Pub Date : 2020-08-31DOI: 10.31082/1728-452x-2020-213-214-3-4-74-81
Aizhan Magazova, Aigul Balmukhanova, Elmira Kanafyanova, I. Shargorodskaya, K. Sharipov
Blindness and low vision, as a social medical problem, occupy one of the leading places in both healthcare and the state economy. Diabetic retinopathy (DR) is a vision-threatening microvascular disease, the most common diabetes complication that affects the retina, causing blindness among working-age adults in developed countries. Difficulties in determining the starting, key pathogenetic links and early diagnosis of this disease do not allow to accurately determine the initial moment of occurrence, and known treatment methods are aimed, as a rule, at slowing down the pathological process. Purpose. Analysis of literature data on the clinical and diagnostic features of diabetic retinopathy. Material and methods. To analyze the literature, information was searched on this problem up to 10 years deep in PubMed / MEDLINE, PMC, Web of Since. For the search, the following terms were used individually or in combination: "diabetes mellitus", "diabetic retinopathy", "diabetic vasculopathy", "optical coherence tomography", "fluorescence angiography", "complications". The search criteria were key studies related to diabetic retinopathy, vasculopathy: meta-analyzes, original studies, retrospective and cohort studies. Results and discussions. Oxygen from the capillary layer of the choroid through the Bruch membrane and retinal pigment epithelium (RPE) gets to the outer retinal layers. Due to complications in the bloodstream, nutrition is impaired which leads to diabetic retinal changes. It is advisable and necessary to study changes in the structures of the choroid in large samples using angio-OCT, since changes in the choroid can be the primary prognostic markers of the development of diabetes in the absence of clinical manifestations of diabetic retinopathy. Conclusion. Changes in the structure of the choroid can become a marker for predicting the development of DR in patients with type 2 diabetes, more accurately and quickly establish a diagnosis in the early stages of the disease, and prescribe appropriate therapy in a timely manner. As a result, patients receive timely care and treatment costs will decrease. Keywords: diabetes mellitus, diabetic retinopathy, choroid, diabetic choriopathy, OCT angiography, choroid structures.
失明和弱视作为一个社会医疗问题，在卫生保健和国家经济中都占有重要地位。糖尿病视网膜病变(DR)是一种威胁视力的微血管疾病，是影响视网膜的最常见的糖尿病并发症，在发达国家导致工作年龄成年人失明。确定这种疾病的发病、关键发病环节和早期诊断的困难，使得无法准确确定发病的初始时刻，而已知的治疗方法通常旨在减缓病理过程。目的。糖尿病视网膜病变临床及诊断特点的文献资料分析。材料和方法。为了分析文献，我们在PubMed / MEDLINE, PMC, Web of Since中检索了近10年来关于这一问题的信息。对于搜索，以下术语被单独或组合使用:“糖尿病”、“糖尿病视网膜病变”、“糖尿病血管病变”、“光学相干断层扫描”、“荧光血管造影”、“并发症”。检索标准是与糖尿病视网膜病变、血管病变相关的关键研究:荟萃分析、原始研究、回顾性研究和队列研究。结果和讨论。氧气从脉络膜的毛细血管层通过Bruch膜和视网膜色素上皮(RPE)到达视网膜外层。由于血流并发症，营养受损，导致糖尿病视网膜改变。在没有糖尿病视网膜病变临床表现的情况下，使用血管oct研究大样本中脉络膜结构的变化是可取和必要的，因为脉络膜的变化可以作为糖尿病发展的主要预后标志。结论。脉络膜结构的改变可以成为预测2型糖尿病患者DR发展的标志，在疾病早期更准确、快速地建立诊断，及时给予相应的治疗。因此，患者得到及时的护理和治疗费用将降低。关键词:糖尿病，糖尿病视网膜病变，脉络膜，糖尿病脉络膜病变，OCT血管造影，脉络膜结构。
{"title":"Structural choroidaid changes in diabetic retinopathy","authors":"Aizhan Magazova, Aigul Balmukhanova, Elmira Kanafyanova, I. Shargorodskaya, K. Sharipov","doi":"10.31082/1728-452x-2020-213-214-3-4-74-81","DOIUrl":"https://doi.org/10.31082/1728-452x-2020-213-214-3-4-74-81","url":null,"abstract":"Blindness and low vision, as a social medical problem, occupy one of the leading places in both healthcare and the state economy. Diabetic retinopathy (DR) is a vision-threatening microvascular disease, the most common diabetes complication that affects the retina, causing blindness among working-age adults in developed countries. Difficulties in determining the starting, key pathogenetic links and early diagnosis of this disease do not allow to accurately determine the initial moment of occurrence, and known treatment methods are aimed, as a rule, at slowing down the pathological process. Purpose. Analysis of literature data on the clinical and diagnostic features of diabetic retinopathy. Material and methods. To analyze the literature, information was searched on this problem up to 10 years deep in PubMed / MEDLINE, PMC, Web of Since. For the search, the following terms were used individually or in combination: \"diabetes mellitus\", \"diabetic retinopathy\", \"diabetic vasculopathy\", \"optical coherence tomography\", \"fluorescence angiography\", \"complications\". The search criteria were key studies related to diabetic retinopathy, vasculopathy: meta-analyzes, original studies, retrospective and cohort studies. Results and discussions. Oxygen from the capillary layer of the choroid through the Bruch membrane and retinal pigment epithelium (RPE) gets to the outer retinal layers. Due to complications in the bloodstream, nutrition is impaired which leads to diabetic retinal changes. It is advisable and necessary to study changes in the structures of the choroid in large samples using angio-OCT, since changes in the choroid can be the primary prognostic markers of the development of diabetes in the absence of clinical manifestations of diabetic retinopathy. Conclusion. Changes in the structure of the choroid can become a marker for predicting the development of DR in patients with type 2 diabetes, more accurately and quickly establish a diagnosis in the early stages of the disease, and prescribe appropriate therapy in a timely manner. As a result, patients receive timely care and treatment costs will decrease. Keywords: diabetes mellitus, diabetic retinopathy, choroid, diabetic choriopathy, OCT angiography, choroid structures.","PeriodicalId":14842,"journal":{"name":"Journal \"Medicine\"","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76442764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-08-31DOI: 10.31082/1728-452x-2020-213-214-3-4-64-73
Nazira Zharkinbekov
Chronic сеrebral ischemia is one of the leading causes of morbidity, mortality and disability in the Republic of Kazakhstan. According to the data from Ministry of Healthcare of the Republic of Kazakhstan, the overall morbidity of the country’s population due to diseases of the circulatory system registered in health care organizations has increased almost three times from 1998 to 2017 over the past 20 years. According to world publications, on average, the incidence of Chronic сеrebral ischemia in the world is relatively high among the elderly, occurring in two-thirds of people over 65 years of age. It is also observed in 50% of people aged 50 to 65 years and in 25% of people aged 45 to 50 years. Purpose. To review of epidemiological data, risk factors, causes, pathogenetic mechanisms, diagnostic algorithms and principles of treatment of Chronic сеrebral ischemia. Material and methods. The literature review on Chronic сеrebral ischemia data was conducted using the Pubmed search engine in Medline electronic databases from 2009 to 2019. Results and discussion. A total of 45 research papers were included. This review examines epidemiological data, risk factors, causes, pathogenetic mechanisms, diagnostic algorithms and principles of therapy for Chronic сеrebral ischemia disease. In the etiopathogenesis of Chronic сеrebral ischemia, a significant part is played by the combination of risk factors known as vascular comorbidity and being the main cause of deaths. Vascular comorbidity is characterized by the involvement into a single pathological process of all risk factors that form Chronic сеrebral ischemia, which lead to a change in cerebral circulation with hypoxia of the brain substance and a cascade of biochemical changes, and subsequently results in diffuse, multi-focal changes in the brain substance. In a case of comorbidity of the atherosclerotic process with dyslipidemia, narrowing of the lumen of the arteries with an increase in the permeability of their wall membranes can be observed, with further damage to the endothelium, activation of synthesis by leukocytes, platelets, endotheliocytes of chemotaxis factors, kinins, growth factors, with the accumulation of active oxygen, peroxidation with the formation of oxidative stress. Chronic сеrebral ischemia therapy with vascular comorbidity, in which all risk factors are В тексте переправлены стилистические и ортографические ошибки. involved in a single pathological process, provides the prevention of polypragmasia, and the assignment of certain pathogenetic drugs aimed at the same pathogenesis that leads to the formation of Chronic сеrebral ischemia. Conclusion. It is most rational to use an antioxidant/antihypoxant in therapy. Such pathogenetic drugs include antioxidant therapy. Among other antioxidants/antihypoxants used in routine practice, Mexidol (ethylmethylhydroxypyridine succinate) is characterized with the strongest evidence base. Keyword: chronic brain ischemia, chronic cerebral circula
{"title":"Chronic cerebral ischemia: review of published works, pathogenetic approaches to therapy","authors":"Nazira Zharkinbekov","doi":"10.31082/1728-452x-2020-213-214-3-4-64-73","DOIUrl":"https://doi.org/10.31082/1728-452x-2020-213-214-3-4-64-73","url":null,"abstract":"Chronic сеrebral ischemia is one of the leading causes of morbidity, mortality and disability in the Republic of Kazakhstan. According to the data from Ministry of Healthcare of the Republic of Kazakhstan, the overall morbidity of the country’s population due to diseases of the circulatory system registered in health care organizations has increased almost three times from 1998 to 2017 over the past 20 years. According to world publications, on average, the incidence of Chronic сеrebral ischemia in the world is relatively high among the elderly, occurring in two-thirds of people over 65 years of age. It is also observed in 50% of people aged 50 to 65 years and in 25% of people aged 45 to 50 years. Purpose. To review of epidemiological data, risk factors, causes, pathogenetic mechanisms, diagnostic algorithms and principles of treatment of Chronic сеrebral ischemia. Material and methods. The literature review on Chronic сеrebral ischemia data was conducted using the Pubmed search engine in Medline electronic databases from 2009 to 2019. Results and discussion. A total of 45 research papers were included. This review examines epidemiological data, risk factors, causes, pathogenetic mechanisms, diagnostic algorithms and principles of therapy for Chronic сеrebral ischemia disease. In the etiopathogenesis of Chronic сеrebral ischemia, a significant part is played by the combination of risk factors known as vascular comorbidity and being the main cause of deaths. Vascular comorbidity is characterized by the involvement into a single pathological process of all risk factors that form Chronic сеrebral ischemia, which lead to a change in cerebral circulation with hypoxia of the brain substance and a cascade of biochemical changes, and subsequently results in diffuse, multi-focal changes in the brain substance. In a case of comorbidity of the atherosclerotic process with dyslipidemia, narrowing of the lumen of the arteries with an increase in the permeability of their wall membranes can be observed, with further damage to the endothelium, activation of synthesis by leukocytes, platelets, endotheliocytes of chemotaxis factors, kinins, growth factors, with the accumulation of active oxygen, peroxidation with the formation of oxidative stress. Chronic сеrebral ischemia therapy with vascular comorbidity, in which all risk factors are В тексте переправлены стилистические и ортографические ошибки. involved in a single pathological process, provides the prevention of polypragmasia, and the assignment of certain pathogenetic drugs aimed at the same pathogenesis that leads to the formation of Chronic сеrebral ischemia. Conclusion. It is most rational to use an antioxidant/antihypoxant in therapy. Such pathogenetic drugs include antioxidant therapy. Among other antioxidants/antihypoxants used in routine practice, Mexidol (ethylmethylhydroxypyridine succinate) is characterized with the strongest evidence base. Keyword: chronic brain ischemia, chronic cerebral circula","PeriodicalId":14842,"journal":{"name":"Journal \"Medicine\"","volume":"55 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73780084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-08-31DOI: 10.31082/1728-452x-2020-213-214-3-4-8-16
A. Avdeyev, M. Mukarov, S. Zhaugasheva, L. Piven, Tatyana Kim
Riociguat is included in international guidelines and local clinical protocols for the treatment of pulmonary hypertension (PH) and chronic thromboembolic pulmonary hypertension (CTEPH), where it is the first choice drug for the treatment of patients with inoperable, persistent and recurrent forms of CTEPH. Therefore, it is necessary to include this drug in the GVoFMC (The Guaranteed Volume of Free Medical Care) reimbursement lists and the CSHI (Compulsory Social Health Insurance) system, which will alleviate access to medication for patients suffering from PH and CTEPH. Purpose of the study. Determination of the cost effectiveness parameters of using riociguat in comparison with bosentan and combined therapy of bosentan/sildenafil in medication therapy of CTEPH. Material and methods. A Markov model of CTEPH dynamics in patients with riociguat prescription was developed in comparison with application of bosentan and sildenafil. Modeling step was 16 weeks, modeling horizon – 10 years. Direct medical costs per patient were taken into account in the model, including the cost of drug therapy, costs of outpatient visits due to CTEPH, hospitalization costs due to clinical deterioration of CTEPH, emergency calls. Results and discussion. The results of “cost-effectiveness” Markov pharmacoeconomic modeling showed that riociguat application reveals a dominant position in comparison with the practice of using bosentan with addition of sildenafil for specific therapy at deterioration of patient's condition up to III-IV functional class (FC). Riociguat is characterized by the best values of “cost effectiveness” coefficients according to efficiency criterion of FC increase and the “value of 6-min walk distance test”. The results of analysis of the impact on budget showed that inclusion of riociguat in GVoFMC/CSHI will lead to budget savings of 154 million tenge in the first year, 294 million tenge in the second year and 415 million tenge in the third year compared to the existing clinical practice without riociguat use. Conclusions. On the basis of conducted complex pharmacoeconomic analysis, the application of riociguat in patients with inoperable or persistent/ recurrent form of CTEPH is a more preferable strategy in comparison with the strategy of application of bosentan with addition of sildenafil and will allow to reduce budget expenses within the framework of GVoFMC and CSHI system. Keywords: pulmonary hypertension, chronic thromboembolic pulmonary hypertension, riociguat.
{"title":"Clinical and economic evaluation of the effectiveness of the use of Riociguat for the treatment of patients with inoperable, recurrent or persistent chronic thromboembolic pulmonary hypertension under the conditions of the Republic of Kazakhstan","authors":"A. Avdeyev, M. Mukarov, S. Zhaugasheva, L. Piven, Tatyana Kim","doi":"10.31082/1728-452x-2020-213-214-3-4-8-16","DOIUrl":"https://doi.org/10.31082/1728-452x-2020-213-214-3-4-8-16","url":null,"abstract":"Riociguat is included in international guidelines and local clinical protocols for the treatment of pulmonary hypertension (PH) and chronic thromboembolic pulmonary hypertension (CTEPH), where it is the first choice drug for the treatment of patients with inoperable, persistent and recurrent forms of CTEPH. Therefore, it is necessary to include this drug in the GVoFMC (The Guaranteed Volume of Free Medical Care) reimbursement lists and the CSHI (Compulsory Social Health Insurance) system, which will alleviate access to medication for patients suffering from PH and CTEPH. Purpose of the study. Determination of the cost effectiveness parameters of using riociguat in comparison with bosentan and combined therapy of bosentan/sildenafil in medication therapy of CTEPH. Material and methods. A Markov model of CTEPH dynamics in patients with riociguat prescription was developed in comparison with application of bosentan and sildenafil. Modeling step was 16 weeks, modeling horizon – 10 years. Direct medical costs per patient were taken into account in the model, including the cost of drug therapy, costs of outpatient visits due to CTEPH, hospitalization costs due to clinical deterioration of CTEPH, emergency calls. Results and discussion. The results of “cost-effectiveness” Markov pharmacoeconomic modeling showed that riociguat application reveals a dominant position in comparison with the practice of using bosentan with addition of sildenafil for specific therapy at deterioration of patient's condition up to III-IV functional class (FC). Riociguat is characterized by the best values of “cost effectiveness” coefficients according to efficiency criterion of FC increase and the “value of 6-min walk distance test”. The results of analysis of the impact on budget showed that inclusion of riociguat in GVoFMC/CSHI will lead to budget savings of 154 million tenge in the first year, 294 million tenge in the second year and 415 million tenge in the third year compared to the existing clinical practice without riociguat use. Conclusions. On the basis of conducted complex pharmacoeconomic analysis, the application of riociguat in patients with inoperable or persistent/ recurrent form of CTEPH is a more preferable strategy in comparison with the strategy of application of bosentan with addition of sildenafil and will allow to reduce budget expenses within the framework of GVoFMC and CSHI system. Keywords: pulmonary hypertension, chronic thromboembolic pulmonary hypertension, riociguat.","PeriodicalId":14842,"journal":{"name":"Journal \"Medicine\"","volume":"78 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78211704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-08-31DOI: 10.31082/1728-452x-2020-213-214-3-4-40-45
A. Bukatov, Akhmetkali Dyussupov, S. Dzhumabekov, Olga Van, Aldyar Massalov, Meyram Zhandauletova
Fractures of the lower limb not only lead to temporary disability, they can also be the cause of a patient's permanent disability. Despite numerous treatment methods, there is currently no precise definite technique. The requirement for all fracture treatment methods is minimally invasive and minimal complications. One of such methods for treatment shin bone fractures is extrafocal uniplanar osteosynthesis. Purpose. To evaluate the effectiveness of the treatment of extrafocal uniplanar transosseous osteosynthesis in case of fractures of the shin bones. Material and methods. The results of the treatment of 98 patients with a shin bone fracture treated with the new technique, developed and tested by uniplanar transosseous osteosynthesis in the Emergency Hospital, Department of Polytrauma and Orthosurgery, are shown for the first time. Patients were divided into two groups, in the 1st group of the research (GR) we used the proposed technique, in the 2nd group of the comparison (GC) was used the G.A. Ilizarov method. Results and discussion. In group patients with GR, the duration of inpatient treatment was halved, the positive results of treatment increased by 1.4 times, and the terms of outpatient treatment were also significantly reduced. Negative treatment results were reduced by 2.6 times, peri-spoke inflammatory processes were reduced by 4.2%. Conclusion. The recommended treatment method, in contrast to the traditional one, showed the most positive result. Due to the simplified version of the apparatus and a small number of components, it is less traumatic thereby reducing the number of complications. Keywords: fractures, extra focal osteosynthesis, minimally invasive, knitting needles with persistent pads.
{"title":"Treatment of fractures of the shin bones with extrafocal uniplanar osteosynthesis","authors":"A. Bukatov, Akhmetkali Dyussupov, S. Dzhumabekov, Olga Van, Aldyar Massalov, Meyram Zhandauletova","doi":"10.31082/1728-452x-2020-213-214-3-4-40-45","DOIUrl":"https://doi.org/10.31082/1728-452x-2020-213-214-3-4-40-45","url":null,"abstract":"Fractures of the lower limb not only lead to temporary disability, they can also be the cause of a patient's permanent disability. Despite numerous treatment methods, there is currently no precise definite technique. The requirement for all fracture treatment methods is minimally invasive and minimal complications. One of such methods for treatment shin bone fractures is extrafocal uniplanar osteosynthesis. Purpose. To evaluate the effectiveness of the treatment of extrafocal uniplanar transosseous osteosynthesis in case of fractures of the shin bones. Material and methods. The results of the treatment of 98 patients with a shin bone fracture treated with the new technique, developed and tested by uniplanar transosseous osteosynthesis in the Emergency Hospital, Department of Polytrauma and Orthosurgery, are shown for the first time. Patients were divided into two groups, in the 1st group of the research (GR) we used the proposed technique, in the 2nd group of the comparison (GC) was used the G.A. Ilizarov method. Results and discussion. In group patients with GR, the duration of inpatient treatment was halved, the positive results of treatment increased by 1.4 times, and the terms of outpatient treatment were also significantly reduced. Negative treatment results were reduced by 2.6 times, peri-spoke inflammatory processes were reduced by 4.2%. Conclusion. The recommended treatment method, in contrast to the traditional one, showed the most positive result. Due to the simplified version of the apparatus and a small number of components, it is less traumatic thereby reducing the number of complications. Keywords: fractures, extra focal osteosynthesis, minimally invasive, knitting needles with persistent pads.","PeriodicalId":14842,"journal":{"name":"Journal \"Medicine\"","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72766399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-08-31DOI: 10.31082/1728-452x-2020-213-214-3-4-53-58
B. Issayeva, S. Soloviev, E. Aseeva, M. Saparbayeva
Clinical manifestations of COVID-19 coronavirus infection have similar clinical symptoms to systemic lupus erythematosus (SLE). This article provides a comparative diagnosis of these two diseases. Practical recommendations are also given to doctors for the management of patients with SLE varying degrees of activity in a pandemic coronavirus infection. Key words: systemic lupus erythematosus, COVID-19, treatment.
{"title":"Practical guidelines for the therapy and monitoring of patients with systemic lupus erythematosus during a pandemic COVID-19","authors":"B. Issayeva, S. Soloviev, E. Aseeva, M. Saparbayeva","doi":"10.31082/1728-452x-2020-213-214-3-4-53-58","DOIUrl":"https://doi.org/10.31082/1728-452x-2020-213-214-3-4-53-58","url":null,"abstract":"Clinical manifestations of COVID-19 coronavirus infection have similar clinical symptoms to systemic lupus erythematosus (SLE). This article provides a comparative diagnosis of these two diseases. Practical recommendations are also given to doctors for the management of patients with SLE varying degrees of activity in a pandemic coronavirus infection. Key words: systemic lupus erythematosus, COVID-19, treatment.","PeriodicalId":14842,"journal":{"name":"Journal \"Medicine\"","volume":"40 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90183957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-08-31DOI: 10.31082/1728-452x-2020-213-214-3-4-33-39
Raushan Idrissova, Farida Mustafaeva, Madina Zhaksybek, Z. Idrissova
In the perinatal and early postnatal period, congenital (antenatal) and intrauterine (intra- and perinatal) CMV are more often manifested by lesions of the liver, brain and organ of vision. Objective. To study the effect of pathogenetic therapy with the metabolic and hepatoprotective drug N-Pentoxinial on the course of persistent CMV/EBV infection of perinatal genesis in children. Material and Methods. The course of latent perinatal cytomegalovirus (CMV) and Epstein-Bar viral infections in children was studied against the background of antiviral treatment (specific against CMV/ EBV immunoglobulin - Neocytect and recombinant alpha-interferon - Viferon No. 10), followed (immediately after 5-7 days after antiviral) by the appointment of 1-2 courses of N-Pentoxinal for 10-20 days. The main group consisted of 20 children (average age 5.4±1.4 years), the control group consisted of 10 children (average age 5.1±1.7 years). All underwent general clinical and virological studies to confirm the diagnosis. Result and discussions. The results obtained indicate that the addition of N-pentoxynial to the basic antiviral therapy for CMV and EBV infection in children improves (accelerates) the elimination of the virus from biological fluids (blood and urine), as well as more rapid normalization of transaminases and alkaline phosphatase. There were no reliably proven allergic reactions. Conclusions. The drug N-Pentoxinial can be prescribed after antiviral therapy for perinatal CMV, EBV infection in order to consolidate the results of antiviral treatment and normalize liver function, especially bile secretion. Keywords: latent perinatal cytomegalovirus/Epstein-Barr viral infection, children, therapy.
{"title":"Results of pathogenetic therapy with the drug N-Pentoxynial in children with current latent CMV/EBV infection","authors":"Raushan Idrissova, Farida Mustafaeva, Madina Zhaksybek, Z. Idrissova","doi":"10.31082/1728-452x-2020-213-214-3-4-33-39","DOIUrl":"https://doi.org/10.31082/1728-452x-2020-213-214-3-4-33-39","url":null,"abstract":"In the perinatal and early postnatal period, congenital (antenatal) and intrauterine (intra- and perinatal) CMV are more often manifested by lesions of the liver, brain and organ of vision. Objective. To study the effect of pathogenetic therapy with the metabolic and hepatoprotective drug N-Pentoxinial on the course of persistent CMV/EBV infection of perinatal genesis in children. Material and Methods. The course of latent perinatal cytomegalovirus (CMV) and Epstein-Bar viral infections in children was studied against the background of antiviral treatment (specific against CMV/ EBV immunoglobulin - Neocytect and recombinant alpha-interferon - Viferon No. 10), followed (immediately after 5-7 days after antiviral) by the appointment of 1-2 courses of N-Pentoxinal for 10-20 days. The main group consisted of 20 children (average age 5.4±1.4 years), the control group consisted of 10 children (average age 5.1±1.7 years). All underwent general clinical and virological studies to confirm the diagnosis. Result and discussions. The results obtained indicate that the addition of N-pentoxynial to the basic antiviral therapy for CMV and EBV infection in children improves (accelerates) the elimination of the virus from biological fluids (blood and urine), as well as more rapid normalization of transaminases and alkaline phosphatase. There were no reliably proven allergic reactions. Conclusions. The drug N-Pentoxinial can be prescribed after antiviral therapy for perinatal CMV, EBV infection in order to consolidate the results of antiviral treatment and normalize liver function, especially bile secretion. Keywords: latent perinatal cytomegalovirus/Epstein-Barr viral infection, children, therapy.","PeriodicalId":14842,"journal":{"name":"Journal \"Medicine\"","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82919491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-08-31DOI: 10.31082/1728-452x-2020-213-214-3-4-82-87
D. Doskabulova, A. Mamyrbaev, A. Tadevosyan, Aiman Kaldybaeva, A. Zheksenova, Кulyan Shayakhmetova, L. Sakebaeva, G. Karashova
The formation of the health of adolescent children is carried out under the influence of many risk factors, including non-medical determinants: lifestyle, socio-economic, household factors and living conditions. Conducting epidemiological studies to identify the leading risk factors for the lifestyle and quality of life of adolescents is currently consistent with the basic directions of development of preventive medicine. Aim. Analysis of literature data, leading factors, the impact of social determinants on the health and well-being of children and adolescents. Material and methods. The choice of publications was made according to keywords that reflected between the indicators of the health of children and adolescents and the factors that influence them. Assessment of the influence of social determinants on the health of children and adolescents made it possible to prepare comprehensive measures to improve the health and health of children and adolescents. Conclusions. In the literature review, the social conditions studied have a decisive influence on the formation of the lifestyle, health and well-being of children and adolescents. Keywords: сhildren, adolescents, social determinant.
{"title":"Influence of social determinants on health and well-being of children and adolescents","authors":"D. Doskabulova, A. Mamyrbaev, A. Tadevosyan, Aiman Kaldybaeva, A. Zheksenova, Кulyan Shayakhmetova, L. Sakebaeva, G. Karashova","doi":"10.31082/1728-452x-2020-213-214-3-4-82-87","DOIUrl":"https://doi.org/10.31082/1728-452x-2020-213-214-3-4-82-87","url":null,"abstract":"The formation of the health of adolescent children is carried out under the influence of many risk factors, including non-medical determinants: lifestyle, socio-economic, household factors and living conditions. Conducting epidemiological studies to identify the leading risk factors for the lifestyle and quality of life of adolescents is currently consistent with the basic directions of development of preventive medicine. Aim. Analysis of literature data, leading factors, the impact of social determinants on the health and well-being of children and adolescents. Material and methods. The choice of publications was made according to keywords that reflected between the indicators of the health of children and adolescents and the factors that influence them. Assessment of the influence of social determinants on the health of children and adolescents made it possible to prepare comprehensive measures to improve the health and health of children and adolescents. Conclusions. In the literature review, the social conditions studied have a decisive influence on the formation of the lifestyle, health and well-being of children and adolescents. Keywords: сhildren, adolescents, social determinant.","PeriodicalId":14842,"journal":{"name":"Journal \"Medicine\"","volume":"88 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83819293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-30DOI: 10.31082/1728-452x-2020-211-212-1-2-55-60
Madina Kaldybayeva, Raushan Idrissova, Z. Urikbaeva, Sergey Khokhulya, Z. Idrissova
In the Repiblic of Kazakhstan in 2018, there was an increase in generalized meningococcal infection (GFMI), which potentially has a risk of high mortality. The aim of the study was to study the clinical features of generalized meningococcal infection (meningococcal meningitis, meningococcal meningitis and mixed-form meningococcal meningitis) during the epidemic upsurge, as well as to evaluate early symptoms of the disease according to new international criteria, 2018. Material and methods. The article describes 59 children aged from 5 months. up to 16 years old. Of these, 35 children (26 boys) with generalized meningococcal infection (GMI): 1 group, age from 0.5 to 10 years with meningitis and meningococcemia (combined GMI) and 2 group, age from 2 to 16 years with meningococcemia - 24 (15 boys). All children underwent a complete clinical and laboratory examination. All children with a retrospective assessment of "red flag" symptoms was performed according to the latest recommendations supported by who the Severity of combined GMI and isolated meningococcemia is almost identical in mortality (8.6% for combined meningitis and meningococcemia and 8.4% for isolated meningococcemia). Results and discussion. In combined GMI, the severity is determined by pleocytosis in the CSF and correlates with inflammatory blood parameters; in isolated meningococcemia, the severity is due to symptoms of shock, primarily cardiovascular insufficiency. Conclusions. Red flag symptoms are particularly significant in children over 3 years of age and adolescents and are specific predictors of septic shock, especially in isolated meningococcemia (83%), but to a slightly lesser extent in combined GMI (71%). Keywords: generalized meningococcal infection, children, epidemic upsurge, meningococcemia, meningitis.
{"title":"Clinical features of meningococcal infection in children during the epidemic upsurge in 2018","authors":"Madina Kaldybayeva, Raushan Idrissova, Z. Urikbaeva, Sergey Khokhulya, Z. Idrissova","doi":"10.31082/1728-452x-2020-211-212-1-2-55-60","DOIUrl":"https://doi.org/10.31082/1728-452x-2020-211-212-1-2-55-60","url":null,"abstract":"In the Repiblic of Kazakhstan in 2018, there was an increase in generalized meningococcal infection (GFMI), which potentially has a risk of high mortality. The aim of the study was to study the clinical features of generalized meningococcal infection (meningococcal meningitis, meningococcal meningitis and mixed-form meningococcal meningitis) during the epidemic upsurge, as well as to evaluate early symptoms of the disease according to new international criteria, 2018. Material and methods. The article describes 59 children aged from 5 months. up to 16 years old. Of these, 35 children (26 boys) with generalized meningococcal infection (GMI): 1 group, age from 0.5 to 10 years with meningitis and meningococcemia (combined GMI) and 2 group, age from 2 to 16 years with meningococcemia - 24 (15 boys). All children underwent a complete clinical and laboratory examination. All children with a retrospective assessment of \"red flag\" symptoms was performed according to the latest recommendations supported by who the Severity of combined GMI and isolated meningococcemia is almost identical in mortality (8.6% for combined meningitis and meningococcemia and 8.4% for isolated meningococcemia). Results and discussion. In combined GMI, the severity is determined by pleocytosis in the CSF and correlates with inflammatory blood parameters; in isolated meningococcemia, the severity is due to symptoms of shock, primarily cardiovascular insufficiency. Conclusions. Red flag symptoms are particularly significant in children over 3 years of age and adolescents and are specific predictors of septic shock, especially in isolated meningococcemia (83%), but to a slightly lesser extent in combined GMI (71%). Keywords: generalized meningococcal infection, children, epidemic upsurge, meningococcemia, meningitis.","PeriodicalId":14842,"journal":{"name":"Journal \"Medicine\"","volume":"120 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87736728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-30DOI: 10.31082/1728-452x-2020-211-212-1-2-67-74
Akmarzhan Rystanbayeva, Aigul Balmukhanova, O. Mashkunova, Kuralay Kaynazarova, Venera Turgumbayeva, S. Abduraimova
To this date, uveitis associated with connective tissue diseases remain relevant due to serious complications that significantly reduce vision and thus worsen the quality of life of patients. Aim. To study the frequency and prevalence, as well as clinical manifestations of ophthalmopathology in connective tissue diseases. Material and methods. A retrospective and prospective study of 534 patients (144 men and 390 women) with connective tissue diseases was conducted, in which ophthalmological disorders were detected. The patients underwent standard rheumatological examination in the department. And also, ophthalmological examination with the determination of visual acuity, intraocular pressure and the use of biomicroscopy, ophthalmoscopy (or cycloscopy). If necessary and possible, additional studies were performed such as: ultrasound B-scan, optical coherence tomography, perimetry. The study examined the type of common disease, age of onset and gender of the patient. Of particular interest were patients with uveal inflammation, in which the localization and nature of the course of inflammation were evaluated. Results and discussion. The most common diseases with eye damage were rheumatoid arthritis (RA) – 129 (24.1%), systemic lupus erythematosus (SLE) – 92 (17.2%), inflammatory bowel disease (IBD) – 95 (17.8%), systemic scleroderma (SDS) – 54 (10.1%) and spondylarthritis (Spa) – 41 (7.8%). In a small percentage of cases, other connective tissue diseases were diagnosed, such as: mixed connective tissue diseases (MCTS) – 24 (4.5%), Overlap syndrome – 21 (3.9%), systemic vasculitis – 23 (4.3%), Behcet's syndrome -18 (3.4%), Sjogren disease – 14 (2.6%) and juvenile idiopathic arthritis - 7 (1.3%). All ophthalmic disorders were divided into four general groups and distributed as follows: inflammatory 27.7%, degenerative 4.9%, vascular 48.7%, side effects of glucocorticoids 18.7%. Uveitis accounted for 52 (9.7%) of all ophthalmopathology, occurring in connective tissue diseases. Unilateral acute anterior uveitis (AAU) was diagnosed in 13 (25%) patients with ankylosing spondylitis, of which 4 (7.8%) had a relapse in the paired eye. Simultaneously, bilateral AAU was detected in 3 (5.7%) patients with Behcet's syndrome. Chronic, recurrent posterior uveitis was diagnosed in 13 (25%) patients with Behcet's systemic vasculitis. All patients with Behcet's syndrome were male at the age of 31±3.1 years. The uveal process approximately started 3.2±1.16 years after the onset of systemic disease. Generalization of inflammation in all departments of uvea was detected in patients with PSA-5 (9.6%), AC – 3 (5.7%), DS – 2 (3.8%) and SLE – 2 (3.8%). In 5 (9.6%) patients, the process was bilateral. Inflammation of the paired eye by the type of AAU was observed in 1 patient and posterior uveitis - in 2 patients. Conclusions. Ophthalmic disorders in the structure of systemic diseases make up 20.2% and vary widely in their clinical manifestations. Chronic blepharoconjuncti
{"title":"Clinical and epidemiological features of visual organ damage in systemic connective tissue diseases","authors":"Akmarzhan Rystanbayeva, Aigul Balmukhanova, O. Mashkunova, Kuralay Kaynazarova, Venera Turgumbayeva, S. Abduraimova","doi":"10.31082/1728-452x-2020-211-212-1-2-67-74","DOIUrl":"https://doi.org/10.31082/1728-452x-2020-211-212-1-2-67-74","url":null,"abstract":"To this date, uveitis associated with connective tissue diseases remain relevant due to serious complications that significantly reduce vision and thus worsen the quality of life of patients. Aim. To study the frequency and prevalence, as well as clinical manifestations of ophthalmopathology in connective tissue diseases. Material and methods. A retrospective and prospective study of 534 patients (144 men and 390 women) with connective tissue diseases was conducted, in which ophthalmological disorders were detected. The patients underwent standard rheumatological examination in the department. And also, ophthalmological examination with the determination of visual acuity, intraocular pressure and the use of biomicroscopy, ophthalmoscopy (or cycloscopy). If necessary and possible, additional studies were performed such as: ultrasound B-scan, optical coherence tomography, perimetry. The study examined the type of common disease, age of onset and gender of the patient. Of particular interest were patients with uveal inflammation, in which the localization and nature of the course of inflammation were evaluated. Results and discussion. The most common diseases with eye damage were rheumatoid arthritis (RA) – 129 (24.1%), systemic lupus erythematosus (SLE) – 92 (17.2%), inflammatory bowel disease (IBD) – 95 (17.8%), systemic scleroderma (SDS) – 54 (10.1%) and spondylarthritis (Spa) – 41 (7.8%). In a small percentage of cases, other connective tissue diseases were diagnosed, such as: mixed connective tissue diseases (MCTS) – 24 (4.5%), Overlap syndrome – 21 (3.9%), systemic vasculitis – 23 (4.3%), Behcet's syndrome -18 (3.4%), Sjogren disease – 14 (2.6%) and juvenile idiopathic arthritis - 7 (1.3%). All ophthalmic disorders were divided into four general groups and distributed as follows: inflammatory 27.7%, degenerative 4.9%, vascular 48.7%, side effects of glucocorticoids 18.7%. Uveitis accounted for 52 (9.7%) of all ophthalmopathology, occurring in connective tissue diseases. Unilateral acute anterior uveitis (AAU) was diagnosed in 13 (25%) patients with ankylosing spondylitis, of which 4 (7.8%) had a relapse in the paired eye. Simultaneously, bilateral AAU was detected in 3 (5.7%) patients with Behcet's syndrome. Chronic, recurrent posterior uveitis was diagnosed in 13 (25%) patients with Behcet's systemic vasculitis. All patients with Behcet's syndrome were male at the age of 31±3.1 years. The uveal process approximately started 3.2±1.16 years after the onset of systemic disease. Generalization of inflammation in all departments of uvea was detected in patients with PSA-5 (9.6%), AC – 3 (5.7%), DS – 2 (3.8%) and SLE – 2 (3.8%). In 5 (9.6%) patients, the process was bilateral. Inflammation of the paired eye by the type of AAU was observed in 1 patient and posterior uveitis - in 2 patients. Conclusions. Ophthalmic disorders in the structure of systemic diseases make up 20.2% and vary widely in their clinical manifestations. Chronic blepharoconjuncti","PeriodicalId":14842,"journal":{"name":"Journal \"Medicine\"","volume":"333 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76366029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-30DOI: 10.31082/1728-452x-2020-211-212-1-2-85-91
Akmarzhan Rystanbayeva, Aigul Balmukhanova, O. Mashkunova, Kuralay Kaynazarova
Ablepsia and hypovision as a social medical problem occupies one of the leading places, both in health care and the economy of the state. Uveitis associated with systemic diseases occur in up to 40% of the population and require an interdisciplinary approach, as they are characterized by polymorphism of clinical manifestations, which makes it difficult to diagnose and treat early, leads to rapid development of complications and disability. Aim. Analysis of literature data on epidemiological and clinical features of uveitis associated with systemic diseases. Material and methods. To analyze the literature, we searched for information about this problem for a period up to 10 years in PubMed/ MEDLINE, PMC, Web of Since. The following terms were used separately or in combination for the search: “uveitis”, “non-infectious uveitis”, “spondylarthritis”, “systemic connective tissue diseases”, “systemic vasculitis”, “complications”, “anti-TNF-α”. The search criteria were key studies related to uveitis and systemic diseases: meta-analyses, original studies, retrospective and cohort studies. Results and discussion. In everyday clinical practice, only close cooperation between rheumatologist and ophthalmologist considering carefully collected anamnestic information, clinical features and course of disease, data of additional examinations contribute to early diagnosis, selection of optimal strategy of treatment, prevention of recurrence and the reduction of visual impairment. Conclusion. All patients with ocular inflammation, especially in the presence of systemic diseases, require the professional attention of clinical medicine specialists. Keywords: inflammatory eye diseases, uveitis, systemic diseases, complications, spondylarthritis, systemic vasculitis, Behcet's syndrome, SLE.
残疾和视力减退作为一个社会医学问题，在国家的卫生保健和经济中都占有重要地位。与全身性疾病相关的葡萄膜炎发生率高达40%，需要跨学科的治疗方法，因为其临床表现具有多态性，难以早期诊断和治疗，导致并发症和残疾的快速发展。的目标。葡萄膜炎合并全身性疾病的流行病学及临床特征的文献资料分析。材料和方法。为了分析文献，我们在PubMed/ MEDLINE, PMC, Web of Since中搜索了长达10年的关于这一问题的信息。以下词语分别或组合使用:“葡萄膜炎”、“非感染性葡萄膜炎”、“脊柱炎”、“全身性结缔组织疾病”、“全身性血管炎”、“并发症”、“抗肿瘤坏死因子-α”。检索标准是与葡萄膜炎和系统性疾病相关的关键研究:荟萃分析、原始研究、回顾性研究和队列研究。结果和讨论。在日常的临床实践中，只有风湿病专家和眼科医生密切合作，结合仔细收集的记忆信息、临床特征和病程、附加检查数据，才能早期诊断，选择最佳治疗策略，预防复发，减少视力损害。结论。所有患有眼部炎症的患者，特别是存在全身性疾病的患者，都需要临床医学专家的专业关注。关键词:炎症性眼病、葡萄膜炎、全身性疾病、并发症、脊柱炎、全身性血管炎、白塞氏综合征、SLE
{"title":"Current issues of ophthalmic rheumatology","authors":"Akmarzhan Rystanbayeva, Aigul Balmukhanova, O. Mashkunova, Kuralay Kaynazarova","doi":"10.31082/1728-452x-2020-211-212-1-2-85-91","DOIUrl":"https://doi.org/10.31082/1728-452x-2020-211-212-1-2-85-91","url":null,"abstract":"Ablepsia and hypovision as a social medical problem occupies one of the leading places, both in health care and the economy of the state. Uveitis associated with systemic diseases occur in up to 40% of the population and require an interdisciplinary approach, as they are characterized by polymorphism of clinical manifestations, which makes it difficult to diagnose and treat early, leads to rapid development of complications and disability. Aim. Analysis of literature data on epidemiological and clinical features of uveitis associated with systemic diseases. Material and methods. To analyze the literature, we searched for information about this problem for a period up to 10 years in PubMed/ MEDLINE, PMC, Web of Since. The following terms were used separately or in combination for the search: “uveitis”, “non-infectious uveitis”, “spondylarthritis”, “systemic connective tissue diseases”, “systemic vasculitis”, “complications”, “anti-TNF-α”. The search criteria were key studies related to uveitis and systemic diseases: meta-analyses, original studies, retrospective and cohort studies. Results and discussion. In everyday clinical practice, only close cooperation between rheumatologist and ophthalmologist considering carefully collected anamnestic information, clinical features and course of disease, data of additional examinations contribute to early diagnosis, selection of optimal strategy of treatment, prevention of recurrence and the reduction of visual impairment. Conclusion. All patients with ocular inflammation, especially in the presence of systemic diseases, require the professional attention of clinical medicine specialists. Keywords: inflammatory eye diseases, uveitis, systemic diseases, complications, spondylarthritis, systemic vasculitis, Behcet's syndrome, SLE.","PeriodicalId":14842,"journal":{"name":"Journal \"Medicine\"","volume":"96 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87425997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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