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MEDICAL SCIENCES
Mechanisms of atherosclerosis development and some problems of its treatment Isakadze А.1, Eliavа G.2, Tsintsadze Т.3, Каsradzе P.4, Mzhavanadze R.5, Topuria L.6,
Buachidze T.7, Topuria E.8 (Georgia) Механизмы развития атеросклероза и некоторые вопросы его лечения Исакадзе А. Л.1, Элиава Г. Г.2, Цинцадзе Т. Г.3, Касрадзе П. А.4, Мжаванадзе Р. Г.5, Топурия Л. С.6, Буачидзе Т. Ш.7, Топурия Е. С.8 (Грузия)
'Исакадзе Автандил Леванович /Isakadze Avtandil - доктор медицинских наук, профессор,
лечебный факультет, Учебный университет «Геомеди»; 2Элиава Георгий Григорьевич /Eliavа Georgi — доктор биологических наук, профессор; 3Цинцадзе Тамара Гивиевна / Tsintsadze Tamara — кандидат медицинских наук, профессор, руководитель департамента, департамент фармации, Грузинский технический университет; 4Касрадзе Павел ААлександрович /Каsradzе Pavel - доктор медицины, профессор, руководитель департамента, департамент спортивной медицины; 5Мжаванадзе Русудан Гивиевна /Mzhavanadze Rusudan - кандидат медицинских наук, ассоциированный профессор,
департамент анатомии и физиологии, Грузинский государственный учебный университет физического воспитания и спорта; 6Топурия Лела Сергеевна / Topuria Lela - кандидат биологических наук, ассоциированный профессор; 7Буачидзе Теймураз Шалвович / Buachidze Teimuraz - кандидат биологических наук, профессор, департамент медицинской биоинженерии; 8Topuria Ekaterina Sergeevna / Топурия Екатерина Сергеевна — доктор химии, ассоциированный профессор,
департамент общей химии, Грузинский технический университет, г. Тбилиси, Грузия
Abstract: development mechanisms of atherosclerotic process are analyzed in the work. There are considered schemes of action mechanism of remedies causing reduction of atherogenic substances in blood plasma both by way of their accelerated removal from blood plasma, and via blocking of their synthesis, as well as remedies oppressing the processes of free-radical oxidation. Creation of combination medications is offered, which conjoin abovementioned action mechanisms with different dominant impacts, depending on degree of manifestation of pathological state that will promote successful differentiated therapy.
Аннотация: в работе проанализированы механизмы развития атеросклеротического процесса. Рассмотрены схемы механизмов действия средств, вызывающих снижение атерогенных субстанций в плазме крови как путем их ускоренного вывода из плазмы крови, так и путем блокирования их синтеза, и средств, угнетающих процессы свободно-радикального окисления. Предложено создание комбинированных препаратов, сочетающих вышеуказанные механизмы действия с разными преимущественными влияниями, в зависимости от степени выраженности патологического состояния, что будет способствовать успешной дифференцированной терапии.
Keywords: atherosclerosis, atherogenic substances, statins, cholestyramine, prostacyclinotherapy. Ключевые слова: атеросклероз, атерогенные субстанции, статины, холестирамин, простациклинотерапия.
Development of atherosclerosis is promoted by many factors of different nature, respectively different mechanisms form the basis of its development and differentiated approach is necessary for its treatment [1, 3, 5, 7].
Development of atherosclerosis is accompanied with intimal thickening of blood vessel walls, formation of cholesterol plaques that is caused by high blood cholesterol and permeability of intima cells in relation with cholesterol, increase of peroxide oxidation of lipoproteins [2, 4, 8].
Accumulation of cholesterol in arterial intima is followed by organic vasoconstruction and possible thrombus formation, lipidosis and calcinosis, cerebral ischemia, development of myocardial infarction and insult.
Therapeutic approach to atherosclerosis, along with decrease of dietary cholesterol foresees reduction of atherogenic substances (lipoproteins with low and very low density and cholesterol) in blood plasma, on one hand, and increase of content of lipoproteins with high density, on the other.
Content of abovementioned lipoproteins can be decreased both by way of their accelerated removal from blood plasma, and via blocking of their synthesis.
Let's consider the mechanisms of hypolipidemic effect of statins. Statins cause hypolipidemic effect, while blocking the cholesterol synthesis in liver, promoting increase of lipoproteins' receptors, reduction of low and transmission density lipoproteins in plasma, decrease of dietary cholesterol (Fig. 1).
Fig. 1. Action mechanism of statins blocking cholesterol synthesis
Accelerated removal of cholesterol and fatty acids from organism is promoted by preparations of cholestyramine group.
Let's consider action mechanism of cholestyramine intensifying the removal o f cholesterol and fatty acids (Fig. 2).
Fig. 2. Action mechanism of cholestyramine intensifying the removal of cholesterol and fatty acids
Blocking of synthesis of atherogenic substances along with blocking of their absorption and accelerated removal from organism promotes intensification of hypolipidemic effect, that's why combined intake of cholestyramine and statins causes pronounced hypolipidemic effect and promotes successful therapy.
As far as free-radical oxidation of proteins is accompanied with atherosclerotic process, administration of medications against free-radical oxidation is of special importance for blocking of atherosclerotic process [6, 9].
Active forms of oxygen, while having clearly manifested toxic action, have a direct effect on ferments, proteins and cell membrane, and besides they cause pathological stimulation and intensification of processes of lipid peroxidation.
Prostacyclinotherapy is of high importance at that time. Lipid peroxidation during hyperlipidemia promotes oppression of prostacyclin synthetase. That's why stimulators of prostacyclin synthesis or medications acting against lipid peroxidation have an effect on prostacyclin synthetase, assist accumulation (deposition) of endogenous prostacyclin, increase of c-AMP in thrombocytes and endothelium, reduction of thrombocytes aggregation and adhesion, endothelium conduction, lipoprotein molecules penetration into sub-endothelium and inhibit formation of atherosclerotic plaques (Fig. 3).
Fig. 3. Diagram
Thus, based on abovementioned, it would be expedient to create combination medication, which conjoin opportunities of blocking of synthesis of atherogenic substances, intensification of their removal from organism, blocking the processes of free-radical oxidation with different dominant impacts, depending on degree of manifestation of pathological state that will promote successful differentiated therapy.
References
1. Gabunia D., Eliava G., Tsintsadze T., Topuria L., Mzhavanadze R. Comparative characteristic of different theories of development mechanism of atherosclerosis. Periodical scientific journal "Gaenati Gerald", 2015, vol. 2, № 4, P. 42-57 (in Georgian).
2. Kezeli D., Sulakvelidze M. Lipid metabolism disorders in internal diseases therapy. Tbilisi, 2010 (in Georgian).
3. Tatishvili N., Simonia G. Internal diseases. Publishing house "Georgian Gerald", Tbilisi, 2002 (in Georgian).
4. Chapidze G., Kapanadze S., Samadashvili D. Non-rooted risk factors of atherosclerosis and new prospects of pathogenic therapy. Polygraphist Ltd, Tbilisi, 2003 (in Georgian).
5. Diagnostics and correction of lipid metabolism disorders aimed at prevention and treatment of atherosclerosis. Recommendations are elaborated by Expert Committee of ARSSC. // Disease prevention and health promotion, 2004. № 5. pp. 7-32 (in Russian).
6. Lankin V. Z., Wichert A. M. Lipid peroxidation in atherosclerosis etiology and pathogenesis. Arch. path., 1989, 51:1:80-84 (in Russian).
7. Libov I. A., Babaev E. K., Gultakova O. S. New aspects of lipid metabolism disorder development and prospects of their correction // Doctor in charge, 2001. № 7. P. 4-11 (in Russian).
8. Myasnikov A. L. Hypertensive disease and atherosclerosis. Publishing house «Medicine», M., 1965 (in Russian).
9. O'Harra Y., Peterson T. E., Harrison D. G. Hypersholestrolemia increases endothelial superoxide anion production. J. Clin. Invest., 1993, 191:2546-2551.
Assessment of the quality of psychiatric care
Rasulov A. (Republic of Azerbaijan) Оценка качества психиатрической помощи Расулов А. Р. (Азербайджанская Республика)
Расулов Агасан Расуд оглы / Rasulov Aqasan - кандидат медицинских наук, главный врач, Республиканская психиатрическая больница №1 Министерства здравоохранения Азербайджанской Республики, г. Баку, Азербайджанская Республика
Abstract: the study deals with the evaluation of services mental health in a psychiatric hospital. A new monitoring tool was developed to collect reliable information about the quality of care for patients. Аннотация: настоящее исследование направлено на оценку услуг, оказываемых в психиатрическом стационаре. Были разработаны соответствующие инструменты, позволяющие собрать объективную информацию о качестве помощи стационарным больным.
Keywords: mental health Services, monitoring, quality management.
Ключевые слова: услуги психического здоровья, мониторинг, управление качеством.
To date, assessment of the quality of psychiatric care is based on individual consideration of the existing structure, process and outcomes of services in the mental health system. An important component for monitoring and evaluating the quality of services in the field of mental health is the availability of standards of care, which should reflect scientific evidence, examples of good practices and the protection of human rights [1]. To each standard should be developed indicators that allow quantitative differentiation between good and bad quality of services.
The purpose of the study - piloting the developed tool for assessing the quality of services in a psychiatric hospital in real practice.
Material and methods. Piloting of the tool was conducted in the country's largest hospital - Psychiatric Hospital No. 1 MZ AR, designed for the simultaneous treatment of patients 1885. The hospital was opened in the mid 30-ies of the last century and to the present time is composed of 30 offices. To pilot the tool has been used by design cross-sectional observational study. Of the 30 hospitals using the method of random sampling (randomization) were recruited from 8 offices (6 male and 2 female). The monitoring was carried out by direct observation of the work of the branch, study of documentation and interviews with patients, staff, physicians, and heads of offices. The monitoring was made by independent specialists (psychiatrists and clinical psychologists) are not working in this hospital.
Developed the monitoring tool consists of 7 sections:
1. Overview of the hospital - number of beds, number of incoming and disposed cases during the studied period, the average duration of persisting.
2. Information related to the sanitary conditions in the hospital, utilities and food .
3. Staffing - the number of psychiatrists, clinical psychologists, nurses and other medical staff, level of training, completing advanced trainings.
4. Observance of patients ' rights in hospital - the number of involuntary hospitalization, informed consent for treatment, and restrictive use of means of insulators, the treatment of patients, the possibility of complaints.
5. Diagnosis and treatment - adequacy of diagnostics, including laboratory and instrumental investigations, compliance with the effective medical treatment of clinical protocols, rational use of drugs, measures to eliminate the adverse effects of drugs, access to psychotherapy.
6. The rehabilitation activities - physical activity, employment of patients in various rehabilitation programs, work with families, organization of leisure.
7. Documentation.
Results. During the monitoring in 8 departments of the hospital it was found that the conditions of stay of patients in General correspond to sanitary-hygienic standards, however, the number of patients in the two women's offices exceeded the number of beds for which these offices were calculated.
The average duration of treatment in hospital is 34±10.4 days. Analysis of staffing of the Department revealed that 5 of the 8 offices staffing physicians were staffed at 75%, and full-time equivalent nursing staff and clinical psychologists - 50%. Social workers were only available in two parts. While 70% of physicians and 100% of the average of the personnel have undergone specialized trainings over the last year.
