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10significantly increased in patients with end-stage renal insufficiency in the case of MFD disorders, which may indicate a close correlation between epiphysis dysfunction and inflammatory activity. The severity of inflammation is determined by the duration of RRT, the length and severity of hypertension, the severity of anemia, the depth of disorders of circadian rhythms of MFE in patients receiving hemodialysis therapy.
Prospects for further research. Changes in the severity of inflammation in patients with CKD stage 5 and HD treated with melatonin are a subject of further research and will be presented in subsequent reports.
Conflict of interests. The authors declare no conflict of interest.
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OXIDATIVE-ANTIOXIDANT STRESS AS A MARKER OF IMDALANCE OF ORAL FLUID HOMEOSTASIS IN PATIENTS WITH GENERALIZED PARODONTAL DISEASES AND ANOREXIA
NERVOSA
Reshetnyk L.
Department of Dentistry, Institute of Postgraduate Education, PhD student
Antonenko M.
Head of Department of Dentistry, Institute of Postgraduate Education, Bogomolets National Medical University Zelinskaya N.
Department of Dentistry, Institute of Postgraduate Education, associate professor
Bryuzgina T.
Research institute of experimental and clinical medicine of Bogomolets National Medical University
Ukraine, Kiev.
Abstract
Objective. To study the balance of fatty acid spectrum of oral lipids as a marker of oxidant - antioxidant stress in patients with generalized parodontitis with anorexia nervosa.
Materials and methods. The study metabolic disorders of fatty acids of the oral fluid was conducted in 28 patients with GP, primary-I, I-II degree, chronic course associated with anorexia nervosa, (average age 26 ± 3.8)
- the main group (M). The comparison group (C) included 23 patients with GP, primary-I, I- II degree, chronic course with no eating disorders. The control group consisted of 25 healthy individuals of the same age category. Patients' oral fluid was used as the object of study. In the spectrum of fatty acids of lipids of the oral fluid, the 9 most informative fatty acids were identified: myristic c i4: o, pentodecane c i5: o, palmitic c i6: o, margarine c i7: o, stearic c i8: o, oleic c i8: i, linoleum c i8: 2, linolen c i8: 3, arachidone c 20: 4. Quantification of the spectrum of lipid fatty acids was performed by the method of normalization of planes and determined the proportion of acids in %.
Results. The fatty acid content of the oral fluid of patients in the main group was significantly different from the control parameters. i2% in patients with anorexia nervosa significantly increased the amount of saturated fatty acids by increasing the content of palmitic acid (c i6o) and reducing stearic acid (c i8o) by 2 times compared with control. It was established that the sum of unsaturated fatty acids was reduced by 2 times due to polyunsaturated fatty acids, and this level was significantly reduced by 2 times in comparison with control group due to 3 times reduction of linoleum fatty acid (c i8: 2), linolenic fatty acid (c i83) 2-fold and unreliable increase in arachidone fatty acid (c 2o:4), in comparison with the control, which in our opinion, reflects disturbance of the oxidant-antioxidant balance and is a marker of stress as an indicator of endogenous intoxication in patients with GP and anorexia nervosa.
In patients with GP initial-I, I-II degree, chronic course of anorexia nervosa in the oral fluid there was a significant violation of lipid metabolism - increase in the content of palmitic fatty acid (Ci6o) and decrease in the content of linoleic fatty acid (c i82).
Conclusions. The revealed features of the course of GP in patients with anorexia nervosa indicate the need for additional treatment and prophylactic measures in this group of patients. Disorders of the fatty acid spectrum of the oral fluid in these patients were necessitate the inclusion in the traditional scheme of treatment of GP aimed at correcting the processes of antioxidant protection, which increase the effectiveness of therapeutic and prophylactic effects.
Keywords: anorexia nervosa, generalized parodontitis, oxidative-antioxidant stress, oral fluid, fatty acids.
Introduction. Generalized parodontal diseases (GPD), including generalized parodontitis (GP), occupy one of the leading places in the structure of human diseases, conceding to cardiovascular and neoplastic processes. According to WHO, the prevalence of GP is 8o-95% [i, 2]. In recent years, there has been a steady tendency towards the disappearance of gender, geographical and territorial advantages in these diseases. Noteworthy is the "rejuvenation" of GP. These circumstances are of great concern to both medical and governmental scientific institutions [3].
The lack of clear ideas about the causal relationships of GP development significantly complicates the effective prevention and adequate treatment of these diseases, slows down the receipt of stable remission of the pathological process, complicates the choice of adequate and valid pharmacotherapy and other components of complex treatment of GP [4, 5, 6].
The urgency of the problem of parodontal tissue diseases is due to the high prevalence that occurs in various parts of the homeostasis of the human body. Among them, particular attention is paid to diseases of the endocrine, cardiovascular, nervous systems, pathology of the gastrointestinal tract and musculoskeletal system, seeing common reference points for GP and these diseases. This circumstance allowed to declare the concept of comorbidity, association and affiliation of a number of somatic diseases and GPs, in particular, anorexia nervosa (AN) [7, 8, 9, io, ii, i2].
Anorexia nervosa is a mental illness that is manifested in the loss of hunger, lack of appetite in the presence of a physiological need for nutrition, causing not only persistent social and labor maladaptation, but also creating an immediate threat to the patient's life [i3, i4, i5, i6, i7, i8]. In the general population, according to WHO, the rate of AN ranges from o.37 to i.o per ioo,ooo population, with a frequency of o.9- 4.3% in
women and o.3% in men and tends to increase [i9, 2o, 2i, 22, 23].
It is noted that changes in the functioning of the vascular, nervous and endocrine systems are observed in AN, disturbances of general homeostasis are observed, in which the metabolism of fatty acids occupies an important place as the key indicators of oxidant - antioxidant stress. There are no data in the literature on changes in homeostasis of the oral fluid as early probable premorbid manifest diagnostic and therapeutic features of GP on the background of anorexia nervosa.
The purpose of the research was to study the balance of the fatty acid spectrum of oral lipids as a marker of oxidant - antioxidant stress in patients with generalized parodontitis, associated with anorexia nervosa.
Material and methods. With informed consent, the research of metabolic disorders of oral fatty acids included 28 patients with GP, initial-II degree, chronic course associated with anorexia nervosa (mean age 26 ± 3.8) - the main group (M). The comparison group (C) included 23 patients with GP, initial-II degree, chronic course with no eating disorders. The control group consisted of 25 healthy subjects of the same age category and all investigated revealed lipid disorders.
All patients with AN had outpatient and inpatient treatment in the psychoneurological department of the Kiev Clinical Hospital at the CT # i Branch of the Public Health Center of PJSC "Ukrzaliznytsya" (head of the department - O.V. Moskalenko). Note, all patients were diagnosed with AN, restrictive form. In no case there were not patients with AN, cleansing form.
As the object of research patients' oral fluid was used. Sampling of the oral fluid was performed on an empty stomach in the early hours in the amount of 5 ml after pre-antiseptic treatment of the oral cavity, the liquid was placed in a io ml tube with a ground cork. Subsequently, a gas chromatographic analysis of the fatty acid composition of the lipids on a gas chromatograph
"Zvet-500" isothermal with a flame ionization detector under the following conditions: a glass column (2.0 mx0.3 cm in size) was used to determine the spectrum of lipid fatty acids. which is filled with 10% PEGS on N-AW-HMDS chromaton (grain 0.125-0.160 mm), column temperature 185°C, evaporator temperature 240°C, nitrogen and hydrogen difference 35 ml/min, air - 300 ml/min, chart speed tapes 10-9A, analysis time 20 minutes. Quantification of the spectrum of lipid fatty acids was performed by the method of normalization of planes and determined the proportion of acids in%. An application for utility model U 201911847 "Method for the diagnosis of generalized parodontitis in patients with nerve anorexia nervosA" was received in 12.12. 2019.
In the spectrum of fatty acids (FA) of lipids of the oral fluid, the 9 most informative FA were identified: of these, myristic C 14:0, pentodecane C 15:0, palmitic C
16 0, margarine C 170, stearic C 180, which make up the sum of saturated fatty acids (SFA), as well as oleic C 181, linoleic C 182, linolenic C 183, arachidonic C 204, which make up the group of unsaturated fatty acids (UFA). Note, linoleum C 182, linolen C 183, arachidonic C 204 fatty acids are included in the amount of polyunsaturated fatty acids (PUFA) and are defined as irreplaceable.
The obtained results were presented as arithmetic mean (M) and standard error (m), taking into account quantitative sampling (n). The data were processed using the Wilcoxon-Mann-Whitney U test in Statistica 6.0. The differences were considered significant at p <0.05.
Results and discussion. The results of the balance of fatty acid lipid composition (%) in patients with generalized parodontitis with anorexia nervosa are shown in table 1.
Table 1
Balance of fatty acid lipid composition of patients with generalized parodontitis of initial-I, I-II de-
Fatty acid Patients (GP, pri-mary-II degree, chronic course+AN), n=28 (%) Patients (GP, pri-mary-II degree, chronic course without AN), n=28 (%) Control n=25 (%)
C 14:0 1,8±0,3 1,6±0,3 1,4±0,3
C 15:0 1,8±0,3 0,8±0,3 -
C 16:0 64,1±1,5* 37,6±1,9* 34,0±1,5
C 17:0 1,8±0,3 0,8±0,3 -
C 18:0 5,6±0,5* 10,8±2,1 12,7±0,4
C 18:1 13,5±1,0* 19,7±1,8* 25,4±0,7
C 18:2 3,6±0,5* 11,1±1,8* 17,9±1,0
C 18:3 2,1±0,3* 3,2±0,2* 5,0±0,5
C 20:4 5,6±0,5 6,5±0,5 3,8±0,5
ESFA 75,1±1,6* 51,6±1,8* 47,9±1,2
EUFA 24,8±1,6* 40,5±1,4* 52,1±1,2
Xpufa 11,3±1,5 20,8±1,5 26,7±1,0
* p<0.05 compared to control
As can be seen from the table, the content of fatty acids of the oral fluid of patients in the main group was significantly different from the indicators in the control. Thus, 12% in patients with anorexia nervosa significantly increased the amount of saturated fatty acids by increasing the content of palmitic FA (C 160) and reducing stearic FA (C 18:0) 2 times compared with control.
It is established that the sum of unsaturated FA is reduced by 2 times due to PUFA, and the PUFA level is significantly reduced by 2 times in compared with control due to 3 times reduction of linoleum FA (C 182), due to 2 times linolenic FA (C 18 3) and unreliable increase in arachidone FA (C 20:4) in compared with the control, which in our opinion, reflects disturbance of the oxidant-antioxidant balance and is a marker of
stress as an indicator of endogenous intoxication in patients with GP in AN.
Taking into consideration that linoleic C 182, linolen C 183, arachidonic C 204 FA are polyunsaturated fatty acids (PUFA), are defined as irreplaceable, and come only with food, (in the human body are not synthesized), and are a marker polyunsaturated lipid oxidation (PLO), we considered it necessary to analyze changes in the fatty acid formula of lipids of the oral fluid in patients with GP, initial-I, I-II degree, chronic course with anorexia nervosa of these indicators. Thus, the characteristics of POL in patients with GP, initial-I, I-II degree, chronic course of anorexia nervosa and control indicators are shown in fig. 1.
Fig. 1. Characterization of polyunsaturated lipid oxidation in patients with generalizedparodontitis initial-I, I-II degree, chronic course, assosiated anorexia nervosa and control parameters.
80
70
60
50
40
30
20
10
Control
Patients (GP, primary-II degree, chronic course+AN),
Patients (GP, primary-II degree, chronic course without AN),
ZSFA
C 16:0
IPUFA
C 18:2
The figure shows that patients with generalized parodontitis of initial-I, I-II degree, chronic course with anorexia nervosa in the oral fluid has a significant violation of lipid metabolism - an increase in the content of palmitic FA (C160) and a decrease in the content of linoleum FA (C 18: 2).
Conclusions:
1. Balance violation between all components of fatty acids (C 14:0, C 15:0, C 16:0, C 17: 0, C 18:0, C 18:1, C 182, C 183, C 204) in patients with generalized parodon-titis, initial -I, I-II degree, chronic course with anorexia nervosa.
2. Certain disorders of lipid metabolism are one of the pathogenetic factors of GP in patients with anorexia nervosa.
3. We assume that the change in lipid balance may be indicative at the stage of premorbid condition of patients with generalized parodontitis, initial-I, I-II degree, chronic course with anorexia nervosa.
4. Increasing the saturation of the lipid complex and reducing the unsaturation due to PUFA may indicate the presence of lipid peroxidation (PLO) and impaired lipid metabolism of the oral fluid, which may contribute to the development of generalized parodontal disease.
5. The revealed change in the fatty acid composition of the lipids of the oral fluid in all patients with generalized parodontitis, initial-I, I-II degree, chronic course with anorexia nervosa is a sign of pronounced oxidative stress, which requires mandatory inclusion in the complex treatment of therapeutic agents antioxidant action (vitamins A, E, D).
Prospects for further research. Changes in the fatty acid spectrum of the oral fluid in patients with GP, initial-I, I-II degree, chronic course with anorexia nervosa indicate the possibility and relevance of the analysis of oral fluid as a biological material for the purpose of diagnosing the status of the processes of PLO and
oxidative-antioxidant stress. This confirms the versatility and importance of oral fluid research in this category of patients.
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ENDOTHELINE-1's DYNAMICS IN NON-PROLIFERATIVE DIABETIC RETINOPATHY AND ITS
CORRECTION WITH L-ARGININE
Semenko V.
graduate student of the Department of Ophthalmology SI "Dnipropetrovsk Medical Academy of the Ministry of Health of Ukraine "
Abstract
Diabetic retinopathy (DR), as one of the most frequent and adverse manifestations of diabetes, remains the leading cause of significant visual impairment. Retina microstructural changes are detected at the DM onset, they gradually trigger the pathogenetic reactions cascade, which lead to microcirculation infringement and tissue hypoxia. According to the classification of the American Diabetes Association, our study involved patients who were diagnosed with a non-proliferative stage of DR in the initial stage with the presence of single microaneurysms, spot hemorrhages or solid exudates. But for a more complete characteristic of step-by-step levels of change, to assess the progress of DR has been chosen criteria developed by a fundamental ETDRS study. The research involved 108 patients (216 eyes) diagnosed with type 2 diabetes between the ages of 45 and 60. Of these, 56 are men and 53 are women. Most patients (95 patients - 88%) experienced emetropic refraction. In 9 patients (8.3%) was determined myopic refraction, of which: 5 had mild myopia, and 4 had moderate myopia. 4 patients (3.7%) had low grade hypermetropic refraction. All patients' visual acuity is corrected. Thus, patients with different levels of ETDRS, depending on the level, also found unequal degree of endothelial dysfunction. The results obtained about the endothelial dysfunction characteristic for each endothelial dysfunction state can be considered as an informative characteristic of different levels of DR severity.
Performed metabolic correction with the use of L-arginine gave positive results. In patients after treatment were objectively determined stabilized DR state.
