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Section 6. Medical science
6. Siddiqui Ali, Spechter Stuart J., Huerta Sergio. Surgical Bypass Versus Endoscopic Stenting for Malignant Gastroduodenal Obstruction:
A Decision Analysis. Dig Dis Sci. - 2007. - Vol. 52. - P. 276-281.
Asadov Damin Abdurahimovich, E-mail: adilfuza@yandex.ru Rakhimov Maksudbek Kalandarovich, Nurullayev Rustam Babajanovich E-mail: rmk_doc@mail.ru Tashkent institute of postgraduate medical education
Tashkent, Uzbekistan
Improve the quality of urological care in patients with uncomplicated urinary tract infections in primary care health of the republic of Uzbekistan
Abstract: Together with general practices in selected areas carried out a comprehensive medical examination of4451 people, accounting for 88.3% of the number to be inspected. Men accounted for 1525 (34.3%) and 2926 women accounted for (65.7%). The prevalence of UTI in the Khorezm region was 11.37 per 100 examined. The prevalence of urinary tract infections was higher in women than in men. In Khorezm region UTI is more common in women in 1,9 times, which can be explained by anatomical and physiological features of urinary organs in women. UTI is more common in women aged 18-50 years and in men older age groups of50-70 years. Use of a specially designed universal questionnaire in epidemiological survey of the population of Khorezm region it possible to determine the prevalence and improve the early diagnosis of UTI.
Keywords: Urinary tract infections, primary health care, Uzbekistan.
Urinary tract infection (UTI) is one of the most common urological diseases worldwide [12].
The incidence of these diseases in Russia is very high, it is about 1000 cases per 100 000 population per year and is growing steadily [5]. Every year there are nearly 26-36 million cases of acute cystitis. It can be assumed that the true prevalence of the disease is much higher, because many patients do not seek medical advice and treat themselves. According to statistics, an average of 1% of the people on the ground each year become ill with pyelonephritis, and every 3 women in their lifetime had at least one episode of dysuria.
According to studies in the USA each year revealed more than 7 million UTI cases in outpatient practice, including more than 2 million caused by cystitis, and 100 thousand patients per year are hospitalized, mainly about a pyelonephritis [9]. In the UK UTI is second only to respiratory diseases among all the microbial processes annually about 8.1 million visits to the doctor for UTI [13]. UTI is more common in women than in men, 50% of adult women are at risk of developing the disease in their lifetime [10]. UTI is often observed in young women aged 18 to 29 years. Over the next 6-12 months after the first episode at 25-40% of patients develop recurrent uncomplicated UTI [8]. At the age of 18-20 years, approximately 20% ofwom-en have a history of at least one episode of UTI in older age groups marked increase in the incidence [11]. About 15% of all antibiotic prescriptions in the outpatient practice in the United States related to the IMP [9]. In New Zealand, held annually almost 800 000 urine culture, what is spent approximately 12.5 million dollars USA.
Prevalence and social significance of these diseases causes interest of researchers to improve and develop methods to improve their diagnosis and treatment.
One of the most effective approaches to improving the quality of medical care is considered to be advanced training of doctors, based on identifying and addressing the systemic causes of medical care of poor quality [7]. A manifestation of the lack of medical qualifications are medical errors, which are based on the inferiority
of expertise, inability to think logically and to use existing and new knowledge into practice. Medical errors permitted in helping the patient, have a negative impact on the quality of care [6, 4].
UTI is an urgent problem and the health care system of Uzbekistan. In the absence of a single standard of treatment of UTI, and reliable criteria to guide urine bacteriological seeding, there are differences in the management of patients in different hospitals. In addition, irrational use of antibiotics leads to the growth of the main uropathogens resistance to many antimicrobial agents, which complicates the choice of effective treatment of UTI.
Studies performed in recent years, including in Uzbekistan made some contribution to the solution of the issue under study. However, it should be noted that the subject of study is only a few above-mentioned disease entities and their groups [1; 2; 3].
Another unexplored aspect of the problem is to identify opportunities and interest in primary care in the control of urological diseases. Past few studies relate mainly specific diagnostic or therapeutic tactics. The planned research is localized in the Aral Sea region, which is a zone of ecological disaster, and the state of health of the population which, as well as the diagnosis of early stages of the disease, should pay special attention to the development ofboth therapeutic and prophylactic measures, which is largely due to the activities of the primary health care.
Such widespread UTI in the world requires the need to develop and implement measures aimed at improving the prevention, improving the quality of patients with UTI, decrease its complications, namely the establishment of guidance to assist the doctor in making clinical decisions.
Objective: Study of the prevalence of urinary tract infections among different populations of the Khorezm region of Uzbekistan and the development of modern approaches ofprocess organization of diagnosis, treatment and prevention in primary care.
Material and methods: Epidemiological study, alopecia, typological method, conducted a survey among the population of people
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Improve the quality of urological care in patients with uncomplicated urinary tract infections in primary care health...
living mainly in the areas of rural health units (RHU) for the presence of urinary tract infections. Studies conducted in Bagat, Gurlan, Kushkupir, Khazarasp, Yangiarik Yangibazar areas and Khorezm region of Uzbekistan, which according to climatic and social conditions are relatively disadvantaged. In each area selected, two RHU, located in the main living room, and with the necessary material and technical base for research. By random sampling in each rural health units were inspected at least ten percent of the adult population. Patients with urinary tract infections have been subjected to in-depth survey and follow-up. The results were subjected to a comparative study with data from other regions and the republic of Karakalpakstan.
Continuous population survey grounded systems approach, providing a comprehensive and in-depth study conducted by the most holistic method, which is important in light of the stated
purpose of the precinct and the traditional territorial principle of health.
The incidence of uptake is not always demonstrates the true prevalence of existing diseases in the population. It is known that a certain part of the population suffers from chronic diseases, for one reason or another do not seek treatment, although in dire need of it. In this connection, to establish the real prevalence of chronic diseases among the population according to the negotiability and this observation is often impossible. On this basis, to assess the true level of disease in the period 2012-2014 yy. members of the Khorezm branch of the Republican Specialized Center of Urology made an epidemiological survey. Together with general practices in selected areas carried out a comprehensive medical examination of 4451 people, accounting for 88.3% of the subject examination (Table. 1).
Table.1. - Population distribution on a territorial basis
Region, RHU, the number of examin-ees% Bagat Gurlan Qushkupir Khazarasp Yangiarik Yangibazar Total
Dekhkanabad Madaniyat I. Kholmetov Namuna Gozovot Quqtom Ataliq Bogdor Guliston Ostona Khorezm Sh.Qungirot
Umber of at least 10 percent of the adult population 443 285 450 205 357 421 449 670 272 639 415 434 5040
The number of survey respondents 396 253 408 183 311 365 403 592 236 558 363 383 4451
% 89,4 88,8 90,7 89,3 87,1 86,7 89,8 88,4 86,8 87,3 87,5 88,2 88,3
The allocation of the composition of the adult population by used the International Classification of Diseases — ICD-10 (1993)
sex and age groups for analysis of individual urological diseases, we (Table. 2).
Table. 2. - Distribution of the surveyed residents by sex and age
Floor Men Women Total
n % n % n %
Age 18-29 325 7,3 877 19.7 1202 27
30-39 409 9,2 734 16.5 1143 25,7
40-49 254 5,7 611 13.7 865 19,4
50-59 302 6,8 361 8.1 663 14,9
60-69 164 3,7 237 5.3 401 9
70-79 66 1,5 99 2,2 165 3,7
>80 5 0,1 7 0,2 12 0,3
Total 1525 34,3 2926 65,7 4451 100
As can be seen from the table, men accounted for 1525 (34.3%) and 2926 women accounted for (65.7%).
For a survey of the population used a specially designed universal questionnaire designed to identify symptoms typical of urological diseases. The purpose ofhis design for this study is the need for a simple, compact and universal «urological» questionnaire suitable for epidemiological and clinical (general medical and urological) practice in the examination of both sexes and all age groups. The questionnaire includes 33 questions related to the symptoms of the lower urinary tract, urinary tract infections, incontinence, and male genital pathology. General practitioners ofprimary healthcare took an active part in cooperation with doctors Khorezm branch of the Republican Specialized Center of Urology the survey population and filling the questionnaire, physical examination was carried out respondents.
For the purpose of screening for urological diseases used ultrasound scanner «Mindray» (China), with Convex probe 3,5 Mhz. When ultrasound scanning of the urinary system drew attention to the morphological changes pyelocaliceal system and renal parenchyma (hydronephrosis, gidrokalikoz, cysts, tumors, etc.), noted signs of rocks and conglomerates salts in the renal cavities.
Urine tests were performed rapid method using test strips Urine-10 ( «Cypress Diagnostics»). If necessary, a microscopy of urine sediment.
All patients on the updated list were invited to the inspection and examination by specially authorized employees of SVP. Control of this procedure was carried out in collaboration with the local administration and the management of medical institutions of the district.
Results and discussion: The prevalence of UTI in the Khorezm region was 11.37 per 100 patients (Table. 3).
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Section 6. Medical science
Table.3. - Indicators prevalence of UTI in adults RHU Khorezm region (n-4451)
№ Region RHU The adult population (>18 years) Sur- veyed % Men % Wo- men % Patients with UTI %
1 Bogot Dekhkanabad 443 396 89,39 14 3,54 31 7,83 45 11,36
Madaniyat 285 253 88,77 11 4,35 18 7,11 29 11,46
2 Gurlan I. Kholmetov 450 408 90,67 15 3,68 32 7,84 47 11,52
Namuna 205 183 89,27 9 4,92 12 6,56 21 11,48
3 Qushkupir Gozovot 357 311 87,11 11 3,54 25 8,04 36 11,58
Quqtom 421 365 86,70 13 3,56 29 7,95 42 11,51
4 Khazarasp Atalik 449 403 89,76 14 3,47 31 7,69 45 11,17
Bagdor 670 592 88,36 18 3,04 49 8,28 67 11,32
5 Yangiariq Guliston 272 236 86,76 12 5,08 15 6,36 27 11,44
Ostona 639 558 87,32 20 3,58 43 7,71 63 11,29
6 Yangibazar Khorazm 415 363 87,47 17 4,68 24 6,61 41 11,29
Shirin Qun-girat 434 383 88,25 17 4,44 26 6,79 43 11,23
Всего: 5040 4451 88,31 171 3,84 335 7,53 506 11,37
Table 4. - Distribution of patients with UTI by age and sex (n-506)
Floor and age of the patients Men Women Total
n % n % n %
Age 18-29 27 5,3 75 14,8 102 20,2
30-39 26 5,1 59 11,7 85 16,8
40-49 29 5,7 59 11,7 88 17,4
50-59 38 7,5 55 10,9 93 18,4
60-69 33 6,5 44 8,7 77 15,2
70-79 16 3,2 40 7,9 56 11,1
80 2 0,4 3 0,6 5 1,0
Total 171 33,8 335 66,2 506 100
The prevalence ofurinary tract infections was higher in women than in men. In Khorezm region BMI is more common in women in 1,9 times, which can be explained by anatomical and physiological features of urinary organs in women.
As can be seen from the 4-table, name is more common in women aged 18-50 years and in men older age groups of 50-70 years.
Besides UTI during an epidemiological study, identify other urologic pathology: urolithiasis, benign prostatic hyperplasia (BPH), malformations of the genitourinary system, varicocele, renal cysts, stress incontinence, infertility, enuresis, etc. All of them received a recommendation for a more thorough examination and treatment by a specialist in the community or in specialized clinics.
Conclusions. The definition of objective values prevalence of UTI is made possible by the identification of latent disease. To solve this problem the most informative targeted epidemiological study a large sample of the population of a certain region.
Essential in carrying epidemiological examination has brought to its implementation ofprimary health care (general practitioners) as the most approximate and having the possibility of early diagnosis of urological diseases. Priority attention should be given to the mandatory annual preventive medical examination and ultrasound of the urinary tract, followed by clinical examination of urological patients.
Use of a specially designed universal questionnaire in epidemiological survey of the population of Khorezm region it possible to determine the prevalence and improve the early diagnosis of UTI.
References:
1. Arustamov D. L., Nurullayev R. B. The prevalence of the most important urological diseases among the rural population of Uzbekistan//Urologiya. - 2004. - N.6. - P. 3 - 6.2, 3, 4.
2. Arustamov D. L., Nurullayev R. B., Tarasenko B. V. Prevalence and drug treatment of benign prostatic hyperplasia in the Aral Sea in Uzbekistan//Journal. theor. and the wedge. medicine. - 2003. - N.3. - P. 19-122.
3. Arustamov D. L., Nurullayev R. B., Tarasenko BV Khudaybergenov U. A. Crystalluria Epidemiology and prevention of primary stone formation in the region of ecological trouble Uzbekistan//Bull. Associ. Doctors Uzbekistan. - 2003. - N. 3. - P. 36-38.
4. Karachevtseva M. A. Scientific-theoretical substantiation of methodology of examination of quality of care: dis. MD. - St. Petersburg., 2004. - 510. P. 2005.
5. Lopatkin N. A., Pugav A. G., Apolikhin O. I. et al. Urology Textbook 5th edition, revised and dopolnennoe. - M.: GEOTAR-MED, 2003. - 520 p.
6. Mikhailov S. M., Resnyansky A. V., Vershinin A. S. et al. Current requirements to the method of assessing the quality of health care: Abs. Dokl. Russian. Scient. Conf. cardiology and cardiosurgery. - Samara, 1996. - P. 25-26.
7. Polyakov I. V., Tverdohlebov A. S. et al. Quality of care and management of the organization: Monograph - SPb., 2007. - 130 p.
8. Brufitt W., Hamilton-Miller J. M. Prophylactic antibiotics for recurrent urinary tract infections. J Antimicrob Chemother 1990; 25 (4): 505-12.
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A comparative clinical and catamnestic analysis of long-term results of carotid endarterectomy in stenosing carotid lesions
9. Foxman B. Epidemiology of urinary tract infections: incidence, morbidity, and economic costs. Am J Med 2002; 113 (Suppl 1A): 5S-13S.
10. Griebling TL. Urinary tract infection in women. In: Litwin MS, Saigal CS, eds. Urologic Diseases in America. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. Washington, D. C.: GPO; 2007. NIH publication 07-5512: 587-619.
11. Rafalskiy V., Khodnevich L. Eur.Urol 2008; 3 (Suppl): 267.
12. Ramakrishnan K, Scheid D. C. Diagnosis and management of acute pyelonephritis in adults//Am Fam Physician. 2005 Mar 1; 71 (5): 933-42.
13. Schappert S. M., Rechtsteiner E. A. Ambulatory medical care utilization estimates for 2006. National health statistics reports; no 8. Hyattsville, MD: National Center for Health Statistics; 2008.
Ataniyazov Makhsudjan Kamaladdinovich, Neurology Department of the Tashkent Medical Academy, Uzbekistan
E-mail: maksudnev@mail.ru
A comparative clinical and catamnestic analysis of long-term results of carotid endarterectomy in stenosing carotid lesions
Abstract: The long-term clinical and catamnestic results of 140 patients after carotid endarterectomy (CEA) and 140 patients after conservative treatment were analyzed. The life quality of patients after 1 year of treatment was assessed. The effectiveness of CEA as a means of prevention of stroke was demonstrated. The possibilities of improving of surgical care for patients with a high risk of stroke are being analyzed.
Keywords: carotid endarterectomy, quality of life, an ischemic stroke.
The highest level of morbidity and mortality in the structure of cardiovascular disease (CVD) is observed in cerebrovascular diseases [1-4].
It is expected that the incidence of stroke will increase in coming years, which is related to an increase in life expectancy and an increase in the population of persons with different risk factors of the cardiovascular disease [1; 2].The stroke rate in the structure of the total mortalityin Russia is 23,4% and 39% in the structure of mortality from cardiovascular disease, which is higher than in many other countries. Over the past 10 years, stroke mortality increased by 30%, this serious pathology develops increasingly in individuals younger than 50 years [1-3]. 46-48 thousand strokes are seen annually in Uzbekistan. The incidence of cerebrovascular disease in Uzbekistan for the 100 thousand of the population is 186; mortality rate — 78 (Data of the Ministry of Health of the Republic of Uzbekistan, 2008). 42,4% of them have a lethal outcome, 41,9% of patients are disabled, and only 15,7% of patients are recovered.
Furthermore, the stroke deteriorates significantly the quality of life (QOL) of patients and the prospects for the stroke rehabilitation, in many cases, are extremely negative. Nursing care is an ordeal for the family members and involves considerable social and economical losses [1; 2; 5]. In this regard, the primary task is to improve the preventive measures of stroke [6-11].
In our country, in the treatment of patients with stenosing carotid lesions we use surgical interventions [3-10], which allows to minimize the effects of the disease [3]. We have studied the clinical efficacy of the most perspective methods for the atherosclerosis treatment of the carotid arteries — the classic surgical (carotid endarterectomy— CEA) and conservative [6]. The comparative clinical and catamnestic analysis of this dataof the treatment used in the early postoperative period and one year after therapy was carried out.
Purpose of the study
Assess the clinical and catamnestic long-term results of carotid endarterectomy in patients with stenosingcarotid arteries on the base of 12-month observation.
Materials and methods
The clinical and catamnestic analysis of the two groups of patients (n = 280) of I, II, III stages with chronic vascular — cerebral insufficiency with stenosing carotid lesions (more than 70%) was carried out. The first group (n=140) underwent CEA and the second group (n=140) had a conservative therapy. After one year, patients were examined again (neurological status, duplex scanning of carotid arteries, neuroimaging), QoL was assessed by using questionnaires, a used pharmacotherapy was analyzed.
The patients in both groups were comparable by age and nature of comorbidity: the frequency of coronary heart disease (CHD) — 55,8 and 34,0%, arterial hypertension (AH) — 84,6 and 86,0%, diabetes mellitus (DM) — 9,06 and 12,0%, respectively (Fig. 1).
The groups were comparable in intensity degree of clinical manifestations of atherosclerosis. Moderate stenosis (narrowing of the carotid artery to 70%) was observed in the 1stgroup in 28 (20,0%) patients, in the 2ndgroup — in 35 (25,0%) patients. Treatment choice was based on the international guidelines [9; 10; 11]. The patients in both groups had a high perioperative risk [10]: residual stenosis, pre- and postdilatation, crimpiness, multivessel disease, and others were observed in 46 (32,8%) patients in the 1stfroup; reducing the pressure in the vessel, long time compression, multivessel disease, the heterogeneous nature of the plaques, contralateral occlusion, and others in 36 (25,7%) patients in the 2nd group.
In addition, the quality of life and patients health status in both groups was analyzed one year after treatment was analyzed. For this purpose, patients were questioned by using multidimensional QOL questionnaire (Euroquality of life — EQ-5D) [8; 9]; neurological examination was conducted, duplex scanning of neck vessels, biochemical blood lipids, magnetic resonance imaging of the brain.
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