Follow-up Observation Of Patients Research Articles

Dispanserization monitoring for HIV-infected patients in the Siberian Federal District in 2013–2017

According to UNAIDS, 1.4 million people are living with HIV in Eastern Europe and Central Asia, 75% of them in Russia. International guidelines recommend regular clinical evaluation of HIV-infected patients, which is achieved through follow-up. Purpose of the study: to characterize the quality of follow-up observation of HIV patients in the Siberian Federal District for the five-year period from 2013 to 2017. Materials and methods. A retrospective descriptive-assessment epidemiological study for the period 2013–2017 was conducted in the Siberian Federal District, in which dispensary observation indicators were most affected by improving the epidemiological situation associated with the spread of HIV infection. Results. The HIV infection in the Siberian Federal District increased during the period under review by 62,4% and reached 1328,5 per 100 thousand population. The prevalence of HIV infection at the beginning of 2018 was 679.0 per 100 thousand population (with an average Russian indicator of 430,2). The SFO accounted for 20,7% of all HIV cases (n = 130 595), which were registered at specialized medical organizations in the Russian Federation. The coverage of HIVinfected patients with clinical observation reached the target value and amounted to 88,2%. The number of patients who were examined to determine the immune status and viral load increased almost 2 times. At the same time, the proportion of HIV-infected people receiving antiretroviral therapy was at the level of 39,8%, which is 4,2% lower than the target values. The proportion of patients surveyed for tuberculosis among those who underwent medical examination in 2017 remains at the level of 87,8%, which does not stabilize the incidence of tuberculosis infection. The number of HIV-infected patients with a diagnosis of active tuberculosis increased 1,4 times to 17 610 in 2017 (10,9% of the number of patients). Conclusion. In the context of the continuing increase in the incidence of HIV infection in the population and an increase in the number of patients in need of various types of medical care, additional measures are needed to improve the quality and effectiveness of follow-up observation of patients with HIV infection.

Pharmacoeconomic effectiveness of using modern technologies in the follow-up care of patients with arterial hypertension

Aim. To conduct a pharmacoeconomic assessment of the use of modern technologies in the follow-up care of patients with arterial hypertension (AH) in the Tyumen region.Material and methods. Using a random sampling technique we selected and examined 1704 patients with AH in the Tyumen region. The average age of patients was 62±75 years, 31,5% were men. Patients are divided into active monitoring and control groups. Weekly sms and e-mail messages with prevention information were sent to patients of the active monitoring group. General practitioners receive a course of training seminars on the features of follow-up observation of patients with AH. After 12 months (±3,2), the patients had repeated examination. We conducted pharmacoeconomic analysis of the intervention.Results. The results of our study showed that the total cost of the disease with active follow-up of patients with AH decreases, which mainly occurs due to indirect expenses. Weekly sms and e-mail notification of patients in combination with educational seminars for general practitioners and cardiologists leads to a change in the structure of expenses for the treatment of patients with AH. We noticed reducing the cost of inpatient treatment, emergency calls, and a decrease in indirect expenses. On the other hand, there is a redistribution of funds spent on pharmacotherapy and cases of outpatient visits. Such redistribution, combined with a decrease in the total cost of the disease, leads to savings in the resources of the health care system and allows an additional 231 patients to be treated within 12 months.Conclusion. The proposed model of active follow-up is economically viable, both by reducing the total cost of the disease, and by redistributing funds towards using pharmacotherapy and outpatient visits, which is the most rational in the treatment of AH.

Досвід застосування препарату Глутоксим у хворих із доброякісними та пограничними епітеліальними пухлинами яєчників після виконання консервативного хірургічного лікування

The objective: to increase the effectiveness of treatment of patients with benign and borderline epithelial ovarian tumors (EOT) after conservative operations performed based on the definition of a high risk group for recurrence and malignancy according to the molecular expression profile of the markers p53, Ki-67, estrogen receptors (ER), CD34 and E-cadherin and inclusion in the complex anti-relapse therapy of the immunomodulating drug Glutoxim. Materials and methods. A clinical examination of 60 patients of reproductive age with EOT was performed, which were treated with organ-sparing surgical treatment (main group). Of these 60 patients, 30 women (subgroup I) were diagnosed with benign EOT (BEOT), the remaining 30 women (subgroup II) were diagnosed with borderline EOT (BoEOT) Ia and Ib stages in FIGO. In removed tumors after routine histopathological examination, the molecular profile was determined by immunohistochemically determining the protein regulator of apoptosis p53, proliferation index (PI) by Ki-67 expression, estrogen receptors — ER, microvessel density by CD34 expression and E-cadherin intercellular adhesion protein. Based on the molecular profile determination data, the removed tumor was ranked as high or low risk of recurrence and malignancy. Patients from the high-risk group for relapse and malignancy according to the molecular profile data included the immunomodulating drug Glutoxim in the complex anti-relapse therapy - intramuscularly 10 mg daily for 2 weeks with a course repeated every six months for 3 years. The control group consisted of 64 patients with BEOT and BoEOT, who underwent conservative surgical treatment without further anti-relapse treatment. Results. During the molecular profile study, it was found that high risk of recurrence and malignancy had EOT with p53 expression (LI ≥15%), high proliferative activity of cells with Ki-67 expression (PI ≥10%), low estrogen reception (LI ER < 49.5%), high density of microvessels on the expression of CD34 (IM ≥40 mv /mm2), low level of intercellular adhesion on the expression of E-cadherin (LI <59%). Molecular profile characterizing a high risk of recurrence and malignancy, in most cases was inherent in BoEOT. The purpose of a comprehensive anti-relapse treatment with the inclusion of the immunomodulatory drug Glutoxim (intramuscularly daily at 10 mg for 2 weeks) after performing of sparing conservative surgical treatment with a repetition of the course every six months in patients at high risk of relapse and malignancy according to molecular profile data has reduced the relapse of EOT to 6.7% in patients of the main group compared with 20.3% in the control group during three years of follow-up observation of patients. The difference is statistically significant (p <0.05). Conclusion. In order to prevent cases of recurrence and malignancy in patients with EOT at high risk of relapse and malignancy according to molecular profile data after a sparing surgical treatment that preserves their reproductive function, it is recommended that Glutoxim is administered in complex anti-relapse therapy at 10 mg intramuscularly per every day for 2 weeks with a repetition of the course every six months for 3 years. Key words: benign epithelial ovarian tumors, borderline epithelial ovarian tumors, high risks of recurrence and malignancy, anti-relapse therapy, reproductive function, Glutoxim.