 100,0±0 80,5±1,8 <0,05
9. Low appetite 80,6±3,1 69,8±2,9 <0,05
10. Rapid fatigue 100,0±0 87,2±3,5 <0,05
11. Nervousness 81,7±3,1 40,5±3,8 <0,05
12. Teething 75,7±3,8 15,6±2,7 <0,05
13. Skin discoloration 86,3±5,6 72,2±2,6 <0,05
14. The presence of white spots on the skin 27,6±2,4 7,0±1,8 <0,05
