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Indirect influence of hormonal status on the development of ischemic insult and its gender peculiarities
Conclusions:
1. Clinical and laboratory efficiency was identified in administration of highly active antiretroviral regimens containing the drug — tenofovir.
2. Adverse effects of highly active antiretroviral therapy regimens containing tenofovir, manifested in nausea, vomiting, bloating and dizziness.
3. Laboratory changes appeared in mild anemia, elevated en-symes (increased levels of alanine aminotransferase) and increased creatinine in the blood, which should be taken into considered when administering the antiretroviral therapy to the HIV patients with kidney and/or liver diseases.
4. Administration of antiretroviral regimens containing tenofovir, considering efficacy and safety allows to enhance the quality of highly active antiretroviral therapy for HIV infection.
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2. Daar E., Tierney C., Fischl M. et al. ACTG 5202: final results ofABC/3TC or TDF/FTC with either EFV or ATV/r in treatment-naive HIV-infected patients. Program and abstracts of the 17th Conference on Retroviruses and Opportunistic Infections. February, 16-19. 2010. San Francisco, California. Abstract, - 59 LB.
3. Hall J. C., Hall B. J., Cockerell C. J. HIV/AIDS in the post-HAART era: Manifestations, treatment, and epidemiology. - Shelton, CT, USA: People's Medical Publishing House - USA, 2011. - P. 389-403.
4. McComsey G., Kitch D., Daar E. et al. Bone and limb fat outcomes of ACTG A5224s, a substudy of ACTG A5202: a prospective, randomized, partially blinded phase III trial of ABC/3TC or TDF/FTC with EFV or ATV/r for initial treatment of HIV-1 infection. Program and abstracts of the 17th Conference on Retroviruses and Opportunistic Infections. February, - 16-19. - 2010. San Francisco. Abstract 106 LB.
5. Saag M. S., Chambers H. F., Eliopoulos G. M., Gilbert D. N., Moellering R. C. The Sanford guide to HIV/AIDS therapy 2012. - Sper-ryville, VA, USA: Antimicrobial Therapy Inc., - 2012. - P. 214.
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DOI: http://dx.doi.org/10.20534/ESR-16-9.10-81-83
VakhabovaNargiza Maksudovna, senior scientific assistant, Neurology department applicant,
Tashkent Medical Academy E-mail: [email protected]
Indirect influence of hormonal status on the development of ischemic insult and its gender peculiarities
Abstract: Hypercortisolemia immediately participated in pathogenetic mechanisms of ischemia deteriorating clinical progress of the disease in patients with ischemic insult. We revealed negative impact of low concentrations of oestradiolum and testosterone on the development and severity of ischemic insult progressing. Keywords: ischemic insult, hormonal status, gender peculiarities.
Ischemic insult (II) is one of the causes of high rate mortality and invalidation of people of workable age; and that conditions the necessity of the study of the factors effecting the progress and outcome of cerebral vascular process.
It is known, that acute stress developing in II causes activation of hypothalamus-petuitary-adrenal system (HPAS) with further increase of glucocorticoids (GC) in blood [1; 4; 5]. In several researches negative effects of hyper cortisolemia, observed in the conditions of excessive or long-lasting stress, were studied, and the interrelation of high concentrations of GC and hyperglycemia (HG) (rr) in acute period of insult was underlined [6]. The existing contradictions in the assessment of the parameters of stress reaction in patients with II, and define the importance of the further study of cortisol metabolism in that category of patients [7; 11].
Significant attention in references is paid to the study of the impact of sexual hormones such as oestradiolum and testosterone on the pathogenesis of brain infarction. It is known and doubtless fact
that, men suffer cardiac diseases more often; though scientists offered the explanation of that phenomenon for the first time. According to the results of the study performed in Lester University, Great Britain, it happens due to sexual hormones [2].
Estrogen hormones play a part of protective factors in ischemic insult. Some experimental studies illustrate that status, in details showing molecular mechanisms and conditions of protective function of that group of hormones. It was determined that, in the conditions of increased physiological level of estradiol (proestrus) CA1 neurons of hippocampus were less injured by the common cerebral-vascular ischemia [10].
Clinical study of the amount of thyroxin, triiodothyronine, thyrotropin, ACTH (etc.), in patients with acute ischemic insult revealed "low triiodothyronine syndrome" and increase of thyrotropin, ACTH, and rennin concentration on the 2nd day of insult; amount of thyroxin was increased on the 7th day of the disease [3; 4].
Sectiom 6. Medical science
Physiological role of testosterone in men is well known and it is formation of male phenotype and provision of spermatogenesis. In female organism testosterone supports anabolic processes (first of all in muscular tissue), metabolism and remodeling of bone tissue. High sensitive and specific method of testosterone definition was absolutely necessary for the diagnostics of pathologic states both in men and women [2].
On the basis of the aforesaid, the study of cortisol, oestradio-lum, and testosterone amount in blood of the patients with isch-emic insult is topical.
The objective of this research was to perform gender analysis of cortisol, oestradiolum, and testosterone levels in ischemic insult.
Materials and methods of the research: we examined 64 patients (40 men and 24 women) from 60 to 81 years old with II, the average age was 69.7±7.8 years old. Average age of women was 68.7±7.7 years old, and the average age ofmen was 67.6±8.0 years old.
All patients had complete clinical laboratory and neural-visual check-up. It was complex and included somatic, neurological, and neurophysiological examinations, ECG in dynamics, roentgenography of thoracic cage organs, clinical and biochemical blood analysis, urine analysis; according to the indications ultra sound checking of abdominal cavity and kidneys was performed.
Severity stage of the insult was defined according to the National Institutes of Health Stroke Scale — NIHSS: severe stroke >25 points, moderate — 5-25 points, and slight one <5 points.
Concentration of cortisol, oestradiolum, and testosterone was studied by means of immune enzyme assay with automatic analyzer EL 808 Ultra Microplete Rider (BIO-TEC Instruments, Inc) with the help of standard reactants set «Steroid IEA-cortisol-01» № 061 P and «Non-extraction IGF-1 ELISA DSL-10-2800». Reference values of cortisol normal amount were equal to 50-250 mg/ml, oestradiolum — 15-60 ng/ml, testosterone — 3.5-8.6 pg/ml.
Statistic analysis of the obtained results was performed with the help of standard Excel software. For comparison of the values Student criterion was used. For the study of the link between the studied values Spirman's coefficient of rank correlation was used.
Results of the research: on the basis of the obtained data we determined that, there was a dependence of II subtypes revealing on the gender of the patients. In men there was more often development of atherothrombotic and lacunary insults (62.5%), and in women — cardio embolic one (58.3%). In women we observed vast infarctions in carotid lumen more often than in vertebral-
basillary one (62.5% and 37.5%). 70.8% of women came to clinic within initial 3-5 hours from the start of symptoms, while among men that percent was equal to 97.5% (P<0.05).
The study of gender differences in symptoms' complex of II showed that women had symptoms "non-classic" for insult such as change of behavior, disorientation, euphoria or depression, and fatigue reliably more often than in men (87.5% versus 47.5% respectively; P<0.05).
In the study of cortisol amount in II we noted reliable increase, in comparison with the control (p<0.05), and women had more reliably lower values than in men (306.5±15.6 versus 269.5±10.4; P<0.05). The percent amount of patients with reference values among women was 29.2% (7 patients), and among men 22.5% (9 patients). Less expressed increase of cortisol concentration in women can testify development of adaptive stress reaction.
Performance of correlation analysis in patients showed dependence between hormonal reaction HPAS and severity of insult according to NIHSS scale.
In the study of oestradiolum amount in the blood of examined patients we detected decrease of that value in comparison with regular values. In women we registered reliable decrease of oes-tradiolum 1.1 fold in blood compared with men (14.8±0.5 versus 12.9±0.8 ng/ml respectively). Registration of reference values in men was equal to 32.5%, while in women — 25.0%.
Correlation analysis of insult severity and oestradiolum amount in blood revealed direct interrelation (r = 0.6; p < 0.05), i. e. indirect influence of oestradiolum on clinical progress of insult.
Testosterone is metabolized with formation of dehydrotes-tosterone and oestradiolum, which has genome-mediated neural protective effect both in men and women [11]. According to the obtained data in men there was reliable decrease of testosterone in blood (3.6±0.1 pg/ml), while in women its level was reliably higher (1.5±0.3 pg/ml) in comparison with normal value (P<0.05).
Correlation analysis showed that, the amount of testosterone has weak link with the severity of insult (r = 0.2; p > 0.05).
Conclusions
1. It was determined that, hyper cortisolemia immediately participated in pathogenetic mechanisms of ischemia deteriorating clinical progress of the disease in patients with II.
2. We revealed negative impact of low concentrations of oestradiolum and testosterone on the development and severity of II progressing.
References:
1. Goncharov N. P., Katsia G. V., Nijhnik A. I. Dehydroepiandrosterone and brain function. Bulletin of ^AMS. - 2006; 6: 45-50.1 (in Russian).
2. Kareva Y. N., Oleinikova O. M., Panov V. O., Shimanovski N. L., Skvortsova V. I. Estrogens and brain. Bulletin of RARAMS. - 2012; 2: 48-52.3 (in Russian).
3. Semenenya I. N. Functional importance of thyroid gland. Success of physiological sciences. - 2004; 35 (2): 41-56.4 (in Russian).
4. Skvortsova V. I., Platonova I. A., Ostrovtsev I. V. et al. Impact of hormones of stress releasing system on the progress of ischemic insult acute stage//Neurol and pediatr jour. - 2000. - № 4. - P. 22-27. 5 (in Russian).
5. Charmandari E., Tsigos C., Chrousos G. Endocrinology of the stress response. Annu. Rev. Physiol. - 2005; 67: 259-284.7
6. Chiodini I., Adda G., Scillitani A. et al. Cortisol Secretion in Patients With Type 2 Diabetes//Diab. Care. - 2007. - № 30. - P. 83-88. 8.
7. Chiodini I., Torlontano M., Scillitani A. et al. Association of subclinical hypercortisolism with type 2 diabetes mellitus: a case-control study in hospitalized patients//Eur. J. Endocrinol. - 2005. - № 153. - P. 837-844. 9.
8. Pierce B. N., Clarke I. J., Turner A. I., Rivalland E. T., Tilbrook A. J. Cortisol disrupt the ability of estradiol- 17p to induce the LH surge in ovariectomized ewes. Domestic An. Endocrinol. - 2009; 36 (4): 202-208. 10.
9. Slowik A., Turaj W., Pankiewicz J. et al. Hypercortisolemia in acute stroke is related to the inflammatory response//J. Neurol. Sci. -2002. - Vol.15. - № 196. - P 27-32. 11.
10. Viau V., Meaney M. J. Alpha1 adrenoreceptors mediate the stimulatory effects of oestrogen on stress-related hypothalamic-pituitary-adrenal activity in the female rat.J. Neuroendocrinol. - 2004; 16 (1): 72-78.
Features of course of idiopathic trigeminal neuralgia between genders
11. Vigen R, O'Donnell C, Barón AE, Ho PM, et al. Association of Testosterone Therapy With Mortality, Myocardial Infarction, and Stroke in Men With Low Testosterone Levels. JAMA.2013;310 (17): 1829-1836.
DOI: http://dx.doi.org/10.20534/ESR-16-9.10-83-85
Juraeva Dilsora Nuriddinovna, Scientist-researcher, State Medical Institute Abu Ali Ibn Sina, Department of Neuralgia, Ministry of Health of the Republic of Uzbekistan Bukhara E-mail: [email protected]
Features of course of idiopathic trigeminal neuralgia between genders
Abstract: To learn etiology geneticist fact concerned with sex of neuralgia of trigeminal nerve. As a conclusion, we can say that idiopathic neuralgia is the most spreaded type of trigeminal neuralgia. Men have more cases of catching this illness than women. At men this disease will occur as losing of taste. Disease-producing factors of neuralgia at men: shaving, tooth brushing, draught; at women: tooth brushing, laughter, draught. A neuralgia attack both at men and women often occurs during summer time. Dependence of duration of illness from gender is not defined.
Keywords: trigeminal neuralgia, Doppler, transcranial Dopplerography, cerebral hemodynamic.
Recently "idiopathic" origin of diseases is very well studied. The term "idiopathic" has been conditionally used for the first time in 1988 by International Headache Classification.
The first attack ofpain occurs without any reasons in 34% cases, during dental treatment in 27% cases, and its connected with senses in 17% cases, in other cases the onset of the illness occurs in combination to different factors (sudden cooling offace, respiratory infections, local wounds and others) [4; 6; 7]. Ethiopathogenesis of course of acute period of trigeminal neuralgia has been considered as uncertain matter until now. Because of problems on early diagnostics, patients often address and are directed to other specialists. In turn, it demands to study disease on the basis of modern technologies. Course of the illness, its non-treatability still creates some problems.
During the last years pathogenesis of special diseases of brain has been studied against functional systems of organism. It helps to define the pathological phenomena of mechanisms of former and new development [1; 3; 6; 7]. Taking into account progressive development of disease and applied physiotherapeutic reflex-therapeutic of resistance to treatment, patients with trigeminal neuralgia disease have surgical operations. Pathogenesis of diseases can be explained by several theories. In many cases, its reason is intra — and extracranial compressions. This can be occur because of space-occupying lesion (tumour) of cranial fossa (neurinoma of acoustical nerve, meningioma, glioma of pons), disposition and artery expansion of cerebellum, aneurysm of the basic artery, tunnel syndrome (at the expense of compression of 2nd and 3rd germinal unit, a crack of the channel of a bone and congenital narrowness of bottom jaw and addition of disease of vessels at old men) odontogenic or rhi-nogenous inflammations. Disease can develop: at removal of teeth, odontogenic neuralgia, as a result of infringement of blood circula-
tion in brain, as a result of herpes infection, it becomes rare the reason demyelinization of trigeminal nerve covers at spreaded sclerosis [2; 5; 6].
The term "idiopathic" has been conditionally used for the first time in 1988 by International Headache Classification. There tunnel compression mechanism this form of neuralgia was analyzed.
From the point of view of spread, among diseases of nerves of brain6 trigeminal neuralgia takes second place after face nerve neuropathy [3; 4]. Trigeminal neuralgia is often observed at middle and old man, but to 40-year-old age the first attacks make 30-35%, at 70 and more year old the first painful attack makes 2-3 percent. Women are ill than men (Shedrenko V. V. 2005) is more often.
Obj ective: To learn etiology geneticist fact concerned with sex of neuralgia of trigeminal nerve
Materials and methods
We have examined 268 patient, age from 30 to 70 (171 of them women (63,8%), 97 men (36,2%)) who were treated on neurology and maxillofacial surgery of medical center of Bukhara region. Results were determined with method of questioning.
Results and discussion
According to our examination the reason of illness most ofpa-tients is unknown as idiopathic neuralgia is atop, and observed for men much more than for women (53, 6:41, 5). At the same time trigeminal neuralgia arose after wounds, 4, (4,1%) for men and 10 (5,8%) for women. Trigeminal neuralgia observed for women like a consequences of herpes (1,8%), diabetes mellitus (1,8%), acute infection (3,5%) when for men this kind of situation were not discovered.
The main etiological facts of concerning neuralgia of trigeminal nerve with sex are given on table 1.
Table 1. - The main etiological facts of concerning neuralgia of trigeminal nerve with sex
No. EXCITING CAUSE Men Women
Number Abc % Number Abc %
1 2 3 4 5 6
1 Idiopathic 52 53,6±5,1 71 41,5±3,8***
2 After Sores 4 4,1±2,0 10 5,8±1,8
3 Acute Infection - - 6 3,5±1,4
4 Herpes - - 3 1,8±1,0
