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Selection of immunostimulatory drugs in the complex treatment of generalized periodontitis in young adults
detoxification process of internal and external metabolites produced by pathogenic microflora. Our investigations have shown that tolerance of test bacteria cells to the effects of metabolites EM-culture markedly decreases as the duration of the biological product.
During the experiment, it was observed that the degree of dilution of the EM has played a crucial role in the inhibition of pathogenic and conditionally pathogenic bacteria. The concentration of EM-culture 106cells/ml is more efficient and quick impact on the suppression of the growth and development of bacteria studied. From this, it follows that the optimal concentration ofEM-preparation, eliminates the growth and development of cells E.coli, L. monocytogenes and P. aeruginosa, is 106cells/ml.
The number of pathogenic and opportunistic bacteria varied markedly, indicating an antagonistic
relationship between the test bacteria and effective microorganisms. These relationships are manifested in interspecific competition, as well as the degree of resistance of pathogenic and opportunistic bacteria to the effects of metabolites produced by the representatives of EM-culture.
As the E.coli is a permanent inhabitant of the intestines of warm-blooded organism, the temperature 360C is the most appropriate for its life. Consequently, the temperature of 200C is optimal for the death of the test bacteria in the presence of EM-culture.
Studies have shown that effective microorganisms, belonging to the EM-culture, could potentially be used for cleaning marine ecosystems by limiting and preventing the development of pathogenic microflora, solving the problem of remediation of the environment.
References:
1. Teruo Higa. Use of Microorganisms in Agriculture & Their Positive Effects on Environmental Safety Nobunkyo, 1991.
2. Teruo Higa. Our Future Reborn: EM Technology Changes The World. Sunmark Publishing, 2006.
Sidelnikova Larisa Fedorovna, National Medical University named after Bogomolets, an assistant professor of restorative dentistry Dimitrova Alla Grigorevna, National Medical University named after Bogomolets, an assistant professor of restorative dentistry, E-mail: a_dimitrova@ukr.net
Selection of immunostimulatory drugs in the complex treatment of generalized periodontitis in young adults
Abstract: In the complex treatment of generalized periodontitis immunomodulators of different structure and mechanism of action “Imudon” and “Immunal” were used. The received clinical results showed that Imudon had a higher efficiency than Immunal.
Keywords: generalized periodontitis, the local factors of the oral cavity protection, Imudon, Immunal.
The high prevalence of periodontal disease in patients with immunodeficiency of different severity, especially in young patients, conditions the impact on the immune system (such as protection factors of the oral cavity), and today the importance of the
problem is only increasing [1, 102; 2, 100; 8, 89; 9, 73; 10].
The market of the drugs that have immunos-timulatory, immunomodulatory properties is wide enough. They are immunomodulators of plant, ani-
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Section 2. Biomedical science
mal, bacterial, and synthetic origins and vaccines (bacterial lysates) [4, 80; 5, 455; 6, 60]. Having studied the action mechanisms of major groups, we opted for 2 medications — a group of vaccines “Imudon” and a locally acting immunomodulators — phytopreparations “Immunal” [8, 89; 9, 73; 10].
“Imudon”, acting by means of immunological mechanisms, causes stimulation of both humoral immunity (increase oflysozyme and interferon in saliva, stimulation of formation of secretory IgA by activating the reaction of the blast transformation of B lymphocytes into plasma cells) and cell immunity (stimulation of phagocytosis by increasing the phagocytic activity of macrophages, natural killer cells, neutrophiles).
Immunal is a stimulant of nonspecific immunity. The juice of echinacea purpurea which Immunal contains has some surfactants of polysaccharide origin that stimulate bone marrow hematopoiesis.As a result, the number of granulocytes increases and as well as this intensifies the activity of phagocytic and cells of the reticuloendothelial system of the liver. The drug inhibits the growth and reproduction of microorganisms. Furthermore, Echinacea purpurea is discovered to have an antiviral action against influenza and herpes viruses.
Giving preference to these drugs, we considered not only their properties, but also the absence of clear contraindications to their prescription [1, 102; 2, 100; 3].
Objective: a comparative analysis of the use of drugs “Imudon” and “Immunal” in the complex treatment of generalized periodontitis.
Material and Methods
We observed 40 patients of the main group and 20 patients of the control group aged 18 to 21 years old with an initial-I degree generalized periodontitis. All patients received a comprehensive treatment scheme in accordance with the protocols of the Ukrainian Ministry of Healthcare [7]. In addition, in the main group 20 patients (I gr.) were prescribed to take Imudon (a drug company “Solvay Pharma”) as a immunomodulatory agent. The other 20 patients (II gr.) were given “Immunal” (by “Sandoz”). The patients in the control group took multivitamin supplement “Biovital.”
The study was carried out in accordance with the protocols of the Ministry of Healthcare of Ukraine [7], which included clinicoradiological and laboratory research methods. As clinical symptoms were evaluated the symptoms such as pain, edema, hyperaemia of the gingival margin, bleeding, discomfort. To register the condition ofperiodontal tissues indexes PMA (Parma, 1960) and PI were used. Hygienic condition of the oral cavity was evaluated by means of an index Grieve-Vermilion (ONI-S). The non-specific resistance of periodontal tissues was identified according to the adsorption reaction of microorganisms of epithelial cells of the oral cavity (PAM, 1982), leukocytes emigration reaction by M. Y. Yasinovkyi (1932). We also studied the cytological structure of the content of periodontal pockets. We found out the level of the secretory IgA in the mixed saliva and gingival fluid by means of G. Manchini’s method (1965).
Immudon was prescribed to take 6 sucking tablets per day for 20 days. Phytoconcentrate “Immunal” was prescribed to take 1 tablet 4 times a day for 20 days.
Results of the study
When using immunomodulatory drugs during the treatment of generalized periodontitis we saw the decrease in gum bleeding, feeling of discomfort, heaviness and pain in the gums after 1-2 visits. After 3-4 sessions in the first group all the observed patients reported that inflammation in periodontal tissues disappeared almost completely. The gum mucous membrane thickened, the edema and hyperemia of the papillas were missing.
The patients of the second group had the decrease in the intensity of inflammation in periodontal tissues after 4-5 sessions. In the third group the patients had a longer treatment time period, and achieving a similar clinical effect required a greater number of visits (up to 8 sessions).
The clinical results are confirmed by a positive dynamics of the condition indexes of periodontal tissues and oral cavity hygiene. Along with the intense anti-inflammatory effect the level of oral cavity protective factors increased.
The dynamics of the emigration of leukocytes into the oral cavity by M. Y. Yasinovkyi (Fig. 1) is particularly interesting.
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Selection of immunostimulatory drugs in the complex treatment of generalized periodontitis in young adults
Fig.1. The dynamics of the leukocytes emigration to the oral cavity during the treatment of generalized periodontitis with different immunomodulators.
Thus, the patients of the first group had the decrease in leucocytes emigration up to 171,1 ± 6,04 cells in 1 mm3 of lavage fluid (p <0.05), the patients of the second group — up to 182,2 ± 4,1 cells in 1 mm3 of lavage liquid (p <0.05). Simultaneously, the patients of these two groups tended to have an increase in the percentage of living neutrophiles, emigrating to the oral cavity which indicates a reduction in vascular penetrance, a decrease in an inflammation process, and the enhance of the periodontal defence powers.
It is also confirmed by the cytology study data. Thus, the patients of all groups had the increased number of unchanged neutrophilic granulocytes, reduction oftheir destroyed shapes and the increased number of phagocytes and lymphocytes.
So the first group of the patients had an increase in the number of neutrophiles by 1.9 times after the treatment, the second group — by 1.8 times and the third — by 1.5 times.
There was a true decrease in the destroyed granulocytes specific gravity: in the first group — by 23%, in the second by 21.5%, in the third — by 16%. At the same time during the treatment the number of full phagocytes was growing: in the first group — by 3.5 times, in the second — by 3.2 times and in the third one — by 2.5 times.
The patients treated with immunomodulatory drugs, clearly showed a tendency to an increase in the number of young epithelial cells.
The comparative analysis of cytological structure of periodontal pockets indicates the positive effect of immunostimulatory drugs «Immunal» and «Imudon» on the dynamics of clinical and laboratory findings, as well as indicators of the local nonspecific protection.
Consequently, the course of treatment, including the use of immunostimulatory drugs does not only reduce the inflammatory picture but it also stimulates the local defensive powers ofperiodontitis. Notably the first group of the patients receiving «Imudon» showed a 15-20% better growth rates of local defence and regeneration of periodontal tissue than the patients of the second group.
The conducted course of treatment with immunomodulators contributed to the increase in the secretory IgA in mixed saliva and gingival fluid (Fig. 2). And the dynamics of this indicator was truly different in the patients of all groups. Thus, the first group of patients had the mean value of the content of sIgA which was close to that of the patients with untreated periodontitis. The patients of the second group also showed the true increase in this indicator by 1.5 times (p <0.05). The third group of patients had an increase by only 0.8 times. After 3 months of the treatment a more stable result was obtained by the patients of the first group. The given data confirm that the therapeutic effect of using the drug «Imudon» is implemented not only by means of the influence of treatment on the disease clinical manifestations, but also by normalizing the factors ofthe immune defence.
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Section 2. Biomedical science
Before treatment After treatment After 3 months of treatment
■ 1 group ■ 2 group ИЗ group
Fig.2. The dynamics of changes of the level of sIgA gingival fluid in all groups of patients, g/l
After 6 months the clinical and laboratory stabilization, as an indicator of resistance remission made up 98.7% in the first group ofpatients,98.1% — in the second group and in the control group — 65.1%, p <0,05.
Conclusion
The use of immunomodulators of both a vegetable origin, and a group of vaccines in the complex treatment of generalized periodontitis helps the intense regression of the inflammation symptoms, the thickening of the vessel wall and the stimulation of the local defense mechanisms of the oral cavity. Some indicators dynamics of nonspecific
resistance of periodontal tissues suggests a higher efficacy of «Imudon.» In the long-term observation (after 3-6 months) stable results were obtained by the patients who received Imudon in the complex treatment. In this group of patients a long-term clinicoradiological stabilization process was noticed, as well as the absence ofthe disease recurrence. In the second group, 25% of the observed patients had the exacerbation of chronic catarrhal gingivitis.
In conclusion, we recommend using Imudon in the complex treatment of generalized periodontitis as a drug that stimulates the non-specific immune response, especially for younger patients.
References:
1. Димитрова А. Г. Обоснование ранней диагностики заболеваний пародонта у лиц молодого возраста 18-25 лет/А. Г. Димитрова//Материалы научной конференции «Акуальные вопросы и перспективы развития стоматологии». Збiрник наукових праць. - Полтава, 2014. - C. 102-104.
2. Одельшкова Л. Ф. Рання дш'ностика захворювань пародонта у молодi - основа профАактики та превентивного л!кування генерал!зованого пародонтиту/Л. Ф. Одельшкова, М. Ю. Антоненко, Г. Г. Д^трова (Ткаченко)//Науковий вюник Нацюнального медичного ушверситету iменi О. О. Богомольця. - 2010. - № 4 (з1). - C. 99-102.
3. СпоФб оцшки ступеня тяжкост ураження тканин пародонту: патент на комплексну модель № 9334/А. В. Борисенко, Л. Ф. Одельшкова, М. Ю. Антоненко, А. Г. Ткаченко//Промислова власшсть. - 2005. - № 9. - C. 5. 121.
4. Carranza F. A. Clinical periodontology/F. A. Carranza//Philadelphia: W. B. Sainders Co, 2010. - P.80-89.
5. Борисенко А. В. Заболевания пародонта/А. В. Борисенко//Киев: ВСИ «Медицина». - 2013. - C. 455.
6. Сидельникова Л. Ф. Стабилизирующий эффект имудона в комплексном лечении заболеваний пародонта и слизистой оболочки полости рта/Л. Ф. Сидельникова, И. Г. Дикова, Б. А. Ревенок, С. М. Захарова//Современная стоматология. - 2004. - № 2. - C. 60.
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Sensitivity of different pathogens to biological antimicrobial agents
7. Протоколи надання медично!' допомоги. Стоматологiя. МОЗ Украши. - Кшв, МВЦ «Медшформ», 2005. C. 95-101.
8. Preus H. R. Periodontal Disease/H. R. Preus. L. Lavrell//London: Anintessence, 2003. - 89 p.
9. Donly K. J. Juvenile periodontitis: a review of pathogenesis, diagnosis and treatment/K. J. Donly, М. Ashkenazi//J. Clin. Pediatr. Dent. - 1992; 16: 73-8.
10. www.rae.ru/fs
Israyelyan Arevik, “Artsakh Scientific Center " SNPO, Stepanakert, Nagorno Karabakh Republic Karapetyan Kristina, Scientific and Production Center "Armbiotechnology" NAS, Yerevan, Republic of Armenia Tkhruni Flora,
Scientific and Production Center "Armbiotechnology" NAS, Yerevan, Republic of Armenia Arstamyan Lilya, ‘Artsakh Scientific Center" SNPO, Stepanakert, Nagorno Karabakh Republic Balabekyan Tsovinar, Scientific and Production Center “Armbiotechnology" NAS,
Yerevan, Republic of Armenia E-mail: kristinakarapetyan@mail.ru
Sensitivity of different pathogens to biological antimicrobial agents
Abstract: In recent years methicillin-resistant Staphylococcus aureus (MRSA) and Proteus mirabilis are significant public health problem worldwide. The diversity of multidrug-resistance (MDR) of pathogenic strains to antibiotics, most widely used for treatment of human diseases in the Republic of Armenia and Nagorno Karabakh Republic were examined and it was shown, that difference of resistance of pathogens to antibiotics depends on their isolation sources. It was shown, that bacte-riocin containing partially purified metabiotics, obtained from Lactobacillus rhamnosus BTK 2012, Lactobacillus acidophilus 1991, Streptococcus sp.K13 and Lactococcus sp. M44 strains inhibited the growth of multidrug-resistant bacteria with different efficiency and it depending from properties of bacteriocins.
Keywords: multidrug resistance, pathogens, bacteriocins, endemic lactic acid bacteria
Introduction
Selective pressure exerted by the use of antimicrobials in both human and animal populations over the past several decades has led to the emergence of multidrug-resistant (MDR) bacterial populations that are resistant to many
commercially available drugs. This is an increasing threat to both human and animal health [1, 397411]. In the WHO European Region, the resistance of some pathogens now reaches over 50% in some countries, and new resistant mechanism are emerging and spreading rapidly caused by highly
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