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МЕДИЦИНСКИЕ НАУКИ

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used extensively in both the surgical and medical fields as an anti-inflammatory agent. Examples of use include generally surgery for traumatic and postoperative inflammatory in dentistry to reduce inflammation and increase antibiotic concentration in cases of periodontitis and also in otolaryngology for cases of upper and lower tract infections and as an expectorant [3]. Papain has traditionally been used as an anti-inflammatory drug. In modern medicine, its use is especially as anti-inflammatory medicine. However, it is unclear whether this drug truly works or just exerts a consequence [4] The aim of the present study is to evaluate the antiinflammatory properties of papain following surgical removal of lower third molars in terms of reducing postoperative pain, facial swelling. The mechanism of action exerted by this protease remains unclear. It is postulated that this protease acts as a depolymerase to scale back the chain length of the protein molecules [5]. The postulated mechanism of action is as follows: As anti-inflammatory Serrati peptidase reduces inflammation by increasing draining of fluid also as thinning the fluid and decreasing the quantity of fluid within the tissues alongside accelerating healing by rapid removal of surrounding dead tissues. As an analgesic: this action is exerted is thru inhibition of pain inducing amines like bradykinin that is usually secreted by the injured cells and tissues. [6]

Proteolytic enzymes are administered to hasten the healing of damaged tissue and thus promote a complication free recovery [7],[8] . The study was undertaken to evaluate the analgesic, anti-inflammatory efficacy of orthal-forte on swelling, pain and trismus after surgical extraction of impacted mandibular third molars. The surgical removal of an impacted third molar tooth can result in considerable pain, swelling, and dysfunction. Swelling usually reaches its maximum within 48-72 hours of the surgical procedure. Minimizing tissue damage can control the amount of postsurgical edema.[9] .. Some believe that ice applied to the operated area decreases vascularity and thereby diminishes transudation. However, no controlled study has verified this practice. [10],[11] The vasoactive amines cause vasodilation, thereby increasing blood flow to the inflamed area. The inflammatory process is necessary if healing is to occur but inflammation also causes edema, pain, and trismus. Mechanism of action : On being absorbed, the enzymes are taken up by the circulating enzyme inhibitors i.e. alpha antitrypsin and alpha 2 macroglobuline, level which rise steeply following injury and tissue destruction. This rise in inhibitor levels is responsible for the period of operative fibrinolytic shut down and maintenance of inflammatory edema which delay healing. These also facilitate the action of plasmin which is necessary to open up the blocked microcirculation, resolve edema and initiate healing. [12]

On the other hand ,In order to avoid or minimize post surgical complications, such as pain, swelling, and trismus, surgeons have either modified surgical techniques, such as using lasers and cryotherapy, or advised the patients to use proteolytic enzymes, such as trypsin, chymotrypsin, papain, serratiopeptidase, and bromelain (pineapple enzyme), along with routine antibiotics, analgesics, and corticosteroids.[12,13] The benefits of administering enzymes after surgical procedures demonstrated both in vitro and in vivo are anti-inflammatory, antithrombotic, and fibrinolytic, thereby minimizing postoperative complications.[14]. Effectiveness of bromelain in reducing swelling among each subtypes (angulations, positions, and classes) was also compared. We found that bromelain was most effective for mesioangular impactions and least effective for horizontal impactions. Similarly, it was more effective for position A than position B and class I than class II types. Assessment of bromelain for three different difficulty index (mild, moderate, and difficult) were also evaluated. It was found that bromelain to be most effective (86.7%) for mild difficulty index, followed by difficult index (62.5%) and moderate difficult index (58.8%). Less effectiveness of bromelain for moderate difficulty index might be due to the fact that more horizontal angulations, position B, and class II index score were added in this category, which needed more operating time and experienced more intraoperative tissue trauma. [15, 16, 17]. A prospective randomized clinical study was done on 40 patients requiring surgical removal of impacted mandibular third molars. All the patients were administered bromelain after surgery to assess postoperative pain and swelling on day 1, 3, and 7. It was found that, in 28 patients, there was reduction in pain and swelling. Further studies have to be carried out to establish bromelain as a successful oral enzyme therapy for oral surgery patients. [18].

The another study assessed the clinical effect of bromelain / serratiopeptidase-diclofenac combination and diclofenac alone on pain, facial swelling and trismus. The comparison of pain intensity showed significant difference between the three groups (P<0.05) indicating an enhanced analgesic effect of diclofenac when ad-

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ministered in combination with bromelain / serratiopeptidase. Post-surgical facial edema is difficult to quantify accurately, since it requires a three-dimensional measurement with an irregular, convex surface and can manifest itself internally as well as externally. Over the years, numerous researchers have tried various techniques in an effort to objectively measure edema. [19] Most of which is indirect assessments of the altered contours of skin surface. In the present study, a single measurement from the tip of tragus to gonion to the tip of contralateral tragus was taken. It is noteworthy to mention herein that the cheek swelling following third molar surgery is diffuse in different planes and is very difficult to measure accurately. The co-administration of bromelain / serratiopeptidase-diclofenac preoperatively and post operatively, produced a clear reduction in postoperative pain and cheek swelling. The mean increase in facial swelling in days 1 and 2 in group II and group III were significantly less than that of group I. This result shows that add on therapy of bromelain / serratiopeptidasediclofenac enhances the control of postoperative facial swelling. The mean pain scores in day 2 in group II and group III were significantly lower than that of group I. This results show that addition of bromelain / serratiopeptidase with diclofenac enhances the control of postoperative pain on day 2. The mean pain score in day 1 in group II was significantly lower than that of group I and group III. The mean pain score in day 2 in group II was highly significant than of group I. This result shows that patient who received bromelain and diclofenac has greater control of postoperative pain than the other groups. Statistical analysis did not show any significant difference in reduction of mouth opening (trismus) between the study groups (P >0.05). The time course for pain and facial swelling findings described in the present study are in agreement with those of a recent multicenter triasl indicating similar symptoms that reached a maximum at days 1 or 2 postoperatively and generally resolved at day 7. [20], [21] The results of Global Assessement of Functioning by patients / dental surgeon analysis showed that the coadministration of bromelain / serratiopeptidase-diclofenac preoperatively and postoperatively, had minimal symptoms and good functioning in social / occupational activities than diclofenac alone.[13]

Reasearch scientist pursue research and determined that the postoperative symptoms after third molar removal surgery were commonly uneventful. The aim of this study was to compare two proteolytic enzymes from different origin and to prove which enzyme provides a faster healing. One of the proteolytic enzymes involves a combination with a flavonoid. This involves trypsin, bromelain, along with a flavonoid rutin. Another proteolytic enzyme is serratiopeptidase that helps in degradation of insoluble proteins causing reduced swelling in the operated site. The subjects were recommended to undergo extraction of impacted teeth in two sittings, one extraction per visit. In the first sitting, subjects were prescribed trypsin, bromelain, and rutin combination after removal of 48 teeth and in the second sitting subjects were prescribed serratiopeptidase after removal of 38 teeth. There was a time interval of 2–3 weeks in between the sittings. The post findings such as mouth opening, swelling, and pain scale were noted. The results showed that the proteolytic enzyme combination of trypsin, bromelain, and rutin is better than serratiopeptidase. Serratiopeptidase caused allergic reaction in some individuals because of proteolytic nature of the drug [22] and causes increase in eosinophils. Due to this reaction, the bronchial asthmatic patients is contraindicative for the use of the same. However, the trypsin, bromelain, and rutin combination showed better results than that of serratiopeptidase. It was revealed that the trypsin, bromelain, and rutin combination had decrease in the inflammatory mediators such as PGE2 and substance P in the oral fluid and clinically the size of the swelling, mouth opening, and exudates from the surgical site was found reduced postoperatively, thus facilitating wound healing. [23]

The effectiveness of the oral enzyme combination bromelain, trypsin, rutoside trihydrate is analyzed on patients with temporomandibular joint (TMJ) osteoarthritis (OA) in a randomized clinical trial. The enzyme combination is applied as a single treatment or in combination with diclofenac sodium for the management of pain. [24] 30 patients were divided into three groups with ten patients each. Group 1 has received 50 mg diclofenac sodium twice a day for ten days. Group 2 has received the same diclofenac treatment with an additional enzyme combination containing 90 mg bromelain, 100 mg rutoside trihydrate, and 48 mg trypsin twice a day for ten days. The amounts of active ingredients are similar to the drug Phlogenzym. The last group has received the oral enzyme combination twice a day for ten days. The groups are not blinded. The patients were evaluated with a numeric rating scale from zero to ten to score the pain. [24] The pain was decreased in all three groups. A remarkable decrease in mean of pain score and the highest decrease in mean was measured

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in group 2 at day four and day seven respectively. The difference was statistically significant indicating a better therapy response while treating with diclofenac sodium and oral enzyme preparation combined in comparison to group 1 and 3. The treatment effectiveness was the same between diclofenac sodium and oral enzymes on their own. The treatment was tolerated by all patients with no sever effects. [24]

Oral enzyme therapy and its diverse application forms have created new opportunities in the treatment of analgesic and inflammatory diseases. The research state on oral enzyme therapy has effects as analgetic, anti-inflammatory, no effects on healthy tissue, rapid separation of dead tissue from healthy tissue, regeneration, granulation, epitilization effects are modern trend of treatment approaches oral and maxilla-facial enzyme therapy.

References

1.Gruenwald J, Brendler Th, Jaenicke C. Physicians' desk reference® for herbal medicines.2007:Pp593, 847.

2.Orthal forte from cipla chymotrypsin. http://WWW.Drug update .com

3.Govindaraju L, Gurunathan D. Effectiveness of chewable tooth brush in children-A prospective clinical study. J Clin Diagn Res 2017; 11:ZC31–34.

4.Christabel A, Anantanarayanan P, Subash P, et al. Comparison of pterygomaxillary dysjunction with tuberosity separation in isolated Le Fort I osteotomies: A prospective, multi-centre, triple blind, randomized controlled trial. Int J Oral Maxillofac Surg 2016; 45:180–185.

5.Caci F, Gluck GM. Double-blind study of prednisolone and papase as inhibitors of complications after oral surgery. J Am Dent Assoc 1976; 93:325–327.

6.Vivek D Menon, MR Muthusekhar. Effectiveness of Papain as an anti-inflammatory Agent in Patients Undergoing Surgical Removal of Impacted Teeth-A Randomized Double Blinded Clinical Trial. J Res Med Dent Sci, 2021, 9 (7):73-76

7.Chopra D, Rehan HS, Mehra P, Kakkar AK. A randomized, double blind, placebo-controlled study comparing the efficacy and safety of paracetamol, serratiopeptidase, ibuprofen and betamethasone using the dental impaction pain model. Int J Oral Maxillofac Surg. 2009;38: 350-5.

8.Martin Levine. Topics in dental biochemistry. Springer-Verlag Berlin Heidelberg, London New York. 2011: Pp 12, 27

9.Benetello V, Sakamoto FC, Giglio FP, et al: The selective and non-selective cyclooxygenase inhibitors valdecoxib and piroxicam induce the same postoperative analgesia and control of trismus and swelling after lower third molar removal. Braz J Med Biol Res 2007: 40:1133

10.Bonnefont J, Courade JP, Alloui A, Eschalier A. Antinociceptive mechanism of action of paracetamol. Drugs 2003: 63: 1–4.

11.Micó-Llorens JM, Satorres-Nieto M, Gargallo-Albiol J, ArnabatDomínguez J, Berini-Aytés L, GayEscoda C. Efficacy of methylprednisolone in controlling complications after impacted lower third molar surgical extraction. Eur J Clin Pharmacol. 2006; 62:693-8

12.Al-Sandook TA, Tawfik NO, Qassim DA. Clinical evaluation of the efficacy of orthal-forte (prolytic enzymes, trypsin and chymotrypsin) on postoperative sequel following the removal of lower impacted third molar. Int J Enhanc Res Sci Technol Eng. 2014;3:169–73.

13.Kannan R, Kavitha R. A Comparative Study of the Anti-Inflammatory Properties of Bromelain/Serratiopeptidase as add on Therapy to Conventional Treatment Following Impacted Third Molar Surgery. World J Pharma Res. 2015;4: 2595–607.

14.Gunde MC, Amnerkar ND. Ethnobotanical And Pharmacological Properties Of Pineapple Protease (Bromelain): A Review. Eur J Pharma Med Res. 2015;2: 126–35.

15.Inchingolo F, Tatullo M, Marrelli M, Inchingolo AM, Picciariello V, Inchingolo AD, et al. Clinical trial with bromelain in third molar exodontia. Eur Rev Med Pharmacol Sci. 2010;14:771–4.

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16.De la Barrera-Nunez MC, Yanez-Vico RM, Batista-Cruzado A, Heurtebise-Saavedra JM, Castillode Oyague R, Torres-Lagares D. Prospective double-blind clinical trial evaluating the effectiveness of Bromelain in the third molar extraction postoperative period. Med Oral Patol Oral Cir Bucal. 2014;19:e157–62.

17.Ordesi P, Pisoni L, Nannei P. Therapeutic efficacy of bromelain in impacted 3 rd molar surgery: A randomized controlled clinical study. Quintessence Int. 2014;45:679–84.

18.Tejpal S, Vinayak M, Umayra F, Tanveer K, et al. Effect of proteolytic enzyme bromelain on pain and swelling after removal of third molars. J Int Soc Prev Community Dent. 2016 Dec; 6(Suppl 3): S197–S204

19.Roger EA, Roger RT. A review of perioperative corticosteroid use in dentoalveolar surgery. Oral Surg Oral Med Oral Pathol. 2000; 90: 406-415.

20.White RP Jr, Shugars DA, Shafer DM, Laskin DM, Buckley MJ, Philips C. Recovery after third molar surgery: clinical and health-related quality of life outcomes. J Oral Maxillofac Surg. 2003; 61: 535-544.

21.Conrad SM, Blakey GH, Shugars DA, Marciani RD, Philips C, White RP Jr. Patients’ perception of recovery after third molar surgery. J Oral Maxillofac Surg. 1999; 57: 12881294.

22.Bhagat S, Agarwal M, Roy V. Serratiopeptidase: a systemic review of the existing evidence. Int J Surg 2013;11;209-17.

23.Tharani Kumar S. , Ashok Prasanna R. , Joshua Rohan Kirubanandan et al. Postoperative Healing after Surgical Removal of Mandibular Third Molar: A Comparative Study between Two Proteolytic Enzymes. 2020 Journal of Pharmacy and Bioallied Sciences | Published by Wolters Kluwer – Medknow S289S294

24.Jayachandran S, Khobre P (2017) Efficacy of Bromelain along with Trypsin, Rutoside Trihydrate Enzymes and Diclofenac Sodium Combination Therapy for the treatment of TMJ Osteoarthritis - A Randomised Clinical Trial. J Clin Diagn Res 11:Zc09-zc11.

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УДК 616-091.0

СТАТИСТИКА СМЕРТНОСТИ ОТ АТЕРОСКЛЕРОТИЧЕСКОЙ БОЛЕЗНИ СЕРДЦА В ПЕНЗЕНСКОЙ ОБЛАСТИ В 2021 ГОДУ

Комарова Екатерина Валентиновна,

к.б.н., доцент

Цыплихин Никита Олегович

ординатор ФГБОУ ВО «Пензенский государственный университет»

Научный руководитель: Фёдорова Мария Геннадьевна

к.м.н., доцент ФГБОУ ВО «Пензенский государственный университет»

Аннотация: Целью данного исследования является изучение структуры смертности населения Рос-

сийской Федерации на примере Пензенской области от атеросклеротической болезни сердца в 2021 году. С этой целью был проведен статистический анализ данных 3837 зарегистрированных случаев смерти, первоначальной причиной которых являлась атеросклеротическая болезнь сердца. При проведении анализа было выявлено, что из 3837 умерших от атеросклеротической болезни сердца доля женского населения преобладает над мужским и составляет 57,8%. Большая часть умерших до момента смерти проживала городе Пенза и других городах области. Наибольший процент умерших от анализируемого заболевания приходится на людей пожилого возраста, в то же время наименьший процент умерших пришёлся на людей молодого возраста. Среди несовершеннолетних случаев смерти от атеросклеротической болезни сердца выявлено не было. Было выявлено, что у женщин заболеваемость атеросклеротической болезнью сердца повышается с каждой последующей возрастной категорией. Среди мужского населения выявлена обратная тенденция: процент умерших от рассматриваемого заболевания с каждой последующей возрастной категорией снижается. Анализ ежемесячной смертности от атеросклеротической болезни сердца в течение года показал, что процент умерших от данного заболевания прирастает в летне-осенний период, достигая максимума в октябре, и падает в зимневесенний период, достигая минимума в марте.

Таким образом, были выявлены гендерные и фенологические особенности смертности населения от атеросклеротической болезни сердца в Пензенской области в 2021 году.

Ключевые слова: статистика смертности, ишемическая болезнь сердца, патологическая анатомия, эпидемиология.

STATISTICS OF MORTALITY FROM ATHEROSCLEROTIC HEART DISEASE IN THE PENZA REGION IN 2021

Komarova Ekaterina Valentinovna, Tsyplihin Nikita Olegovich

Scientific adviser: Fedorova Maria Gennadievna

Abstract: The purpose of this study is to study the structure of mortality of the population of the Russian Fed-

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Рис. 1. Соотношение мужчин и женщин, умерших от атеросклеротической болезни сердца в зависимости от возрастной категории

Половые особенности смертности от атеросклеротической болезни сердца могут быть объяснены особенностями воздействия половых стероидных гормонов на эндотелий сосудов. Исследования показывают, что высокие концентрации эстрогенов в женском организме, по сравнению с мужским, позитивно влияют на липидный спектр крови и имеют защитное действие в отношении эндотелия сосудов и замедляют развитие атеросклеротических бляшек в стенке артерий мышечно-эластического и мышечного типов. Снижение концентрации этих гормонов в постменопаузальный период приводит к увеличению случаев заболеваний сердечно-сосудистой системы у женщин [6-12].

Рис. 2. Количество умерших от атеросклеротической болезни сердца за 2021 год

Смертность от атеросклеротической болезни сердца в течение года менялась в зависимости от сезона и месяца. Так, больше всего людей скончалось от рассматриваемого заболевания в октябре – 11,4% от умерших за весь год; меньше всего умерло в марте – 5,9% всех умерших. Количество умер-

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ших с течением времени изменяется плавно, при этом можно выделить периоды подъема и спада смертности от атеросклеротической болезни сердца. Таким образом, ежемесячное количество умерших снижается в период с января по март, затем с апреля по июль наблюдается рост смертности. В августе происходит небольшое снижение количества умерших по сравнению в данными за июль, однако затем рост количества умерших продолжается вплоть до октября. В оставшееся время года происходит падение смертности от рассматриваемого заболевания (рис. 2).

Таким образом, можно предположить, что смертность от атеросклеротической болезни сердца увеличивается в период с апреля по октябрь и снижается в период с ноября до марта. Возможно, что изменение смертности в различные фенологические сезоны может быть связан с изменениями среднесуточной температуры воздуха и атмосферного давления в исследуемой географической зоне

[13,14].

Выводы

Таким образом, можно сделать несколько выводов:

1.В период с январь по декабрь 2021г. в Пензенской области зарегистрировано 6177 случаев смерти от болезней системы кровообращения. Из них в 3837 случаях в патологоанатомическом диагнозе в качестве основного заболевания была указана атеросклеротическая болезнь сердца.

2.Среди всех случаев смерти на женщин приходится большая часть – 57,8%, на мужчин – меньшая часть, 42,2%.

3.На долю городского населения приходится 63,8% случаев смерти от атеросклеротической болезни сердца, на долю сельского – 35,5% смертей.

4.Наибольший процент умерших от атеросклеротической болезни сердца приходится на людей в возрасте от 60 до 74 лет. Наименьшее число умерших зарегистрировано среди людей в возрасте от 18 до 44 лет. Среди людей до 18 лет случаев смерти от атеросклеротической болезни смерти не зарегистрировано.

5.Выделяются периоды подъема и спада смертности от атеросклеротической болезни сердца в разные фенологические сезоны. При этом наибольшее количество умерших было зарегистрировано в октябре, наименьшее – в марте.

Список источников

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2.Герасимова, Л. И. Социально-экономическое значение заболеваемости и смертности от болезней системы кровообращения / Л. И. Герасимова, Н. В. Шувалова, С. Р. Тюрникова // Здравоохранение Чувашии. 2013. № 2. С. 51-57. – EDN RCDCVJ.

3.Оганов Рафаэль Гегамович и Масленникова Галина Яковлевна (2013). Демографические тенденции в Российской Федерации: вклад болезней системы кровообращения. Международный журнал болезней сердца и сосудов, 1(1), 3-10. doi: 10.24412/2311-1623-2013-1-3-10.

4.Зайратьянц ОВ, Мишнев ОД, Кактурский ЛВ. Коронарогенные и некоронарогенные некрозы миокарда. Острый коронарный синдром и инфаркт миокарда (определения, статистика, классификации, критерии диагностики). В кн.: Доклады Московского общества патологоанатомов. V.I (март-май 2014 г.). Эд. О. В. Зайратьянц. М: ООО Нович, 2014. С. 175-211.

5.International statistical classification of diseases and health problems. 10th revision. T. 2. WHO; 1995: 34, 46-7

6.Andrea Iorga, C.M. Cunningham, Shayan Moazeni [et al.]. The protective role of estrogen and estrogen receptors in cardiovascular disease and the controversial use of estrogen therapy. Biology of Sex Differences. 2017;8(1):33. doi: 10.1186/s13293-017-0152-8

7.Stice J.P. [et al.]. Estrogen, aging and the cardiovascular system. Future Cardiol. 2009;5:93–103.

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