Chief Editor
Vol. 3 No. 3 (2021): VESTNIK of KSMA
Full Issue
FUNDAMENTAL MEDICINE
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HUMAN LOCUS MICROBIOTE
AbstractSummary. Human oral microbiome is a the unique extensive ecosystem which is the most available for studying. Existing data highlight the critical role o f opportunistic and pathogenic bacteria in developing infectious diseases such as dental caries, tonsillitis, periodontitis as well as in developing a num ber o f somatic complaints. The study o f the hum an oral microbiome and the composition o f species highlight the mechanism of bacterial influence together w ith bacterial matabolites on the appearance o f pathological conditions and on the hum an organism as a whole. This review describes the normal human oral m icrobiota, saliva as the nutritional source o f microorganisms, m etabolism o f the oral bacteria, characteristics o f biofilms as the forms o f existence in communities, and program HOMD.
INTERNAL MEDICINE
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GENDER DIFFERENCES IN THE OCCURRENCE OF PAINLESS ISCHEMIA IN RESIDENTS OF HIGHLANDS
AbstractA b stract. Painless m yocardial ischem ia (BIM ) significantly worsens the prognosis of patients w ith coronary heart disease, as shown by num erous clinical studies o f domestic and foreign cardiologists. Patients w ith BIM are at increased risk in terms o f the developm ent of cardiovascular complications as compared to patients who do not have episodes of ischemia. A.I. M artynov et al (1995) note that the risk o f sudden death in patients with BIM increases 5-6 times, the development of myocardial infarction and chronic heart failure - 1.5 times, m ore often there is a need for revascularization and / or repeated surgical intervention. A num ber o f researchers consider “silent” ischem ia to be a poor prognostic sign, since its presence is associated w ith an increased risk o f developing unstable angina pectoris, m yocardial infarction and sudden death. Since"mute" ischemia does not m anifest any discom fort in the region o f the heart, its im portance is often underestim ated.
QUESTIONS OF SURGERY
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COURSE OF WOUND PROCESS IN PATIENTS WITH GALLSTONE DISEASE LIVING IN HIGH MOUNTAIN AND LOW MOUNTAIN RANGES
AbstractSummary. The purpose of the research paper of present the results of the course of the wound process in patients previously living in high mountains and operated in Bishkek (low mountains) and in patients perm anently living in low mountains. There are results o f studies of 27 operated patients from the highlands and 26 residents o f the low m ountains suffering from cholelithiasis com plicated by chronic cholecystitis. The findings were assessed on the basis o f clinical and echo-m orphom etrical indicators o f the surgical wound. The studies were perform ed on the 1st, 3rd and 5th day after the operation. Complications o f the wound process were noted in 6 out o f 27 observed patients from the highlands, and in 2 out o f 26 residents o f the low mountains.
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USING OF GASTROGRAPHIN IN ADHESIVE SMALL INTESTINAL OBSTRUCTION
AbstractA task: To evaluate the therapeutic value o f Gastrografin in the treatm ent o f adhesive small bowel obstruction after unsuccessful conservative treatment.
Summary reference data: Gastrografin is a hyperosm olar w ater-soluble contrast agent. In addition to its diagnostic value w hen surgical intervention is required, there is probably a therapeutic role for this contrast agent in adhesive small bowel obstruction.
Criterions: In patients w ith clinical m anifestations o f adhesive small bowel obstruction, conservative treatm ent was carried out in the absence o f suspicion o f intestinal strangulation. In patients w ith a positive effect, conservative treatm ent was continued for the first 48 hours. Other patients, w ith no clinical or radiological im provem ent in the first 48 hours, were random ized to either Gastrografin or surgery. The appearance o f Gastrografin in the colon w ithin 24 hours was regarded as partial intestinal obstruction and conservative treatm ent continued. Patients in whom the contrast did not reach the colon w ithin 24 hours were considered to have complete intestinal obstruction and underwent surgical treatment. If conservative treatm ent with or w ithout Gastrografin was unsuccessful for more than 48 hours, surgery was performed. Results: The study included 84 patients. The group for the study o f Gastrografin ended up with 13 patients, and the group for surgical treatm ent - 11 patients. In 10 out o f 13 patients receiving Gastrografin, intestinal obstruction resolved w ithout surgery. The use of Gastrografin significantly reduced the need for surgical intervention (by 76.9%). The appointm ent o f Gastrografin was safe even after the ineffectiveness o f conservative treatment. Complete resolution o f intestinal obstruction occurred on average 41.0 ± 3.5 hours after adm inistration o f Gastrografin.
Conclusion: The use o f Gastrografin for adhesive ileus o f the small intestine is safe and reduces the need for surgical intervention in case of unsuccessful conservative treatment. -
ON THE DIAGNOSIS OF ACUTE CHOLECYSTITIS IN THE ELDERLY
AbstractResume. The aim o f the study: comparative assessm ent o f clinical and diagnostic data in elderly and younger patients with pain in the right upper quadrant o f the abdom en and diagnosed w ith acute cholecystitis.
Materials and methods. The study included 426 patients who were admitted to the emergency departm ent with pain in the right hypochondrium during 2019. A fter collecting retrospective data, patients were divided into groups according to their age: <65 and >65 years. The diagnosis o f acute cholecystitis was m ainly established on the basis o f ultrasound examination.
Results. Acute cholecystitis was diagnosed in 52 o f 301 patients in group I and in 48 o f 125 patients in group II. The ratio o f wom en and m en with acute cholecystitis was 2.25 in groupI and 0.71 in group II (p = 0.016). The average leukocyte count in patients w ith acute cholecystitis in group I and group II was 9907x109 / L (± 4.437) and 17083x109 / L (± 7485), respectively (p <0.001).
Conclusions. Acute cholecystitis is a com m on diagnosis in elderly patients with pain in the right hypochondrium. It is more common in wom en at an early age, but gender differences tend to change with age. Older patients w ith acute cholecystitis have higher leukocyte counts than younger patients. Clinicians should m aintain some degree o f awareness when evaluating geriatric patients w ith right upper quadrant pain. -
DIAGNOSTIC AND PROGNOSTIC VALUE OF NEUROOPHTHALMOLOGICAL INVESTIGATION RESULTS IN TRAUMATIC BRAIN INJURY
AbstractSummary. Traumatic brain injury affects the m ost active part o f population. Ocular pathology is a frequent com plication o f traum atic brain injury. Revealing ocular signs in acute stage o f traum atic brain injury is still disputable.Goal o f the research: Investigating clinical and functional disorders of fundus and visual analyzer, elaboration and substantiation o f pathogenetic direction of prevention of optic nerve atrophy w ith estim ation o f its efficiency in the acute period o f m ild skull brain injury.
Material and methods: 110 patients w ith m ild skull brain injury. The age o f injured persons was from 17 to 82 years. Males about 77 persons (77.0%), females - 23 (23.0%).
Results: The norm al borders o f visual field were determ ined in 84.4% at isolated severe skull brain injury and in 69.1 % - in com bination with mild skull brain injury. The data of research o f cerebral and orbital hem odynam ics showed that the injured patients with mild skull brain injury register the true (p<0.05) increase of resistance index, especially in the group of patients with optic neuropathy.
Conclusion: Optic neuropathy in acute period of traumatic brain injury diagnosed in 19.6% cases, optic disc congestion in 9.8% и retinal angiopathy in 25.5% cases. Im provem ent of visual acuity, decreasing o f resistance index and increasing o f blood stream linear velocity in cerebral and ophthalmic arteries as a result o f m ild traumatic brain injury complex management considering ocular pathology have been achieved.
OBSTETRICS AND PEDIATRIC QUESTIONS
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THE CLINICAL COURSE OF NEONATAL PATHOLOGICAL JAUNDICE IN PRETERM AND FULL-TERM INFANTS
AbstractThe aim o f our research was to study the structure and features o f the clinical course of prolonged neonatal pathological jaundice. The object o f the study was newborns with pathological hyperbilirubinem ia: premature newborns (198 children) and full-term newborns (205 children). The severity o f the condition was assessed by changes in bilirubin, and the clinical manifestations o f jaundice were assessed on the Kramer, AVPU, and Glasgow scales. The data analysis revealed, that the structure o f prolonged pathological neonatal jaundice is dominated by hyperbilirubinem ia o f m ixed genesis, more often in com bination w ith intrauterine infection. Prem ature infants observed earlier, in term infants - a late diagnosis o f the disease. Clinical and laboratory assessm ent o f the patients ' condition allows us to conclude that prem ature infants have a m ore pronounced severity of the disease. However, the late diagnosis o f jaundice in full-term children causes high hyperbilirubinem ia during hospitalization.
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FEATURES OF THE CONDITION OF FETUS AND NEWBORNS BORN FROM WOMEN LIVING IN HIGH ALTITUDE CONDITIONS ON THE BACKGROUND OF ARTERIAL HYPOTENSION
AbstractAbstract. A study was carried out o f w om en w ith arterial hypotension against the background o f the developm ent o f the pathological state of the fetus and newborns born to women living in two different climatic regions of Osh city and in the highlands of Chon-Alay district of Osh region. In the pathogenesis o f pregnancy complications caused by arterial hypotension, the leading im portance is attached to vascular disorders and microcirculation disorders, leading to systemic hemodynam ic changes in the body of a pregnant woman. It was found that in mountainous terrain, arterial hypotension and exogenous hypoxia affect the "mother-placenta-fetus-newborn" system, increasing the load on the respiratory, circulatory and hem atopoietic organs of the mother, and also leads to impaired placental function.
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ALLERGIC DISEASES IN CHILDREN UNDER CONDITIONS OF NEW CORONAVIRUS INFECTION PANDEMIC
AbstractAnnotation. Coronavirus infection - COVID-19 (CoronaVirus Disease - coronavirus disease - 2019) caused by the SARS-CoV-2 virus (severe acute respiratory syndrome CoronaVirus 2 - severe acute respiratory syndrome) has become a real disaster for all of humanity. Today, issues related to diagnostics, clinical presentations, treatm ent o f the complications, preventive measures, including vaccination for a new coronavirus infection, are relevant. It is also im portant to identify risk factors for a severe course o f the disease, features o f the developm ent o f infection against the background o f com orbid conditions and various immunological reactivity o f the hum an body. The comorbidity o f allergic and infectious diseases is based on the common hum oral and cellular m echanisms o f the immune response. The trigger for the developm ent o f allergic diseases is often the viruses of measles and chickenpox, influenza, parainfluenza, rhinoviruses, enteroviruses, respiratory syncytial viruses, coronaviruses and others. M ost allergic patients are predisposed to acute respiratory viral infections. COVID-19 occurs in 0.39-12.3% o f children. Children tend to have m ilder disease than adults and have low m ortality rates. A t the same time we should not forget about the adequate support for patients w ith chronic diseases, especially children with allergic diseases. Viruses and preventive hygiene measures associated w ith a pandemic are triggers o f an exacerbation o f bronchial asthm a and atopic dermatitis. Early diagnosis, adequate treatm ent o f allergic diseases in children and provision o f doctors w ith inform ation are also problematic. It is im portant to understand w hich AD patients are particularly at risk and how inhaled glucocorticosteroids may affect the course and outcome o f COVID-19. International associations and societies have developed guidelines for the m anagem ent of children with allergies during the COVID-19 pandemic. Inhaled glucocorticosteroids (ICS) for bronchial asthm a reduce the expression o f genes o f the m ain target receptors for the SARS-CoV-2 virus. Anti-inflam matory therapy for asthma, prim arily ICS, should be continued until asthm a control is achieved, w hich w ill help to reduce the risk of an unfavorable course of COVID-19.
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HYGIENIC ASSESSMENT OF THE REGIME OF THE DAY CHILDREN OF PRESCHOOL AGE IN CHILDREN'S EDUCATIONAL INSTITUTIONS
AbstractResume: The study of the health status of preschool children was earlier and remains relevant at the present time, due to the fact that during this period there are intensive processes of growth and developm ent o f the child's body, biological and functional maturation o f children takes place to study in educational schools. In this regard, this review article presents data from domestic and foreign literature in recent years (2005-2020) on topical issues o f the hygienic significance o f the daily regim en and its components - namely: sleep, nutrition, physical activity o f children, educational process, etc. The above analysis o f literature data and the structuring o f topical issues indicate their influence on the health status and physical developm ent o f preschool children in the conditions o f children's educational organizations. The authors note the unfavorable dynamics o f physical developm ent and disorders in the state o f health o f children due to non-observance o f the above-listed individual components o f the daily regim en in preschool educational institutions.
QUESTIONS OF FORENSIC ACTIVITIES
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PATHOMORPHOLOGY OF THE LUNGS AT DEATH FROM COVID-19 ON FORENSIC MATERIAL (period march-december 2020)
AbstractAbstract. The purpose o f the article was to study the pathom orphological changes in the lungs and other organs on the basis o f forensic medicalm aterial during the death of persons outside hospitals from the asymptomatic course o f COVID-19. The sectional m aterial of the thanatology departm ent of the Republican Center for Forensic M edicine o f the M inistry of Health of the Kyrgyz Republic for the period M arch-Decem ber 2020 was analyzed. In the amount o f 232 cases, o f w hich 89 (38.4%) cases were confirmed by polymerase chain reaction, 53 (22.8% ) were not confirmed, and in 90 cases (38.8%), unspecified bronchopneum onia was exhibited. The age o f the deceased is from 37 to 60 and over, 151 (65.1%) men, 81 (34.9%) women. In pathomorphologycal changes in the lungs corresponded to different phases o f developm ent o f diffuse alveolar damage (DAP). In the exudative phase, edema, desquam ation o f the alveolar epithelium, the presence o f hyaline membranes and throm bohemorrhagic phenom ena prevailed. In the proliferative phase, pronounced deposits of fibrin and fibrin-like substances in the alveoli, thickening o f the interalveolar septa, the growth o f connective tissue in the interalveolar septa. In the liver, pronounced fatty dystrophy, in the myocardium, pronounced edema.
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MACROMORPHOLOGICAL PICTURE OF PULMONARY TISSUE AND HEART OF PERSONS DIED FROM COVID-19 (based on forensic material)
AbstractSummary. The article reflects the results of the analysis of cases of forensic medical examination of the corpses of persons who died from COVID-19 in 2020. It was established that in 2020, 1,361 investigated corpses were registered in the thanatology department, of which 232 deaths occurred from COVID-19. The largest number of deaths from COVID-19 was registered in the m onth of July (149 cases out of 262 corpses examined this month). Polymerase chain reaction o f 89 (38.4% ) confirmed cases, 53 (22.8% ) unconfirm ed cases, and unspecified bronchopneum onia (J 18.0) - 90 cases (38.8%). Mortality among males was 65.1% (151 cases), females - 34.9% (81 cases). In 43.5% (101 cases), corpses were delivered to the morgue from houses, in 9.9% (23) - from the street, in 4 cases (1.7% ) - from tem porary shelters.
Macroscopically, the target organ-lungs looked enlarged, filled the chest cavity, the visceral pleura, thickened, dark bluish color, the lungs felt dense in places, airy in places, weighing about 1400.0 dark red hem orrhages w ith fairly clear boundaries, in the lum en o f individual bronchioles there are dark red throm bi, bronchioles are thickened, w hen the lung tissue is compressed, a foamy-hemorrhagic fluid flows out. The myocardium in the section, especially o f the left section, in hem orrhages o f banded, rounded forms o f dark red color against the background o f w hitish-gray areas o f the myocardium. In places, hemorrhages merge, forming a continuous field of dark red color.
LINGUISTIC ASPECTS IN MEDICINE
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OPTIMIZING THE TEACHING PROCESS OF SYNONYMYS TO MEDICAL STUDENTS
AbstractAbstract. This article examines synonyms and their usage in the speech of medical students. The speech o f an educated person should be good. A skill of using words in different registers allows using correctly separate sides of a language (lexicon, grammar, syntax that are essential for speaking).
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THE ROLE OF DICTIONARY WORK IN FORMING COMMUNICATION COMPETENCE OF MEDICAL STUDENTS
AbstractAbstract. This article examines the issues of working with a dictionary on Russian language lessons. The article is about the essence and methods of dictionary work in forming communication competence of a medical student.