Dysthymic disorders and a hangover of dependence on alkagol-this is the most observed condition. This condition requires in-depth clinical research and extensive analysis of the course of the disease. In modern psychiatry, the concept of comorbidity is widely used, on the basis of this concept lies the presence of two or more diseases in one patient. Since comorbidity prolongs the clinical picture of the disease, it complicates the diagnosis of the disease for doctors and requires special attention from doctors for treatment. Affektiv in drug-dependent patients, the importance of diagnosing disorders and distinguishing their variants is important. Rapid rational treatment measures arc required to relieve symptoms, otherwise affektiv treatment without eliminating pathology will be ineffective at any level of the disease.
This article provides summary recommendations of some manuscripts related to Covid-19 and diabetes mellitus comorbidity. Manuscripts related to this topic were searched in PubMed. The article describes the mechanisms how COVID-19 may enhance complications in individuals with diabetes mellitus and providing special considerations on anti-diabetes drugs commonly used in patients with type 2 diabetes in view of COVID-19 developed by group of researches. These recommendations can be useful for those physicians who are involved in case management of Covid-19 and diabetes mellitus.
Сердечно-сосудистые заболевания (ССЗ) и психоэмоциональные расстройства - обычное явление. Пациенты с ССЗ, а именно с хронической коронарной болезнью сердца чаще страдают психоэмоциональными расстройствами, чем население в целом. У людей с психоэмоциональными расстройствами больше шансов в конечном итоге разовьется сердечнососудистые заболевания, а также у них более высокий уровень смертности, чем у населения с изолированным психоэмоциональным расстройством. Пациенты с сердечно-сосудистыми заболеваниями, которые также находятся в психоэмоциональном расстройстве, имеют худший исход, чем пациенты, не страдающие психоэмоциональными расстройствами. Существует ступенчатая взаимосвязь: чем тяжелее психоэмоциональное расстройство, тем выше последующий риск смерти и других сердечно-сосудистых событий [4].
Вполне возможно, что психоэмоциональные расстройства является лишь маркером более тяжелых сердечно-сосудистых заболеваний, которые пока невозможно выявить с помощью имеющихся в настоящее время исследований.Однако, учитывая повышенную распространенность психоэмоциональных расстройств у пациентов с сердечно-сосудистыми заболеваниями, вероятна причинно-следственная связь с сердечнососудистыми заболеваниями, вызывающими более выраженными психоэмоциональными расстройствами, или с депрессией, вызывающими более частые сердечно-сосудистые заболевания, и худшим прогнозом для сердечно-сосудистых заболеваний. Было описано много возможных патогенетических механизмов, которые правдоподобны и вполне могут быть важны [2,3].
Однако, независимо от наличия причинно-следственной связи, психоэмоциональные расстройства является основным фактором качества жизни и сама по себе требует профилактики, выявления и лечения. Психоэмоциональные расстройства после острого сердечного приступа обычно является расстройством адаптации, которое может улучшиться спонтанно при комплексном кардиологическом лечении. Дополнительные стратегии ведения пациентов с сердечными психоэмоциональными расстройствами включают программы кардиологической реабилитации и физических упражнений, общую поддержку, когнитивно-поведенческую терапию, прием антидепрессантов, комбинированные подходы и, возможно, программы лечения заболеваний.
Наличие нескольких факторов риска может свидетельствовать о более важном общем риске, чем значительное увеличение от нормальных значений одного фактора риска. Современные тенденции стратификации риска у пациентов с ишемической болезнью сердца поляризованы между использованием простых данных и комплексных показателей, традиционных данных и новых факторов риска, общевалидных показателей и персонализированных показателей, в зависимости от характеристик пациента, типа ИБС, степени воздействия на предложенную терапию. Вся известная информация и методики могут быть интегрированы в сложную систему оценки риска.
To Evaluate the effectiveness and safety of neuroaxial anesthesia for lower limb joint replacement in elderly and senile patients with a high comorbidity index and ASA class III and IV physical status.
Materials and Methods: The studies were carried out in a multidisciplinary TMA clinic in 40 geriatric patients with a comorbid background who were operated on under conditions of combined spinal-epidural anesthesia. 29 patients underwent total hip arthroplasty (THA), 11 - total knee arthroplasty (TKA). Inclusion criteria: elderly (65 to 75 years) and senile (76-90 years) age, and over 90 - long-livers, pain syndrome for more than one year, no contraindications for regional methods of anesthesia. For continuous monitoring of the vital functions of the patient, we used the "resuscitation-surgical" monitor YUM 300 (LLC "Company UTAS" Ukraine).
Conclusion: For elderly and senile patients with a high risk of comorbidity, the technique of unilateral spinal and epidural anesthesia with low doses of intrathecal local anesthetic (5 mg 0.5% hyperbaric solution of bupivacaine with 20 μg fentanyl) and additional administration of low doses of bupivacaine into the epidural space 7, 5 mg is a safe method of anesthesia and allows you to achieve the proper sensory - motor block, which is necessary for the replacement of the joints of the lower extremities.
The combination of alcoholism with depressive disorder is manifested by mild to moderate depressive disorder. Addiction to alcohol often leads to the development and reversal of depression. Depressive disorders also have a significant impact on the nature of alcohol dependence. Ethanol disrupts the metabolism of dopamine, a monoamine in the central nervous system and a neurotransmitter that is mainly involved in controlling the sensitive area. Therefore, the treatment and diagnosis of comarbitis cases with alcoholism and depressive disorders require separate study.
A study of 341 patients with an established diagnosis of acute myocardial infarction was carried out. The patients are divided into 2 groups. The first, main, included 233 patients with acute myocardial infarction, who subsequently developed depressive disorders, confirmed clinically and using diagnostic scales; the second group consisted of 108 patients who also had acute myocardial infarction, but did not subsequently suffer from symptoms of depression. Clinical and dynamic observation of patients in the postinfarction period was carried out with control of the condition in a month, three months, six months, 12 months after myocardial infarction. Clinical observation was used to detect the presence of symptoms of depression. Among patients with MI with DS in the first days after MI, more than half (51.1%) reported a permanent decrease in mood more often than other symptoms, i.e. these patients showed an affective component of depression, while the ideator component of depression, which manifested itself in thinking retardation to one degree or another, was in 27.5% of patients, motor retardation (motor component) was detected in 21.5% of those observed. In patients with almost the same frequency, the anxious and melancholic type of affect was noted (47.0% and 41.2%, respectively), the dysphoric type of affect was found in 11.8% of cases, which is 4 times less than anxious and 3.5 times less than the melancholic type. In cases of prolonged depression, the severity of affective disorders more often directly correlated with the severity of the physical condition. If not so long-term depressive episodes were largely due to "their own vision of the disease", the severity of their symptoms depended on the conversation with the doctor and the information received from him, the degree of awareness of his diagnosis, possible complications, and not very much depended on the general somatic status itself. then the course of prolonged depression in patients worsened with the aggravation of the cardiological and general somatic condition of patients. Psychosomatic parallelism in the majority of protracted depressions was manifested by the generalization of asthenic symptom complexes (increased general weakness, intolerance to exertion, lethargy, adynamia, severe daytime sleepiness in combination with early insomnia) with deterioration of the somatic state. At the same time, it was noted that with prolonged depression, there were always more or less pronounced cognitive disorders (reduced memory for past events, limited ability to comprehend what was happening around, remember new information, impaired concentration). Postinfarction depressive episodes lasting up to six months can be attributed to nosogenies; depressive episodes of postinfarction genesis with a protracted course, probably with a high degree of confidence can be attributed to somatogenias.
The study of pathogenetic predictors of the development of anxiety-depressive disorders in myocardial infarction will make it possible to develop ways of their correction, thereby reducing the frequency of complications of the postinfarction period. Clinical studies were based on the examination of 58 patients with MI (mean age 59.2 ± 4.7 years) who were admitted to the cardiological hospital for treatment, and the observation data for them at the stage of rehabilitation. On the basis of the presence of anxiety-depressive symptoms, the patients were divided into 2 groups. The first control group consisted of 14 patients with MI without depressive disorders. The second group included 44 age-matched patients who underwent MI with symptoms of anxiety and depression without comorbid cardiovascular pathology. The diagnosis of myocardial infarction was based on the results of clinical examination, ECG changes, laboratory parameters, and echocardiographic data. In order to assess the mental status of the subjects, subjective methods were used: the hospital anxiety and depression scale (HADS) for patients in a somatic hospital and recommended for use in patients with post-infarction period. Markers of endothelial dysfunction in blood plasma were determined by enzyme immunoassay using appropriate test systems. Since fibrinogen is one of the key factors in the blood coagulation process, disorders of which with a tendency to thrombotic changes are one of the central links in the pathogenesis of MI, the level of oxidized fibrinogen with parameters of the functional state of endothelial cells was studied. In the early stages after myocardial infarction, the level of oxidized fibrinogen was 1.7 times higher in the study group compared to the control, although, in general, the level of fibrinogen in the study group was within normal values. In the subsequent periods of the study, the level of oxidized fibrinogen was in high values and, on average, exceeded the control values by 1.64 times. Since one of the key roles in the development of dysfunction and endothelial destruction is assigned to the factors of oxidative stress, a correlation analysis of the relationship between the oxidative modification of fibrinogen and the parameters of endothelial function was carried out. A direct correlation was shown between the level of oxidized fibrinogen and the level of Endothelin-1 (r = 0.78, p <0.01), and a direct correlation with the level of von Willebrand factor (r = 0.365, p <0.01). Linear regression analysis confirmed the associations of oxidized fibrinogen with the indicated parameters of endothelial dysfunction. Based on the results obtained, it can be emphasized that with MI, in patients with developed DS, along with increased oxidative changes in lipids and plasma proteins, there is also a significant oxidative modification of fibrinogen, which does not depend on the concentration of fibrinogen. Oxidized fibrinogen potentiates potentially prothrombogenic changes in the vascular-platelet link of hemostasis, in particular, the acceleration of leukocyte-platelet aggregation. The revealed signs of thrombotic and hypercoagulant hemostasis disorders in patients with MI with depressive disorders, such as signs of endothelial dysfunction, elevated von Willebrand factor levels, are associated with oxidative changes in plasma fibrinogen in patients with MI with the development of DS, have a high diagnostic value.
Важным фактором эффективности проведения лечебно реабилитационных мероприятий, является отношение пациента к болезни. Качество ремиссий, а следовательно, и уровень жизни больного, зависит во многом от комплаентности и общей приверженности терапии. Наличие сопутствующих заболеваний, в частности для больных шизофренией, может оказывать существенное влияние как на клиническую картину, так и на форму отношения пациента к лечебному процессу в целом.
Сравнительный анализ клинико-иммунологических показателей 50 детей с коморбидным течением атопического дерматита, которых мы наблюдали в 2017-2019 годы, с показателями детей с атопическим дерматитом (N=30).
Интернет-зависимость признана одним из распространенных вариантов аддиктивных нарушений нехимической природы и имеет значительные негативные социальные, медицинские и экономические последствия. Погруженность в виртуальный мир кибернетического пространства проявляется повышенной раздражительностью и агрессивностью, склонностью к противоправным действиям, враждебным восприятием близких людей и окружающего мира.
Согласно литературным данным ХОБЛ чаще присоединяется к другим заболеваниям, в то же время фоновая патология может способствовать развитию ХОБЛ. Механизмы, лежащие в основе данных системных проявлений, изучены недостаточно, однако в некоторых работах поднимается вопрос о причинно-следственной связи тяжести течения ХОБЛ и выявляемости коморбидной патологии.