Вестник Института последипломного образования в сфере здравоохранения Республики Таджикистан

ANTIDESTRUCTIVE ACTION OF GLUCOCORTICOIDS AT EARLY REUMATOID ARTHRITIS
30.10.2015

Ahunova N.T., Holova Z.U., *Niyazov F.I.

ANTIDESTRUCTIVE ACTION OF GLUCOCORTICOIDS AT EARLY REUMATOID ARTHRITIS

Department of Therapy of the State Education Establishment “Institute of Postgraduate Education in Health Sphere of Republic of Tajikistan”

*Department of Internal Disease № 3 of the Tajik Medical State University named after Abuali-ibn-Sino

Aim. Study of antidestructiveactionsofglucocorticosteroids on the background of the basic treatment of early rheumatoid arthritis by methotrexate.

Materials and methods. Present results of treatment of 42 patients (all women) in the age of 32 to 58 years (mean 45 years). Duration of disease from 0,5 to 2 years with a valid RA (ARA criteria, 1987), observed during the year. Exclusion criteria were the presence of stomach ulcer or 12-duodenal ulcer. Patients with IV stage of radiographic disease. All patients were divided into two groups: 1 – 22 persons receiving methotrexate 10 mg per week and glucocorticosteroids7.5mg / day; 2 – 20 patients treated only by methotrexate. Nonsteroidal anti-inflammatory drugs were allowed in both groups. To assess the therapeutic effect was used clinical, laboratory and radiographic performances.

Results. In the 1st group in 8 of 22 patients decline was registered of the index of Larsen. Mainly due to the decrease or disappearance of cystoid enlightenment and of phenomena of periarthric osteoporosis. In the second group decrease of this indicator was observed only in three patients. Reduction of the index of Larsen did not correlate with the expected decrease in erosion, growth of erosions in the two groups was almost the same (2.0 and 2.4 respectively).

Conclusion. In patients with early rheumatoid arthritis reception of corticosteroids in combination with methotrexate helps to reduce osteochondral destruction, estimated by the index of Larsen.
Read more
OPTIMIZED APPROACH TO THE TREATMENT OF LIMB FRACTURES IN PATIENTS WITH ORTHOPEDIC TRAUMA
30.10.2015

Ahmedov Sh.M., Sirodzhov K.H., Muradov A.M., Holov D.I., Rahimov A.T.

OPTIMIZED APPROACH TO THE TREATMENT OF LIMB FRACTURES IN PATIENTS WITH ORTHOPEDIC TRAUMA

Department of Traumatology and Orthopedics of the State Education Establishment “Institute of Postgraduate Education in Health Sphere of Republic of Tajikistan”

Aim.Optimization of diagnostics and surgical treatment of fractures in patients with multiple injuries.

Materials and methods. The work is based on analyzing results of diagnosis and treatment of 183 patients in the period 2001-2013, which were divided into 2 groups. In the main group osteosynthesis of fractures optimized with the lipid spectrum of blood plasma, in the control group treatment of fractures is traditionally held. The examination program of patients included: clinical examination, beam diagnostics, clinical laboratory tests, the study of the concentration of total lipids, catalase, atherogenic index calculation, the concentration of cholesterol, low density lipoprotein, very low density lipoproteins, determine the extent of fat globulemya.Results. An important criterion of the outcome of treatment of patients with multiple injuries is the number of complications during the acute period of traumatic disease. Organ dysfunction were observed in 3,0 and 4,9% patients respectively in groups, which in 0,9% and 2,4% of cases have led to deaths. Venous insufficiency of limb was observed in 2,0% and 3,7% of patients, kompartmen syndrome – 0,9% and 2,4% of cases, fat embolism syndrome was observed in 1,2% of patients in the control group.

Conclusion.The positive effect of the results of treatment of patients of the main group due to an optimized approach to the treatment of fractures with the use of of lipid spectrum and sparing ways of osteosynthesis. Modified isovolemichemodilution allows to withdraw patient from a state of shock, improves blood oxygen transport minimizes amount of blood loss, the degree of endogenous intoxication, the risk of fat embolism syndrome and other vital violations.
Read more
TWO CASES OF LATE DIAGNOSIS OF ACROMEGALIA
28.10.2015

Rahmonov V.D., Kasymova S.D.

TWO CASES OF LATE DIAGNOSIS OF ACROMEGALIA

Course of Endocrinology of the State Education Establishment “Institute of Postgraduate Education in Health Sphere of Republic of Tajikistan”

This article describes 2 cases of late diagnosis of acromegaly caused by pituitary adenomas. Showing difficulties primary diagnosis of the disease. Demonstrated experience in application of modern methods of drug therapy Sando- statin LAR in adequate doses to the achievement of the inactive phase of the disease
Read more
PRIMARY CEREBRAL STROKE PREVENTION
28.10.2015

Abdurahmanova R.F., Izzatov K.N., Hadibaeva G.R., Sharifova B.A., Rashidova O.A.

PRIMARY CEREBRAL STROKE PREVENTION

Department of Neurology and Medical Genetics of the State Educational Establishment «Institute of Postgraduate Education in Health Sphere of Republic of Tajikistan»

The article describes main directions of primary prevention of cerebral stroke. It is shown that the system of primary prevention of stroke is divided on population strategy and high-risk strategy. Population strategy is aimed at informing the public about modifiable risk factors associated with lifestyle, and possibility of their correction. A population strategy is aimed at informing the public about modifiable risk factors associated with lifestyle, and possibility of their correction. Strategy of a high risk means early identification of patients in high risk groups followed by preventive medicamental and (if necessary) of vascular surgery treatment. Thus, changes in lifestyle, adequate antihypertensive, antithrombotic, hypoglycemic therapy, normalization of lipid metabolism, reasoned surgery on carotid arteries can significantly reduce the risk of a first stroke.
Read more
SOME FEATURES OF CROSS BORDER TRANSMISSION OF MALARIA TO THE REPUBLIC OF TAJIKISTAN IN PREDELIMINATION PERIODS
28.10.2015

*Sharipov A.A., *Narzuloeva M.F., **Saiburkhonov D.S.

SOME FEATURES OF CROSS BORDER TRANSMISSION OF MALARIA TO THE REPUBLIC OF TAJIKISTAN IN PREDELIMINATION PERIODS

*Department of Infectious Diseases of the State Educational Establishment “Institute of Postgraduate Education in Health Sphere of the Republic of Tajikistan”

**State Establishment “Republican Center for control of Tropical Diseases”

Aim. To explore some features of cross-border malaria transmission in the territory of the Republic of Tajikistan in predelimination periods.

Materials and methods. Are used reporting documentation of the National Centre for Combating Tropical Diseases (Malaria), medical history of patients with malaria hospitalized in Clinical Infectious Diseases Hospital and Medical Center of Dushanbe. In the subsequent were calculated the arithmetic mean value of all the obtained results, and also evaluation given to them.

Results. During the analyzed period in the country there is a decrease in the incidence of malaria, especially local. At the same time, is growing the percentage of imported malaria cases among the registered patients (2011 – 28,2%, 2012 – 45,5% and in 2013 – 78,6%). From the total nu 38 of imported cases during the analyzed period in Tajikistan in 30 malaria cases caused by Plasmodium vivax (78,9%) and in 8 cases – malaria caused by Plasmodium falciparum (21,1%). Importation of malaria caused by Plasmodium vivax, was mainly from Asia (Afghanistan – 15 cases, Pakistan – 10 cases, India – 3 cases, Iran – 1 case), and only in 1 case – from South America (Guyana). Malaria caused by Plasmodium falciparum, was imported mainly from African countries (Guinea – 4 cases, from Sierra Leone, Nigeria, Sudan – one case each), and 1 case of Afghanistan. In all 10 cases of diseases brought into the country by mosquitoes, malaria was caused by Plasmodium vivax, that has occurred as a result of flight infected mosquitoes from the nearby Islamic State of Afghanistan. All cases of infection of citizens (7 local residents and 3 military border guards) were recorded in the border areas of Shuroabad district of Khatlon region.

Conclusion. It was established that import cases of malaria in the analyzed period were recorded in 17 cities and districts of the republic, most of which according to climatic and geographical features of conditions for reproduction and produce progeny of disease vectors (mosquitoes kind of Anopheles). Untimely identification of patients and do not implementation of the relevant anti-malaria activities will contribute to risk of exposure to the local population of imported malaria cases
Read more
VALUE OF THE WEBER TEST IN DIAGNOSIS OF DIFFERENT FORMS OF OTOSCLEROSIS
28.10.2015

Shamsidinov B.N., *Azizov K.N., Muhtorova P.R., Shaydoev S.S.

VALUE OF THE WEBER TEST IN DIAGNOSIS OF DIFFERENT FORMS OF OTOSCLEROSIS

Department of Otorhinolaryngology of the State Educational Establishment «Institute of Postgraduate Education in Sphere of Republic of Tajikistan»

*National Medical Center of Republic of Tajikistan

Aim. To evaluate the impact of sound perception and sound conduction disorders in otosclerosis on the lateralization of sound, to determine the forms of disease, in which the experience of Weber is most effective, set the value of the experiment at two intensities for detecting of lesions of cochlea in otosclerosis.

Materials and methods. We analyzed audiograms of 100 patients with otosclerosis. Information of threshold tonal audiometry, binaural balance of loudness and also difference in the threshold of differentiation on 500 and 2,000 Hz were compared with experimental results of Weber.

Results.Revealed that dependence of lateralization from the value of bone-air interval in “pure” and mixed form of otosclerosis is not always observed. In this paper the experimental data of Weber were compared with thresholds differentiation. In order to identify destruction of hair apparatus the data of lateralization was compared with the results of binaural loudness balance. In this case, the change in lateralization of sound at above-threshold intensity was observed. Thus, in the direction of sound on above-threshold intensity it is possible to judge about degree of preservation of receptor on the worse hearing ear.

Conclusions. Weber test is suitable for determining of significant differences in sound-conducting and sound-apparatus on both sides. The test results can be properly evaluated only after comparison with the results of other tests. Weber’s experience desirable to perform on two intensities, because it increases its clarity allows to identify in individual cases the accelerated increase of volume and to solve the problem of bone-air “rupture” in the ear with large lesion sound-system.
Read more
AZIKAV IN COMPLEX TREATMENT OF HERPES ZOSTER
28.10.2015

Salimov B.M, Kasymov O.I, Munieva S.H.

AZIKAV IN COMPLEX TREATMENT OF HERPES ZOSTER

Department of Dermatology and STIs of the State Educational Establishment «Institute of Postgraduate Education in Health Sphere of Republic of Tajikistan»

Aim.A study of the effectiveness of atsikav (acyclovir) in the complex treatment of patients with herpes zoster.

Materials and methods. Under observation were 48 patients with herpes zoster. Among the patients with herpes zoster were 32 (66,2%) men and 16 (33,3%) women aged between 18 and 84 years. Methods: clinical, statistical.

Results. Treatment of patients has gone well. Side effects and complications of the drugs were not at any patient. The results showed the effectiveness of the treatment by complex therapy. So excellent results (clinical recovery) with typical form of herpes zoster in the end of the 1st week of observation in the complex therapy was achieved in 83.3% of patients and after 12-14 days in 100%. Among patients with bullous form of herpes zoster to the end of the 1st week of observation treatment has given excellent results in 80%. In hemorrhagic and generalized forms of herpes zoster to the end of the 1st week of treatment, a significant improvement was observed in 65% of patients and after 12-14 days in 80%. It should be noted that atsikav had no hepatotoxicity to any patient.

Conclusion. Patients with herpes zoster most frequently observed over the age of 60 years. More common at men. In winter, autumn and spring incidence is higher than in summer. Concomitant diseases were more common at older age groups. Atsikav antiviral drug can be recommended in the complex treatment of patients with herpes zoster.
Read more
EXPERIENCE IN DEVELOPMENT AND INTRODUCTION OF CLINICAL PROTOCOLS ON CHILDHOOD DISEASES IN MEDICAL PRACTICE OF REPUBLIC OF TAJIKISTAN
28.10.2015

*RahmatulloevSh.R., **SaidmuradovaG.M., *RahmatulloevaS.I., TolibovA.H.

EXPERIENCE IN DEVELOPMENT AND INTRODUCTION OF CLINICAL PROTOCOLS ON CHILDHOOD DISEASES IN MEDICAL PRACTICE OF REPUBLIC OF TAJIKISTAN

*The Ministry of Health and Social Protection of Population of Republic of Tajikistan

**Department of Pediatric Infection Diseases of the Tajik State Medical University

Aim.Studying experience of development of clinical protocols in other countries to improve national clinical protocols for childhood diseases.

Materials and methods. During the period from 2002 to present time, total were developed 4 clinical guidelines and protocols (CP) on the main diseases of childhood. Main purpose of creating of CP is to ensure the target groups with an exhaustive instructions for making decisions on their use in clinical practice. Rational use of clinical protocols depends of complying of all design rules with the search and evaluation of the best available evidence. Basic requirements for compiling of CP is using of evidence based medicine (EBM) with a systematic generalization of scientific proofs in their development.

Results. Earlier developed clinical protocols were little informative, compiled in an incomplete volume, while topics of discussed nosologies were duplicated from the previous protocol. After the introduction and application of CP in practice treatment of childhood diseases on the place were not held follow-up assessment monitorings.

Conclusion. Was established, that the adaptation of the existing pocket book of WHO of hospital care for children in view of features of local medical practices with limited economic and financial resources, with coverage of priority conditions of childhood is considered appropriate because it does not require the high cost of the adaptation process
Read more
ANALYSIS OF MORBIDITY OF COLORECTAL CANCER IN REPUBLIC OF TAJIKISTAN
28.10.2015

*Rasulov S.R., **Karimov A.M.

ANALYSIS OF MORBIDITY OF COLORECTAL CANCER IN REPUBLIC OF TAJIKISTAN

*Department of Oncology of the State Educational Establishment «Institute of Postgraduate Education in Health Sphere of Republic of Tajikistan»

**State Establishment “Republican Oncological Scientific Center” of the Ministry of Health and Social Protection of population of Republic of Tajikistan

Aim. To perform statistical analysis and identify the most characteristic features of colorectal cancer in the population of Republic of Tajikistan.

Materials and methods. Clinical data of 115 patients with colorectal cancer in the age of 18 to 92 years, who were treated in department of oncoproctourology of State Establishment “Republican Oncological Scientific Center” of Ministry of Health of Republic of Tajikistan in 2012 was studied. Tumor morphologically verified in all patients. In a planned regularity were hospitalized 89 patients, by emergency indications – 26 patients. To all performed endoscopy of the intestine, ultrasonic and review roentgenologic researches of the abdomen.

Results. Frequency of morbidity is somewhat more among males (52,2%). Peak of morbidity occurs in the age of 50-69 years (46,9%). Up to 40 years colorectal cancer diagnosed in 14,8%, over the age of 70 years – in 18,3%. In the majority of cases the tumor located in rectum (67%), then in sigmoid – 9,6%, in downstream parts of the large bowel – 6,1% and less in transverse section – 0.9%. Patients with early stages of tumor development (T1-2N0-1M0) constituted only 9,1%. In 67,3% of patients established locally advanced process, 23,6% had distant metastases. Metastases often observed in liver (42,3%) in liver and lung (23,1%), in peritoneum (19,2%) and less in skeletal bones and distant lymph nodes. Intestinal obstruction was observed in 17,4% of patients, intestinal bleeding – in 5,2%.

Conclusion. The most frequent localization of colorectal cancer is in straight line, then in sigmoid colon and in cae¬cum. Peak of morbidity occurs in the age of 50-69 years (46,9%). In the primary appeal for medical assistance 89,1% of patients had locally advanced (67,3%) or generalized (21,8%) process.
Read more
EFFECTIVENESS OF REHABILITATION OF SURDUSPEDAGOGICAL SCHOOL-AGE CHILDREN WITH SENSORINEURAL HEARING LOSS COMBINED WITH CEREBRAL PALSY
28.10.2015

*OchilzodaA.A., **SolievaM.S.

EFFECTIVENESS OF REHABILITATION OF SURDUSPEDAGOGICAL SCHOOL-AGE CHILDREN WITH SENSORINEURAL HEARING LOSS COMBINED WITH CEREBRAL PALSY

*Khujand City Health Center number 2

**Sughd Regional Hospital, Tajikistan

Aim.Evaluating the effectiveness of surduspedagogical rehabilitation of sick children with sensorineural hearing loss in combination with cerebral palsy by modern methods of medical treatment, physical therapy action and serdusped- agogical rehabilitation methods, using stationary sound-amplifying device “Audio filter MT”.

Materials and methods. Were examined 75 children aged from 7 to 14 years for the period of 2009-2013 in the conditions of the Regional SurduslogicalCenter.In medical, psychological and pedagogical department of the City Health Center №2 of Khujand. Were studied 41 boys (54.6%) and 34 girls (45.3%). All the patients underwent complete otorhinolaryngological examination, hearing test using tone threshold and speech audiometry, examination of and neurological status, CT and MRI of the brain, EEG was recorded, REG, EchoECG, consulting of neurologist and ophthalmologist for evidence of cerebral palsy.

Results. The results of complex course of treatment have shown that school-age children has greatly improved the motor area, normalized muscle tone, increased Personal self-service skills, the children began to take on their own hands: toys, spoons, began to move with the help of outsiders. In the course of daily surduspedagogicalactivities children gradually began to try to repeat after the teacher uttered sounds, starting with the most simple articulatory.

Conclusion. An effective surduspedagogical rehabilitation of school-age children with sensorineural hearing loss in combination with cerebral palsy is achieved by using a complex of medical treatment and new physiotherapy treatments with simultaneous surduspedagogical classes using stationary sound-amplifying device “Audio Filter-MT.”
Read more