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Risk factors of the development of arterial hypertension in children in Uzbekistan regions
Fig.4 demonstrates that in patients with POAG at the first stage the threshold of retinal sensitivity was 4,50 ± 0,08 dB before the treatment, after the treatment the index increased reliably (p < 0,001) by 22,2% and was 3,50 ± 0,07 dB; at the stage II the POAG index before the treatment was 7,20 ± 0,08 dB, after the therapy the index increased (p < 0,001) by 15.3% and was to 6,10 ± 0,09 dB if compared to that before the treatment at the same stage of the disease indicated as 100%; at the third stage the POAG index prior the therapy was 11,7 ± 0,09 dB and after the treatment increased (p < 0,001) (by 9,4%) to 10,6 ± 0,08 dB if compared to the index before the treatment at the same stage of the disease.
In the second group (fig.4) at the first stage of POAG the threshold of the retinal sensitivity was 4,6 ± 0,1 dB before the treatment
and after the treatment the index (p < 0,05) increased (by 4,3%) and was 4,40 ± 0,09 dB; at the second stage of POAG the index before the treatment was 7,00 ± 0,13 dB and after the therapy it increased (p > 0,05) to 6,8 ± 1,4 dB being by 2,9% higher if compared to the index before the treatment at the same stage of the disease taken for 100%; at the third stage of POAG the index before the therapy was 11,5 ± 0,13 dB, and after the treatment it elevated (p > 0,05) to 11,3 ± 0,08 dB which was by 1,7% higher if compared to the data before the treatment at the same stage.
According to the data obtained by computer statistic Humphrey perimetria, there was increase in the photosensitivity of retina, decrease in quantity, size and depth of the scotoma, widening the area with normal photosensitivity in patients of the basic group (fig.5).
Figure 5. Humphrey perimetria of the left eye of the patients with second stage of POAG before and after the treatment
Thus, Ronocit (Citicoline) induces marked neuroprotective effect at POAG, rendering the effective protection of the nerve tissue and slow down the apoptosis. Besides the improvement of the clinic and functional indices of the visual organ we have observed the improvement of the general feeling, attention and working ability in all the patients.
Conclusion:
1. Analysis of the obtained results indicated to high enough clinic efficiency of Ronocit (Citicoline) drug for the conservative treatment of patients with POAG and compensated IOP.
2. This drug might be recommended as the background neuroprotective therapy.
References:
1. Kurishova N. I. The role of the methods of visualization of the optic nerve disc and the nerve fibres layer of retina at the earlier diagnostics of glaucoma. Glaucoma, - 2007, - 1; 16-22 p.
2. Kurishova N. I. Glaucoma optic neuropathia. - Moscow, Med Press Inform, - 2006, - P. 315.
3. Kuroyedov A. V., Gorodnichiy V. V. Computer retinotomography (HRT): diagnostics, dynamy and reliability. - Moscow, - 2007, -126 p.
4. Shkarlova S. I. Glaucoma and catarracta. Seria "Medicina dlya vas" Rostov on Don; Fenix; - 2001; - 192 p.
5. Nesterov A. P. Glaucoma. - Moscow; MIA; - 2008, - 357 p.
DOI: http://dx.doi.org/10.20534/ESR-16-11.12-95-97
Ubaydullayeva Sevara Abdullayevna, Senior scientific assistant, applicant to the department of Ambulatory Medicine, Tashkent Pediatric Medical Institute E-mail: mbshakur@mail.ru
Risk factors of the development of arterial hypertension in children in Uzbekistan regions
Abstract: The article was dedicated to the study of children performed according to multi stage program, in the process of which it was determined, that the most significant risk factors of arterial hypertension in children and adolescents in the Republic of Uzbekistan were sedentary style of life, irrational nutrition, and heredity.
Arterial hypertension (AH) is one of the most important risk factors of cardiovascular pathology development and it is one of the leading reasons of lethal outcomes in the world [1; 2]. In the modern time it is doubtless, that origin of AH is in childhood and adolescence, when neurogenic and humoral mechanisms of cardiovascular system regulation are formed [5].
Section 7. Medical science
According to some authors the prevalence of AH among children and adolescents varies from 2.4 to 18% [3], and according to the results of other researchers from 0.76% to 33% [4].
Formation of AH in children and adolescent, as well as in adults, effects a series of factors, including height [6], body mass at birth, original emotional tone, constitutional-typical and personal characteristics, high level of anxiety and emotional tension, significantly related to hypertensive reactions [4].
Nowadays revealing of risk factors becomes a common strategy of cardiac-vascular pathology prevention. Categories of risk factors of cardiovascular diseases include psycho-social (stress factors, low education level, depression), traditional (AH, smocking, obesity, dyslipidemia) factors and biochemical markers [5]. These are so-called modified factors. Non-modified factors include age, gender, and genetic predisposition. Majority of teenagers have combination of factors, which significantly exceeds the risk of cardiovascular disease development [1; 2]. At the same time most of RF (unfavorable psycho-emotional background in family, hypodynamics, irrational nutrition, overweight, unstable arterial pressure) are modified [5].
Keywords: arterial hypertension, children, risk factors.
The objective: to characterize physical development of children and teenagers with arterial hypertension in the Republic of Uzbekistan.
Materials and methods of the research. Examination of the children was performed in compliance with multi stage program. For the research we chose educational facilities. The first epidemiological stage was aimed to study the prevalence of arterial pressure increase and risk factors of cardiovascular disease occurrence among children and adolescents of the Republic of Uzbekistan. At that stage of the study we enrolled 1226 children in the age from 11 to 17 years old by means of non-selecting overall method for the assessment of arterial pressure, definition of antropometric values of physical development, reveal of genealogical and social peculiarities in the history. At the first stage of the study we performed a polling of 718 girls and 508 boys in compliance with the objective and the problems.
In 363 (29.6%) children increase of arterial pressure (AP) was fixed just once. That provided relative inclusion of these children to the group ofchildren and adolescents with "White coat hypertension" (WCH) phenomenon. Later medical staff of the educational facility was recommended to follow the children of that group with measurement ofAP in school not less than once a month. At the second (outpatient) stage we examined 254 teenagers at the age 12-17 years old, among them 126 boys and 128 girls, who had increased values of arterial pressure in every triple screening assessment with 10-14 days interval.
According to the results of the study we created two clinical-functional groups for monitoring dependently on the type of hypertension: 139 (12.9%) children and adolescents with labile arterial hypertension (LAH) and 115 (10.7%) children and adolescents with stable arterial hypertension. All examined children had registered high values of AP for corresponding gender, height, and age within three doctoral check ups with 10-14 days interval. At the moment of checking the patients did not receive antihypertensive agents.
Statistical processing of the results was performed with the help of computer software Microsoft Excel with calculation of reliability with Student's t-criterion.
Results and discussion. The data of the polling revealed absence of following the day routine and healthy style of life by majority of children. The most significant deviation of the day routine was hypodynamics, little physical activity. Hypodynamics (regular physical activity only during the classes of physical training in school) was noted in 63.2% boys and 86.5% girls. Only 22.3% boys and 7.0% had regular participation in sport activities.
In the age aspect the number of children and adolescents spending not less than 2-3 hours per day outdoor and playing mobile games decreases with age, and more significantly among girls. If in 12 years old age regular and long-lasting walking and games outdoor were registered in 77.9% boys and 70.8% girls, to 17 years old age
that number diminished to 68.9% and 55.8% respectively (p<0.05). Significant part of spare time children and adolescents in all age groups spend in front of computer and watching TV programs.
Stereotypes of irrational nutrition, not corresponding to the principles of healthy style of life, were revealed in 56.1% boys and 50.1% girls. The most often registered deviations of routine were absence of competent breakfast, having meal on request, and late dinner. The quality of pupils' nutrition differed by its incompetence and imbalance. Majority of children and adolescents (88.0% boys and 75.9% girls) have regular living on snacks and everyday drinking sparkling water (p<0.05). Only 61.9% boys and 71.0% girls have meat, milk and diary products, vegetables, and fruits in their everyday ration.
Analysis of the incidence of unfavorable anamnesis factors according to polling revealed several characteristic features dependent on the type of arterial hypertension, age, and gender.
In the age interval 12-14 years old time spent on computer and TV programs more than 3 hours per a day in the group of boys with SAH was observed reliably more often in comparison with the patients with normal AP (p<0.05). Among girls spending more than 3 hours per day on computer and TV programs was observed reliably more often in the group with LAH (p<0.05) in comparison with the children without AH. In the group of adolescents of 15-17 years old the incidence of spending more than 3 hours per a day on computer and TV programs did not significantly differ both among boys (p>0.05), and among girls (p>0.05) in all compared groups. Among the boys stereotypes of irrational nutrition were reliably more often among the children and adolescents in the group with normal AP (p<0.05) and SAH (p<0.05), while among the girls in the group with LAH (p<0.05).
Complicated heredity with not less than 3 pathologies was registered in case ofpresence of the 1st (siblings, parents) and 2nd (aunts, uncles, grandparents) relationship degree. Cardiovascular diseases, which were taken into account, were hypertonic disease, myocardial infarction, and angina appeared before 55 years old. Besides that, risk factors of AH included lipid exchange disorders in family history, renal pathologies, and obesity.
Complicated heredity was not immediate correcting risk factor, but its presence testified a greater degree of occurrence of AP increase in children and teenagers, and that provided formation of risk groups according to development of AH and prevention of AP increase via effecting correcting factors of environment.
Results of the analysis of heredity testified reliably greater burden among the examined children with SAH in comparison with LAH in hypertonic disease 57.0% versus 14.4%, p<0.01.
We did not reveal reliable differences in the burden of cardiovascular diseases between the groups with LAH and SAH (myocardial infarction, angina) and renal diseases (p>0.05).
Clinical efficacy of percutaneous coronary intervention in patients with coronary artery disease with low left...
Complicated heredity with disorders of lipid exchange was reli- Disorders of lipid exchange and obesity were more significant in
ably more significant in the group with SAH (82.5% versus 30.7%, the group with SAH compared with LAH (82.5%). p<0.01). Similar results in the group with SAH were obtained in Thus, the most significant risk factors of arterial hypertension in
relation to obesity (78.1%). children and adolescents were hypodynamics, irrational nutrition,
and complicated heredity.
References:
1. Bunina Y. Risk factors of the development of primary arterial hypertension in children and adolescents/Y. Bunina, N. Minilova, U. Rov-da//Doctor: Monthly scientific-practical journal. - 2010. - No 1. - P. 40-43 (in Russian).
2. Importance of risk factors of the development of arterial hypertension in children and adolescents/I. S. Kozlova//Collection of the materials of XVI Congress of pediatricians of Russia "Topical problems in pediatrics". - M., - 2009. - P. 188.
3. Markers of metabolic syndrome in teenagers with arterial hypertension/I. V. Plotnikova//Pediatrics. - 2007. - V. 86. - No 3. - P. 39-43.
4. Compulsory conditions for the prevention of cardiovascular and other non-infectious diseases in Russian Federation/R. G. Organov [et al]//Cardiovascular therapy and prophylaxis. - 2010. - No 6. - P. 4-9.
5. Correlation of anthropometric indices and cardiovascular disease risk factors: Caspian Study./R. Kelishadi [et al.] Int J Cardiol -2006. - 71 (4):437-442.
6. The metabolic syndrome in children and adolescents/P. Zimmet, G. Alberti, F. Kaufman [et al.]//Lancet. - 2007. - No 369 (9579). -P. 2059-2061.
DOI: http://dx.doi.org/10.20534/ESR-16-11.12-97-102
Fozilov G Hurshid, PhD the interventional cardiologist in the department of Endovascular surgery of the Republican Specialized Centre of Cardiology, Tashkent, Uzbekistan Abdullaev Timur A., MD, PhD, prof the Head of department of Heart failure of the Republican Specialized Centre of Cardiology, Tashkent, Uzbekistan.
Bekbulatova Regina Sh. PhD the Head of department Ultrasound Diagnostic of the Republican Specialized Centre of Cardiology, Tashkent, Uzbekistan.
Karimov Anvar M. the resident of Heart failure department of the Republican Specialized Centre of Cardiology, Tashkent, Uzbekistan.
Tsoy Igor A.,
the resident of Heart failure department of the Republican Specialized Centre of Cardiology,
Tashkent, Uzbekistan. E-mail: Hurshid.uzb.1976@rambler.ru
Clinical efficacy of percutaneous coronary intervention in patients with coronary artery disease with low left ventricular ejection fraction in the long term
Abstract
Aims: to study the clinical and hemodynamic efficacy of percutaneous coronary intervention in patients with coronary artery disease with a low left ventricular ejection fraction in the near and long-term follow-up.
Methods and results: In a prospective observation we studied analysis of the life and dynamics parameters of intracardiac hemodynamics in 65 (47.1%) patients with low left ventricular ejection fraction (less than 45%). In our study, the incidence of angiographic success with stent implantation in patients with coronary artery disease with a low left ventricular ejection fraction was 92.3% (60), the immediate success of the procedure was 85.7% (59), and the clinical success of in-hospital — 85.7% (59). The survival rate in the long term without the development of large cardiac complications was 83.1% (54). The incidence of MACE was 16.9% (11). The LVEF increasing was observed in 60% (39) patients, decreasing of the LVEF in 15.4% (10) patients and in 10.8% (7) patients it was not changed. In patients with a positive growth in LVEF after PCI in the long-term observation reversibility of LV remodeling processes were registered.
