ASSESSMENT OF COGNITIVE STATUS IN PATIENTS WITH AKINETIC-RIGID AND TREMOR-DOMINANT PARKINSON’S DISEASE

Objective: To study cognitive changes in patients with akinetic-rigid and tremor-dominant Parkinson’s disease (PD). Methods: From January to May 2019 were examined and responded 32 patients with akinetic-rigid (n=15; 46.9%) and tremor-dominant (n=17; 53.1%) PD. The average age of the patients was 66.5±3.7 years. All patients of PD before and after receiving appropriate therapy were responded using the MMSE (Mini-Mental State Examination) scale to detect the possible cognitive dysfunctions. The study of cognitive functions in patients was conducted before the start of therapy, as well as 3 months after treatment. Results: At the admission, cognitive disorders were more significant in akinetic-rigid PD than in a tremor-dominant PD. After 3 months of appropriate therapy, cognitive dysfunction rates in patients with akinetic-rigid PD improved significantly (p<0.001) in compare to tremor-dominant PD (p<0.05). Conclusions: Using the MMSE scale helps to detect and determine the severity of cognitive changes in a timely manner and the risk of further development of dementia in patients with PD, that allows to start corrective activities in time. Timely detection and appropriate approach to the treatment of the underlying disease and the correction of cognitive impairment significantly improves the quality of life of patients themselves, contributes reducing economic costs. Keywords: Parkinson’s disease, cognitive disorders, akinetic-rigid and tremor-dominant Parkinson’s disease, MMSE scale.

CONTENT-ANALYSIS OF THE PHARMACEUTICAL MARKET OF NONSTEROIDAL ANTI-INFLAMMATORY DRUGS IN GROUPS OF ACETIC ACID DERIVATIVES IN THE KYRGYZ REPUBLIC

Objective: To segment the pharmaceutical market of non-steroidal anti-inflammatory drugs (NSAIDs) of the derivatives groups of acetic acid in the Kyrgyz Republic. Methods: The database of the State Registry of Medicines registered and approved for Medical use in Kyrgyzstan, the Department of Drugs Security and Medical Engineering of the Ministry of Health of the Kyrgyz Republic is used for analysis. Results: Analysis showed that the leaders of the pharmaceutical market in Kyrgyzstan the number of registered medicines (M) under the trade names are Medical Drugs (MD) with international generic name: diclofenac, ketorolac, indomethacin. It has been established that there are 99 trade names of NSAIDs of the groups of acetic acid derivatives in the Kyrgyz pharmaceutical market. The largest part of the range consists of diclofenac (M01AB05), represented by 62 trade names MD (62.6%), and ketorolac (M01AB15), represented by 20 trade names MD (20.2%). In the pharmaceutical market of Kyrgyzstan are NSAIDs from the groups of acetic acid derivatives from 15 countries, of which 21.1% of MDs are produced by neighboring countries, and 73.3% – in far countries. Conducted studies have revealed that the structure of the range of NSAIDs groups of acetic acid derivatives is dominated by soft medicinal forms, which making up 37.4%. A comparative analysis of the composition of MD by the number of active substances revealed that 92.9% of NSAIDs of the groups of acetic acid derivatives are monodrugs. Based on the analysis of the price segmentation of NSAIDs of the groups of acetic acid derivatives, most of the drugs are in the low-price segment. Conclusions: A sufficient assortment saturation of the pharmaceutical market of Kyrgyzstan NSAIDs groups of acetic acid derivatives has been revealed. The pharmaceutical market of the Kyrgyz Republic is dominated by monocomponent NSAIDs in the form of soft medicinal forms produced in foreign countries. Only 7 MDs from this group are in the high-price range, making the remaining drugs financially available to consumers. Keywords: NSAIDs, indomethacin, diclofenac, etodolac, ketorolac, aceclophenac.

CLINICAL AND SOCIAL ASPECTS OF HEROIN ADDICTION: MODERN STATE OF ISSUE

The article provides a brief overview of the literature, which deals with the issues of heroin addiction, its history, prevalence, statistics, clinical characteristics, diagnostics, prevention and countermeasures, as well as programs aimed at social rehabilitation and harm reduction from injecting drug use. Issues such as physiological foundations and features of disease and remission formation, withdrawal, motivational attitudes of drug users, structure users of narcotic substances, the impact of pre-morbid features, socio-demographic, clinical-dynamic, regional and gender aspects of heroin addiction, and also existing approaches to therapeutic and preventive measures are considered in narcology. Medical and social consequences expressed in the form of the spread of hemo-contact infections, such as HIV/AIDS and viral hepatitis; risky behavior and its impact on the growth of sexually transmitted infections; reducing and completely losing social status; suicide-aggressive actions have been studied. The analysis of data on the study of the prognostic value of the socio-demographic and clinical-dynamic characteristics of heroin addiction and its effect is provided on the outcome of the disease. Keywords: Drugs, drug addiction, heroin addiction, opioids, addiction treatment

THE VALUE OF SOME CLINICAL AND DYNAMIC CHARACTERISTICS OF HEROIN ADDICTION IN EVALUATION OF THE PROGNOSIS OF DISEASE

Objective: To study and provide the clinical and dynamic characteristics of heroin addiction and their impact on the prognosis of the disease and formulate the recommendations to improve the narcological care. Methods: The values of some clinical and dynamic factors in the assessment of the prognosis of heroin addiction in 170 patients were investigated. Results: It has been established that the combination of such clinical and dynamic factors of heroin addiction as the early onset of familiarization the use of narcotic substance in the age of 20 years, the use of heroin as a first sample of the narcotic substance, the duration of the disease more than ten years, a highly progressive rate of the course, the presence of concomitant viral hepatitis or positive HIV status may determine an unfavorable prognosis of the disease. Clinical and dynamic factors of favorable prognosis are: the late start of drug use – over the age of 40 years; the first test drug is different from heroin; duration of drug use up to 5 years; the low-progressive rate of the disease, the absence of concomitant diseases associated with injecting drug use in the form of viral hepatitis and HIV. Conclusions: The highlighted prognostic criteria for heroin addiction and the offered to their base prognostic «risk group» of patients will optimize clinical and organizational approaches in fulfillment of complex measures aimed at the treatment and rehabilitation of patients with heroin addiction. Presented characteristics can be taken into account in the formation of preventive measures, a differentiated approach to dispensary supervision of persons suffering heroin addiction. Keywords: Opioids, narcomania, heroin, prognosis, addiction, narcological care

CLINICAL CASE OF CEREBRAL TOXOCAROSIS

Toxocarosis can be manifested by pathology of various organs and systems of the body, occurring under the mask of many diseases. This dictates necessitates a more thorough familiarization with this pathology of doctors of various specialties, in particular, dermatologists, ophthalmologists, therapists, neuropathologists. The article describes a clinical case of successful diagnosis and treatment of the most severe, in terms of consequences, the forms of this disease – cerebral toxocarosis. Timely diagnosis of pathology includes cerebral MRI and immunological studies of blood serum for the presence of antitoxocarosis antibodies. Albendazole – a broad-spectrum antihelminthic drug has proven to be highly effective in the therapy of this pathology. Proper diagnosis and, as a result, adequate therapy are the guarantors of a favorable outcome in this form of the disease. Keywords: Toxocarosis, brain, diagnostics, treatment, albendazole

EVALUATION OF HELICOBACTER PYLORI IN PATIENTS INVOLVED TO CHRONIC DYSPEPSIA

Objective: To determine the frequency of Helicobacter pylori (HP) in patients with chronic dyspepsia referred to private laboratories in Mazar-i-Sharif city in 2019. Methods: This study is a descriptive cross-sectional study which the sampling method has performed randomly on six private laboratories in Mazari-Sharif city. The population under study consisted people with digestive disorders and a number of them had no any signs and symptoms. Subjects of study were persons that referred to serological and stool testing for HP at private laboratories in Mazar-e Sharif city in the winter season of 2019. Of course, the patients included in this study are mostly those who have been treated with gastritis tablets at one time but have not been cured. The variants of study included gender, age group, presence and absence of signs and symptoms, place of residence. The patients’ information was obtained through the patient record book and patient’s examination result sheet in which the blood serum and their stool were used for diagnosis. Results: From 108 patients were recruited for HP study, 53 people were men and 55 people women, who were used for diagnosis serologic and stool tests, which showed that 74% of patients had positive result for HP and 26% negative result for HP and these patients were between the ages of 15-65 in terms of presence and absence of sign and symptoms, 57% with loss of weight and stomach irritation, 14% with anorexia, 7% had headache and vertigo and 22% had no signs and symptoms. Conclusions: The present study on 108 who were referred to private laboratories for blood or stool examination were positive for male (39%) and negative (13%), for female (33%) were positive and (15%) negative. Likewise their age groups were different with the majority of patients being between the ages of 15-25 and the minority were 56-65 years. 57% of patient complaining gastric irritation, severe stomach pain and loss of weight. Keywords: Helicobacter pylori, gastritis, indigestion, dyspepsia, diagnostic tests, sensitivity, resistance.

CLINICAL AND IMMUNOLOGICAL CHANGES OF NON-GONOCOCCAL URETHRITIS

Objective: To study the clinical features and the state of general immunological reactivity in non-gonococcal urethritis (NGU) in men. Methods: Examined 100 men between the ages of 20 and 48 years: 75 patients of NGU (main group) and 25 healthy (control group). The average age of the patients was 26.7±1.7 years, and the male of control group was 27.9±1.7 years. Clinical, microscopic, immunological research methods were used, including direct immunofluorescence (DIF), polymerase chain reaction (PCR). Results: Ureaplasma urealyticum was found in 37 (49.3%) patients, 33 (44%) had Chlamydia trachomatis, 23 (30.7%) had Mycoplasma genitalium, 16 (21.3%) had Trichomonas vaginalis. In 24 (32%) of NGU patients had a mixed infection: in 14 (18.7%) had a combination of two STIs and in 10 (13, 3%) had three infections. In 51 (68%) of patients the process passed in the form of monoinfection. Various complaints (dysuric disorders, pain, discomfort and agglutination of the labium urethra) were presented by 51 (68%) of sick patients. The excretions from the urethra were marked in 46 (61.3%) of patients, reproductive disorders are 3 times less common. Immunological disorders were manifested by a decrease in CD4 and CD8 lymphocytes, PHA, PN and IL-10, increase – IgM, IgG, CIC, TNFα, IL-1β. Conclusions: The most common cause of NGU is Ureaplasma urealyticum and Chlamydia trachomatis. In most cases NGU proceeds in the form of monoinfection. Subjective and objective symptoms occur in 64% and 59% of patients, respectively. Immunological disorders were detected in 71% of patients. Keywords: Non-gonogococcal urethritis, direct immunofluorescence, immunoenzyme method, polymerase chain reaction

COMPREHENSIVE PREVENTION OF INSTABILITY IN HIP REPLACEMENT FOR HIP FRACTURES AND THEIR CONSEQUENCES IN POSTMENOPAUSAL OSTEOPOROSIS IN MULTIPAROUS WOMEN

Objective: To reduce instability rate after hip replacement (HR) in postmenopausal osteoporosis in multiparous women. Methods: Analyzed data of HR performed by 126 multiparous women with postmenopausal osteoporosis and hip fractures and their consequences. In the main group (n=65; 51.6%) of patients prevention of instability of endoprosthesis components was carried out using the proposed measures, in the control group (n=61; 48.4%) of patients – with traditional approaches. Clinical and X-ray methods, densitometry, a comprehensive method of assessing hip function by Harris, statistical methods are used in the implementation of the work. Results: In the main group influenced by proposed approaches in the dynamics have seen a decrease in the frequency of osteoporosis and due to this – an increasing osteopenia. In addition, there was a decrease in the frequency of instability of endoprosthesis components compared to the control group from 14.8% to 4.6% (p<0.005). Conclusions: Rational operation planning, and its implementation taking into account the peculiarities of the current of osteoporosis, continuous medication and rational post-operative rehabilitation are effective ways to reduce the frequency of instability in hip replacement in considered pathology. Keywords: Postmenopausal osteoporosis, hip replacement, hip fractures, multiparous women, baseline treatment for osteoporosis

ASSESSMENT OF RISK FACTORS AND DETERMINING THE LEVEL OF PREVENTABLE FETAL DEATH IN WOMEN WITH TROUBLED PREGNANCY

Objective: To examine the risk factors of stillbirth in the Republic of Tajikistan. Methods: Maps of individual observation of the course of pregnancy and the history of births of women with antenatal and intranatal fetal death in institutions of III and II levels have been studied. Retrospectively has been conducted the clinical audit of 187 cases of stillbirth. Results: The main causes of stillbirths were intrauterine growth retardation syndrome and fetal malformations. The most common risk factors for stillbirth were factors associated with inadequate medical care and factors related to family and women. At the same time, most of the cases of antenatal fetal death (83%) and intranatal fetal death (74%) were preventable or conditionally preventable. Conclusions: Our research confirms the need for perinatal audit, which aims to find the causes and risk factors of stillbirth with the subsequent implementation of solutions to prevent such cases of stillbirths in the future. Keywords: Stillbirths, antenatal fetal death, intranatal fetal death, classification of the ReCoDe, risk factors, levels of, levels of preventable stillbirth

AVICENNA’S INFORMATION ABOUT THE HEALING PROPERTIES OF BLACK SEED

The end of the 20th and the beginning of the 21st centuries in modern medicine can be called the era of the second birth and large-scale phytochemical and pharmacological study of black seed (Nigella sativa L. ). Today, the experience of the famous doctor and encyclopedist Avicenna on the clinical use of herbal medicines, created on the basis of black seed, can be a boost for their safe use against many severe human diseases. Nigella sativa L. is considered to be an ancient medicinal preparation of Eastern medicine. In this review, we analyzed five books, «The Canon of Medical Science», some other medicinal treatises of Avicenna, as well as modern studies on therapeutic properties and practical applications of black seed. Collected information from various books of the scientist were subjected to pharmacological, phytochemical and biochemical screening. Keywords: Abuali ibni Sino, Avicenna, black seed, Nigella sativa L., «Canon of Medical Science», «Al-Vohia», phytotherapy, misaj