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Indicators psychological status in patients with chronic heart failure
in 18 (10.1 %) cases were different combinations offocalization of the lesion (genitals, pubic area skin, the inner surface of the skin thigh).
Among the 42 patients 20 (47.6 %) members of genital herpes distributed on the skin of the labia majora, even in 8 (19.0 %) with the transition to the mucosa of the labia minora, 6 (14.3 %) cases, isolation of the mucous shell inner surface of the labia minora, skin of pubis in 4 (9.5 %) cases. Combinations of the lesions on the skin of the labia majora and the inner surface of the skin of the hips were examined in 4 (9.5 %) patients.
In the study of clinical manifestations in a group of tested patients, 67.3 % (148 patients) were diagnosed with vesicular form of GH, which was represented by small bubble elements (from single (1-3 pcs.) In addition, the multiple types of lesion, from 12 to 30-40 pcs. with serous, serous-purulent contents, grouped character, positioning the modest swelling on the hyper-emic skin and mucous of the genitals. Among 4 cases of manifestations of bullous form transformations of GH with bubbles from the larger size of 1.0 cm. to 3-4 cm. Accompanying by subjective symptoms namely itching (67.3 %), burning (56.4 %) and hyperesthesia as a feeling of tingling at 62.0 % of patients. Regression of lesions was on average in 7-8 days.
Erosive form of GH was defined in 18.2 % (40 patients) and patients had superficial defect of skin and mucous membranes of the genitals with a scalloped form, unclear edges follow the contours of the former bubble elements on the wet hypermetric surface with the character of serous exudation. Epithelialization was performed average within 9-10 days. Erosive form of GH in the majority of cases have been presented with subjective symptoms such as burning (18.2 %) and pain (15.4 %) in the local lesions.
Among the observed patients in 10 % of cases was erosive and ulcerative form GH, which was presented as a profound lesions (dermal tissue of skin), in combination with a surface defect of skin and
mucous membranes of the genitals. Along with this, 4.5 % of the patients had ulcerative lesions GH presented deep lesions of the skin of the genitals. Ulcers form GH was presented sweepingly-oval form, ranging in size from 0.5 to 1.0 cm. in diameter with irregular, slightly infiltrated eminence as well as with hyperemic edges. The bottom is covered with serous-hemorrhagic exudate with local granulation tissue. Subjective symptoms of ulcerous and erosive ulcerous forms of GH was pain in the lesions. The course of these forms of the disease was prolonged, averages 14-16 days with a slow epithelialization of lesions and cicatricle tissue.
In the studied group of patients, local subjective symptoms in 30 patients (13.6 %) has been neuralgic pains radiating to the groin and lower limbs along the sciatic nerve, weakness, aches, headache, and increasing body t ° from 37 to 5 - 38 °C. In 20 (18.2 %) patients had complications in the form of a unilateral inguinal lymphadenitis (32 patients), with an increasing size of a hazelnut and tenderness as well as in 8 patients was defined the accession of secondary pyogenic infection.
Thus, based on the study of clinical materials has been found that 60 % of patients with recurrent disease GH was prolonged in a duration irom 1 to 5 years, with the frequency of recurrence of genital herpes in 55.5 % of patients between 6 and 12 relapses in a year. The clinical manifestations ofGH characterized in 67.3 % cases ofvesicular, erosive 18.2 %, 10 % erosive peptic ulcer and 4.5 % forms of skin lesions and mucous membranes of the genitals, which predispose a massive eruption of herpes viruses in the environment and which was an epidemiologi-cally unfavorable factor in the spread of these viruses among population.
Conclusion. Taking into account the peculiarities of the clinical course of GH, it is necessary to assign the new approaches in therapy. Hence, for the possibility to contribute to more rapid epithelialization of destructive lesions which could be considered as prevention of the epidemiological spread of the viral etio-agent and reducing the number of relapses of the disease.
References:
1. Дробышева Н. Н. Вопросы диагностики генитального герпеса//Вестн. дерматол. - 2002. - № 5. - С. 21-23.
2. Дубенский В. В. Генитальная герпетическая инфекция//Российский журнал кожных и вен.бол. - 2002. - № 3. - С. 54-56.
3. Марченко Л. А. Генитальная герпетическая инфекция у женщин (клиника, диагностика, лечение): Автореф. дис. ... д-ра мед. наук. - М., 1997. - 41 с.
4. Марченко Л. А. Генитальный герпес у женщин (клиника, диагностика, лечение)//М^епа medica. - 1996. - № 2. - С. 53-73.
Kadirova Shahlo, Bukhara State Medical Institute Kamilova Umida Kabirovna, Prof., Republican Specialized Scientific-Practical Medical Center of Therapy and Medical Rehabilitation JSC, Uzbekistan E-mail: [email protected]
Indicators psychological status in patients with chronic heart failure
Abstract: In patients with heart failure to study the psychological status of the relationship between indicators of psychological status and progression of the disease: patients with FC III identified more often more severe disorders with revalence of depressive disorders.
Keywords: chronic heart failure, psychological state, depression, anxiety.
Chronic heart failure (CHF) — progressive and unfavorable the risk of mortality, and the mortality rate of patients in amounts prognosis disease of the cardiovascular system, a major cause of dis- of15-50 % throughout the year. The problem is closely related mental ability and violation of reduced life expectancy in developed coun- and physical health does not cease to be relevant for many thousands tries. According to the Framingham study, its frequency doubles ev- ofyears [1; 2; 3]. In recent years greatly increased interest in the study ery decade, and in the next 20-30 years, it will increase by 40-60 %. of psychosomatic aspects, reflecting the rise and for cardiovascular The disease worsens the quality oflife ofpatients is 4 times increases disease. Multicenter study INTERHEART Study involving 52 coun-
Section 4. Medical science
tries, 29 thousand. Surveyed showed that the incidence of myocardial infarction nine determine independent risk factors, among which are the third most important anxiety and depression [4]. Despite the fact that depression in cardiovascular diseases, the subject of many studies, only some of them have studied the relationship affective disorders with chronic heart failure [5; 6]. Psychological status is of great importance in the course and progression of heart failure and determine the quality of life of these patients [8; 9]. In patients with heart failure in the presence of depressive disorders significantly increases the risk of recurrent hospitalizations and deaths [1; 4].
Objective. To investigate the psychological state of patients with post-infarction cardiosclerosis complicated FC I-III chronic heart failure.
Materials and Methods. The study included 62 men with coronary artery disease postinfarction cardiosclerosis complicated with chronic heart failure (CHF) I-III by NYHA FC. Assessment of psychological status was performed using the method of The Zung self-rating depression scale, reactive and personal anxiety — Spiel-berger questionnaire, adapted Khanin. To assess the psychological defense used the technique of Life Style Index (LSI) — Plutchik-Kellerman. Statistical processing of results of research carried out on a personal computer type IBM PC/AT using packet spread-
sheets ECXEL 6.0 Windows-95 parameters are described in the form M ± SD. The statistical significance measurements obtained by comparing the average values determined by Student (t) with the computation of the error probability (P) for testing normality (by kurtosis criterion) and the equality of the population variance (F — Fisher's exact test). For statistically significant changes have taken confidence level P < 0.05. Statistical significance for qualitative variables was calculated using the x2 criterion (chi-square) and the z-criterion (Glanz). For dependency analysis features calculated the Pearson correlation coefficient of pair (r).
Results and Discussion: 6-minute walk test results showed that among the studied patients with FC I constituted 32.6 %, with 35.7 % FC II and III FC 31.7 %. Initial SHOKS indicators in patients with CHF FC I made up 3.5 ± 0.51, with CHF FC II 5.6 ± 0.62 points, respectively. In patients with heart failure FC III this indicator was — 8.6 ± 0.97 that was 147 % higher compared to SHOKS in patients with CHF FC I. The patients after the processing and analysis of questionnaires from 42 (55.5 %) were identified violations of varying degrees of severity of psychological state. Among the examined patients with FC I CHF patients with depression accounted for 19.4 %, with anxiety disorders accounted for 33.5 % (Fig. 1).
Fig.1. The incidence of anxiety and depression in patients with chronic heart failure ( %)
When FC II patients with depression accounted for 36.4 %, the patients with anxiety states accounted for 23.2 %. In patients with FC III patients with depression accounted for 39.8 %, anxiety was observed in 18.5 % of patients. Prospective studies have shown that depression is an independent risk factor for increased mortality and hospitalization rates in patients with chronic heart failure (5). Mild depression occurs in 43.7 % of patients, moderate in 31.5 % of patients and severe in 24.8 % of patients. For patients with CHF has been characterized by an increased degree of denial of existing problems, displacement (with the exception of the idea of consciousness and related emotions), different control emotions and over-reliance on a rational interpretation of the situation. With the denial of the existence of compensation were associated severity: the higher is the rate of denial in patients with CHF, the expressions were anxious and depressive disorders. The combination of these features is sustainable (R = 0.9; p < 0.001). Affective disorders such as anxiety and depression were closely linked (r = 0.50; P < 0.001) and were typical of patients with younger age (r = -0.46; p < 0.05 and r = -0.66; P < 0.001, respectively). The emergence of depression was proportional to the severity of clinical symptoms (r = 0.46;
P < 0.05) and decrease in exercise tolerance (r = 0.49; P < 0.05). Depression has a negative impact not only on the forecast ofthe patients, but also on the clinical course of the disease (1). As a favorable factor was considered as presence of intellectualization of patients with heart failure with this type of psychological defense mechanism we have not been characterized by affective disorders (R = 0.59; F = 2.9; p < 0.05). Established relationship between psychological defense mechanisms and severity of clinical symptoms such as palpitations (connection with the denial of r = 0.42; P < 0.05), pain (dependent on the severity of the regression r = 0.46; P < 0.05). The relationship of depression and the severity of the physical condition of patients are sustainable (P < 0.05).
Conclusions. Thus, in patients with heart failure to study the psychological status of the relationship between indicators of psychological status and progression of the disease: patients with FC III identified more often more severe disorders with prevalence of depressive disorders (39.8 %) than with FC I (19.4 %). For patients with chronic heart failure has also been characterized by an increased degree of denial of the problems with controlling emotions, and over-reliance on a rational interpretation of the situation.
Structural-functional state and feature remodeling of left ventricle in patients with coronary artery disease after revascularization
References:
1. Gallagher D., O'Regan C., Savva G. M. et al. Depression, anxiety and cardiovascular disease: which symptoms are associated with increased risk in community dwelling older adults?//J Affect Disord. - 2012. - 142(1-3): 132-138.
2. González H. M., Tarraf W. Comorbid cardiovascular disease and major depression among ethnic and racial groups in the United States./Int Psychogeriatr. - 2013. - 25(1): 833-841.
3. Junger J., Shellberg D., Muller-Tasch T. et al. Depression increasingly predicts mortality in the course congestive heart failure//Eur. J. Heart. Fail. - 2005. - 7(2): 261-267.
4. Yusuf S., Hawken S., Stephanie Ounpuu S. et al. INTERHEART Study Investigators. Effect ofpotentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study//The Lancet. - 2004. - 364(9438): 937-952.
5. Choi N. G., Kim J., Marti C. N. Late-Life Depression and Cardiovascular Disease Burden: Examination of Reciprocal Relationship//Am J Geriatr Psychiatry. - 2014. - 22(12): 1522-1529.
6. Mittag O., Meyer T. The association of depressive symptoms and ischemic heart disease in older adults is not moderated by gender, marital status or education//Int J Public Health. - 2012. - 57: 79-85.
7. De Jonge P., Rosmalen J. G., Kema I. P. et al. Psychophysiological biomarkers explaining the association between depression and prognosis in coronary artery patients: a critical review of the literature//Neurosci Biobehav Rev. - 2010. - 35(1): 84-90.
8. Baune B. T., Stuart M., Gilmour A. et al. Moderators of the relationship between depression and cardiovascular disorders: a systematic review//Gen Hosp Psychiatry. - 2012. - 34(5): 478-492.
9. Rustad J. K., Stern Th. A., Hebert K. A. Diagnosis and Treatment of Depression in Patients With Congestive Heart Failure: A Review of the Literature//Prim Care Companion CNS Disordv. - 2013. -15(4): PMC 3869617.
Alyavi Anis Lutfullaevich, professor Kamilova Umida Kabirovna, professor E-mail: [email protected] Tulaganova Dildora Karimovna, Radjabova Diyora Iskandarovna, Shodiev Jasur Davlatovich, Republican Specialized Scientific-Practical Medical Center of Therapy and Medical Rehabilitation JSC, Uzbekistan
Structural-functional state and feature remodeling of left ventricle in patients with coronary artery disease after revascularization
Abstract: The article estimated the dynamics of systolic and diastolic function in patients with acute myocardial infarction after myocardial revascularization. The study involved 42 patients with acute myocardial infarction with ST segment elevation up to 6 hours of onset. Primary stenting of the infarct-related artery in patients with acute myocardial infarction with ST segment elevation allows most early as possible to prevent the development of pathological remodeling of the left ventricle compared with patients who underwent thrombolytic therapy as an effective and subsequent endovascular intervention.
Key words: acute myocardial infarction, revascularization, remodeling.
Rapid restoration of the vessel patency (reperfusion therapy) — the most effective way to reduce the risk of death and other adverse outcomes in patients with acute coronary artery occlusion occurred, regardless of the manner in which this is achieved [1]. Successful application of thrombolytic therapy has reduced mortality from acute myocardial infarction (AMI) to 20 %. However, lack of adequate restoration of antegrade flow in 45 % of cases, as well as a large number of contraindications to thrombolytic therapy and a high risk of bleeding complications contributed to the development and widespread use of an effective recovery method of endovascular coronary blood flow [2; 3].
Over the past decade it has increased the share of endovascular treatment of coronary heart disease (CHD) in the world. The choice of this treatment strategy of CHD, to counterbalance the surgical treatment in combination with conservative therapy caused the immediate efficacy and safety ofthe endovascular procedure to achieve adequate restoration of coronary blood flow in the majority of cases [4; 5; 6].
Primary endovascular restoration of coronary blood flow has several advantages over thrombolytic therapy. There is evidence that
reperfusion of the myocardium using the endovascular procedure is more than 95 % of patients with acute ST-segment elevation myocardial infarction (STEMI), then thrombolytic therapy restoration of blood flow is achieved only 70-75 % [7; 8].
A major randomized trial, which compared the results of angioplasty and thrombolytic therapy was the PAMI (Primary Angioplasty in Myocardial Infarction), which included 359 patients with acute myocardial infarction. 195 patients underwent angioplasty with the immediate success of 97.1 %. Interestingly, despite the minimal time from chest pain and ST-segment elevation before thrombolytic therapy than before PTCA restore myocardial perfusion disappearance of chest pain and normalization of the ST segment occurred rapidly after angioplasty than after thrombolytic therapy (mean 290 and 354 minutes, respectively; p = 0.004).
Endovascular method promotes effective limitation of the size of the damaged myocardium in the early stages of the onset of the disease, prevents the development of residual stenosis in the infarct-relat-ed artery (IRA) and pathological remodeling of the left ventricle (LV)
