Maladaptation Syndrome Research Articles

MICROELEMENTS AND THEIR PHYSIOLOGICAL SIGNIFICANCE FOR THE BODY OF CHILDREN AND ADOLESCENTS

Abstract: This review article discusses the role of micro and macro elements in pediatrics. A thorough study of the biological role of MEs, carried out in recent years, has made it possible to accumulate factual material reflecting their influence on various physiological functions of the body and, in particular, on the metabolism of a growing organism. About 20 chemical elements take part in the formation and development of various body tissues and their physiological reactions. MEs take an active part in various types of metabolism of proteins, fats, and carbohydrates; influence the course of redox processes, the synthesis of hormones, the functions of the internal secretion organs and the nervous system. The effects of ME, which are part of physiologically active compounds, manifest themselves mainly in their influence on metabolic processes and their too high or too low content is fraught with far-reaching consequences. Knowledge of the physiological level of vitally important, irreplaceable MEs in the body of newborns, the parameters of their balance and significance in the processes of adaptation to extrauterine living conditions will contribute to the development of measures to prevent the implementation of maladaptive syndromes and those diseases in the genesis of which the main role is played by a lack or excess of MEs in the body, their imbalance.

Assessment of the Biochemical Status of Women in Labor with Preeclampsia

This review presents the results of scientific work on the study of the immuno-biochemical status of women in labor with preeclampsia. Indicators of developing problems in the body of a pregnant woman are changes in the biochemical composition of the blood, which make it possible to predict maladaptation syndrome in newborns.

State of health of medical students

This article discusses the state of health of young students studying Pharmacy, Industrial Pharmacy at the Volyn Medical University. The purpose of the article is to determine the state of health of students of higher education in the medical profession. The results of the analysis of students' medical records allow us to state the presence of problems in their state of health. Each student of higher education during the academic year, on average, was ill 2–3 times and missed 10–15 days of study at the institute (depending on age and gender).
 Most often, students are sick with viral respiratory diseases (43-51 cases per 100 examined), diseases of the digestive organs (10-18 cases), vision (3-15 cases) and excretory system (5-12 cases), injuries (10-20 cases ) and infectious diseases (7– 14 cases).
 One of the integral criteria of adaptation is the assessment of the state of health on the basis of morbidity indicators, the level of which allows to most objectively reflect the degree of health loss, as well as to determine the priorities of prevention. Given the fact that the environmental factor has priority in the development of diseases in young people (up to 30%), the dominance of the specified pathologies may indicate the formation of an environmental maladaptation syndrome. Along with that, today the range of factors of the internal student environment has significantly expanded, which determine up to 12.5% of cases of illness in junior courses.
 According to the results of our research, the largest group in the structure of students' diseases is acute respiratory viral diseases. Influenza among students of higher education, of various ages, is registered in one-third to one-half of cases.
 In connection with the deterioration of students' health, it is necessary to introduce special, health-improving classes into the educational process, which would allow providing individual assistance to students in the prevention of diseases and health preservation.

Psychological state of patients during adaptation to removable dentures and methods of optimization

BACKGROUND: Optimized use of removable dental prosthesis and enhancement of the adaptation period to such orthopedic substituting dental constructions in the oral cavity are the actual aims of practical stomatology.
 AIM: This study aimed to estimate the psychological state of patients in the process of adaptation to removable dental prostheses and to assess the influence of dental prosthesis fixation on the optimization of adaptation for them.
 MATERIALS AND METHODS: In the case of psychosensoryanatomicalfunctional maladaptation syndrome, the psychological states of 35 people with partial and 38 with complete tooth loss before and during the adaptation period of their dental rehabilitation for removable acrylic dentures were assessed. The study groups were divided into two subgroups, depending on the method used to improve the fixation of dentures.
 RESULTS: During the initial examination, all study patients with partial or complete tooth loss had impaired adaptability to these conditions, mainly due to anatomical and functional disorders of the masticatory apparatus. During the adaptation period, an improvement in the psychological status of the patients was noted, especially in those who used the cream for fixation of dentures for domestic production.
 CONCLUSION: During their adaptation to the removable partial and full dentures, patients are recommended to use the prescribed cream to improve their fixation and thereby allow the reduction of painful symptoms from the prosthetic bed tissues and significantly improve the psychological status of the patients during the adaptation period.

EPR spectroscopic evidence of iron-catalysed free radical formation in chronic mountain sickness: Dietary causes and vascular consequences

Chronic mountain sickness (CMS) is a high-altitude (HA) maladaptation syndrome characterised by elevated systemic oxidative-nitrosative stress (OXNOS) due to a free radical-mediated reduction in vascular nitric oxide (NO) bioavailability. To better define underlying mechanisms and vascular consequences, this study compared healthy male lowlanders (80 m, n = 10) against age/sex-matched highlanders born and bred in La Paz, Bolivia (3600 m) with (CMS+, n = 10) and without (CMS-, n = 10) CMS. Cephalic venous blood was assayed using electron paramagnetic resonance spectroscopy and reductive ozone-based chemiluminescence. Nutritional intake was assessed via dietary recall. Systemic vascular function and structure were assessed via flow-mediated dilatation, aortic pulse wave velocity and carotid intima-media thickness using duplex ultrasound and applanation tonometry. Basal systemic OXNOS was permanently elevated in highlanders (P = <0.001 vs. lowlanders) and further exaggerated in CMS+, reflected by increased hydroxyl radical spin adduct formation (P = <0.001 vs. CMS-) subsequent to liberation of free ‘catalytic’ iron consistent with a Fenton and/or nucleophilic addition mechanism(s). This was accompanied by elevated global protein carbonylation (P = 0.046 vs. CMS-) and corresponding reduction in plasma nitrite (P = <0.001 vs. lowlanders). Dietary intake of vitamins C and E, carotene, magnesium and retinol were lower in highlanders and especially deficient in CMS + due to reduced consumption of fruit and vegetables (P = <0.001 to 0.028 vs. lowlanders/CMS-). Systemic vascular function and structure were also impaired in highlanders (P = <0.001 to 0.040 vs. lowlanders) with more marked dysfunction observed in CMS+ (P = 0.035 to 0.043 vs. CMS-) in direct proportion to systemic OXNOS (r = −0.692 to 0.595, P = <0.001 to 0.045). Collectively, these findings suggest that lifelong exposure to iron-catalysed systemic OXNOS, compounded by a dietary deficiency of antioxidant micronutrients, likely contributes to the systemic vascular complications and increased morbidity/mortality in CMS+. Trial registryClinicalTrials.gov; No: NCT01182792; URL: www.clinicaltrials.gov.

High-Altitude Erythrocytosis: Mechanisms of Adaptive and Maladaptive Responses.

Erythrocytosis, or increased production of red blood cells, is one of the most well-documented physiological traits that varies within and among in high-altitude populations. Although a modest increase in blood O2-carrying capacity may be beneficial for life in highland environments, erythrocytosis can also become excessive and lead to maladaptive syndromes such as chronic mountain sickness (CMS).

Improvement of physical qualities of servicemants, who received concusion of the brain

Ensuring a high level of combat capability of servicemen is a necessary and sufficient condition for their successful fulfillment of the task of defending our state. The activity of a serviceman is characterized by increased physical and mental stress, the impact on the psyche of various stressors, performing tasks in special conditions associated with risk to life and health [1, 2, 3]. However, extreme stress, eating disorders and rest, as well as other harmful factors of work, no doubt, reduce the body’s adaptive reserves and lead to the development of maladaptation syndrome, psycho-emotional status and disability [4].The participation of the Armed Forces of Ukraine in hostilities in the east of the country has led to a significant increase in the number of servicemen with combat injuries, mutilations or injuries. According to experts, almost all participants in hostilities have health problems, in particular 2–3 times higher probability of diseases such as hypertension, gastritis, osteochondrosis, spinal hernia [5; 6]. One of the most common combat injuries is contusion, its prevalence among the total number of injuries is 70 [7; 8; 9; 10]. Changes in mental and physical states are observed in servicemen with contusions [5; 11; 12]. This contingent of servicemen is important for the Ukrainian army, as their combat experience is important as a basis for the development and improvement of military training. But their health can be an obstacle to the successful performance of their duties.Therefore, the purpose of our study is to substantiate, develop and evaluate the effectiveness of a comprehensive program of ergogenic orientation for servicemen after contusion to increase their combat capability. To achieve this goal, the following tasks are defined:- analysis and generalization of modern scientific and methodological approaches to the recovery and rehabilitation of servicemen who had combat injuries;- analysis of the peculiarities of the way of life and the state of special physical qualities of servicemen who had contusions as factors that ensure combat readiness;- substantiation and development from the theoretical and methodological standpoint of measures to optimize the lifestyle and physical training program for servicemen who have suffered a concussion.Material: The article analyzes and summarizes modern scientific and methodological approaches to the recovery and rehabilitation of servicemen who have suffered injuries, substantiates measures to optimize lifestyles and physical training programs for servicemen who have suffered a concussion.Results: Our previous studies have found that the dosed use of exercise balances the processes of excitation and inhibition in the central nervous system, enhances its regulatory role in coordinating the activities of important organs and systems involved in the pathological process

Comparative analysis of the health status of middle-school age when studying in different educational programs

Summary. Research shows negative trends in health of schoolchildren: increasing morphofunctional disorders, mental and behavioral disorders, acute and chronic somatic morbidity, maladaptation syndrome, as well as negative health dynamics and the highest morbidity among middle school students. The aim of the study was to determine the state of health of students during basic school stage, under the conditions of using traditional and meritocratic education systems. Materials and Methods. The study involved 266 students of general secondary education institutions aged 10-14 years. Results. Analysis of the level of pathological lesions in different educational programs established the highest level for diseases of the endocrine system with an increase in pathology in the dynamics of learning by 220.8 ‰ in traditional education and 172.8 ‰ in meritocratic education. Pathology of the eye and adnexa was more common among students throughout the meritocratic program with its significant increase in both education systems, while the number of digestive diseases increased more significantly in traditional education (p &lt;0.01). The decrease in pathological lesions occurred only in diseases of the respiratory system with meritocratic education. There was a significant increase in the percentage of the second group of health (from 62.3 ± 5.5% to 77.9 ± 4.7%) in education on the meritocratic system, and insignificant increase in traditional education due to reduced proportion of healthy children. Under the conditions of the traditional education system, the number of cases of acute diseases was higher (p &lt;0.05-0.01) and a significant increase in their total duration was determined at the end of the 5th and 6th grades (p &lt;0.05). At the same time, all indicators of acute morbidity decreased during years of study 7 to 9, regardless of gender, educational program and type of general secondary education institution. Conclusions. Studying under the conditions of the meritocratic system was accompanied by a more intensive increase in the prevalence of diseases of the eye and adnexa, but a decrease in pathological lesions of the respiratory system. During the implementation of the traditional educational program, a more significant increase in the prevalence of digestive diseases was registered, as well as the number of cases and the total duration of acute diseases at the end of the 1st and 2nd year of basic school. Comparative analysis of morbidity indicators revealed a significant impact of intensification of the educational process on the progression of ophthalmic pathology, chronic diseases, against the enduring general trend as to the dynamics of acute morbidity and the overall structure of pathological lesions.

PSYCHO-VEGETATIVE "CHAOS" AS AN IMBALANCE OF HOMEOSTATIC SYSTEMS IN STUDENTS: METHODS OF ITS EARLY DIAGNOSIS

The aim of the work was to study the psycho-vegetative state of students using standardized questionnaires. Materials and methods of research. The study involved students of 18–20 y/o, I–II course of the medical university. According to the results of screening of 448 students, we used a standardized questionnaire by OM Vein. There were 82 people with signs of autonomic dysfunction, which comprised the main study group. To assess the state of autonomic balance, we used cardiointervalography; to verify the hyperventilation syndrome, we used the Nijmegen questionnaire; to assess the psycho-emotional state and anxiety, we used the State-Trait Anxiety Inventory. Results of the research. Among 82 students with signs of autonomic dysfunction, the average score by the Vein scale was 36.12 ± 4.26 points (p ˂ 0.001) vs. 15 points denoting the norm. Subjective symptoms identified by the Vein scale closely correlated with the results of the Nijmegen questionnaire. A positive indicator of the latter – 36.24 ± 1.26 points – was observed in 71.95 % of people, which indicated the presence of hyperventilation syndrome in this group of students. The rest of the students in the main group had a negative result (less than 23 points), although according to the Vein scale, they had signs of autonomic dysfunction, which could indicate a certain premorbid condition. According to the State-Trait Anxiety Inventory, among the 82 people surveyed, students with signs of personal anxiety scored the most points, which were accompanied by emotional "explosions" (56.1 %), neurotic conflicts (35.37 %), feelings of insecurity (46.34 %) and anxiety (37.8 %), etc. We found an association between signs of anxiety and hyperventilation syndrome (r = 0.76). According to the results of the assessment, against the background of anxiety and neurotic symptoms and manifestations of hyperventilation syndrome, the results of the survey revealed signs of somatoform autonomic dysfunction in a significant proportion of students (71.95 %) of the main group, including complaints of respiratory, circulatory and gastrointestinal nature. The lack of isolated psychological markers specific to each psychosomatic disorder should also be noted. Thus, the identified signs of autonomic imbalance by the Vein questionnaire were significantly correlated with the manifestations of hyperventilation syndrome, increased anxiety, somatoform abnormalities, which is the evidence of statistical significance and informativeness of the results of the surveys. Conclusions. Screening surveys among students using standardized questionnaires, analysis of heart rate variability allows identifying a risk group with manifestations of psycho-vegetative dysfunction, maladaptation syndrome and recommending the use of certain health measures to improve quality of life, professional activity.

The structure of morbidity of secondary school children

Intensification of the educational process is one of the risk factors for increasing the prevalence of morphofunctional disorders, acute and chronic somatic morbidity, mental and behavioral disorders, maladaptation syndrome. Many researchers have found a negative chronological dynamics of school health and a high incidence among secondary school students. The purpose of the study is a comparative analysis of the structure and dynamics of morbidity of children during secondary school. The study involved more than 266 students of secondary schools aged 10 to 14 years. The state of health was assessed according to preventive medical examinations conducted by specialists of the Institute of Child and Adolescent Health of the National Academy of Medical Sciences of Ukraine with the informed consent of parents and according to the bioethical norms of the Helsinki Declaration (as amended in 2013). Statistical data processing was performed using the licensed package SPSS Statistic v.20 using Student’s t test. The highest level of morbidity was found in diseases of the endocrine system (468.4±39.7‰), the organ of vision and the appendix (322.8±37.2‰), the circulatory system (310.1±36.8‰) and respiration (303.8±36.6‰). Among girls, endocrine (520.7±57.7‰) and ophthalmological pathology (386.7±56.2‰) were more often registered, and among boys – mental and behavioral disorders (168.7±39.9‰; p&lt;0.05). During the training, negative dynamics was determined for diseases of the endocrine system (due to a probable increase in their number among boys, at p&lt;0.05), diseases of the digestive system, eye and appendages due to decreased visual acuity (p&lt;0.01). In the structure of endocrine pathology, 60% were thyroid diseases in both sexes, and the prevalence of grade 1 obesity was higher among boys (p&lt;0.05). Mental and behavioral disorders were mainly represented by disorders of activity and attention in adolescent boys, sleep disorders – in girls; hyperkinetic behavioral disorders – in both sex groups. Gender features in the structure and dynamics of morbidity of secondary school students to a greater extent in diseases of the endocrine system, eye and appendix with a general negative tendency to increase the prevalence of these groups of diseases.

Зв'язок даних спортивного анамнезу професійних легкоатлетів зі стійкою прегіпертензією в підготовчому періоді річного макроциклу

Prehypertension is considered a significant risk factor for the development of arterial hypertension. A syndrome of overtraining and associated dysfunctional disorders of the autonomic nervous system may be the cause of an increase of blood pressure. However, clear criteria for the diagnosis of this syndrome have not yet been established, and the study of the meaning of symptoms, including anamnestic ones, continues. The purpose of the study was to establish a connection between the anamnesis data of professional athletes with sustained prehypertension during the preparatory period of the training macrocycle. Material and methods. We examined 30 professional athletes, who were distributed into two groups which were representative by age and sex, depending on their blood pressure values. All subjects underwent blood pressure monitoring, anthropometric and physical examinations, inquiries regarding complaints, training activity and sports history. Results and discussion. The study showed that athletes with high normal blood pressure indicated higher exercise intensity, a predominance of anaerobic activity during their training, an increase in the intensity of exercise in the last three months; sleep disturbances and a decrease in exercise tolerance was significantly more frequent in this group. The last two factors have the most significant impact on the relative risk of blood pressure increase. A sustained high normal blood pressure in professional athletes during the preparatory period of the training macrocycle is associated with the development of signs of fatigue and overtraining, which we noted in our study. The latter determines both the need for more in-depth examination, monitoring of such patients and the importance of the further scientific study of the problem. We also noted significant differences in the characteristics of training activity: athletes with prehypertension had a higher level of physical activity in training, which was 8.33 ± 0.71 points on the scale of training intensity RPE (against 7.0 ± 1.26 points in the group persons with optimal blood pressure, p = 0.006), they also had the highest percentage of anaerobic work (p = 0.004). Conclusion. Timely detection of maladaptation syndrome in professional athletes in the preparatory period can be useful as support for feedback from the athlete, and monitoring blood pressure during the week in a comfortable environment for the athlete. There is a need for further research to determine the prognostic value of symptoms of overtraining in terms of increased blood pressure, as well as the likely dependence of these changes on the quantitative and qualitative characteristics of physical activity

Complex treatment of periodontitis: patient’s reaction to the therapy

Relevance. The success of treatment of periodontal diseases directly depends on the patient’s response to the therapy, therefore, the characteristics of the person’s personal characteristics can affect both the effectiveness of treatment and the prevention of relapse of the disease.Purpose. To study the features of the internal picture of the disease in the process of complex treatment of adult patients suffering from chronic generalized periodontitis.Materials and methods. The generally accepted comprehensive treatment of chronic generalized periodontitis in 69 middle-aged and elderly men was carried out taking into account the personal response of patients Solovyov «Psychosensory-anatomical-functional maladaptation syndrome».Results. When patients were discharged from the hospital, there was a difference in the phenomena of maladaptation among the elderly and middle-aged: in middle-aged people, sufficient adaptation to the conditions of existence was determined; in elderly people, due to the existing comorbid pathology, a state of maladaptation was diagnosed, which was caused by the presence of complaints of defects in the dentition.Conclusion. In elderly people, as soon as possible after completion of treatment in a hospital, dental rehabilitation cannot be considered completed, which requires the adoption of organizational measures for their timely provision of dentures.

Global REACH 2018: Andean highlanders, chronic mountain sickness and the integrative regulation of resting blood pressure.

What is the central question of this study? Does chronic mountain sickness (CMS) alter sympathetic neural control and arterial baroreflex regulation of blood pressure in Andean (Quechua) highlanders? What is the main finding and its importance? Compared to healthy Andean highlanders, basal sympathetic vasomotor outflow is lower, baroreflex control of muscle sympathetic nerve activity is similar, supine heart rate is lower and cardiovagal baroreflex gain is greater in mild CMS. Taken together, these findings reflect flexibility in integrative regulation of blood pressure that may be important when blood viscosity and blood volume are elevated in CMS. The high-altitude maladaptation syndrome chronic mountain sickness (CMS) is characterized by excessive erythrocytosis and frequently accompanied by accentuated arterial hypoxaemia. Whether altered autonomic cardiovascular regulation is apparent in CMS is unclear. Therefore, during the 2018 Global REACH expedition to Cerro de Pasco, Peru (4383 m), we assessed integrative control of blood pressure (BP) and determined basal sympathetic vasomotor outflow and arterial baroreflex function in eight Andean natives with CMS ([Hb] 22.6±0.9g·dL-1 ) and seven healthy highlanders ([Hb] 19.3±0.8g·dL-1 ). R-R interval (RRI, electrocardiogram), beat-by-beat BP (photoplethysmography) and muscle sympathetic nerve activity (MSNA; microneurography) were recorded at rest and during pharmacologically induced changes in BP (modified Oxford test). Although [Hb] and blood viscosity (7.8±0.7vs. 6.6±0.7cP; d=1.7, P=0.01) were elevated in CMS compared to healthy highlanders, cardiac output, total peripheral resistance and mean BP were similar between groups. The vascular sympathetic baroreflex MSNA set-point (i.e. MSNA burst incidence) and reflex gain (i.e. responsiveness) were also similar between groups (MSNA set-point, d=0.75, P=0.16; gain, d=0.2, P=0.69). In contrast, in CMS the cardiovagal baroreflex operated around a longer RRI (960±159vs. 817±50ms; d=1.4, P=0.04) with a greater reflex gain (17.2±6.8vs. 8.8±2.6ms·mmHg-1 ; d=1.8, P=0.01) versus healthy highlanders. Basal sympathetic vasomotor activity was also lower compared to healthy highlanders (33±11vs. 45±13bursts·min-1 ; d=1.0, P=0.08). In conclusion, our findings indicate adaptive differences in basal sympathetic vasomotor activity and heart rate compensate for the haemodynamic consequences of excessive erythrocyte volume and contribute to integrative blood pressure regulation in Andean highlanders with mild CMS.

Evaluation of the effectiveness and satisfaction of patients in the treatment of pain dysfunction of the temporomandibular joint, taking into account the peculiarities of the personality and compliance

The work is devoted to the actual problem of dentistry — the treatment of pain dysfunction of the temporomandibular joint (TMJ), the occurrence of which among the adult population is increasing in Russia and abroad. The purpose of the study was to assess the effectiveness and satisfaction of patients with the treatment of pain dysfunction of the TMJ, taking into account the characteristics of the typological orientation of higher nervous activity and compliance. Using semi-quantitative methods, methods of assessing personal response to the disease, known as "Psychosensory-anatomical-functional maladaptation syndrome" (SPSAF), patient satisfaction and compliance, the effectiveness of treatment of TMJ pain dysfunction in 57 men aged 25 to 42 years, with taking into account their temperament. In group 1 (sanguine persons) included 19 people; in 2 (choleric) — 15 people; 3 (phlegmatic) — 11 people; in 4 (melancholic) — 12 people. It was established that before treatment, patients with pain dysfunction of the TMJ had a state of disadaptation. After the patients underwent a complex of dental treatment and preventive measures recommended by dentists, there was a positive trend in the personal response to the disease and, in conclusion of the dynamic observation of the patients, they were adapted to the conditions of existence. A positive change in the internal picture of the disease affected the patient satisfaction with treatment. Patients of groups 1 and 3 were generally satisfied with the results of treatment, which corresponded to the data obtained in evaluating the effectiveness of the treatment and preventive measures taken (40.91% and 64.1%, respectively). Patients of groups 2 and 4 of the study, despite the high clinical efficacy of treating TMJ pain dysfunction (32.18% and 19.7%, respectively), were less satisfied with the results of treatment due to the typological features of their higher nervous activity that play not the last role in ensuring compliance. The most committed to the implementation of medical recommendations were patients of 3 groups who performed them regularly and in full. Patients of groups 1, 2 and 4 carried out the recommendations of the dentist partially, from 25% to 50%. Despite the knowledge of medical recommendations, the possibility of negative consequences for non-compliance, most patients did not have adequate commitment to perform medical prescriptions, did not voluntarily fully follow the prescribed treatment regimen and behavior. Taking into account the findings, it was suggested to pay more attention to the somatopsychic approach in diagnosing and treating various diseases, including organs and tissues of the masticatory apparatus, taking into account the personal response to the disease, typological orientation of higher nervous activity and other factors that take into account the individual characteristics of the patient.

Exaggerated systemic oxidative-inflammatory-nitrosative stress in chronic mountain sickness is associated with cognitive decline and depression.

Chronic mountain sickness (CMS) is a maladaptation syndrome encountered at high altitude (HA) characterised by severe hypoxaemia that carries a higher risk of stroke and migraine and is associated with increased morbidity and mortality. We examined if exaggerated oxidative-inflammatory-nitrosative stress (OXINOS) and corresponding decrease in vascular nitric oxide bioavailability in patients with CMS (CMS+) is associated with impaired cerebrovascular function and adverse neurological outcome. Systemic OXINOS was markedly elevated in CMS+ compared to healthy HA (CMS-) and low-altitude controls. OXINOS was associated with blunted cerebral perfusion and vasoreactivity to hypercapnia, impaired cognition and, in CMS+, symptoms of depression. These findings are the first to suggest that a physiological continuum exists for hypoxaemia-induced systemic OXINOS in HA dwellers that when excessive is associated with accelerated cognitive decline and depression, helping identify those in need of more specialist neurological assessment and targeted support. Chronic mountain sickness (CMS) is a maladaptation syndrome encountered at high altitude (HA) characterised by severe hypoxaemia that carries a higher risk of stroke and migraine and is associated with increased morbidity and mortality. The present cross-sectional study examined to what extent exaggerated systemic oxidative-inflammatory-nitrosative stress (OXINOS), defined by an increase in free radical formation and corresponding decrease in vascular nitric oxide (NO) bioavailability, is associated with impaired cerebrovascular function, accelerated cognitive decline and depression in CMS. Venous blood was obtained from healthy male lowlanders (80m, n= 17), and age- and gender-matched HA dwellers born and bred in La Paz, Bolivia (3600m) with (CMS+, n= 23) and without (CMS-, n= 14) CMS. We sampled blood for oxidative (electron paramagnetic resonance spectroscopy, HPLC), nitrosative (ozone-based chemiluminescence) and inflammatory (fluorescence) biomarkers. We employed transcranial Doppler ultrasound to measure cerebral blood flow (CBF) and reactivity. We utilised psychometric tests and validated questionnaires to assess cognition and depression. Highlanders exhibited elevated systemic OXINOS (P< 0.05vs. lowlanders) that was especially exaggerated in the more hypoxaemic CMS+ patients (P< 0.05 vs. CMS-). OXINOS was associated with blunted cerebral perfusion and vasoreactivity to hypercapnia, impaired cognition and, in CMS+, symptoms of depression. Collectively, these findings are the first to suggest that a physiological continuum exists for hypoxaemia-induced OXINOS in HA dwellers that when excessive is associated with accelerated cognitive decline and depression, helping identify those in need of specialist neurological assessment and support.

Clinical characteristics of women with infertility and ovaricovaricocele

Despite numerous studies devoted to the etiological factors and pathogenetic aspects of infertility, the lack of a comprehensive analysis of the causes of ovarian dysfunction and the exact diagnosis leads to the polypharmacy of hormonal drugs and their low effectiveness. One of the less well known and poorly studied factors is pelvic venous complications, including varicose veins of the ovaries. Violation of venous circulation in the pelvic organs plays a significant role in the structure of gynecological pathology, particularly in the development of ovarian dysfunction. The purpose of our study was to analyze the clinical characteristics of women with functional infertility and ovaricovaricocele, namely the features of anamnesis of life, gynecological and somatic anamnesis, the study of which allows to assess and determine the risk factors, possible causes of ovarian dysfunction and the formation of varicose veins. To solve the goals and objectives, were prospectively examined and divided into 2 groups for the comparative analysis 117 pregnant women of reproductive age (21–44 years old) with functional infertility: the main group was 62 women with infertility and varicose veins in the ovaries; comparison group has 55 women with infertility without varicose veins. Patients were examined by a specially designed questionnaire, which included the results of gynecological and somatic anamnesis, anamnesis of life. In the main group of women there is an increased proportion of women with intellectual differentiation of labor and psycho-emotional and physical activity, which may be the basis for the formation of maladaptation syndrome with the subsequent occurrence of functional disorders of the reproductive system. In addition, conditions of work with considerable physical activity can indirectly have a negative effect on venous hemodynamics in the small pelvis. Women with functional infertility and ovaricovaricocele had a high incidence of infectious diseases in childhood — 83.9%. It is precisely at the stage of formation of reproductive function that the action of an infectious factor can be significant in the occurrence of violations of complete oogenesis in the subsequent reproductive life of patients. Attention is drawn to the large number of inflammatory diseases of the internal organs in women as the main group and the comparison group in the study of the somatic anamnesis: from the otolaryngologic organs — 48.3%, respiratory organs – 54.7%, genitourinary system — 43.5% and in the structure of gynecological diseases: inflammation of ovaries — 43.5%, vagina and cervix — 25.8%, suggesting that factors of violations of folliculogenesis in active reproductive age may be inflammatory diseases of the genitals. There is a significant percentage of dyshormonal abnormalities in the form of abnormal uterine bleeding in the structure of gynecological pathology in women with functional infertility and ovaricovaricocele (30.6%) against patients with infertility without structural changes in ovarian veins. Patients with infertility are more likely to point out dysgharmony of sexual life (58.1%), which in patients with varicose veins in the pelvic organs was accompanied by dyspareunia (32.2%), suggesting the role of chronic stress as a risk factor for ovarian dysfunction, which is also exacerbated by the presence pain of syndrome in the lower abdomen in women of the main group (77,4%). The more significant percentage of gynecological pathology of endocrine genesis in women with functional infertility and ovaricovaricocele and the presence of certain extragenital pathology, which affects the formation of pelvic pelvic flooring in comparison with patients with infertility without structural changes in ovarian veins, is established during the analysis of the clinical characteristics of the significant percentage of venous hemodynamics in the functional properties of the ovary and induces further investigation of the role of varicose veins of the pelvic reservoirs, in particular ovariсovariсocele, in the pathogenesis of ovarian dysfunction in order to further develop the methods of therapeutic correction.

Особливості перебігу гестації, пологів та перинатальні наслідки у ВІЛ-інфікованих жінок (Ретроспективний аналіз)

The objective: was to determine the peculiarities of gestation, childbirth and the newborns state in HIV-infected women. Materials and methods. A retrospective analysis of 1050 medical cards of HIV-positive pregnant women and their newborns and 85 women without HIV during 2012-2015 years was conducted. Results. CD4+ concentration and viral load indicate effective antiretroviral therapy in most patients. The most often complication of gestation in women with HIV is placental dysfunction. Such a threatening complication as placental abruption was observed in 37 (3.5±0.56%) HIV-infected pregnant women and in 12 (1.4±0.4%) control women. Fetal distress was found in 109 (10.4±0.94%) patients of main group versus 16 (1.9±0.46%) control women (p&lt;0.05). A higher blood loss rate during labour and caesarean section in HIV-infected women with long-term high-level antiretroviral therapy was noted. The maladaptive syndromes in early neonatal period were identified in newborns from HIV-infected women. The decompensation of placental insufficiency with critical circulation disorders plays a significant role among the causes of perinatal mortality in this newborns. Conclusions. The gestation process in pregnant women with HIV-infection is characterized by the greater frequency of perinatal complications and threatening conditions for both - the mother and the fetus. The current theory about the effects of HIV on the hemostasis system justifies the importance of studying the rheological status and the function of endothelium in HIV-infected pregnant women for timely diagnosis, treatment and prevention of obstetric and perinatal complications. Key words: HIV-infected pregnant women, pregnancy course, childbirth, mother–placenta–fetal system, perinatal consequences.

A System-of-Systems Framework for Improved Human, Ecologic and Economic Well-Being

“Advances in technology and management not keeping pace with the ever-increasing urban problems” is attributed in this research to the poor understanding of person-focused governance of societal, environmental and economic entities. The objective of this paper is to present an adaptive institutional model of person-driven effectiveness and ineffectiveness. The model proposes that human, ecologic and economic outcomes are heavily influenced by a complex system of systems, spanning from individually unique “non-physical influencers” to a broader set of social and environmental influencers that have a common impact on the larger society-environment-economy (SEE) system. At the heart of the model is an analytic formulation that explains the phenomena of non-physical blocker, enhancer and indifferent, which are responsible for the adaptation and maladaptation of social agents and, accordingly, for the sustainability and unsustainability of SEE systems. Examples are provided to illustrate the model applications: (a) the non-physical and maladaptive syndromes as antecedents of multi-morbidity; and (b) the broadened and narrowed minds as sources of sustainability and unsustainability at the SEE system level within the context of emerging technologies such as engineered nanomaterials.

Neonatal adaptation in infants prenatally exposed to antidepressants--clinical monitoring using Neonatal Abstinence Score.

BackgroundIntrauterine exposure to antidepressants may lead to neonatal symptoms from the central nervous system, respiratory system and gastrointestinal system. Finnegan score (Neonatal Abstinence Score, NAS) has routinely been used to assess infants exposed to antidepressants in utero.AimThe purpose was to study neonatal maladaptation syndrome in infants exposed to selective serotonin reuptake inhibitors (SSRI) or serotonin-norepinephrine reuptake inhibitors (SNRI) in utero.MethodRetrospective cohort study of women using antidepressants during pregnancy and their infants. Patients were identified from the electronic health record system at Karolinska University Hospital Huddinge containing pre-, peri- and postnatal information. Information was collected on maternal and infant health, social factors and pregnancy. NAS sheets were scrutinized.Results220 women with reported 3rd trimester exposure to SSRIs or SNRIs and who gave birth between January 2007 and June 2009 were included. Seventy seven women (35%) used citalopram, 76 used (35%) sertraline, 34 (15%) fluoxetine and 33 (15%) other SSRI/SNRI. Twenty-nine infants (13%) were admitted to the neonatal ward, 19 were born prematurely. NAS was analyzed in 205 patients. Severe abstinence was defined as eight points or higher on at least two occasions (on a scale with maximum 40 points), mild abstinence as 4 points or higher on at least two occasions. Seven infants expressed signs of severe abstinence and 46 (22%) had mild abstinence symptoms. Hypoglycemia (plasma glucose <2.6 mmol/L) was found in 42 infants (19%).ConclusionSevere abstinence in infants prenatally exposed to antidepressants was found to be rare (3%) in this study population, a slightly lower prevalence than reported in previous studies. Neonatal hypoglycemia in infants prenatally exposed to antidepressant may however be more common than previously described.

PO-0679 Neonatal Adaptation In Infants Prenatally Exposed To Antidepressants; Clinical Monitoring Using Neonatal Abstinence Score

Background Intrauterine exposure to antidepressants may lead to neonatal symptoms from the central nervous, respiratory and gastrointestinal system. Neonatal Abstinence Score, NAS, has routinely been used to assess infants exposed to antidepressants in utero . Aim To study neonatal maladaptation syndrome in infants exposed to selective serotonin reuptake inhibitors (SSRI) or serotonin norepinephrine reuptake inhibitors (SNRI) in utero . Method Retrospective cohort study of women delivering at Karolinska University Hospital Huddinge between January 2007 and June 2009, who were using antidepressants during pregnancy, and their infants. Information was collected on maternal and infant health, social factors and pregnancy. NAS sheets were scrutinised. Results Two hundred and twenty women with reported 3rd trimester exposure to SSRI/SNRI were included. Seventy-seven women (35%) used citalopram, 76 (35%) sertraline, 34 (15%) fluoxetine, 33 (15%) other SSRI/SNRI. Twenty nine infants (13%) were admitted to the neonatal ward, 19 were born prematurely. Hypoglycemia (plasma glucose Conclusions Severe abstinence was rare in this cohort of infants exposed to SSRI/SNRI and the majority of all scored infants had no signs of neonatal maladaptation. Hypoglycemia was detected in one out of five infants and might be overrepresentated in SSRI/SNRI exposed infants.