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Iodine in medicine and pharmacy

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–Home page–The use of Iodine in medicine
Астана Tue, 13.11.2012 02:56
The use of Iodine in medicine

3.1 General characteristics of Iodine drugs

The history of therapeutic use of iodine dates back centuries. Healing properties of substances containing iodine have been known for 3000 years before the discovery of this element.

Iodine has local and resorptive action; it has antibacterial, antiviral and antimycotic properties. Iodine also causes antifungal, anti-acidosis, cystoside, viricidal effects, the activity against of some spores.

Iodine is able to actively oxidize amino acids of bacterial proteins containing SH-and OH-groups. This are mainly bacterial enzymes and transmembrane proteins. Their quaternary structure changes at the oxidation and they lose their catalytic and enzyme activity. This action manifests itself for proteins of bacteria, protozoa, viruses, fungi and others.

Iodine blocks respiratory enzymes of bacteria, thereby manifesting its bactericidal and bacteriostatic properties.

Iodine forms a complex compound with lysozyme, which has the ability to absorb micro-organisms. Complex compound of molecular iodine has a broad spectrum of antimicrobial activity. The highest antibacterial activity is observed against streptococci, Klebsiella, Proteus, Escherichia, Lactobacillus.

The problem of iodine use is that high concentrations of it irritate the skin and mucous membranes, and a single dose of 2-3 g of iodine is lethal for humans.

There are four groups of iodine drugs:
1. Containing elemental iodine: 3 - or 5% alcohol solution of iodine, Lugol's solution.

2. Inorganic Iodide – potassium and sodium Iodide - the majority of manufactured drugs contains from 25 to 250 mcg of microelement.
3. Organic substances, deiodinating elementary iodine: iodoform, iodinol and etc.
4. Iodine containing organic compounds where iodine is tightly bound in the molecule - radio-opaque substances

Iodine containing drugs have different properties:

1. Elemental iodine has antimicrobial and antifungal (fungicidal) action, its solutions are widely used for treatment of wounds, the preparation of the surgical field, etc.

2. Iodine Solutions have anti-inflammatory and revellent properties. Being applied to the skin and mucous membranes it causes irritating action and may cause reflex changes in the organism.

3. Iodine drugs block accumulation of radioactive iodine in the thyroid gland and help to its excretion from the body, thereby they reduce radiation dose and weaken the radiation influence.

4. An intake of iodine drugs influences on the metabolism, increases the thyroid function . Small doses of iodine inhibit the thyroid function by inhibiting the formation of thyroid-stimulating hormone of the anterior pituitary. This property is used in the treatment of patients with thyroid disease.

5. It was also established that iodine affects the metabolism of fats and proteins. The use of iodine drugs decreases blood cholesterol levels and decreases its coagulability.

6. The use of iodine drugs as expectorants and mucolytic agents (liquefaction of mucus)is explained by reflex stimulation in secretion of mucus by glands of the respiratory tract and proteolytic activity (proteolysis).

7. radio-opaque substances containing iodine are used for diagnostic purposes.

8. Artificially synthesized radioactive isotopes of iodine І123, І125, І131 are used to determine a functional condition of the thyroid gland and the treatment of the number of its diseases. The use of radioactive iodine in a diagnosis is related to the ability of iodine to be selectively accumulated in the thyroid gland. Its use for medical purposes is based on the ability of the radiation of radioisotopes of iodine, to destroy cells glands that produce hormones.

Iodine drugs is used externally and orally: they are used externally as an disinfecting, revellent and derivant agents in cases of inflammatory and other diseases of the skin and mucous membranes. They are used orally for the treatment of atherosclerosis, chronic inflammation of the respiratory tract , tertiary syphilis, for the prevention and treatment of endemic goiter in cases of chronic poisoning by mercury and lead. In the experiments, high doses of iodine used to treat poliomyelitis, virus diseases and some diseases of the central nervous system.

Among a few specific women's health disorders caused by hormonal disorders, where high doses of iodine drugs can be used, are fibrocystic breast disease (mastopathy), endometriosis (transport of mucous coat of womb body to various tissues and organs) and uterine fibroid (benign neoplasm). The therapeutic effect of iodine drugs is explained by its ability to convert estradiol – which is more active and possibly cancer-causing type of estrogen (female reproductive hormone) - to a less active and more secure estriol.

The use of iodine drugs as expectorants and mucolytic agents (liquefaction of mucus) is explained by reflex stimulation in secretion of mucus by glands of the respiratory tract and proteolytic activity (proteolysis).

Iodine drugs are relatively cheap and affordable. They used since ancient times as a high therapeutic and healing remedies which various indications for use. They are still very important.

3.2 Iodine drugs used as antiseptics

The most simple forms of iodine are water and alcohol solutions of iodine. They couldn’t find use in surgery for a very long time, although in 1865 - 1866 the great Russian surgeon N.I. Pirogov used iodine tincture for the treatment of wounds.

In modern conditions a surgical infection is a clinical and a general biological problem. The surgical infection is one of the most complicated, difficult and urgent and medical problems, acquiring social, economic and nationwide importance.

Increase in the number of purulent diseases, postoperative septic complications, increase in cases of generalization of infection, and different toxic and allergic reactions significantly complicate the further development of surgical science.

Under strict control of the nosocomial infection, suppurative complications of surgical incision are recorded in 33-38%, bloodstream infection in 0.6-2%, bedsores - 2%. A length of hospital stay increases for 15-18 days. Among nosocomial infections the rate of postinjection infections reaches 20% in surgical hospitals, and 76,5% in outpatient clinics.

The skin infection at a place of injection of an intravascular catheter is the most common source of colonization and spread of infection, if a catheter remains in a vessel for the period up to 10 days. Annually nearly 400 thousand of catheter-related infections are registered in the United States.

At the present time many antiseptics aimed for the sterilizing of an surgical field, surgeon's hands, the skin before injections, an injection of intravascular catheters, bends of elbow before vessels puncture do not always provide reliable sterility.

Recent studies show that many strains of microorganisms are resistant to traditional antiseptics (Furacilin, an aqueous solution of chlorhexidine, potassium permanganate solution). For example Ps. aeruginosa remains in a solution Furacilin in the amount of 106 CFU / ml.

The frequency of isolation of clinically resistant to Furacilin Staphylococcus spp., Pseudomonas spp. among contaminants of antiseptics is 89,6 ± 2,7 and 100,0 ± 0,8% correspondently.

There is no a secret that the wide use of Antibiotics has created a new evolutionary problem - the problem of unwanted artificial selection. The matter is that an Antibiotic may kill not all of harmful bacteria, there may be one among thousand of millions of these microorganisms which will be able to resist the drug. If this resistant microorganism become again pathogenic and successfully reproduce itself, it will be necessary to develop an Antibiotic of a new generation and the situation will repeat again.

In the most cases, parenteral Antibiotic therapy is used for the prevention and treatment of postoperative purulent complications. To achieve optimal bactericidal concentrations of Antibiotics in the wound it is necessary to take additional high doses of expensive drugs that significantly increase the risk of various complications of systemic antibiotic therapy.

One of the ways of this problem solution is a development and use of immobilized antimicrobial agents with a targeted local prolonged therapeutic activity that allows to create high concentrations of a drug in a wound and to reduce a risk of complications in the impact of antibiotic therapy on the skin.

Many countries, conduct an intensive search for new drugs that could reliably prevent the spread of nosocomial infections. Over the past 40 years, the range of tools has been significantly expanded due to introduction of new medications, including antiseptics from the group iodophors.

Modern iodophors are highly effective drugs for the prevention and treatment of chronic inflammatory processes in surgery. The drugs have a broad spectrum of antimicrobial, fungicidal activity, they are well tolerated in patients. Their side-effects are extremely rare with a prolonged use. Iodophorsare stable during prolonged storage. High clinical and bacteriological effectiveness of modern iodophorsallows us to consider this group of antiseptics as drugs of choice in the hospital and in outpatient surgical practice.

The advantage of iodophors is good solubility in water and the presence of detergent properties in the most of them. At the present time due to these advantages iodophors are used as skin antiseptics in many countries.

Bactericidal and virucidal activity of iodophors significantly exceeds the tincture of iodine, Lugol's solution and compared with the latter, they are less toxic.

The antimicrobial action of iodine is based on its damage of the cell wall of pathogenic microorganisms. Iodine, releasing from the complex with polyvinylpyrrolidone and contacting to biological material, compounds iodamine with proteins of bacteria cells, coagulates them and kills microorganisms. It provides quick bactericidal action on gram-positive and gram-negative bacteria. The drug is also active against fungi, viruses, protozoa. It has a more lasting effect than general alcoholic solutions of iodine.

Iodophors preserve high antiseptic properties of iodine during a long period of being on the skin. They are easily soluble in water, non-toxic with a prolonged and frequent use, rarely cause allergic reactions, are stable during storage.

High clinical and bacteriological effectiveness of iodonatum and other iodophors can allow to consider them as popular drugs in a hospital and an outpatient surgical practice.

Iodonatum is a highly effective and inexpensive antiseptic drug of a new generation.

Iodonatum is an aqueous solution of surface-active substances with iodine. Liquid dark brown color with low iodine smell, foaming by shaking. Iodonatum blends with water in any ratio. It contains about 4.5% of active iodine.

Iodonatum has bactericidal activity that is not only due to the content of iodine but also to surface-active media.

Iodonatum is active against intestinal bacillus, Staphylococcus aureus, Proteus, seudomonas aeruginosa (concentration of 0,0005% of free iodine leads to death in 5 min); it also has fungicide properties.

Iodonatum, used as a skin antiseptic, at a sterilization of an surgical field and surgeon's hands, bends of elbow before vessels puncture, allows significantly decrease a risk of infection complications.

At the present time iodine complex used together with polyvinylpyrrolidone - a typical iodophor - povidone-iodine is active against many resistant strains of microorganisms, spores, Candida, adenovirus, herpes virus and HIV.

Povidone-iodine has antiseptic, disinfectant, antibacterial, antifungal, antiprotozoal and antiviral effect.

Povidone-iodine - has some significant advantages over other iodophors: it keeps high antiseptic properties of iodine, even in the presence of blood, plasma, does not cause development of resistant forms of microorganisms, doesn’t have allergic effects on the body, non-toxic.

Foreign iodophors produced in various drug forms - a solution, ointment, aerosol, shampoo, liquid soaps, gels, suppositories, powders, single use wipes, suture and dressings impregnated with the drug are successfully used to disinfect the skin of surgeon and a surgical field, for the prevention and treatment of a wound infection and for the local treatment of burns.

Iodantipirin (1-phenyl-2.3-dimethyl-4-iodinepirozolon) is used for emergency prevention of tick-borne encephalitis as a drug of choice.

Iodantipirin used to treat hyperpoliglucosis with renal syndrome, diseases caused by non-polio enteroviruses of Coxsackie and ECHO viruses, influenza, herpes viruses, HCMV. Yodantipirin is effective at bacterial infections as well like tuberculosis, chlamydiosis. The study of the protective mechanism of Yodantipirin has showed that one of the leading factors in its prophylactic effect is a high stimulation of α-and β-interferons. Within 4 hours after administration of the drug, antiviral protein level grows dozens times in the most of the people, and in 12 and 24 hours - in the hundreds or thousands of times. At that it causes a significant stimulation of cellular and humoral immunity. In addition, the drug has low toxicity; it doesn’t have mutagenic, embryotoxic, immunotoxic and allergenic activity.

With regard to its application, it is used for the induction of α-and β-interferon in cases of viral diseases, as well as an anti-inflammatory and immunomodulating drug.

In combination with organic substances such as polyethylene glycol, polyvinyl alcohol, iodine does not lose valuable properties, but instead gets some new. There was described an antibacterial and fungicidal effect of iodinated polystyrene. Such polymers do not release active iodine; they manifest antimicrobial activity only in contact with contagious matter. At the introduction of iodine in the polyurethane polymers there was marked the effective inactivation of HIV. A release of iodine from the complex with polyurethane by mean of desorption helps to rapid (15-30 min) inactivation of HIV.

In 1917 Lumiere used starch Iodide for the treatment of infected wounds, as an alternative to most antiseptics which dissolved in protein environment. His challenge was to obtain an active antimicrobial agent, stable as «in vitro» so as «in vivo», the effect of which could continue for several hours or days. The compound of iodine with natural superpolymer starch gave very promising results. Lumiere proved antimicrobial properties of the drug in the following way: he placed 10g of muscle tissue in the initial stages of microbial decomposition in two glass bottle banks. He pour 100 ml of water solution of iodine with the content of 25 mg of free iodine in one of the glass bottle banks and 10 ml of water solution of starch with the content of 25 ml of iodine in the second glass bank. The bottles were shaken several times. In half an hour it wasn’t possible to find free iodine in the first glass bottle bank. The next day the content of the bottle showed the picture of complete bacterial decay. The solution in the second bottle preserved blue color during a month and the content didn’t have any signs of decomposition.

In 1956, V. O. Mokhnach started researches of antibacterial, antiviral and antimycotic effect of various compounds of iodine with starch and its components were started in different institutions.

There were started studies of antibacterial action of starch iodide by the hospital named after S.P. Botkin in Leningrad. M.A. Rapoport studied the effect of amyloodinium (starch iodide), mainly on enteric bacteria: Eberthella typhi abdominalis, Salmonella paratyphi A, S. paratyphi B, Shigella dysenteriae Flexner, Sh. dysenteriae Sonne. Even in the 10-40-fold dilutions of the drug and containing 1 g of crystalline iodine per 100 ml of amyloodinium solution, which was used for the treatment of patients, there was observed the rapid death of these bacteria.

In 1957, the Leningrad Institute of Antibiotics , A.I. Drozdov tested activity amyloodinium «in vitro» against to some types of yeast, yeast-like fungi and dermatophytes. Dilutions of drugs were prepared in normal saline solution, which served as a control and, in a volume of 1 ml. In each dilution they added 500 thousand yeast test-organisms or fungal elements. Seeding from corresponding dilutions was done in accordance with sectors in Petri dishes with wort agar. Analysis of results was done at a temperature of 37 ° C in 5 days of growth for yeasts and yeast-like fundus and in 10 days - for dermatophytes. They took Candida albicans, C. tropicalis, C. krusei, Saccharomyuces cerevisiae, Trychophyton gypseurn, T. crateriforme, Microsporon lanosum, Epidermophyton K.-W as test organisms.

Tests showed that 20-fold dilution of the drug, i.e. at concentrations of crystalline iodine of 18-20 mcg / ml, all test organisms except Candida krusei, died already in a half an hour of exposure. C. krusei was more resistant: it died in 6 hours. At the same time the control gave a big growth of this organism.

Antimicrobial action of iodine polysaccharides not only very effective but in some cases significantly superior to aqueous solutions of potassium poliyodide.

The latter, of course, deserves a special attention as studied polysaccharides - starch, amylose – don’t have any anti-microbial properties, but, in contrast, they are nutrients for microbes. In the presence of starch and amylose iodine molecules form compounds with them, colored in the intense blue color. Tens and hundreds of iodine molecules, included in the content of the polysaccharide, form a single molecule with sharing electrons, tied up to the compound of high-polymer molecule. Due to the fluctuations of the electron density in these compounds, the latter may become donors of iodine compounds in the form of J +1. These iodine compounds have strong oxidizing properties, which explain their intensive antimicrobial action with a broad antimicrobial spectrum.

In 1958, the Department of Microbiology, of the Leningrad Sanitary Medical Institute conducted studies of the action of iodide of starch, and amylose-iodine and amylopectin iodine in regard to the number of pathogenic microbes and the Department of Spore-Bearing Plants of the Botanical Institute named after V.L. Komarov under the guidance of M.A. Litvinov conducted studies in regard to saprophytes.

It was established that the effect of amylose-iodine greatly exceeds effects of solutions of polyiodide and potassium iodidewith the same content of molecular iodine. This paradoxial fact deserves a special attention, because the studied polysaccharides don’t have any antimicrobial properties, but, in contrast, they are nutrients for microbes. Nevertheless, the addition of this "nutrient" to a solution of iodine-iodide increases its antimicrobial effect. The lowest bactericidal concentration of iodine against to Staphylococcus aureus and Bacterium coli in iodine-iodide is 16, amylose-iodine - 2 mcg / ml.

Oxyanions of iodine, binding iodine in the state of oxidation of 1-/+, provides a high antibacterial effect of starch iodide.

Starch-iodine complex has antibacterial activity; it is characterized by a strong absorption band in the spectrum from XM - ~ 600 nm and according to studies of Mokhnach V.O. it concludes iodine in the form of positive monovalent.

A high antibacterial effect and non toxicity amylose-iodine are used with great success for the treatment of such severe pathology, such as chemical burns of the esophagus.

In conclusion, Mokhnach V.O. writes, that water solutions of starch iodide don’t contain any elemental iodine in the form of the molecule I2 what explain their non toxicity. Most of antibacterial effects are attributed to oxyanion /0~(/1 +), which contains a highly positive monovalent iodine. It can be assumed that starch iodide complex has antiseptic properties itself.

The action of amylose-iodine accelerates immunological reactions in the body.
Iodamide exceeds antiseptic effect of iodoform, hygroscopicity of the drug helps to rapid absorption of secretions from the surface of wounds and sores. In the opinion of the author , intoxication at external use of the drug is excluded.

The main advantages of polymers-iodine are their intensive chemotherapeutic effect, low toxicity and cost, and a lack of development of microbial resistance to iodine as well. V.O. Mokhnach (1962) gave the most complete description of the medicinal properties polymer-iodine that received the name of - blue iodine.

Blue iodine was discovered several times. For the first time the scientist from Leningrad V.O. Mokhnachev tried the drug on himself during the Great Patriotic War, when had severe bacterial dysentery. And in the 50s he participated in testing the drug effect on a big group of people suffering dysetery, colitis and enterocolitis of moderate and high severity in the medical hospitals of Leningrad.

Stool of patients taking at that time blue iodine, stabilized in the first 5 days since the beginning of treatment. A bacteria clearance of the intestinal tract occurred on 5th -10th day. Excellent results! The daily dose of the drug for those patients was 500 g. It was spent 7 daily doses for the treatment of each patient. It often happens that higher doses of drugs are used in the treatment of acute and chronic intestinal infections. It should be mentioned that Mokhnach V.O. himself increased the dose of blue iodine up to 1500-2000 mg per day.

People know about healing properties of blue iodine as they personally experienced magic properties of this drug numerous times. Indeed, having antiviral, antibacterial and antifungal effects, it helps to treat the most serious diseases, which cannot be treated even with fashionable imported drugs.

Alcohol and aqueous solutions of iodine are known to every person from childhood. We use them throughout our life as an effective antiseptic for the treatment of wounds. But its toxicity makes it unsuitable for intake in large doses. On the contrast, the blue iodine is non-toxic.

Theoretically, we can assume that the complex of the blue iodine drug halogenates (iodizes) DNA and RNA, containing viruses, both inside and outside of the cell due the mechanism of recognition and due to specific chemical interactions. This happens by means of the substitution of a hydrogen atom in groups of purine and pyrimidine bases which composep DNA and RNA containing viruses. New agents being synthesized due to halogenation any longer don’t have properties of the virus.

The ability of iodine easily penetrate to the cell membrane makes the drug especially valuable for all infections, which pathological process take place in the intracellular structures.

Blue iodine kills dysentery bacillus within three days, but it is necessary drink it up to seven days. Of course, dysentery is a very dangerous disease and demands medical interference. But blue iodine may save your live until arrival of doctors.

Blue iodine is iodinated starch. The compound of iodine with starch neutralizes its toxic properties in regard to human cells and animals, enhances it for pathogens (Usefulintestinal microflora of the gastrointestinal tract is also not subjected to "murderous" effect of iodine blue), so blue iodine does not cause poisoning and can be consumed in large doses.

Besides when administered, starch, being part of the drug, coats stomach ulcers and other affected places of the gastrointestinal tract, creating a protective layer that helps to rapid healing. Iodine stimulates activity of the pancreas, which is the protector of our body.

Blue iodine is simply irreplaceable in cases of acute and chronic diseases of infectious nature.

Blue iodine kills dysentery bacillus within three days, but it is necessary drink it up to seven days. Of course, dysentery is a very dangerous disease and demands medical interference. But blue iodine may save your live until arrival of doctors.

Blue iodine is used at the treatment of stomatitis, stomach ulcer, and nonhealing wounds, conjunctivitis and diarrhea with blood, colitis and enterocolitis, tonsillitis, various kinds of poisonings and burns.

Irrigation of the large intestine with blue iodine prevents the processes of decay, causes a local bactericidal action.

Blue iodine is the best remedy in cases of chemical poisoning and burns.
Blue iodine is daily administered as enemas of 50 grams within a week in cases of the ulcerative lesions of the large intestine.

Blue iodine improves elasticity of blood vessels, which allows to recommend it for the treatment of not only effects of stroke. Blue iodine helps to normalize high and low blood pressure. In addition, due to its the sedative properties, it can be taken as a depressant. It treats thermal and chemical burns, especially when there is no possibility to provide urgent medical assistance.

Depending on the severity of condition it is recommended to do syringing within seven or ten days in cases of gynecological diseases of inflammatory nature. Simultaneously with the syringing it is necessary to take 1-2 tablespoons of blue iodine.

One third or even a half of a glass of blue iodine can be taken on an empty stomach in cases helminthic invasions. Blue iodine is safe even at bathing of eyes of infants.

Healing blue iodine rejuvenates the body. Blue iodine is quite compatible with remedies of traditional medicine. For example, a combination of blue clay and blue iodine is effective in the treatment of indigestion. It is well known that clay has a wonderful property to pull toxins out from the body. On this reasons the interaction of these wonderful traditional remedies is very successful.

In the normal reaction of the body you can safely gargle the throat in cases of tonsillitis, taking 2-3 sips of blue iodine.

In cases of conjunctivitis, 2-3 drops of a specially prepared solution (1 teaspoon of blue iodine dissolved in 10 tablespoons of warm distilled water) can be instilled in eyes in the morning and in the evening within a week. Many patients take a glass of the drug, mixed with fresh juice for better taste, 2-3 times a day before a meal, in cases of diseases of the gastrointestinal tract .

There is a pharmaceutical drug iodinol prepared on the basis of polyvinyl alcohol. Iodinol is also blue iodine. It is also is an excellent antiseptic, non-toxic, inexpensive and a very stable product that can be stored for a long time. The main active substance of iodinol is molecular iodine, which has antiseptic properties. Polyvinyl alcohol is a high molecular compound, a synthetic polymer which gives as a same intensively blue color reaction with the solution of iodine-iodide, as a natural polymer starch.

The content of polyvinyl alcohol in iodinol slows isolation of iodine and prolongs its interaction with tissues of the body. It also reduces the irritating effect of iodine on the tissues. Doctors recommend to use it in cases of chronic tonsillitis, conjunctivitis, purulent edemas, trophic ulcers, septic wound and burns, for disinfection in surgery and gynecology.

In the Russian Federation there was patented a composition for the treatment of dermatomycosis (%): Iodine - 1,6-4,1; Potassium Iodide - 2,9-7,3; polyvinyl alcohol - 8,3-13,4; ethyl alcohol – 14,7 -36,7; glycerin - 3,1-5,0; water - up to 100,0.

The invention is related to medical drugs, in particular to drugs based on iodine. It may be used for the treatment of dermatomycosis such as trichophytosis, microsporia, favus in humans and animals.

The well known treatment of dermatomycosis that includes Miconazole and Clotrimazole creams, medications for the treatment of skin as Chlorhexidine and Eliconazole, as well as lime sulfur and antifungal drugs for oral administration.

The Institute of Emergency in Leningrad has conducted a research on the introduction polymers-iodine like amyl iodine and iodinol in the treatment.
Long-term studies of the properties of aqueous solutions of iodine with starch, polyvinyl alcohol, polyvinylpyrrolidone showed that the biologically active form is a part of the polarized molecule I2 and oxyanions IO-, precisely iodine in a positive monovalent form with the degree of oxidation +1.

In the human body, under the influence of iodide oxidase, nonreactive iodide anion inert coverts into physiologically active I+1. A blue coloration and antiseptic properties of iodine-containing substances are related with exactly this form of iodine. The connection between biological activity of halogen compounds and their coloring is proved in this way.

Widely used drug Lipiodol was developed by the Guerbet laboratory in Paris. It is poppyseed oil, 38% of which is iodine. The drug is deposited in the skin and is slowly absorbed into the blood. One capsule of Lipiodol contains 200 mg of iodine.

The Institute for Scientific Research attached to Emergency hospital named after N.V. Sklifosovsky together with the Department of Medical Purpose Biopolymers of the National Scientific and Research Experimental Institution developed a medical composition that contains an immobilized biocompatible copolymer of iodine which has expressed bactericidal properties. The drug contains 1.5% iodine and was named yodopor.

Yodpolikom, film-forming polymer containing iodine, is used for cleansing preparation an operational field. The concentration of iodine in the form of a film is 33%. In comparison with alcoholic solutions of iodine, Yodpolikom doesn’t irritate the skin. After a cleansing preparation of a surgical field, yodpolikom dries on the skin within 1-2 minutes, forming a solid thin film of brown color, which is insoluble and unwashable in water. The film, besides the hermetic nature and its bactericidal properties , provides a complete bacterial impermeability for a long time (more than one day), and it can be easily removed with alcohol and gradually washes away within 3-5 days.

Due to the ability of Yodpolikom to form a antibacterial film, the drug can be recommended for treatment of postoperative sutures, in the period before and after removal of skin sutures. At that the use of gauze bandage is not obligatory.

Iodine containing substances can be ionic and nonionic. Ionic substances increase the osmolarity of the blood and the plasma. In some cases, they may cause allergic reactions dangerous to the lives of patients. The use of non-ionic contrast agents reduces the risk of complications, and in spite their cost they are much more commonly used for parenteral administration.

Contrast iodine-containing substances may be fat-or water-soluble. Fat-soluble drugs have a higher viscosity and are slowly absorbed by tissues. On this reason they are used only for sialography and hysterosalpingography. The water-soluble drugs with quick absorption, can be used instead barium sulphate for the study of the gastrointestinal tract, if patients have contraindications to the use of barium.

There are also common tablet drugs of prolonged action
• Antistrumin, containing 1000 mcg of potassium iodide
• Iodetten- 100, Iodetten- 200, containing 100 mcg and 200 mcg of potassium iodide, correspondently;

3.3 Prevention and treatment of iodine deficiency disorders

The pioneer of the population wide iodine preventative measures David Marin wrote: "It is easier to prevent the goiter disease than any other disease, it may be crossed out from the list of human diseases as soon as the society will decide to take some efforts in this direction”.

In accordance with WHO, the prevention of micronutrient deficiency is one of the most cost-effective ways of improving the health and well- being of people.

The elimination of iodine deficiency, as one of the reasons of mental retardation, is one of the high-priority issues in the field of nutrition and public health and healthcare.

However, as the health authorities so as the population in many countries underestimate the threat of iodine deficiency for mental and physical potential of the nation.

The international community sets a goal to liquidate iodine deficiency diseases in the whole world.

Global measures taken in the last 20 years have changed the geography of iodine deficiency diseases.

For example, 14 countries in Western and Central Europe have achieved normal levels of iodine intake and liquidated the threat of iodine deficiency diseases. At the same time, iodine deficiency still preserved in many countries, including Kazakhstan

Results of the study, conducted in 1989 in the eastern part of Slovakia, can be used as an example of successful preventative measures of endemic goiter. It was found that with the introduction of iodine preventative care, the frequency of hyperplasia of the thyroid gland decreased from 50% to 25% with the absence of goiters of large and medium sizes.

The European Thyroid Association (1985) came to conclusion that the morbidity of endemic decreased in Bulgaria, the Czech Republic, Slovakia and the Netherlands due to programs iodization.

As it was noted in Shymkent olbats, the sharp and statistically significant attenuation of endemic goiter was marked in all the examined residential areas. In some villages (Mankent, Vysokoye, etc.) it exceeded the rate which was considered the margin for endemic goiter.

In accordance with the Endocrinology Research Center of Russian Academy of Medical Sciences, an insufficient intake of iodine creates a health hazard for 100 million of Russians. It requires organization of constant effective preventive measures against iodine deficiency disorders.

Results of the study of the potential danger of goiter in different territorial geocomplexes of the Republic of Kazakhstan oblige to introduce a differential prevention of goiter throughout the territory of the country. The prevention of endemic goiter, as well as a fight with hypovitaminosis, tuberculosis and other diseases in Kazakhstan, should be a special concern of the Government.

The results of the research about prevalence and severity of iodine deficiency in different regions of the republic, which was conducted by the Academy of Nutrition of the Republic of Kazakhstan in 1999, pointed out to the necessity of activation population-wide iodine preventative measures.

The development of complex measures, which involved the industrial sector in particular producers of salt, all levels of society and active participation of government agencies, led to the adoption of the regulatory and legal framework and its phased introduction. In accordance with the results of researches, there were developed and adopted the following regulatory and legal framework:

• The decree of the Government of the Republic of Kazakhstan by № 1283 of October 5, 2001 "On prevention of iodine deficiency disorders in the population of the Republic of Kazakhstan for 2001 - 2005";

• Special decree of the Government of the Republic of Kazakhstan by № 86 of January 23, 2003 "On ratification of the agreement “On prevention of iodine deficiency disorders in the population of the states-participants of CIS ";

• The law of the Republic of Kazakhstan by № 489 of October 14, 2003 "On prevention of iodine deficiency diseases in the Republic of Kazakhstan."
These studies were taken into consideration while preparing of "State program of reformation and development of Health Care of the Republic of Kazakhstan for the period 2005 - 2010 years", which was approved by the Decree of the President of the Republic of Kazakhstan, in the part on compulsory and free supplementation of pregnant women with iodine containing drugs.

Population-wide iodine preventative care

Conducting of population-wide preventative measures, compounds of iodine (potassium iodide or stable potassium iodate stable) are added to the most common foods: salt, dairy products, bread, water.

There are 4 methods of iodine prevention of endemic goiter in the world:
• iodized salt in North America, Europe, CIS countries;
• iodization of bread in Australia, the Netherlands;
• iodized oil: South America, New Guinea;
• intake of iodine drugs.

There are other ways to prevent iodine deficiency. There were attempts to iodinate tap water, but this method didn’t meet expectations. Tea is iodized in Tajikistan. There are ideas to iodinate soil with iodine-containing fertilizers.

The main way to liquidate iodine deficiency is universal salt iodization.
Iodine iodized salt is used in food and water to cope with more or less lack of iodine; it usually contains 10 - 25 g of Potassium Iodide per 1 ton of salt. The use of iodized salt in practice is the easiest, cheapest and the most effective way of population-wide iodine preventative care. However, this method has some drawbacks.

Iodized salt consumption is related with meeting of certain conditions:
• Firstly, it maintains its properties only within 3-4 months;
• Secondly, iodine is almost completely evaporated from it by boiling;
• Thirdly, iodine can also evaporate from the salt, slightly wetted, or stored in open containers.

In Russia, in the late nineties salt production increased almost in 10 times due to measures taken by the Government the Russian Federation, as well as due to serious efforts of enterprises of salt industries, which received assistance from UNICEF for reconstruction of equipment for salt iodization and quality control.

Replacement of unstable Potassium Iodide by more stable potassium iodate and increase of iodine content in the mass of salt dramatically increased the quality of iodized salt. Storage time of it increased from 3 months to 12 months.

The use of iodized salt is a basic way to prevent iodine deficiency diseases, it is able to eliminate iodine deficiency. There are no more effective program of prevention of iodine deficiency in the Health Care practice.

The world practice has shown that there is no alternative to iodized salt for a large scale national program of iodine preventative care.
Basing on the international experience it can be said that iodine preventative care with the use of iodized salt is completely safe.

More commonly table salt is iodized. The main method used for the wide-population preventative care is iodization of table salt by means of adding of iodide or iodate in concentrations ranging from 7 to 100 mg of iodine per 1 kg of salt depending on the legislation of the country.

In most countries, potassium iodide is added to salt in the amount of 20-40 mcg / kg, what corresponds to 15-30 mcg of iodine ions per 1 g of salt.

In 1998, in Russia, by the decision of Chief Sanitary Doctor there was adopted a new standard for population-wide prevention care due to which table salt is iodized by adding of 40 ± 15 mg of potassium iodate, which is thermally stable and more stable than iodide, per 1 kg of salt. At that it is taken into account that the consumption of a healthy adult is about 10 g of salt per day, what effectively solves the issue of elimination of iodine deficiency in adults. However, they continue to produce table salt with an addition of potassium iodide in the amount of 25 mg / kg with the purpose of population wide prevention care.

Several studies have noted the effectiveness of use of iodized salt for the improvement of the iodine status in the population and the lack of serious side effects.

Generally, over the past 20 years, the problem of iodine deficiency has been solved with the introduction of salt iodization programs in developed countries.
Epidemiological studies point to transient increase in the morbidity of thyrotoxicosis in the older age group in the first 3-5 years after the introduction of universal salt iodization. The reason is a manifestation of a hidden toxic nodular goiter that occurs even with a small increase in iodine intake.

Hereafter the conduct of population-wide preventive care will lead to a significant reduction in the prevalence of all forms of goiter, including toxic multinodular goiter.

Population-wide iodine preventive care should be carried out continuously in areas of iodine deficiency. At that positive effects in the population level are observed in a considerably long period of time. For example, a reduction in the frequency of endemic goiter from 25 to 1.3% was observed in Turkish schoolchildren, living in the region with moderate iodine deficiency, in 10 years after the introduction of mass of salt iodization.

Population-wide iodine preventive measures help to reduce the tension of iodine deficiency in the population. However, moderate and light iodine deficiency is preserved in the population what is explained with a lack of necessary social conditions.

Group iodine preventive measures

At certain periods of life (teenage period, pregnancy, breast-feeding) the need for microelements increases and the body needs regular additional intake of physiological doses. The group iodine preventive care ma y be recommended in these cases.

The group iodine preventive care is conducted at scale of certain groups at a high risk of development of iodine deficiency diseases: children, teenagers, pregnant and lactating women, persons of childbearing age.

The group prevention is carried out by a regular long-term intake of drugs, containing a fixed physiological dose of iodine:
• for children under 12 - 50-100 mcg per day;
• for teenagers and adults - 100 - 200 mcg per day;
• during pregnancy and during breast feeding - 200 mcg per day.

The most effective group preventive care is in organized groups of the population - kindergartens, schools and orphanages.
There was conducted the analysis of the use of iodine additives in children. In most studies, iodized oil was used as an additive, other forms of iodine additives were used in other studies.

It is proved that iodine additives are an effective measure for reducing of the goiter frequency and improvement of the iodine status in children.
There were marked positive effects of iodine additives on the physical and mental development, as well as on reducing of child mortality.

Only 1.8% of children had side effects of iodine additives, and the most side effects were mild and temporary.

Individual iodine preventive measures

It is conducted in individuals by long-term use of drugs containing physiological doses of iodine.

The need for iodine increases during the organism growth, especially at the age of 6-9 and 13-15 years and for women during pregnancy and lactation, with high psycho-emotional and physical stress, trauma, intoxication, infections with prolonged febrile period, with supercooling of the body. The pathological state of the thyroid gland (apart of thyrotoxicosis) requires a greater amount of iodine intake, which may increase up to 400-500 mcg per day.

Currently, according to accepted standards in Russia, "Potassium iodide" drug is prescribed for the group and individual iodine preventive care. The recommended dose of potassium iodide for the group and individual preventive care among high-risk groups of development of iodine deficiency diseases: children under 12 - 50-100 mcg, teenagers and adults - 100-200 mg, pregnant and lactating women - 200 mcg, 1 time per day for a long time .

It was revealed that even in areas with adequate iodine intake without additional intake of iodine additives there were observed signs of iodine deficiency in 92% of pregnant women. It was also revealed that even after the introduction of population-wide iodine preventive care be means of iodized salt there was observed moderate increase in the frequency of hypothyroidism in a population that develops in the groups of young and middle age, who previously had iodine deficiency. These facts point out to the need of the group and individual iodine preventive care, even after the successful introduction of the population-wide iodine preventive care.

Never use iodized salt for pickling cucumbers or cabbage. Pickles either will ferment or acquire a bitter taste.
Potassium iodide is decomposed during storage, iodine evaporates (sublimates), so that iodized salt has a small store time.

It is not desirable to use iodized salt for marinating and pickling of products. Loss of iodine is increased by heating of salt under influence of sunlight, high humidity and aeration.

In the production of iodized salt, iodine compounds are added in an the amount of, for example, 25 g of potassium iodide per 1 tonne of salt. At that it is possible uneven distribution of small amounts of iodine in the total mass. It is not possible to know the exact dose of iodine at consumption of salt that contains both iodide and potassium iodate. It is possible to get overdose of non organic compound of iodine, from one part of the product while another part of the product will not contain iodine.

It should also taken into consideration that a lot of people adhere to the principles of healthy nutrition. They either exclude salt from the diet or significantly limit its intake.

In recent years, public health organizations, promote limited consumption of salt as a measure of lowering of hyperpiesis and reducing of a risk of cardiovascular diseases.

Since iodized salt is important in the fight against iodine deficiency, the propaganda of limited use of salt led to an overall decrease in iodine intake in many developed countries.

For example, the public health survey of iodine content in urine, conducted in early 1970 in the USA, found that every fortieth resident suffers from moderate and severe iodine deficiency. This research, taken in 20 years, has revealed moderate and severe iodine deficiency in every ninth citizen.

Potassium iodide, recommended as a standard, for the group and individual iodine preventive care has many side effects, especially with a long-time administration, and contraindications.
Recently there is wide spread practice of iodizing of other products apart iodization of salt. Iodine is added in some other bakery products, milk.

In 1993, in Russia, a receipt and a health certificate were developed and approved, in the established order. According to this certificate 60 mg of potassium iodide are added per 100 kg of flour. For the convenience of consumers, bread was baked in the form of bars with weight of 300 g. After baking a standard bar of iodized bread contained about 100-120 mcg of iodine.

In remote regions with bad and unreliable means of communication, the transportation of iodized salt is difficult or not possible. The prevention of iodine deficiency disease is done with the help of iodized oil.

The use of the safest but not less effective iodine containing drugs is the most important issue for the group and individual iodine prevention care.

Thus, the Endocrinology Research Center (Moscow) studied the effectiveness of potassium iodide tablets produced by "Merck" (Germany). One tablet of the drug contained a physiological concentration of potassium iodide. The effectiveness of this drug was tested in rural schools of the area with mild and moderate deficiency.

The results of the conducted studies revealed that a daily intake of 100 mcg of potassium iodide normalizes indications of iodine metabolism in children without causing side effects.

The use of Lipiodol drug. Providing the program of iodine deficiency prevention with Lipiodol drug does not require large material costs, specially trained personnel, labor-intensive programs of monitoring and controlling. The drug is taken orally 1 time a year and the effect lasts up to 2 - 3 years at intramuscular injection.

Prolongation of the action is due to the fact that iodinated fatty acids in the body are used for the synthesis of fatty tissue, iodine slowly enters in the bloodstream while fat metabolism.

Taking into consideration advantages of organic compounds of iodine compared to its inorganic forms, dietary supplements containing organic forms of iodine are used more widely in the last years together with traditional ways of iodine prevention care with help of iodized salt.

At the present time polymers-iodine are widely used in the treatment of iodine deficiency diseases.

The first sign of iodine deficiency in the body is extreme tiredness, fatigue, irritability, feeling of weakness in the morning. It is necessary to take blue iodine in case of manifestation of these troubling signs. It will help to improve health and maintain a good mood. Blue iodine charges the body with energy that it makes possible easily to refuse from coffee and strong tea.

It is not recommended to take blue iodine 1-2 tsp, 2 times a week for the "prevention of iodine deficiency,": the researches of V.O. Mokhnach showed that a low concentration of blue iodine allows disease-causing microbes in the human body to develop strains which are resistant to its action. V.O. Mokhnach had an individual approach to the treatment of different disease with blue iodine: he treated dysentery giving patients 100 ml of blue iodine 5-6 times a day, and in case of cholera he gave 3 l (!) of the drug per day.

It is better to take it daily not less than 5 tbs within 5 days a month for the prevention of iodine deficiency.

There are following general rules for its intake. If the thyroid gland is healthy it is necessary to take 8 tbs 1 time per day, approximately in 30 minutes after a meal drinking after with drinking jelly: to take it for 5 days and after to have a beak for 5 days or to drink it every other day. Seriously ill people need an individual dosage (1-3 teaspoons), the duration of taking of the drug is individual.

The maximum permissible dose of blue iodine should not be more than 4 teaspoons. The maximum daily dose of blue iodine for an adult is 7-8 teaspoons. This dose should be increased gradually, increasing the dose on 1-2 teaspoons per day. At that it is necessary to drink blue iodine after with milk or drinking jelly.

Blue iodine is absorbed in the upper small intestine within a half an hour and then it gets to the thyroid gland through the bloodstream. This is an important advantage of blue iodine compared to iodine salts.

According to the surviving written sources, remedies made of different types of seaweeds were widely used in the 8th century in Japan and in Chinese medicine. In ancient China, laminaria was used for the treatment of malignant tumors.

In the far north region, coast-dwellers used laminaria in the diet as a source of vitamins and minerals to cope different diseases.

Iodine-elam is a dietary supplement, produced by the Arkhangelsky experimenting seaweed plant. Iodine-elam was created by the research department of "Fitolon-Med" LLC (St. Petersburg).

Iodine-elam is a source of iodine, a gift of the sea, which concentrates all substances in the bio-available, organically bound form, vitally necessary for a human .

Iodine-elam is designed to cope with a lack of iodine, calcium, other microelements and to excrete toxins and radionuclids from the body.

Iodine-Elam is a complex drug containing iodine, laminaria extract, calcium alginate, pharmaceutical aid: microcrystalline cellulose, lactose, polyvinylpyrrolidone and calcium stearate. Each tablet Iodine-Elam contains 80-100 mcg of iodine.

The main component is laminaria extract which is natural and absolutely safe for a human source of organically bound iodine.

Greatest practical value of all of them is calcium alginate. It is an effective enterosorbent which is able to excrete from the intestinal tract, the blood and radionuclids. Functional properties of alginates do not change during thermal conditioning.

Each tablet of Iodine-Elam contains in organically bound, bioavailable form::
• macro-and microelements, normalizing the metabolism: iodine, calcium, potassium, magnesium, manganese, selenium, silver, zinc, cobalt, copper, and others;

• microcrystalline cellulose, which regulates functions of intestinal tract and excrete toxins and wastes from the body.

Iodine, contained in Iodine-Elam, is organically bound with amino acids, and on this reason:
• it is preserved without loss for a long time;
• doesn’t irritate the gastrointestinal tract;
• characterized by good tolerability and a lack of toxicity even with overdose;
• necessary amounts of iodine are well absorbed by the body;

Using of the unique technology, 10-15% of water-soluble substances, in conversion to oven-dry weight, are extracted from air-dried laminaria.

Iodine-elam recommended as a source of iodine to eliminate its deficit in the diet, especially in areas of endemic iodine deficiency:
• normalization of the thyroid gland, the endocrine system, hormonal balance and, consequence, improvement the metabolism;
• for the prevention of calcium deficiency;

• in the complex treatment of mastopathy;
• as a radioprotector;
• to improve mental and physical performance;
• to strengthen the immune system, increase the body's defenses;
• to reduce the manifestations of inflammatory degenerative lesions of periodontal tissues.

Iodine-elam was tested in four schools of the Great Novgorod. Students, from 1st to 10th class, who were under regular medical control regarding the increase in the thyroid gland of 1-2 degrees, daily received one tablet of iodine-Elam within three months. The results of the study have revealed significant decrease in the thyroid gland (at the average on 21.7%), all children reported feeling better.

It was proved experimentally that the substance is Iodine-Elam - EL doesn’t have side effects even at 100-fold excess of the physiological dose. Contraindications to receiving of Iodine-Elam are individual intolerance, thyrotoxicosis and hyperthyroidism, severe renal disease accompanied by renal insufficiency.

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1.Aydinov GT, Schwager, MM, VJ Ryzhkov etc. The structure of nosocomial infections in hospitals in Rostov region and Prevention / / Sat: Current problems of epidemiology, diagnosis and prevention of nosocomial infections. - St. Petersburg., 2003. - Pp. 83-85.

2.Alekseev VA, Mironova Tatyana The effect on intestinal microflora iodinol / / In.: Iodinol in human and veterinary medicine .- L.: Science .- 1967 .- P. 70 - 71.
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