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quantity of young cells of a connective tissue (profibroblasts, fibroblasts, macrophages etc.).
The analysis of complications in compared groups has shown that patients of 1 group in 2 (9 %) and 1 (5 %) second group have been shown the complication in the process of injury in form of a wound suppuration that has led partial lysis of transplants. In 1 group lysis observed on 1.5 % of a surface of a body, in comparison group on 1 % of a surface of a body.
Conclusion
Suggested method of implementing modern coverings for injuries after surgical necroctomy and autodermoplastics treatment of patients with ambustion which had been shown by the researchs, favours to maintain necessary optimal environment for the healing of the wound, provides additional protection from mechanical protection. Causes fast cuticularization and effective recovering integrity of skin integument. Reduces the quantity of wound complications.
References:
1. Admakin A. L., Sidelnikov V. O., Maksjuta V. A., Kovalenko A. A., Nigmatulin M. G. Theses of reports of III congress of combustiolo-gists in Russia. - M., 2010. - P. 158.
2. Alexeys A. A. Modern methods of treatment ambustions h ambustion desease//Pract. journal. Kombustiologi. - 1999. - № 1// [Electronic resource]. - Available from: htpp://www.burn.ru
3. Alekseev A. A. The Way of treatment deep ambustions/A. A. Alekseev, B. K. Gavriljuk, K. Z. Salahiddinov, J. I. Tjurnikov, I. V. Savint-seva, I. I. Selezneva//the Patent for the invention of the Russian Federation № 2385744, from 4.10.2010.
4. Cousins of M. I. Kostjuchenok, B. M. Rany and infection from wounds. - M.: Meditsina, 1990. - 592 p.
5. Maksjuta V. A. Synthetic dressings for injuries after late necrectomy with deep ambustions/Maksjuta V. A, Skvortsov J. R., Chmyrev I. V.//Vestn. Dews. Voen.-medical akad. - 2012. - 1 (37). - P. 140-145.
Suwonov Qayim Jahonovich, PhD, Senior scientific employee-researcher, Research Institute of Sanitation, Hygiene and Occupational Diseases, Ministry of Health of Uzbekistan
Nuraliyev Nekkadam Abdullaevich, MD, Professor, Chief Researcher, Research Institute of Sanitation, Hygiene and Occupational Diseases, Ministry of Health of Uzbekistan E-mail: [email protected]
Intensity indicators of bacterial translocation in experimental acute obstruction of small and large intestine
Abstract: The purpose was to study the germination of microorganisms in the mesenteric lymph nodes (MLN), liver, spleen, lung, peripheral and portal blood, peritoneal exudates in experiment dynamics for evaluating the intensity of bacterial translocation (BT) at experimental acute obstruction thin (EAOSI) and colon (EAOC). It was found that the of at EAOSI and EAOC intensity of BT or the percentage of germination of microorganisms (PGM) of extraintestinal organs of animals at different stages of the experiment differed. BT intensity was most pronounced in MLN than in the liver, spleen and lungs.
Keywords: bacterial translocation, microorganisms, extraintestinal organs, experimental studies, acute obstruction, small intestine, large intestine.
The bacterial translocation (BT) is the passage of bacteria through the mucous membrane of the gastrointestinal tract in extraintestinal body parts [1].
The "BT phenomenon" occurs quite frequently [2; 3]. At present time, this phenomenon is interpreted in two ways: first supporters believe that BT is developing under the influence of stress, injury, or other external extreme impacts and reducing the activity of the immune system, with a pathogenetic link of some diseases; proponents of a second believe that BT is not only the transfer of pathogens endogenous infections in the internal environment of the organism, but also is a natural defense mechanism of the body [4; 5].
It is well known that most often from a normal flora are capable of translocation Escherichia coli, Proteus spr, some other members of the family Enterobacteriaceae, transient strains of Bacillus subtillus, Gram-positive aerobes, a low ability to translocate obligate anaerobes [6; 7].
Purpose of the study
The study and evaluation of germination of microorganisms from the mesenteric lymph nodes (MLN), liver, spleen, lungs, peripheral and portal blood, peritoneal fluid in the experiment for evaluating the dynamics of the intensity of BT in experimental acute obstruction of the small and large intestine.
Materials and methods
240 white mongrel mice aged 2-3 months and weighing 18-25 g. were used for research. Before the experiments, all animals were divided into groups, then they were for 3 days and weighed thermometry was performed. During these days, weight loss and fever are not detected. Identification and differentiation of the seeded microorganisms carried by conventional bacteriological methods. For this «HiMedia» (India) company culture media used.
In carrying out research using model eksperimental acute obstruction of the small intestine (EAOSI) and colon (EAOC)
Intensity indicators of bacterial translocation in experimental acute obstruction of small and large intestine
proposed Kruglyandskiy Y. M. [8] in our modification. There were conducted 3 series of researches.
All laboratory animals divided into 4 groups:
• Group 1 — EAOSI, n = 72;
• Group 2 — EAOC, n = 72;
• Group 3 — animals which were opened in the abdominal cavity, but not performed obturation (group comparisons, n = 72);
• Group 4 — intact laboratory animals (control group, n = 24).
In turn, 1, 2, 3 groups were divided into subgroups:
- 1a, 2a and 3a — EAOSI EAOC and lasted 24 hours (n = 8);
- 1b, 2b and 3b — EAOSI and EAOC, lasted for 48 h. (n = 8);
- 1c, 2c and 3c — EAOSI and EAOK, lasted for 72 h.(n = 8).
The results and discussion
It was found that in EAOSI and EAOC the intensity of BT were different depending on the duration of the experiment and its species. We have identified following microorganisms are representatives of normal intestinal microflora — Escherichia spp, Enterobac-terspp, Citrobacterspp, Klebsiellaspp, Proteus spp, Staphylococcus spp, Enterococcus spp, Bacteroides spp.
Research evidence that when EAOSI after a 24-hour period the PGM on MLN was 45.8 ± 5.9 % (n = 33). This rate increased after 48 hours to 91.7 ± 3.3 % ( n = 66), and after 72 hours, this parameter was 100 % (n = 72) (P < 0.05).
The PGM indicator different from the liver of the same MLN parameters so if for 24 hours microorganisms were inoculated in the liver 29.2 ± 5.4 % (n = 21) cases, then after 48 and 72 hours, these parameters were increased — up to 56.9 ± 5.8 % (n = 41) and 81.9 ± 4.5 % (n = 59), respectively (P < 0.02 and P < 0.001).
A distinctive feature of microbial inoculation of lung parenchyma was that PGM several times was significantly low compared with other organs described. After forming EAOSI 24 hours the growth of microorganisms of the lung tissue was observed, while the PGM after 48 and up to 72 hours — respectively 9.7 ± 3.5 % (n = 7) and 15.3 ± 4.2 % (n = 11). In the study comparing the performance of groups and control positive bacteriological indicators are not obtained.
In the next stage of the research examined the intensity of BT on extraintestinal organs of animals at different times during EAOC. It is found that in the subgroup 2a (EAOC after 24 hours) PVM in MLN was at the level of EAOC indicator — 41.7 ± 5.8 % (n = 30) versus 45.8 ± 5.9 % (P > 0.05). However, 48 hours revealed significant differences between these parameters — 59.7 ± 5.8 % (n = 43) vs. 91.7 ± 3.3 %, (n = 66) — P < 0.001. The results after 72 hours were identical in EAOSI and EAOC.
Results of studies on the liver showed the following results: PGM after 24 hours 18.1 ± 4.5 % (n = 13) after 48 hours 51.3 ± 5.9 % (n = 37) and after 72 hours 80.6 ± 4.7 % (n = 58). After 24 hours in the liver EAOC of PGM 1.6 times significantly low compared to EAOSI, but after 48 hours of significant differences between the indicators have been identified (P < 0.05).
Trends in research on lung tissue were similar to data PGM spleen. If indentificate microorganisms failed (0 %) after 24 hours, 48 hours later, the figure was 16.7 ± 4.4 % (n = 12) and 72 hours PGM
significantly increased 2.2-fold (P < 0.001) compared to the previous rate — 36.1 ± 5.7 % (n = 26). In the spleen in all stages of the experiment between the indicators are not revealed statistically significant differences, but the performance of the PGM lung after 72 hours were significantly different between these models is 2.4 times. As in the studies at EAOSI at EAOCin the group of comparison and control the growth of microorganisms was not found.
The results show that after 24 hours EAOSI in portal blood PGM reached 33.3 ± 5.6 % (n = 24), while this figure was EAOC 15.3 ± 5.6 % (n = 11). But after 48 hours of these parameters was significantly increased relative to the previous indicators — respectively 56.9 ± 5.8 % (n = 41) and 37.5 ± 5.7 % (n = 27) — P < 0.001. When studying the following experimental data period (72 hours) and at EAOSI and EAOC PGM was found in all animals — respectively 100 % (n = 72). It established that these figures 3.0 and 6.5 times were significantly longer than the indicators 24 hour period of the experiment, and respectively 1.8 and 2.7 times significantly longer than the 48-hour indicators of the experiment (P < 0.001).
In these models, and the timing of the experiment conducted microbiological studies with peripheral blood of animals. These results indicate that failed to identify microorganisms in both models after 24 hours. But with an increase in the period of the experiment (48 hours) reported the growth of microorganisms. PGM indicators in both models were respectively 19.4 ± 4.7 % (n = 14) and 25.0 ± 5.1 % (n = 18).
The indicators of PGM in peritoneal fluid differed sharply from the peripheral blood parameters, but were close to the data portal blood. Research results according to the duration of the experiment (24, 48, 72 hours) were as follows: the EAOSI respectively — 48.6 ± 5.9 % (n = 35), 65.2 ± 5.6 % (n = 47) and 94.4 ± 2.7 % (n = 68); EAOC respectively —34.7 ± 5.6 % (n = 25), 58.3 ± 5.8 % (n = 42) and 97.2 ± 1.9 % (n = 70).
It should be emphasized that in both models, only when the 24-hour period were significant differences between the figures obtained (P < 0.05), not significantly different figures for other terms with each other (P > 0.05).
The comparison and control groups in microbiological studies portal blood and peripheral bacteriological negative results were obtained. However, in the control group of the peritoneal fluid after 48 and 72 hours seeded microorganisms PGM equal respectively — 2.8 ± 1.9 % ( n = 2) and 4.2 ± 2.4 % (n = 3). These controls were identical to other biological samples.
Conclusions:
1. EAOSI and EAOC intensity BT or PGM extraintestinal organs of laboratory animals at different stages of the experiment differed.
2. BT intensity was most pronounced in MLN and liver, and spleen than in lung. The intensity of this phenomenon was directly proportional to the terms of the experiment.
3. PGM of MLN and liver are recommended as a pilot a microbiological criterion for assessing the intensity of bacterial translocation in the experiment.
References:
1. Berg R. D. Bacterial translocation from the intestines//Jikken Dobutsu. - 1985. - 34(1): 1-16.
2. Nuraliev N. A., Ergashev V. A., Bektimirov A. M.-T. Bacterial translocation: etiology, detection, and mechanisms of: a review//Journal of Clinical and Theoretical Medicine. - Tashkent, 2012. - 7: 45-49 (In Russia).
3. Filos K. S., Kirkilesis I., Spiliopoulou I. et al. Bacterial translocation, endotoxaemia and apoptosis following Pringle manoeuvre in rats//Injury. - 2004. - 35(1): 35-43.
4. Nikitenko V. I., Tkachenko E. I., Stadnikov A. A. Translocation of bacteria from the gastrointestinal tract - a natural defense mecha-nism//Experimental and clinical gastroenterology. - Moscow, 2004. - 1: 48-52 (In Russia).
5. Gencay C., Kilicoglu S. S., Kismet K. et al. Effect of honey on bacterial translocation and intestinal morphology in obstructive jaun-dice//World. J. Gastroenterology. - 2008. - 14: 3410-3415.
6. Ergashev V. A., Nuraly N. A. The phenomenon of bacterial translocation and location of microorganisms in its formation//Infection, immunity and pharmacology. - Tashkent, 2014. - 2 (3): 236-239 (In Russia).
7. Strobel O., Wachter D., Werner J. et al. Effect of a pneumoperitoneum on systemic cytokine levels, bacterial translocation, and organ complications in a rat model of severe acute pancreatitis with infected necrosis//Surg Endosc. - 2006. - 20(12): 1897-1903.
8. Kruglyanskiy Y. M. Bacterial translocation with obstructive ileus (experimental research): Abstract. Dis. cand. honey. Sciences. -Moscow, 2007. - 24 p. (In Russia).
Talipov Rustam Mirkabilovich, Tulaboyeva Gavhar Mirakbarovna, Tashkent Institute of Physician Improvement, Tashkent, Uzbekistan E-mail: [email protected]
The effectiveness of ACE inhibitors and sartans patients with acute myocardial infarction in the elderly on a distant stage monitoring
Abstract: Therapy normopress and enalapril, against the background of basic therapy has shown efficacy in the development of the pathological process of regression, reduced fraction of atherogenic lipids, improve endothelial dysfunction and recovery of myocardial contractility. At the same time, more pronounced and significant dynamics found in patients with myocardial infarction treated with normopress.
Keywords: acute myocardial infarction, hypertension, ACE inhibitors, sartan, endothelial dysfunction.
Relevance
The problem of rational pharmacotherapy ofAMI draws attention due to several reasons. There are a large number of drugs and non-drug therapies used in the treatment of patients with AMI. But quite often there is no objective information regarding the comparative effectiveness of various drugs and treatment regimens. Endothelial dysfunction is the first link in the pathophysiology of cardiovascular-renal continuum, which is based on the progressive vascular disease [1], exacerbated by the influence of risk factors such as arterial hypertension (AH), and leads to kidney and heart failure and death [2]. The blockade of the renin-angiotensin-aldosterone system (RAAS) using ACE inhibitors and sartans and elimination of the negative influence of angiotensin II is a rational approach to achieve regression of endothelial dysfunction [2; 3].
Aim of work
Evaluating the effectiveness ofACE inhibitors and angiotensin receptor blockers II in the management of patients with acute myocardial infarction arterial hypertension in the elderly.
Materials and methods of investigation
The clinical observations and studies carried out in the cardiology department of Tashkent City Clinical Hospital № 7 served as a basis for this work. This is a retrospective study of patients admitted to the Tashkent Hospital № 7 with MI. Patients of both sexes were included. As a result of screening of patients in accordance with the criteria included 631 patients 386 of them older than 60 years, the average age was 70.92 ± 7.22. This open randomized prospective comparative study included 141 patients with the established diagnosis of acute myocardial infarction and arterial hypertension. The study does not include patients older than 80 years with symptoms of decompensated hepatic and renal failure, decompensated diabetes, chronic heart failure (CHF) with over the FC II and III at the time of admission. The patients were selected randomly. Group 1included 66 patients treated with Losartan in the average daily dose of 61.9 ± 32.5 mg. (Normopress 50 mg. CCL Pakistan), Group 2 included75 patients treated with Enalapril in the average daily dose of 6.5 ± 2.0 mg.
The groups were comparable on the baseline characteristics (sex, age, premorbid background, extend of myocardial damage, degree ofhypertension, comorbidities), and the level of decrease in the heart rate (HR).
All patients received standard therapy (including ^-blockers in 21.1 % of cases, statins — 29.6 %, desagregants — 82 %, diuretics — 31 %, calcium antagonists — 15 %, retard forms of nitrates — 64, 74 %) for 2 months. Patients of Group 1 received Normopress, in average daily dose of 61.9 ± 32.5 mg., patients of Group 2 received Enalapril in average daily dose of 6.5 ± 2.0 mg. All patients were surveyed, outcomes were reported, complete physical examination and prospective analysis of patient medical records were carried out. Complete physical examination included the stratification of risk factors: measurement of blood pressure and heart beat rate in dynamics, clinical urine analysis, clinical blood analysis, biochemical blood analysis (including: lipid profile, coagulation profile, troponin I, indicators of antioxidant system of the blood, electrocardiogram (ECG), echocardiogram. All indicators were assessed within 5 days from the date of admission and after 2 months.
Methods of statistical analysis of the study results: we used the package of statistical applications MEDIOSTAT. Besides, the standard methods of variation statistics were used: calculation of mean value, standard deviation (M ± m), and Student's test (p < 0.05).
Results of investigation
At admission, systolic blood pressure (SBP) and diastolic blood pressure (DBP) in patients with myocardial infarction were high (fig. 1). During the 2 months of observation, all patients maintained the self-control diaries reflecting their BP, heart beat rate and state of health. Comparison of the mean values of SBP surveyed on the 20th -25th day and after 2 months, revealed a significant advantage of hypotensive effect achieved with Normopress, compared to that of Enalapril which provided significantly less effect (fig. 1).
