The immune system and endometriosis

The article analyzes the literature data on the immune system and endometriosis. The features of the immune system, as well as the mechanisms of endometriosis development in the case of immune system dysfunction, are considered. Aim. To study the role of the immune system in the pathogenesis of endometriosis. Material and methods. To analyze the literature, we searched for information about this problem up to 10 years deep in PubMed/MEDLINE, PMC, and Web of Sсiеnce. The following terms were used individually or in combination: "genital endometriosis", "immune system", "cytokines", "autoantibodies". The search criteria were key studies related to genital endometriosis and the immune system: meta-analyses, original studies, retrospective and cohort studies. Results and discussion. There is a need to improve understanding of the potential origin of the General immunopathophysiology of endometriosis in order to identify therapeutic target areas that may allow relief or, ultimately, prevention of this disease. Immunological markers in this aspect have certain prospects. Conclusion. Although the role of cytokines in the development of endometriosis has been determined, it is not well understood. In this regard, it is difficult to clearly determine how they affect the pathogenesis of endometriosis. Keywords: endometriosis, immune system, cytokines, autoantibodie.

Analysis of the dental health level within the framework of a social project for medical examination and maintenance of orphanages in the Republic of Kazakhstan

Today, the issues of studying the dental health of children and adolescents living in various regions of the Republic of Kazakhstan remain relevant. The health of the younger generation, including dental health, is an important priority area that contributes to improving the quality of life. Aim. To study dental morbidity in children and adolescents in various regions of the Republic of Kazakhstan. Material and methods. A survey of 608 children and adolescents living in educational institutions was carried out. The results of the preventive dental examination were recorded in an electronic dental card. Passport data, subjective, objective data and data of intraoral examination were included in the electronic map for studying the prevalence. Particular importance was attached to the state of oral hygiene, the indicator of sanitized patients and the need for sanitation of the oral cavity. Results and discussion. The rationale for conducting the survey in various regions of the Republic of Kazakhstan was the study of the level of health in children and adolescents to establish risk factors for dental morbidity. Dental examination of 608 children and adolescents testifies to the high intensity and prevalence of dental caries, periodontal tissue diseases, dentoalveolar anomalies. Most children and adolescents need oral cavity sanitation, this figure was 51,9%. Undoubtedly, in educational institutions it is necessary to carry out sanitary and educational work and timely sanitation of the oral cavity. The obtained statistical data will allow us to draw up a "dental health map" of children and adolescents living in various regions of the Republic of Kazakhstan and develop a comprehensive program for the prevention of dental diseases. Conclusions. One of the main issues in dental practice is the study of the prevalence of caries in early childhood, including among children under 14 years of age, in order to prevent the development of complications, to carry out preventive measures to improve the quality of life. Dental caries is the most common among children living in educational institutions. Also, 28% of children have poor-quality fillings, decayed teeth, and due to non-observance of oral hygiene, inflammatory diseases of the periodontal tissues develop. About 35% of children need orthodontic care due to the development of dentoalveolar anomalies. Orthodontic care, which is a paid service, is not fully provided to this category of children and adolescents. Therefore, there remain a number of organizational-preventive and organizational-therapeutic measures that need to be addressed. Keywords: examination, dental health, analysis, project.

Anxiety disorders in clinical practice - a modern view on the problem of therapy

Clinically significant anxiety occurs in 5-7% of the general population and in 25% or more of patients seen by general practitioners. The lifetime incidence of anxiety disorders can be over 30%. Anxiety in adolescence and young adulthood often later develops into depression. The line between a “normal” response to a threat and a pathological anxiety disorder is often very blurred and there may be a continuum from personal distress to mental disorder. The real clinical situation is that most people with anxiety do not have their diagnosis. Only about a quarter (27.6%) of people who meet DSM-V, criteria for anxiety disorder receive treatment. The aim of the study was to optimize the treatment of anxiety disorders using the drug Mexidol®, taking into account modern data of epidemiology and neurobiology. Material and methods. This review is based on relevant publications obtained through selective searches in PubMed from 2010 to 2020 (58 references). The search was conducted for the following words: anxiety disorders, terminology, Mexidol®. The presence of at least one of these keywords served as a criterion for inclusion in this review. Results and discussion. Recently, there have been changes in the classification of anxiety disorders terminology. In ICD-10, disorders that were previously defined as neuroses are now located systemically in the headings F40 - F42: panic disorder, agoraphobia, social phobia; specific isolated phobias; general anxiety disorder, obsessive thoughts, compulsive actions and others. Estimates are widely spread across countries, with the highest prevalence in low-income countries (5.0%), lower in middle-income countries (2.8%), and lowest in high-income countries (1.6%). Mixed anxiety-depressive disorders are also one of the manifestations of chronic cerebral ischemia (CCI). In order to optimize treatment and to consider development of psychosomatic pathology in patients with anxiety disorders, Mexidol® is widely used. It has a vegetotropic, anti-stress, anxiolytic and other effects. Mexidol® creates a mechanism for biological desensitization of recurring neurotic, anxious experiences, stabilizes the parameters of the neuropsychiatric status. Conclusions. Our clinical and research experience shows that the management of patients with anxiety disorders can be optimized with the use of Mexidol®. Against the background of sequential drug therapy in most studies, a regression of affective disorders was noted (a decrease in the severity of anxiety, depressive manifestations, and asthenic syndrome). Keywords: anxiety disorders, terminology features, Mexidol®.

Modern approaches to the diagnosis and treatment of mixed anxiety-depressive disorders in primary health care

The relevance of this work is due to the wide prevalence of mixed anxiety-depressive disorders among general medical practice patients. At the present stage of development of the psychiatric service in the Republic of Kazakhstan, a new concept has been developed that assumes the transfer of a number of borderline mixed anxiety-depressive disorders to the competence of PHC doctors with the need for their treatment with modern antidepressants. The purpose of this work. Development and implementation in general clinical practice of modern methods of diagnosis and treatment of mixed anxiety-depressive disorders. Material and methods. 30 patients with mixed anxiety-depressive disorders of the borderline level, who were treated on an outpatient basis (Nursultan) was examined. The study was conducted using international psychometric scales: Hospital Anxiety and Depression Score (HADS), Hamilton Anxiety and Depression Rating Scale (HDRS, HAM-A). Results and discussion. As a result of the study, it was found that among patients with mixed anxiety-depressive disorders who were treated on an outpatient basis, young people of working age from 21 to 50 years (83.3%) prevailed, in whom psychogenic anxiety-depressive disorders accounted for 60%. In the course of clinical observations, objective data were obtained indicating that when treating depressive states of mild and moderate severity with Mianserin drug on an outpatient basis, by the end of the second week of treatment, there is a fairly pronounced positive dynamics in the reduction of symptoms of depression. By the end of the second month of taking this drug (8 weeks), most patients had no symptoms of depression. Conclusions. Practical clinical observations have shown that the modern Mianserin antidepressant, possessing a wide range of clinical effects combining thymoanaleptic action proper with anti-anxiety, sedative and hypnotic effects is well tolerated by patients and can be recommended for widespread use in the treatment of mixed anxiety-depressive disorders in general medical practice. Keywords: depression, anxiety, primary health care, general medical practice, antidepressants.

Human teeth enamel as a test for assessing the consequences of radiation pollution of the environment

Technogenic radioactive contamination of the external environment has a radiation effect on flora and fauna, including humans. Radionuclides entering the biosphere become a source of external, contact and internal radiation in a variety of combinations. The electron paramagnetic resonance dosimetry is a technique that allows a retrospective assessment of an individual dose to be made. Purpose of the study. Assessment of the long-term consequences of the impact of radiation contamination of the territories adjacent to the landfill on the health of the population using biotesting methods. Material and methods. A reconnaissance and radioecological survey of environmental objects was carried out using analytical methods, which made it possible to determine the quantitative content of toxic components, priority pollutants and radioactive isotopes. The objects of study are the Bokeyordinsky and Zhanibeksky districts of the West Kazakhstan region (WKR), adjacent to the Kapustin Yar test site. The values of the volumetric activity of natural and technogenic radionuclides in soil samples, drinking water and biosubstrates (teeth, samples of human peripheral blood) from settlements of the surveyed areas were studied. Results and discussion. Measurements of gamma radiation showed that along the perimeter of the polygon and in nearby settlements, the radiation level is in the range of 0.06–0.14 µSv/h. An insignificant excess of the level of radioactivity persists near the fall of missiles in the Bokeyordin region. The indicators of the general morbidity of the adult population of maternal and child mortality in the indicated regions were also studied. It was found in the inhabitants of the Bokeyordinsky district with a reliability of p = 95% in the studied teeth, betta and gamma activity is less than the natural level and indicates that the content of radionuclides in the studied teeth is not higher than their natural level. A noticeable excess of the activity of radionuclides K40 and Ra226 is noted among residents of Zhanibeksky district. Conclusions. In the surveyed districts of the region, there is an unsatisfactory state of health of children and women, especially of fertile age, a high level of primary morbidity, maternal mortality; there is a tendency for the growth of eco-dependent human diseases (previously unrecorded forms of oncological diseases, congenital malformations, diseases of the hematopoietic and nervous systems). The conclusions can be used to implement measures to improve the ecological state of the region and the health of the population. Keywords: radionuclides, radioactivity, biosubstrate, polygon, ecology, eco-dependent diseases.

Клиническое значение результатов исследования DAPA HF (Dapagliflozin and prevention of adverse-outcomes in heart failure) для пациентов и врачей. Консенсус совета Экспертов

The article presents the results of the DAPA-HF study - evaluating the efficacy of dapagliflozin, used at a dose of 10 mg once a day, in addition to the standard treatment for patients with chronic heart failure with reduced left ventricular ejection fraction, compared to placebo. An analysis of current clinical recommendations related to this issue was carried out, the results of recent clinical studies and metaanalyses conducted were highlighted. Based on the results of the study, the need is postulated to optimize drug therapy of this category to patients with persistent symptoms of heart failure, despite standard therapy, with the addition of dapagliflozin to reduce the risk of cardiovascular death and hospitalizations for heart failure, improve the course of the disease. Keywords: chronic heart failure, dapagliflozin, low ejection fraction, effects of type 2 sodium-glucose co transporter inhibitors, diabetes mellitus.

The conception of the probable role of the biological active chromium in the emergence of insulin resistance and alimentary obesity

The conception of probable alimentary chromium role in connection with metabolic reasons emergence of insulin resistance in the alimentary obesity and type 2 diabetes is represented. The violation of insulin receptors structural organization and conformation with these pathological conditions in connection with redox states of chromium is supposed. Based on information from general chemistry and chromium metabolism, higher biological activity of hexavalent chromium when compared to the activity of trivalent chromium is assumed in insulin-resistant conditions. Aim. To analyze the literature data on the a supposed participation of chromium in food and chromium nutraceuticals in connection with insulin resistance at the metabolic level. Material and methods. The analysis of the literature was carried out by the method of manual search and selection of the most important and significant for the analyzed issue monographs and articles up to 60 years in depth. The search criteria were works directly related to the association of food chromium with the insulin-dependent metabolic response of cells and the activity of insulin receptors. No works published over the past 10 years that introduce principled novelty and are of principled importance for the present problem have not been identified. Results and discussion. The concept of the supposed participation of chromium as an essential element in connection with the metabolic reasons for the formation of insulin resistance and the structural organization of insulin receptors depending on the redox state of chromium is presented. Keywords: hexavalent and trivalent chromium, insulin resistance, redox state, insulin receptor, alimentary obesity, diabetes.

Neurological manifestations of tuberous sclerosis in children (own observations)

Tuberous sclerosis (Pringle-Burneville disease) is a polysystemic genetic disease and occurs in the population with a frequency of 1:50000. Objective of the study. To study neuropsychic status and dynamics of tuberous sclerosis development in children. Material and Methods. Have been examined 33 children aged from 1 to 14 years, who were observed in the neurological pediatric department of the University Clinic ("Aksay") of Asfendiyarov KazNMU. All children had apigmented spots and coffee-milk stains on the torso and extremities, not protruding above the skin level. All children showed characteristic neuroimaging changes in the brain by magnetic resonance imaging (MRI) and computed tomography (CT) - areas of dyshinesia cortically and subcortically, i.e. tubercles. As well as changes in internal organs (hamartoma variants). All children underwent a complete laboratory examination (general blood count, standard biochemical parameters), electroencephalography of the brain (EEG), as well as ultrasound examination of internal organs. Results and conclusions. As a result of our study, it was revealed that the main symptom confirming the diagnosis of tuberous sclerosis is the presence of tubers (95-100% of patients). Moreover, there is a topographical relationship between tubers detected during MRI examination and the presence of foci on the EEG. Thus, a particular manifestation of the disease in patients is symptomatic epilepsy with onset in the first months of life (96% of patients). Keywords: tuberous sclerosis, epilepsy, children, hamartomas, pigmented spots, cortical dysgenesis, tubers.

Frequency of symptoms of temporominal joint dysfunction in children and adolescents in orphanages

Diseases of the temporomandibular joint (TMJ) occur in 20-76% of the population, of which up to 70-89% are functional joint disorders. In children and adolescents, TMJ dysfunction occurs in 14-20%. Among the variety of pathogenetic factors in the development of this pathology, the most important are: stress, psychological disorders, imbalance in the tone of the masticatory muscles, occlusive disharmony. Purpose of the study. To study the prevalence of symptoms of TMJ dysfunction, including prenosological, in children and adolescents living in orphanages. Material and research methods. The frequency of occurrence of symptoms of functional disorders of the TMJ, including prenosological, was studied in 331 children and adolescents living in orphanages. The comparison group consisted of 218 students of secondary school No. 30 in the city of Almaty. Results and discussion. These symptoms were found in 32.62% of children and adolescents living in orphanages in the city of Almaty, and in 35.32% of practically healthy individuals, and their frequency increased with age. More common in girls. In different combinations there were revealed the dislocation of the middle inter-incisive line, pain on palpation of the masseter muscles, joint noise, malopening mouth. Dentofacial anomalies were more often observed in children and adolescents with certain symptoms of functional disorders of the temporomandibular joint. Keywords: temporomandibular joint malfunction, children and adolescents living in orphanages.

Essential tremor not just a tremor (review)

Essential tremor is one of the most common movement disorders. The nature of this disease is not fully understood. It was believed that this pathology manifests itself only by tremor, and symptoms such as depression, anxiety and apathy in patients with essential tremor can only be regarded as a reaction to the presence of tremor. Cognitive impairment is a concomitant pathology that can occur in the elderly, which accounts for a more frequent onset of the disease. But is it really so Purpose of the study. To study the literature data to identify the presence in patients with essential tremor of such signs that can be attributed to the group of "non-motor" symptoms. Material and methods. In order to study the literature data, a search was carried out in the Web of Science, PubMed databases. During the search, all articles published since 2000 were examined and the following terms were used in combination with "essential tremor": "non-motor symptoms", "anxiety", "depression", "apathy", "cognitive impairment", "sleep disorders", "hearing impairment", "hyposmia". The main search terms were studies based on the study of patients with essential tremor: meta-analyzes, original studies, retrospective and cohort studies. Results and discussion. It can be unambiguously argued that symptoms such as anxiety, depression, apathy and cognitive, hearing and smell dysfunctions are characterised to the patients with essential tremor. The first three manifestations were attributed to the response to the presence of tremor. And cognitive functions, hearing and smell dysfunctions was considered a concomitant pathology, which occurs quite often in old age, which accounts for a more frequent onset of the disease. But in reality, everything is not so simple. The literature data, which began to appear over the past 20 years, make it clear that the previously mentioned clinical manifestations may well be regarded as "non-motor" symptoms of essential tremor. Conclusion. Nowadays neurologists are increasingly faced with the problem of differential diagnosis of essential tremor. Despite the fact that everything was very simple and clear on the diagnosis of this disease, in recent years more and more data have appeared in favor of the fact that essential tremor is a heterogeneous disease that manifests not only by tremor. But this is also a disease, which, due to its heterogeneity of pathophysiology, can give great variability in the clinical picture. Keywords: essential tremor, nonmotor symptoms, anxiety, depression, cognitive impairnment, dementia.