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11Saliva is a natural liquid biological medium which neutralizing and mineralizing properties are largely due to the state of acid-base balance which objective parameter is pH. According to the received data, the lowest values of pH were also recorded in group 3 (6.3) which distinguished it not only from the accepted normative indices but also from parameters of group 1 where they also were less than normal.
Decreased salivation rate led to an increase of oral fluid viscosity which minimum value corresponded to group 1 and the maximum - group 3 which fully explained the significant complaints of patients of dryness and lack of saliva.
Conclusion: Thus, the study shows that more than 80% of patients with COPD in combination with CHD have dental complaints, which patients associate with the start of drug intake.
1.The most frequent complaints are dryness in the mouth, loss or distortion of taste sensations, burning tongue and dry lips, bad breath and increased sensitivity of teeth.
2. It was noted that the frequency of these complaints increases with the duration of basic therapy for somatic pathology.
3. Manifestations of COPD in combination with CHD against intake of basic therapy include changes in the physical properties of mixed saliva, expressed by a decrease in the secretion rate, as well as increased acidity and viscosity properties which directly depend on duration of drugs intake.
The perspectives of further scientific research - In this regard, the evaluation of the long-term side effect of drug therapy on the oral cavity in such patients is timely and relevant, and the polymorphism of subjective and clinical manifestations encourages the development of adequate integrated diagnostic and prophylactic methods.
References
1. Bagisheva N.V., Ivashchuk E.V., Fedotova O.I. (2015). Inhalation glucocorticoids as a risk factor
for mucosal lesions in the mouth. Spravochnik-vracha-obshchej-praktiki (8), 7-10.
2. Gurevich M.A., Dolgova E.V., Kuzmenko N.A. (2016). Chronic obstructive pulmonary diseases, arterial hypertension and ischemic heart disease: features of pathogenesis, clinical picture, therapy. RMJ. (16), 1098-1102.
3. Chuchalin A.G., Avdeev S.N., Aisanov Z.R., Belevsky A.S., Leschenko I.V., Meshcheryakova N.N., Ovcharenko S.I., Shmelev E.I. (2014). Russian respiratory society. Federal Clinical Recommendations for the Diagnosis and Treatment of Chronic Obstructive Pulmonary Disease. Pulmonologya. (3), 15-54.
4. GOLD -Global Initiative for Chronic Obstructive Lung Diseases (updated 2011-2015).
5. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease (GOLD): Updated 2016. 80 p.
6. Guggenheimer J. Xerostomia: Etiology, recognition and treatment / J. Guggenheimer, P.A. Moore (2003). The Journal of the American Dental Association. 134(1), 61-69.
7. Proctor G. Osailan B., Pramanik R., Shirlaw P.J., Challacombe S.J. (2010). Drug related hyposaliva-tion: a review of physiology and sites of drug ac-tionOral Diseases. (16), 505.
8. Scully C. Drug effects on salivary glands: dry mouth. (2003). Oral Diseases. (9), 165-176.
9. Shen T.C, Chang PY, Lin CL (2015). Risk of periodontal diseases in patients with chronic obstructive pulmonary disease: a nationwide population-based cohort study. Medicine. (94), 2047
10. Tonetti M.S ., Van Dyke T.E. ( 2013). Periodontitis and atherosclerotic cardiovascular disease: consensus report of the Joint EFP/ AAP Workshop on Periodontitis and Systemic Diseases. J Periodontal. 84(4 Suppl.), 24-29.
11. Zeng XT, Tu ML, Liu DY (2012). Periodontal disease and risk of chronic obstructive pulmonary disease: a meta-analysis of observational studies. PLoS One.(7), 46508.
PATTERN OF CARDIAC RHYTHM VARIABILITY OF PREGNANT WOMEN DEPENDING ON THE FETUS SEX
Kalentyeva S.V.
Kemerovo State Medical University, professor
Kemerovo
ABSTRACT
The purpose of the research is to find out the pattern of a mother's cardiac rhythm variability depending on the fetus sex. Due to the high prevalence of neurohumoral control disturbances, especially of reproductive function, the women, who gestate male fetus, are in less conducive conditions to conception and gestation of male fetus, which is less resistant to disturbing factors. Under these circumstances there are more risks for perinatal sequelae.
Keywords: fetus sex, cardiac rhythm variability, perinatal sequelae.
Cardiorhythmography is a functional method of diagnosing the state of the vascular system, based on a spectral analysis of heart rate variability. The scope of the method has been expanding rapidly in recent years. In the field of clinical applications - this is neurology, therapy, occupational pathology, radiation injuries,
emergency conditions, narcology, oncology. In the field of labor physiology and ecology, cardiorhythmog-raphy is used to investigate the characteristics of the adverse effects of industrial and environmental conditions and biorhythmological effects.
Obstetricians were among the first to use the evaluation of heart rate variability (HRV) of the fetus to characterize its condition. The clinical significance of heart rate variability was first evaluated in 1965 when E. Hon and S. Lee [9] noted that the fetal distress was preceded by an alternation of intervals between contractions before there were any discernible changes in the heart rate itself. Twenty years later attention was drawn to the presence of physiological rhythms in the signal of the heartbeat. Cardyotachogram together with the registration of fetal movement became the main information base of industrial devices - fetal monitors ("Hewlett Paskard" and other companies).
For obstetrician-gynecologists, the proposed method is of interest primarily as an opportunity to predict the course and outcome of pregnancy and childbirth for the mother, and as an opportunity to assess the condition of the fetus and the newborn. The method is characterized by high information content and accuracy. It allows to determine the level and activity of various human functional systems, the state of metabolic (energy) reserves and the degree of neuroendocrine interrelations.
In a review article by M. Hirsch et al. [8] the clinical characteristics of fetal HRV, the influence of the autonomic nervous system and other physiological factors are given, and attention is also drawn to circadian changes in the fetal HRV. The authors suggest that the fetal circadian rhythms seem to correlate with the mother's HRV. Pathological factors affecting fetal HRV are examined: fetal CNS disease, medication intake, etc. Progressive reduction in HRV or lack of heart rate variability in the fetus is a signal of concern about the risk of fetal death. Pregnancy in relation to the mother's organism is represented as a stress-effect, the physiological basis of which is the processes of adaptation and compensation. During fetal development the placenta forms a system of life-support of the fetus for which the mother's organism is an external contour [16]. The indicator of the adaptive activity of the human body is the circulatory system. Thus, the analysis of the heart rhythm of the pregnant woman reflects her homeostasis in the "mother-placenta-fetus" system in the process of adaptation of the organism.
In the literature there are studies of HRV of pregnant women, parturient women and newborns with physiological pregnancy and various perinatal complications [2, 6, 7, 10-12]. However, these studies do not consider the variability of the mother's HRV parameters from the sex of the fetus.
The purpose of the study was to identify the characteristics of the indicators of heart rate variability in the mother depending on the sex of the fetus.
Materials and methods. In the course of the study which was conducted from 2014 up to 2016 years 1870 pregnant women were examined on the basis of the obstetric clinic No. 5 in Kemerovo. The material collection program provided for the compilation of a statistical map - a list of issues to be studied as well as research on the cardiorhythm of pregnant women characterizing the state of the mother-fetus system. The survey was conducted by non-invasive methods and met the requirements of the Helsinki Declaration of the World
Medical Association on the ethical principles of medical research involving people as subjects (2013). All subjects gave informed consent to participate in the study.
The program "SPECTR.exe" provides time analysis of heart rate variability - one of two methods (time and frequency analyzes) used in the study of HRV according to cardiological research standards developed by the working group of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology [14]. Time analysis is based on the mathematical processing of changes in the duration of a series (more than 100) consecutive cardio intervals with the calculation of various coefficients that allow us to judge the regulation of the rhythm of the heart.
Computer treatment of cardiac rhythm allows to assess the state of central, including vegetative regulation, sympathoadrenal (F1-fast waves), baroreceptive (F2-average waves) and vagoinsular (F3-slow waves) activity, to reveal the inadequacy of the regulatory-metabolic and endocrine adaptation of the female body, the nature of the reaction of the fetoplacental complex and the utero-placental bed. The information is collected under conditions that correspond to the requirements described in the manuals on the study of the autonomic nervous system and basic metabolism [15].
The initial condition was recorded when the mother was awake in a horizontal position. Prior to recording, blood pressure was measured and the pulse counted. 5 records were produced using the "PULS" program using a heart rate monitor, a personal computer and software (Tsirelnikov N.I., 2001) in accordance with the following stages.
Step 1. Registration of the initial state (background). The tachogram was registered in real time, as a result of which the spectrum of the spectral power density of the variability of the cardiointervals was formed.
Step 2. The first functional test: the account in the mind in the form of consecutive subtraction of the number 7 from the original digit 500 (mental load).
Step 3. The recovery phase after the first functional test (recovery 1) - 5 minutes after the end of the functional test.
Step 4. A second functional test with hyperventilation was performed for 3 minutes with the inclusion of predominantly diaphragmatic (deep and frequent) respiration. Step 5. Recovery phase after the second functional test (recovery 2). Recorded 5 to 10 minutes after the end of the second functional test.
The program "SPECTR.exe" carried out an analysis of the rhythm of the heart. The program provides for direct analysis of cardiac rhythm data, with the following parameters assessed:
1) Initial activity of sympathoadrenal - F1, barore-ceptive - F2 and vagoinsular regulation - F3 (hyper or hypoactivity), normal indices: F1 - 30-130 cu, F2 - 1 / 5-1 / 10 of F1, F3 - 1 of F2.
2) The response of regulatory types to functional tests (dynamic response, ie 15% reduction of the original F1 with a mental sample and hyperventilation, with an increase of 15% from the initial F2 and F3 - norm,
discoordination, response inactivity), all three types of regulation, as well as the genesis of violations.
3) Estimation of the reserve of adaptation of regulations, i.e. recovery after loads in 5 minutes, in normal terms these indicators should be equal to the initial ones.
This evaluation is most important in terms of forecasting. In the structure of the spectrum, 3 ranges are distinguished:
1) low-frequency less than 0.08 Hz - characterizes the predominance of sympathetic-adrenal regulation, conditionally designated F1;
2) mid-frequency 0,09-0,16 Hz - characterizes the state of baroreceptive regulation (F2);
3) high-frequency 0.17-0.5 Hz - characterizes, basically, the activity of vagoinsular regulation (F3).
The initial stage of the statistical processing of the obtained information provides for the application of the program Microsoft Office 2013 Pro EN to spreadsheet (academic license Open License 62007606).
Using the above program was carried out the formation of a database. On the basis of the generated database was audited, sorting, and coding (encryption) of the information received. In the process of the next stage of information processing was formed pivot tables. For a visual image of materials of the research applied different types of charts.
To prove statistical significance of the results of the research were used the software package IBM SPSS
Statistic Base Campus Edition Campus Value Unit License v. 24 (license agreement No. 20160805-1 from 30.08.2016 with JSC "Predictive Solutions").
Statistical processing of data was built taking into account the nature of the distribution of the received data. The nature of distribution of variables in the considered complexes was determined using the criterion Shapiro-Wilk.
The obtained data did not meet normal distribution. Therefore, to determine the statistical significance of differences mapping populations used non-parametric evaluation criteria of study results. To assess statistical significance in the comparison groups (non-paired populations), we used the criteria Mann-Whitney and X2. The critical significance level was taken as 0.05 [3].
Results and discussion
For the purpose of revealing the features of the heart rate variability indices in relation to the sex of the fetus, all pregnant women were divided into 2 groups:
I group - 983 women with male fetuses and II group -887 women with female fetuses. The average age of women in group I was 21.94 ± 0.7 years and in group
II 22.12 ± 0.7, i.e. there was no reliable age difference in these groups. According to cardiointervalography (Table 1), the initial condition of parturients of group I was characterized by parasympatheticotonia and dominance of the autonomic heart rate regulation loop.
Table 1
Initial indices of cardiointervalography in mothers of boys and girls
Indicators Boys' mothers (n=983) Girls' mothers (n=887) p
Average spectrum power, lg 10 2,61±0,6 2,31±0,4 p>0,05
Heart rate, уд/мин 82,96±13,6 91,75±10,2 p<0,05
R-R ср., сек. 0,74±0,1 0,64±0,1 p<0,05
VLF, lg 10 2,3±0,7 2,25±0,6 p>0,05
LF, lg 10 1,59±0,5 1,57±0,5 p>0,05
HF, lg 10 1,36±0,5 1,45±0,6 p>0,05
Мо, сек. 0,77±0,2 0,66±0,1 p<0,05
АМо, % 39,18 42,5 p<0,05
SI, у.е. 65,82±6,1 77,92±7,1 p<0,05
VEI, у.е. 87,89±6,6 85,5±5,5 p>0,05
VRR, у.е. 3,70±0,4 3,83±0,4 p>0,05
AIRP, у.е. 53,59±2,1 69,25±2,9 p<0,05
Total spectrum power, lg 10 2,46±0,6 2,42±0,6 p>0,05
Balance of central regulation, у.е 5,38±0,8 3,89±0,3 p<0,01
Vagosympathetic index, у,е 0,59±0,02 0,64±0,02 p>0,05
Normoadaptive state, % 82,8 100 p<0,01
Hypoadaptive state, % 3,5 - p<0,001
Hyperadaptive state, % 13,7 - p<0,001
Note (here in after): VLF - low-frequency (20-second) rhythm, LF - mid-frequency (10-second) rhythm, HF -high-frequency (3.5-second) rhythm, Mo - mode, AMo - mode amplitude, SI - stress index, VEI - vegetative equilibrium index, VRR - vegetative rate of rhythm, AIRP - activity index of regulation processes.
When carrying out the " Score" test (Table 2), there was a moderate increase in the tone of the sympathetic link of the autonomic nervous system and the role of the central contour of cardiac rhythm control against
the background of the high activity of the parasympathetic regulation loop without altering the activity of the humoral link (Mo).
Table 2
Indicators of cardiointervalography during the "Count" test for mothers of boys and girls
Indicators Boys' mothers (n=983) Girls' mothers (n=887) p
Heart rate, уд/мин 83,48±11,9 92,5±11,5 p<0,05
R-R ср., сек. 0,72±0,1 0,65±0,09 p<0,05
VLF, lg 10 2,14±0,9 1,88±0,5 p<0,05
LF, lg 10 1,35±0,5 1,23±0,5 p>0,05
HF, lg 10 1,18±0,7 0,91±0,7 p>0,05
Мо, сек. 0,78±0,2 0,68±0,2 p<0,05
АМо, % 37,81 39,68 p<0,05
SI, у.е. 95,33±9,8 108±11,7 p<0,05
VEI, у.е. 114,48±9,2 128,83±11,8 p<0,05
VRR, у.е. 5,63±0,6 6,83±0,8 p<0,05
AIRP, у.е. 55,41±4,4 58,75±1,9 p>0,05
Total spectrum power, lg 10 2,32±0,7 2,02±0,5 p>0,05
Balance of central regulation, у.е 7,21±0,9 3,60±0,3 p<0,001
Vagosympathetic index, у,е 0,51±0,03 0,42±0,003 p<0,05
Normoadaptive state, % 72,4 91,7 p<0,01
Hypoadaptive state, % 10,4 8,3 p<0,05
Hyperadaptive state, % 17,2 - p<0,001
Domination of the central control loop, % 75,9 75 p>0,05
Domination of the autonomous control loop, % 6,9 16,7 p<0,001
Domination of the central control loop with high activity of the autonomous, % 17,2 8,3 p<0,001
Adaptive Capabilities, %:
good 65,5 83,4 p<0,01
satisfactory 34,5 8,3 p<0,001
bad - 8,3 p<0,001
In 10.4% of women giving birth hypoactive reactions were observed manifested in a decrease in the total power of the spectrum (post-loading "energy deficiency") [5] and a decrease in the variation range of the RR-interval which indicated a low reactivity of the autonomic nervous system. In 17.2% of women in labor hyperactive reactions were observed which may be associated with metabolic disorders, which were also recorded in these women on an electrocardiogram. In all women of group I adaptive-adaptive mechanisms of regulation of the circulatory system corresponded to high or middle levels.
According to the data of CIG, the tone of the sympathetic part of the autonomic nervous system predominated in the II group (as evidenced by the increase in IN and AMO), which indicates the centralization of cardiac rhythm control, caused by increased activity of the hypothalamic-limbic and cortical structures. This testifies to the imperfection and lower functional capabilities of the heart and autonomous mechanisms for monitoring its activity in women of this group, the apparent dominance of mechanisms of extracardiac regulation of the heart rhythm [4].
Such mechanisms according to the literature [1] conceal the danger of overstrain and disruption of adaptation with the subsequent development of the pathological process. Against the background of the initial sympathicotonia during the load period, the activity of both regulating circuits increased with the predominance of the autonomic one. The high level of functioning of the autonomous circuit of heart rate regulation was evidenced by the predominance of high-frequency
components on the rhythmograms. This increased the likelihood of imbalance in regulating systems which in 8.3% of cases led to a breakdown in adaptive-adaptive mechanisms of heart regulation.
Thus in women of group II in connection with the high prevalence of disorders in the nerve-humoral regulating link, especially the reproductive function, it is evident that the less favorable background for conception and gestation of male fetuses [13] as less resistant to damaging factors, conditions for more the number of perinatal complications.
References
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2. Cherny V.I. Possibilities of the integral method for assessing the functional state of the body for monitoring the effectiveness of therapy and predicting the outcome of pregnancy in patients with preeclampsia of varying severity. Cherniy, V.S. Kostenko, A.V. Si-dorenko // Health of the child. No. 8 (43), 2012. P. 6064.
3. Computer technologies of information processing in medicine and public health: education material. - Kemerovo: KemSMA, InSEPZ, 2016. - 281 p.
4. Dmitriev D.A. Heart rate variability / D.A. Dmitriev. - Cheboksary, 2010. - Publisher: Chuvash State Pedagogical University I.Ya. Yakovleva. - 129 p.
5. Dmitrieva S.L. The state of the autonomic nervous system in women with a weakness of labor activity / S.L. Dmitrieva, S.V. Khlybova, G.N. Khodyrev, V.I. Tsirkin // Medical Almanac. №6, 2011. P. 76-79.
6. Dmitrieva S.L. Variability of heart rate at different stages of the gestational process / S.L. Dmitrieva, S.V. Khlybova, V.I. Tsirkin, G.N. Khodyrev. - Kirov, 2013. - Publisher: Medical Information-Analytical Center. - 124 p.
7. Fanaskov S.V. The variability of the heart rhythm of the mother and fetus in hematogenous infection of the fetal egg / S.V. Fanaskov // Mother and child. No. 1, 2011. P. 45-48.
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9. Hon E.H, Lee S.T. Electronic evaluations of the fetal heart rate patterns preceding fetal death: further observations // Am. J Obstetr. Gynecol. №87, 1965. P. 814-826.
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13. Silva P. Da, Aliken R. P., Phind S. M. et al. Influence of placentally mediated fetal growth restriction on the onset of puberty in male and female lambs // Reproduction. №122 (3), 2001. P. 375-383.
14. Task force of the European Society of cardiology and the North American Society of pacing and electrophysiology. Heart rate variability. Standards of mesurements, physiological interpretation and clinical use // Circulation. №93,1996. P.1043 - 1065.
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КЛ1Н1КО-Б1ОХ1М1ЧНЕ ОБГРУНТУВАННЯ Л1КУВАННЯ ЗАХВОРЮВАНЬ ПАРОДОНТА У ПАЦ16НТ1В З ПСИХОСОМАТИЧНИМ СТРЕСОМ
Кононова О.В.
1нститут громадського здоров'я 1мен1 О.М. Марзеева НАМН Украши,
старший науковий ствробтник
CLINICAL-BIOCHEMICAL SUBSTANTIATION OF TREATMENT OF PERIODONTAL DISEASES IN PATIENTS WITH PSYCHOSOMATIC STRESS
Kononova O. V.
State Institution "O.M. Marzeieve Institure for Public Health, National Academy of Medical Sciences of
Ukraine ", Kiev Senior Research Fellow
АНОТАЦ1Я
Вражешсть та характер nepe6iry захворювань пародонта залежать ввд ряду факторiв та психолопч-ного стресу зокрема. Зважаючи на щ обставини, визначення певного ствввдношення мш психосоматич-ним станом пащенпв та станом гх тканин пародонта представляе певний науковий штерес. Для ефектив-ного л^вання захворювань пародонта у цих пащенпв необхвдно експериментально обгрунтувати ефек-тивнють запропонованого комплексу адреноблокаторiв.
Мета: визначити вплив психосоматичного стану на тканини пародонта обстежених оаб та експериментально обгрунтувати ефектившсть запропонованого комплексу адреноблокаторiв.
Методи дослвдження: для вивчення суб'ективних реакщй людини на вплив рiзних факторiв навколи-шнього середовища була використана спещально розроблена анкета. Для дiагностики рiвня тривожносп було використано тест на самовизначення, що включае реактивну та особисту тривогу за Спшбергером.
Експериментальний адреналшовий стрес моделювали у щyрiв пероральним застосуванням гелю з ад-реналшом у дозi 0,36 мг/кг протягом 10 дшв. Лшкомщин уводили з питною водою в дозi 60 мг/кг. Гель адреноблокаторiв (зоксон + нщерголш i абазон) уводили шляхом застосування у дозi 0,6 мг/кг. У сирова-тщ кровi щyрiв визначали вмют глюкози, триглiцеридiв, загального холестерину та малонового дiальде-пду (МДА), актившсть уреази, лiзоцимy, еластази та каталази.
