City Polyclinics Research Articles

Prevalence and risk factors of glaucoma among the population of Ganja city, Azerbaijan

Aim. To determine prevalence of glaucoma among adult urban population on example of Ganja city of the Azerbaijan Republic.Methods. In city polyclinics primary examination was performed in 6585 people that makes 3% of adults of the population. Among the examined patients the indications for thorough in-patient work-up were determined in 250 patients. The diagnosis of glaucoma was confirmed in 220 patients (90 males and 130 females). The prevalence of glaucoma was determined (in % of the examined patients). The patients were divided into groups according to their gender, age, education, family history, presence of eye and internal diseases. A group with the lowest prevalence of glaucoma was chosen as a reference, and the other groups were termed as study groups for the assessment of relative risk of glaucoma development.Results. Glaucoma was revealed in 2.7±0.28% of males and 3.9±0.34% of females (p 0.05). Morbidity rate in women is higher compared to men. Risk factors of glaucoma are: intraocular pressure 21 mm Hg - 3.8±0.24%, compromised family history - 4.7±0.27%, diabetes mellitus - 3.66±0.24%, myopia - 5.7±0.3%, cataract - 10.0±0.4%, arterial hypertension - 11.9±0.4%. General morbidity rate of glaucoma among patients older than 20 years old is 3.45±0.23%. The lowest prevalence of glaucoma was determined among people of 20-29 years old (0.9±0.22%; 95% confidence interval 0.40-1.33). Prevalence of glaucoma increases with age of the examined patients. Statistically significant increase of prevalence of glaucoma is detected among population aged 40 years or older (3.3±0.49% of people aged 40-49 years) and reaches its maximum among people aged 60-69 years (12.2±1.56%).Conclusion. Prevalence of glaucoma among population of Ganja aged 20 years and older is comparatively high; differentiated monitoring of intraocular pressure with risk factors taken into account is reliable for early detection of glaucoma.

EFFECTIVENESS AND SAFETY OF THE «DE ALEX» BIO COMPLEX AS MONOTHERAPY AND IN COMBINATION WITH TAMSULOSIN IN PATIENTS WITH BENIGN PROSTATIC HYPERPLASIA

Introduction . Lower urinary tract symptoms (LUTS) are a common complaint in patients with benign prostatic hyperplasia (BPH), and they significantly affect patients’ quality of life. According to the guidelines of the European Association of Urology on management of LUTS (2016), herbal drug preparations can be used as monotherapy and as a part of combination therapy. Plant extracts with anti-inflammatory, spasmolytic, anti-oedemic, anti-androgenic, estrogenic effect can inhibit prostatic growth, stimulation, proliferation factors, α-adrenoreceptors, 5α-reductase, muscarine acetylcholine receptors. The article describes experience of using the «De Alex» bio complex as monotherapy and in combination with tamsulosin in patients with BPH. The study objective is to evaluate effectiveness and safety of the "De Alex" bio complex as monotherapy and in combination with tamsulosin in patients with BPH. Materials and methods . Clinical and laboratory examinations of 30 patients with BPH were performed. The patients were selected at the stage of primary clinical screening in Moscow city polyclinics (branch No. 1 of the City Polyclinic No. 62 of the Moscow Healthcare Department) and Moscow Region polyclinics (City Polyclinic No. 3 of the Orekhovo-Zuyevo Central City Hospital of the Moscow Region). The study duration was 12 weeks. Results . Based on the obtained data, the "De Alex" bio complex has significant anti-inflammatory, spasmolytic effect, can affect prostate volume, increase urine flow rate and control (which was confirmed by the results of the follow-up examination) and therefore increase patients’ quality of life. Conclusion . The "De Alex" bio complex has shown a high level of safety: during the study, the dietary supplement didn’t cause any side effects. Furthermore, the bio complex didn’t significantly affect the total and free levels of prostate-specific antigen and testosterone. The patients demonstrated high compliancy since "De Alex" has proved to be an effective and safe supplement with fast effect. Considering the above, we can recommend the "De Alex" bio complex at dose 1 tablet 2 times a day for 3 months (1–2 courses a year) as an effective and safe preparation that can be used as monotherapy or in combination with alpha-blockers to manage LUTS.

EVALUATION OF BETA-ADRENOBLOCKERS TREATMENT IN CARDIOVASCULAR DISEASES COMORBID WITH DIABETES IN OUTPATIENT SETTING

2 FSBEIHEI.P. PavlovRyazanskyStateMedicalUniversity. Ryazan , Russia Aim . To evaluate the practice of beta-blockers (BB) usage in cardiovascular disease (CVD) patients with diabetes (DM) in two outpatient registries. Material and methods . Registry PROFILE is the patients (n=1531) with CVD, visited specialized cardiological department of medical research center of Moscow during the period 2011-2015, and registry RECVAZA — patients (n=3690), visited 3 city polyclinics in Ryazan city in 2012-2013. Number of DM patients is 221 (14,4%) in PROFILE and 699 (18,9%) in RECVAZA. Results . In the RECVAZA, the rate of BB prescription was almost the same in CVD and DM; in PROFILE there was significantly more frequent prescription of BB, especially after myocardial infarction (86,4%) and in chronic heart failure (72,6%). In both registries bisoprolol was in use most commonly: 61,8% in PROFILE and 75,4% in RECVAZA. Among DM patients, not taking BB, in PROFILE registry there were additional contraindications: chronic obstructive pulmonary disease and asthma, than in RECVAZA. Conclusion . Clinicians of the specialized cardiological department, comparing to clinicians in local outpatient institutions more actively prescribed BB to DM patients, especially in the cases when this could improve long-term outcomes of the disease. This matches with recent clinical guidelines.

Child and Adolescent Health in Armenia: Experiences and Learned Lessons

The health of children and adolescents of Armenia has been affected by various socioeconomic, environmental, educational, and behavioral factors, demonstrating trends typical for both developed and developing countries. Key issues to be addressed by Armenian pediatricians are child mortality, malnutrition, and growth failure in the early years and overweight in later years. The case of Armenia illustrates how countries in transition are currently tackling both "old" problems (mortality and malnutrition) and "new" emerging morbidities (chronic diseases and adolescent health problems) based on social and health determinants, but the financing of the health system is far from satisfactory. Lessons of Armenia indicate the need for more cooperation between general practitioners and pediatricians at a primary care level. In addition, a better balance between inpatient and outpatient care could be achieved, which is not yet the case. Nevertheless, the overall performance of the Armenian child health care system can be considered satisfactory when bearing in mind the limitation of resources. Among the successful factors are those inherited from the Soviet period health system, including key institutions such as rural health posts and health centers, city polyclinics, and hospitals. These institutions mostly meet the needs of Armenian children and families today.

Частота выявления полиморфизма генов Helicobacter pylori, ассоциированных с устойчивостью к кларитромицину

The article is devoted to the investigation of polymorphism of Helicobacter pylori genes associated with resistance to Clarithromycin (Т2182С, A2142G/С, and A2143G mutation) using the polymerase chain reaction (restriction fragment length polymorphism). The following was investigated: the biopsy material from altered areas of gastric mucosa obtained from outpatients of Kursk city polyclinics and referred to fibroesophagogastroduodenoscopy in order to conduct the differential diagnostics between the gastroesophageal reflux disease and the dyspeptic syndrome. During the research, no cases of А214G/C mutation were detected in the investigated biopsy material. It was found out that Т2182С mutation was detected in 10.3% of cases, while mutation A2143G - in 13.79% of cases. Thus, the incidence of НР mutations related to the resistance to Clarithromycin is 24.13%, which is the rationale for the use of reserved 1 st - and 2 nd -line eradication schemes to treat НР-associated diseases in city of Kursk.

AIR POLLUTION OF THE CENTRAL CITY OF THE REGION BY CARCINOGENS

In the article based on the result of simulation modeling there are maximum one time concentrations of carcinogens, released to the air with emission of stationary sources. We did comparative analysis of the air pollution levels in the service districts of children's city polyclinics according to annual mean concentrations of individual carcinogens in the air and percentage of the receptor points where their calculated concentrations did not comply with the hygienic norms.

Application of Clinical Aging Indicators for the Assessment of Neurological Health via Screening Among Residents of the Almaty Region.

IntroductionLife expectancy at birth is considered to be a primary indicator of public health success. However, an increase in life expectancy is meaningless if it is not accompanied by an equivalent increase in the number of life years without disability such as physical, cognitive, and psychological abilities. The main consequences of disease leading to neurological dysfunction are directly related to issues such as the inability to walk, talk, learn, live in society, or take care of oneself. The objective of the study was to conduct a medical examination of elderly people as a part of the scientific program “Development of a model (program) of anti-aging to provide active longevity of elderly people of Kazakhstan.”MethodsAs part of a pilot study, we assessed the presence of the following clinical indicators of aging: cognitive impairment (MMSE test), pyramidal symptoms, and ataxia. We conducted medical examination (screening) among 150 elderly persons in Almaty City Polyclinic #8 and 287 elderly persons in Central Regional Clinic of Rayimbek Area, Almaty region aged 45 and above.ResultsThe results show that the intensity of changes is directly dependent on the age of the study groups. The cognitive function is the most affected and depends on the age of examinees. The changes are more expressed among residents of Almaty region. The average MMSE score in Almaty was 28.2 (age group of 45–49 years) and 25.8 (age group of 80 and above), and 27.3 and 24.0 respectively in Almaty region. The various symptoms among residents of Almaty tend to stabilize after 65 years, however, the frequency of ataxia continues to grow and increases significantly after 75 years.ConclusionsConsidering that important risk factors of neurological disorders are cerebrovascular diseases of various origins (primarily hypertension, atherosclerosis, and diabetes), an adequate treatment of these diseases will increase a healthy lifespan. Furthermore, it is necessary to conduct additional research for possible methods of reducing existing morbidities so that healthy aging can be achieved.

Http://www.iiste.org/Journals/index.php/JBAH/article/view/17428

Dementia is a disease that is most common and most damaging in the elderly. Nearly 4.6 million new cases are found each year and is found in the number doubled every 20 year and it is estimated there are 81.1 million people in the year 2040. (Velayudhan L, Poope M, Archer N, Proitsi G, Brown R, lovestone S.(2010)). Luchsinger and colleagues found that diabetes mellitus have an increased risk propensity on samples were non-amnestic mild cognitive impairment. The risk of mild cognitive impairment caused by diabetes mellitus was 8.8% for the entire sample and is higher in African-American population of 8.4% and a population Hispanik11,0% compared with the Non-Hispanic whites were 4.6% reflecting prevalence of diabetes mellitus in minority populations in the United States. (Luchsinger JA, Reitz C, patel B, Tang MX, Manly JJ, Mayeux R.(2007)).This study was a cross sectional study. Place of research: Geriatric Clinic, Clinic of Internal Medicine Endocrine SMF RSUP.H.Adam Malik and Lions Club of Medan City Polyclinic jl. Anggrung no.5. Periode 10 February 2011 until May 2011. Any patients who met the inclusion and exclusion criteria were included in the study will be done when blood sugar levels which will then be followed by a fasting blood sugar levels in the next day and on the same day the patient will psychiatric interview examination. All data collected will be analyzed further. Results from this study, of the 124 samples obtained, there were 38 samples (30.6%) with a normal MMSE interpretation, 24 samples (19.4%) with interpretation of probable cognitive impairment and 62 samples (50%) who had a definite interpretation of cognitive impairment . By chi square analysis found as many as 38 people who had a normal MMSE score interpretation consisted of 73.7% men and 26.3% women. of 24 samples of group interpretation MMSE score, probable cognitive impairment found 41.7% of men and 52.3% women and 62 samples of definite cognitive impairment found 38.7% of men and 61.3% of women with a figure of significance 0.002 (p <0.05). With Kolmogorov- Smirnov analysis can be seen that there are 30 samples or 24.19% of the sample who did not have diabetes mellitus who had a probable interpretation of MMSE cognitive impairment and 27 samples or 21.77% of the sample who had diabetes mellitus who also had MMSE interpretation, probable disturbance cognitive significance with the number 0.269 (p> 0.05). In the study showed that the elderly can experience mild cognitive impairment and diabetes mellitus have a role in the incidence of mild cognitive impairment in the elderly. Keywords: cognitive impairment, diabetes mellitus

AFOBAZOLE EFFECTIVENESS IN THE COMPLEX TREATMENT OF PATIENTS WITH ARTERIAL HYPERTENSION

Aim.To study the potential increase in the treatment effectiveness due to accounting for psychological and emotional status features of patients with arterial hypertension (AH). Material and methods. Psychological status features were assessed in 300 patients with essential AH, aged 35 years and older, who attended the Moscow City Polyclinics No. 9. The main group (n=264) was administered antihypertensive therapy and Afobazole (30 mg/d), while the control group (n=36) received only antihypertensive therapy. The number of ambulance calls and the regularity of antihypertensive pharmacological therapy over the last 3 years were assessed. The Spielberger-Khanin and Strelau scales were used for the questionnaire-based assessment of psychological and emotional status. All participants underwent Holter blood pressure (BP) monitoring at baseline and 6 and 18 months after the start of the treatment. Results. Our variant of antihypertensive therapy was clinically effective and associated with normalised BP parameters, decreased levels of state and trait anxiety, and reduced number of hospital admissions due to the main disease and comorbidities. Conclusion. Adding Afobazole to the long-term complex treatment of AH patients facilitates stable positive dynamics of BP parameters, normalisation of psychological characteristics, increased duration (up to 6-12 months) of clinical stability periods, and a halved number of hospital readmissions over the following 1,5 years.

ASSESSMENT OF MOTIVATIONAL AND COGNITIVE STATUS OF PRIMARY CARE CLINICIANS WHO TREAT METABOLIC SYNDROME PATIENTS

Recently, the clinicians’ attention has been driven to metabolic syndrome (MS), due to increasing prevalence and adverse prognosis of MS. The goal of the treatment of any chronic disease is the achievement of adequate therapeutic compliance which, in turn, is determined by motivational status of both clinicians and patients. The associations between clinicians’ motivation for long-term treatment, their knowledge levels, and the readiness to apply this knowledge in practice, on one hand, and the achievement of chronic disease compensation in patients, on the other hand, deserve further investigation.Aim. To analyse the readiness of primary care clinicians for the treatment of MS patients. The specific objective was to assess the district therapeutists’ knowledge, skills, and readiness to implement them in clinical practice while treating MS patients.Material and methods. The study included district therapeutists working at Moscow City polyclinics. In 2011-2013, the participants took continuous medical education courses at the Therapy Department No. 2, Post-diploma Medical Education Faculty, Moscow State Medico-Stomatological University. The doctors’ knowledge and skills were assessed in a questionnaire survey.Conclusion. The results obtained demonstrate inadequate readiness of district therapeutists for the treatment of MS patients.

Use of Addenbrooke’s cognitive examination-revised to evaluate the patients’ state in general medical practice

The differential diagnosis of cognitive impairments is of great importance in mental disorders detectable in general medical practice. Objective: to study whether Addenbrooke's Cognitive Examination — Revised (ACE-R) may be used in these patients. Patients and methods. The study was conducted in two steps at somatic hospitals and city polyclinics. It enrolled 130patients (36 men and 94 women) with anxiety-depression spectrum disorders (ADSD), mild cognitive disorders (MCD) and a concurrence of these conditions. The authors used the following psychometric scales: the hospital anxiety and depression scale; the mini-mental state examination; the frontal assessment battery; ACE-R; ten words learning test. The psychometric characteristics of ACE-R and the possibilities of its use were estimated to detect MCD. The differences in the spectrum of cognitive impairments were analyzed in patients with different types of ADSD. Results. ACE-R is shown to be an effective neuropsychological tool for the primary diagnosis, detection, and evaluation of MCD in the general medical network. The results of ACE-R use indicate that the spectrum of cognitive impairments has substantial differences in patients with different types of non-psychotic disorders.

HIV testing uptake and acceptability in an inner city polyclinic

Up to 33% of HIV-infected adults in the UK remain undiagnosed and efforts to increase HIV testing are underway. HIV testing was conducted amongst individuals presenting to a polyclinic at a central London hospital using a point of care test. Demographic and HIV risk data was collected along with a patient feedback questionnaire exploring acceptability of the HIV testing experience. Seventy-one out of 93 (76%) individuals accepted HIV testing. Of those accepting HIV testing, 53/71 (75%) had never previously tested for HIV despite, 45/53 (85%) of these being registered with a GP. Twenty-seven out of 71 (38%) of individuals testing had at least one risk factor associated with HIV acquisition, and of these 17/27 (63%) had never previously tested for HIV infection. There were no new HIV positive diagnoses during the period of testing. Respondents indicated a high level of satisfaction with the service and more than 85% found the service to be helpful, educational and convenient. This small proof of concept pilot showed uptake of HIV testing in this setting to be high and acceptable to patients.

Pharmacoeconomic analysis of conservative strategy for the treatment of patients with diabetic foot syndrome in Moscow

Aim. To perform cost-effectiveness analysis of prescription of pharmaceutical products and dressing materials and their consumption volume for inandout-patient treatment of diabetic foot syndrome (DFS). To analyse efficacy of the treatment in terms of modern therapeutic standards. Materials and methods. This retrospective study is based on the medical documentation of 139 DM1 and DM2 patients with DFS from differentmedical facilities of Moscow (2007). 72 patients were given general out-patient care by surgeons of city polyclinics, 50 ones received specialized aidin the regional Diabetic Foot Cabinet. 67 patients were hospitalized: 20 for general care in the department of purulent surgery of a military hospital,27 for specialized care in the department of purulent surgery of a city hospital, 20 for high-technology care in the endocrinological clinic of the FirstMoscow State Medical University. Results. Therapeutic strategy for DFS patients used in the regional Diabetic Foot Cabinet met the current therapeutic standards. General out-patientcare by surgeons of city polyclinics was at variance with the algorithms adopted in this country. Pharmacoeconomic analysis of the spectrum of pharmaceuticalproducts used for in- and out-patient treatment of DFS patients revealed frequent and ungrounded application of drugs whose woundhealing effect remains to be confirmed (pentoxifylline, thioctoic and alpha-lipoic acids). Conclusion. Additional training courses for surgeons of Moscow polyclinics are needed to improve the quality of medical aid to DFS patients. Suchpatients must be referred to regional Diabetic Foot Cabinets. Pentoxifylline, thioctoic and alpha-lipoic acids need to be substituted by pharmaceuticalswith validated therapeutic efficacy.

Condom use among patients attending six sexually transmitted disease clinics in Switzerland.

Persons treated for a sexually transmitted disease have been shown to be at increased risk for human immunodeficiency virus infection. Levels of condom use among these patients are presented, and sociodemographic and behavioral factors associated with self-reported never use of condoms are analyzed. This was a cross-sectional study of 2,257 patients treated at six sexually transmitted disease clinics in Switzerland between July 1990 and December 1992. Overall, 46.3% of the patients reported that they had never used condoms. Among heterosexual men, this level was 48.3% (n = 1,751), among homosexual and bisexual men it was 21.6% (n = 268), and among heterosexual women it was 60.1% (n = 238). In a logistic multivariate regression analysis, factors significantly associated with never use of condoms among heterosexual men included age over 29 years, not of Swiss origin, low level of education, few partners in the previous 6 months, contraction of the sexually transmitted disease from a stable partner, and not being an injecting drug user. These results document the high levels of condoms never being used in this population and highlight the importance of condom promotion activities provided by sexually transmitted disease clinics.

Medical examination of disabled people due to injuries in city polyclinics and medical units

Analyzing materials on disability caused by injuries, according to the city of Saransk from 1970 to 1980, we found that, despite fluctuations in the intensive indicators of primary disability for individual years, there is a distinct tendency to increase them.