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8Dysphoric (typical sad-bitter mood). Interaction with some of these patients can bring a pronounced psychological discomfort to the doctor. But knowledge of the psychological basis of this type of patient behavior will help the doctor better understand his needs, expectations, fears and emotional reactions, optimally organize the process of interaction with him, use certain tools of influence. It is important to understand that, even showing complete indifference to the outcome of treatment, the patient most wants to hear the words of hope and needs to strengthen his faith in the best. Patients who are constantly worried about their condition need a calm, optimistic and attentive conversation with the doctor, and patients who show aggression reactions to others and the doctor need a reputable confident position of the doctor who will help to cope with the strongest fear for their lives hidden in their souls.
Thus, understanding the type of patient's response to the disease will help make the union of the doctor and the patient more effective, contributing to the psychological well-being of both participants in the treatment process.
References
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4. Прохоров А.О. Практикум по психологии состояний: Учебное пособие. - СПб: Речь. - 2004. -480 с.
5. Середина Н.В., Шкуренко Д.А. Основы медицинской психологии: общая, клиническая, патопсихология / Серия «Учебники, учебные пособия». - Ростов н/Д: «Феникс». -2003. - 512 с.
6. Тиганов А.С. Общая психиатрия / М.: Медицина. - 1999. - 405 с.
HUMORAL IMMUNITY OF ORAL CAVITY IN CHILDREN WITH CHRONIC CATARRHAL GINGIVITIS AND COMORBID DIABETES MELLITUS
Kotelban A.,
Department of Pediatric Stomatology, PHD, Assistant
Moroz P.
Department of Surgery №1, PHD, Assistant Higher State Educational Establishment of Ukraine «Bukovinian State Medical University»
Abstract
Stomatological examination of 30 children 12-aged with diabetes type I that was treated at the endocrinological departments of Regional Children's Clinical Hospital, 30 children with chronic catarrhal gingivitis and 30 sameaged absolutely healthy children, the pupils at school №22, on the base of chirurgical and children dentistry department, has been carried out. Various violations has been established humoral immunity of oral cavity in children with chronic catarrhal gingivitis and diabetes type I.
Keywords: diabetes type I, gingivitis, lysozyme, immunoglobulins.
Diabetes mellitus (DM) is the fourth degree in the structure of all diseases of the endocrine system among the children's population in Ukraine and most often causes severe chronic damage to organs and systems [2]. The classic clinical complications of diabetes include retinopathy, nephropathy, neuropathy, and macro-vascular disease. In 1993, Loe proposed another complication - periodontal tissue diseases [1, 2]. In own studies, Taylor and Borgnakke characterized this dental nosology as a consequence of impaired glycemic control in such a cohort of patients. Diseases of perio-dontal tissues on the background of metabolic disorders, according to literary data, occurs in 90% of cases [3, 4, 8].
The main factor in the development and progression of diabetic changes in periodontal tissues is chronic hyperglycemia, which, in turn, triggers a whole range of pathophysiological mechanisms. According to many researchers, immunological mechanisms play a special role in the pathogenesis of inflammatory diseases of periodontal tissues [5, 6, 7]. Immunopathogen-
esis of inflammatory and dystrophic diseases of perio-dontal tissues is realized through cellular and humoral factors of specific and nonspecific resistance.
Researchers pay special attention to the role of violation of general and local immunity, which is not enough studied and relevant.
The aim is to study the characteristics of humoral local immunity of the oral cavity in children with chronic catarrhal gingivitis and comorbid diabetes mellitus, on the base of the existing metabolic disorders.
Materials and research methods.
To achieve this aim 12-year-old children with type 1 diabetes mellitus (30 people), who were hospitalized at the endocrinology department of the regional children's clinical hospital, Chernivtsi, were examined. A comparison group (30 somatically healthy children with signs of chronic catarrhal gingivitis) and a control group (30 somatically and dental healthy children of the same age) were formed from pupils of school No. 22 in Chernivtsi.
Evaluation of local immunity of the oral cavity was carried out by determining the content of sIgA, IgA, IgG and the level of lysozyme in the oral fluid. Mixed saliva was collected in the morning, after rinsing twice with distilled water, by spitting into test tubes in a volume of 5 ml. To obtain serum, saliva was centri-fuged for 10 min. at 1500 vol. / min The state of immu-nological parameters was investigated by ELISA kits for lysozyme (Immundiagnostik., G. Bensheim, Germany), IgG - Seramun (g. Gaydezee, Germany), IgA -Seramun (g. Gaydizee, Germany), sIgA - Diametra ( Perugia, Italy).
The obtained results were processed statistically using the licensed program Microsoft Excel. The mean value (M), the error of the mean (m), the reliability of the statistical indicators (p) were evaluated.
The results of the study and their discussion.
A significant difference was found in the values of immunoglobulins and lysozyme in the oral fluid of diabetic children and somatically healthy with signs of chronic catarrhal gingivitis.
The level of lysozyme in the oral fluid of children of group I is 1.2 times higher than group II and 1.5 times with group III, which can be explained by the protective-compensatory mechanism of the nonspecific immune response.
In children with diabetes, the slgA content (0.3961 ± 0.007) is in 1.4 times higher than the control group (0.2791 ± 0.003). This indicates the enhancement of a specific protective barrier that protects the microorganism from the damaging effects of various pathogenic and conditionally pathogenic microflora.
IgA content tended to increase in children in the monitoring group. The highest rate is 0.2385 ± 0.0001 in children's oral fluids, with concomitant diabetes mellitus. This is due to the long time of the pathological process in the periodontal tissues and the decrease in the reactivity of the organism.
The high level of IgG reflects the state of stress of the protective level of local humoral immunity and chronic inflammatory process in the periodontal tissues of children of two groups with signs of chronic ca-tarrhal gingivitis (the main group - 0.497 ± 0.0005 and the comparative - 0.3219 ± 0.0005).
There is convincing evidence that immune deficiency and non-specific and specific protection factors in varying degrees affect the tissues of the oral cavity, reducing its resistance to microflora, affects the formation of complicated variants of the clinical manifestations of the disease.
The results of immunological studies have shown that with the deepening of the pathological process in periodontal tissues in diabetes mellitus, there is a steady tendency to decrease the lysozyme index from 0.081 ± 0.001 (for mild) to 0.0705 ± 0.0085 (for severe ), a decrease in lysozyme concentration in the oral fluid correlates with an unfavorable prognosis of the disease.
In children with chronic catarrhal gingivitis in the oral fluid, is a high level of sIgA in the oral fluid is observed with mild chronic catarrhal gingivitis (in children with comorbidities - 0.412 ± 0.003, and in somatically healthy ones - 0.326 ± 0.006). With moderate
and severe chronic catarrhal gingivitis, there is a significant decrease in the level of lysozyme in the oral fluid (p <0.001), which is due to the depletion of the immune system and a significant decrease in the "first line" of the specific humoral protection of the oral cavity at the sIgA level. Observed inhibition of colonization of the epithelium by microorganisms and preventing the entry of foreign antigens to the internal environment of the body.
Increased IgA concentration is formed as a result of a certain disruption of the structure of periodontal tissues. In our opinion, that part of the immunoglobulin is formed by splitting the sIgA structure into separate fragments that are not capable of agglutinating microorganisms and preventing the adhesion of bacteria to epithelial cells.
Also, there is a tendency to a significant increase in the level of IgG in the oral fluid (among children of the main group: with a mild - 0.4889 ± 0.0006, medium
- 0.4895 ± 0.0005, severe - 0.4960 ± 0.003, and in the comparison group - 0.3214 ± 0.0006, 0.3217 ± 0.0011 and 0.3245 ± 0.0005, respectively. It is believed that an increase in the number of IgG reflects the presence of a secondary immune response, an active inflammatory process and bacterial aggression in periodontal tissues.
Conclusions
It was found that among children with signs of chronic catarrhal gingivitis of the main and comparative observation groups, changes in the system of nonspecific and specific humoral immunity of the oral cavity are noted. The highest rates were found in the oral fluid of children with concomitant pathology of type I diabetes. Mild chronic catarrhal gingivitis is characterized by a high content of lysozyme, sIgA, IgA and low
- IgG. With moderate and severe chronic catarrhal gingivitis, there is a decrease in the level of lysozyme, sIgA, IgA in the oral fluid and an increase in IgG.
References
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3. Колесова Н.А. Метаболчт та структурт особ-ливосп змш тканин ясен у дпей, що страждають на цук-ровий дабет / Н.А.Колесова, Л.О.Хоменко, К.О. Карачев-ська // Вюник стоматологи. - 2004. - № 4 (45).-С. 67-71.
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5. Смоляр Н.1. Рiвень секреторного iмуногло-булшу А у ротовш рвдиш як показник стану мюце-вого iмунiтету порожнини рота дней / Н.1. Смоляр, Н.Л. Чухрай, Г.В. Прчак, З.Р. Пришко // Новини стоматологи. - 2006. - № 3. - С.52-55.
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больных с воспалительными заболеваниями паро-донта / Ю.Г. Чумакова, А.И. Перова, О.В. Мороз, Н.Н. Запорожец // Вюн. стоматологи. - 2001. - № 2. - С.26-28.
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Lozano, C. Posada [et al.] // Acta Odontol.Latinoam. -2011.- Vol. 24, №. 2.- P. 176-182.
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MODERN ASPECTS OF THE TREATMENT OF THE ABDOMINAL CAVITY AGAINST RETAINED
FORMS OF PERITONITIS
Moroz P.,
Department of Surgery №1, PHD, assistant
Kotelban A.
Department of Pediatric Stomatology, PHD, assistant Higher State Educational Establishment of Ukraine «Bukovinian State Medical University»
Abstract
Acute peritonitis is one of the most severe complications in abdominal surgery. The high incidence, unpredictable course, lack of effectiveness of existing methods of treatment - all this determines the relevance and practical importance of this problem. Issues of improving the effectiveness of treatment of acute peritonitis are one of the most difficult problems of abdominal surgery. Despite significant advances in the development of methods for treating such patients, mortality remains high (from 16% to 63%) and has no tendency to decrease. At the present stage there are no absolutely specific methods for the treatment of acute peritonitis. This is due to the diversity of etiological factors, the versatility of pathogenesis, changes in clinical manifestations under the influence of various factors. The method of sanitizing the peritoneal cavity in complex treatment with common forms of acute peritonitis, by supplying oxenovenic antiseptic solutions to the peritoneal cavity under pressure, allows for a rapid progressive decrease in microbial contamination of the exudate, reduce the frequency of intra-ab-dominal complications and increase the effectiveness of treatment of such patients.
Keywords: Acute peritonitis, surgical treatment, "Dekasan", special device.
Introduction. Despite the development of new and improvement of existing methods of surgical treatment, the use of a powerful arsenal of modern intensive care means, the mortality rate with widespread peritonitis remains at a high enough level [2,3,5]. In this regard, in recent years, the attention of surgeons shifted to in-depth study of the pathogenesis of peritonitis in order to develop effective methods for its treatment. Among them, the issue of adequate intra- and postoperative debridement of the wooden cavity as the main element of detoxification remains relevant.
Objective: to improve the efficiency of treatment of patients with advanced peritonitis by providing conditions for maximum removal of microorganisms, including anaerobic, not only from the exudate, but also from the surface of the peritoneum. The object and methods of research. The study included 136 patients with advanced peritonitis.
The results of the study, their discussion. In all patients, the peritoneal cavity is reorganized after the elimination of the cause of peritonitis [1,4,6]. After the evacuation of the existing exudate, the parietal and visceral peritoneum was flushed with an oxygenated antiseptic solution according to the developed procedure.
To do this, in a sealed container with an antiseptic solution ("Dekasan") through a tube with holes placed at the bottom of the can, under pressure, atomic oxygen is introduced, which passes through the solution, oxygenates it, and creates pressure in the pressurized can, provides the solution through a separate tube to the peritoneal cavity.
A stream of solution is successively directed to the parietal and visceral peritoneum, washing away from its surface necrobiotic tissue, fibrin layers, and the washing solution is removed by suction. The jet of the solution, in addition to the washing, cleansing effect, provides microvibration of tissues, a kind of vibratory massage, which helps to improve the blood supply to tissues, stimulates regenerative processes [7,8]. The operation is completed by placing drainage tubes in all sloping areas of the peritoneal cavity, which are connected to a larger diameter pipeline. In the postoperative period, using the developed device for active prolonged sanation, using the infusion mode (Fig.1), we wash the peritoneal cavity with antiseptic solutions, and with the suction mode we remove the exudate (Fig.2) [7,8]. Characteristically, the device operates on an individual closed circuit, does not require constant sterilization of auxiliary elements.
