Euroasian Health Journal

Cardiovascular diseases are the leading cause of death in the world. Moreover, mortality from them increases annually, and the main portion is caused by atherosclerotic disease. The high prevalence of heart disease in the world is due to the presence of a number of risk factors in patients. In addition to well-known diseases such as high blood pressure, diabetes mellitus, smoking, physical inactivity, and obesity, hyperlipidemia also plays an important role in the development of atherosclerotic disease. Thus, people with elevated levels of low-density lipoprotein cholesterol have a 2-fold higher risk of developing atherosclerotic disease than people with normal levels. Therefore, as preventive measures in the fight against this disease, it is necessary to control not only such diseases as overweight, smoking, alcohol, physical inactivity, hyperglycemia, high blood pressure, but also hypercholesterolemia. As drugs aimed at preventing the development of atherosclerotic disease and related complications, statins are the most studied drugs used in primary and secondary prevention. However, when using statins, approximately 1/3 of patients reach the target cholesterol level. In addition, sometimes side effects may develop (although very rarely), including myopathy and rhabdomyolysis, new cases of diabetes. To increase the frequency of reaching the target level of cholesterol and reduce the risk of side effects, it is recommended to use a combination of lipid-lowering drugs with a synergistic mechanism of action, and prescribe them in the one tablet. Such a combination is statin + ezetimibe, a drug that prevents the reabsorption of cholesterol in the intestine. Rosuvastatin, which has the highest lipid-lowering effect, is recommended as a statin. The combination of rosuvastatin+ezetimibe has shown an advantage over statin monotherapy in terms of lowering low-density lipoprotein cholesterol cholesterol and reducing the development of side effects. 

Iron deficiency anaemia is a global public health problem, particularly affecting pregnant women. The association between anaemia and poor maternal, fetal and neonatal outcomes is now well established. Anemia is increasingly recognized as a potentially modifiable risk factor for postpartum haemorrhage, a leading cause of maternal morbidity and mortality. Adverse fetal and neonatal outcomes include preterm birth, growth restriction and increased mortality. Maternal iron deficiency may also be associated with neurocognitive impairment in infants. Iron requirements increase during pregnancy and are influenced by hepcidin, a master regulator of iron homeostasis. Recent advances in our understanding of systemic and placental iron homeostasis may improve therapeutic efficacy by altering the dose and frequency of oral iron supplementation. Future studies should be adequately powered to assess patient-centred outcomes and cost- effectiveness in pregnant women.

Aplastic anemia is a rare, life-threatening, and heterogeneous bone marrow blood disorder characterized by peripheral pancytopenia and bone marrow hypocellularity. It results in peripheral cytopenia with trilineage aplasia of the bone marrow. Anemia, bleeding, infection, and several other clinical symptoms are usually the first manifestations of aplastic anemia. In most cases, aplastic anemia is caused by autoimmune mechanisms that target progenitor stem cells, resulting in pancytopenia. Bone marrow transplantation is the definitive treatment for severe aplastic anemia; however, failing this option, combination immunosuppressive therapy with antithymocyte globulin and cyclosporine A is used as first-line therapy. Below, we present a case report highlighting the possible delay in response to an antithymocyte globulin protocol in the treatment of severe aplastic anemia. Regarding antithymocyte globulin, it can have various effects on the immune system, including depletion of T cells in the blood and peripheral tissues, and possibly a direct effect on hematopoietic stem cells.

The aim of the study: was to investigate the distribution of the concentration of highly sensitive troponin I (hsTnI) in a representative sample of residents of the Chui region of the Kyrgyz Republic, taking into account gender and age.
Material and methods. The material was a representative sample of the population aged 18-65 years in the Kyrgyz Republic (n = 1276, including 529 men and 747 women). An analysis of the distribution of hsTnI levels in the population was carried out taking into account gender and age. The level of hsTnI in blood serum samples was measured by immunochemiluminescent assay with microparticles, using Architect Stat High Sensitive Troponin I reagents (Abbott, USA) on an automated analyzer Architect i2000SR (Abbott, USA). The level of statistical significance was taken to be 0.05.
Results. The median hsTnI concentration in the sample was 1.2 pg/ml, the interquartile range was (0.6; 2.0) pg/ml. The 99th percentile was 19.7 pg/ml. hsTnI levels were significantly higher in men -1.5 (0.8; 2.3) pg/ml, than in women - 1.0 (0.4; 1.8) pg/ml, (p = 0.009). The relationship between hsTnI concentration and age was characteristic of both men (r = 0.13; p = 0.002) and women (r = 0.16; p<0.001). Despite the lower initial values of hsTnI concentration, the rate of its increase with age was higher in women. A detailed comparative analysis of the dynamics of hsTnI concentration in different age groups in men and women was carried out.
Conclusion. The revealed gender differences in the distribution of hsTnI concentration and its age dynamics must be taken into account when determining the threshold levels of this biomarker. 

Currently, a new field of medicine – palliative care – is rapidly developing worldwide. The World Health Organization recommends that governments of all countries ensure palliative care is accessible to every child with a severe, incurable illness. The aim of this article is to propose directions for the development of pediatric palliative care in the Kyrgyz Republic based on a review of existing global practices and the current situation in the country. Materials and Methods. Literature review of scientific publications for the last 30 years in PubMed, as well as on the websites of leading international and national organisations (World Health Organization, European Association for Palliative Care, etc.), regulatory framework of the Kyrgyz Republic was conducted. It has been shown that there is no national-level system for providing pediatric palliative care in the Kyrgyz Republic. However, all the necessary conditions for its establishment and rapid development exist. Prospective directions for ensuring the right of terminally ill children and their families to access pediatric palliative care at the national level have been proposed. These include the development of a long-term state policy for the phased introduction of inpatient and outpatient services, the creation of a continuous medical education system for healthcare workers, and the establishment of a registry of children in need of palliative care to assess their needs and facilitate financial and economic planning for comprehensive multidisciplinary support.