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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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Section 6. Medical science
Fig.1. The concomitant pathology in groups of patients
Results and discussion
In assessing the results of CEA and conservative treatment, cases of inefficiency and/or complications in the 12-month postoperative period were analyzed.
An ischemic stroke occurred in 3 (2,14%) patients in the 1st group and in 11 (7,8%) patients in 2nd group; transient ischemic attack was observed in 2 (1,9%) patients in the 1st group and in 8 (7,9%) patients in the 2nd group; the defeat of the cranial nerves — in 12 (8,6%) patients in the 1st group. Totally there were 5 cases (3, 6%) of acute cerebrovascular accident in the 1st group (CEA) and in 19 (13,6%) patients in the 2nd (conservative treatment).
Thus, the immediate clinical efficacy of treatment within 12 months of the postoperative period in the group of conservative treatment was higher (19 or 13,6%) than in the group of CEA (5 or 3,6%).
According to current recommendations, patients after surgery should be registered on the dispensary registration books and receive intensive drug therapy (statins, antiplatelet agents, antihypertensive therapy) [6; 7; 8]. The observation in the long term period has shown that not all patients seek medical care in the place of residence. It is revealed that 32,7% of patients after CEA are observed at the neurologist, and the rest — at the physician in the place of residence. Nevertheless, a significant proportion of patients received effective treatment (Fig.2).
The effectiveness of pharmacotherapy in patients undergoing CE and conservative therapy in the long term period
Fig. 2.
The quality of life and health of patients in both groups one year after treatment was analyzed. Most patients noted an improvement in overall health. QoL in the 2nd group of patients was 0.708 and in the 1st group — 0.575 (r<0,01). Thus, the quality oflife of patients after CEA proved better than after conservative therapy. However, both figures were significantly higher than that of high quality of life with disease-free survivability within 1 year (QALY) in patients after AI (about 0.3). The obtained data is consistent with domestic and foreign authors [6; 7].
Conclusion
Thus, it is important to identify promptly and refer patients with stenosingcarotid lesions to the EC. These treatment methods
are highly effective and safe and provide a high level of quality of life in cerebrovascular disease.
Indications for CEA in 98% of patients were identified by vascular surgeons. For the neurologists it is also necessary to actively identify and promptly refer patients with stenosingcarotid lesions with the presence of hemodynamically significant stenosis of the vessels more than 70% for treatment to the departments of Vascular Surgery (angioneurology). In the postoperative period patients should be registered on the dispensary registration books and observed by a neurologist, who carries out laboratory control, duplex scanning of neck vesselsoptimizes drug therapy, formulates recommendations for further treatment.
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Hygienic assessment of long-term dynamics of the quality of water supplied to the population with centralized...
Proposed revisions in the organization of care for patients with of treatment and reduce the cost and improve the quality of life of
stenosing carotid artery will significantly increase the effectiveness patients.
References:
1. Karimov S. I., Ghazanchian P. O., and others. The results of the reconstruction of the carotid arteries in patients with ischemic stroke//Jour. Problems of Biology and Medicine № 3 (49) 2007 3.
2. Belousov Y. B., Belousov D. Y., Afanasyev E. V. and others. Predicting the effect of statins on direct medical costs for secondary prevention in patients at high risk for cardiovascular disease. Qualified clinical practice in 2011; 1: 97-115.
3. Parfenov V. A., Verbitskaya S. V. International recommendations for the secondary prevention of ischemic stroke and their implementation in outpatient practice. Neurology, neuropsychiatry, psihosomatology. 2011 (1), 16-21.
4. Kucherenko S. S. Carotid endarterectomy and carotid stenting: the pros and cons. Bulletin of Russian Military Medical Academy. 2011; 3 (35): 220-5.
5. Kulikov A. Y. Practical aspects of quality oflife assessment. Report on V congress with international participation pharmacoeconomics and pharmacoepidemiology «Razvitie in RF », 1 March 2011, Samara.
6. Gavrilenko A. V., Sandrikov V. A., Ivanov V. A.and others. Carotid endarterectomy or carotid stenting: the choice of optimal treatment of patients with carotid stenosis. Angiology and vascular surgery. 2011; 17 (2) 70-7.
7. Kavteladze Z. A., Bylov KV, Drozdov S. A.and others. Carotid stenting or endarterectomy. International Journal of interventional cardiology. 2011; 24: 53-4.
8. Brott T. G., Co-Chair, Halperrin J. L. et al. ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients WithExtracranial Carotid and Vertebral Artery Disease. Circulation, 2011; 124: 489-532.
9. Yagudin R. I., Kulikov A. Y., Nguyen T. Definition of « threshold of society's willingness to pay» in Russia, European countries and CIS countries. Pharmacoeconomics 2011; 4: 7-12.
10. Yadau J. S., Wboley M. H. et al. for the Stenting end angioplastic witch Protection in Patient at High Risk for EndarterectomyInvestingators (SAPPHIRE) et al. N Engl J Med 2004; 351: 1493-501.
11. Brott T. G., Hobson R. W. 2nd, Howard G. et al. Stenting versus endarterectomy for treatment of carotid-artery stenosis. CREST. N Engl J Med 2010; 363 (1): 11-23.
Atakhanova Dilbar, Nukus branch of the Tashkent Pediatric Medical Institute, teacher E-mail: dilbar.atahanova@mail.ru
Hygienic assessment of long-term dynamics of the quality of water supplied to the population with centralized and decentralized water supply
Abstract: On the basis of long-term dynamics of the quality of water supplied to the population with centralized and decentralized water supply of the Republic of Karakalpakstan, in assessing the levels of water pollution by chemical parameters as a risk factor for the population as a priority indicator index in terms of Karakalpakstan, can use the amount of total hardness of drinking water 7.0 or 10.0 mEq/l (depending on the presence or absence of structures for special treatment of tap water).
Keywords: water quality, water supply utilities, departmental water supply, sources of decentralized water supply.
The analysis of materials of many literary sources revealed that the majority of the authors of works devoted to the study and assessment of the sanitary conditions ofwater population of Karakalpakstan (RK), notes serious shortcomings of domestic water supply and often inadequate O'zDST 950-2011 quality of drinking water used by the population, which leads to higher levels of morbidity. At the same time it noted the insufficient coverage of the population (especially in rural areas), centralized water supply systems [1, 15-17; 2, 76; 3, 19; 4, 81].
According Madreimova A. et al. [5, 229-231; 6, 17-19; 7, 227229], the overall security of the population of the RK tap water is 60% (in urban areas — 72%, in rural areas — 47%). These figures indicate that about 40% of the RK use water from open reservoirs and wells (respectively 28% in the cities, rural areas — up to 59%).
Sanitary situation is complicated by the fact that, according to the same authors, Specific gravity of non-standard water samples in all of these sources — 44.8%, in open water — 49.7%; wells —
76.8%. Bacteriological quality of the water is much better — the proportion of non-standard water samples are respectively 3,8-9,85,2%.
These numbers suggest that the sanitary evaluation of the quality of water used by the population of RK, priority have chemical pollution of water, which are major risk factors for the population because of the possibility of occurrence of diseases such as fluorosis and dental caries, cholelithiasis and urolithiasis, some other nosological forms of non-infectious diseases.
In the study of conditions and the state of the water supply of Karakalpakstan should be considered division of its territory into 4 zones with different population densities.
In the southern zone of the RK (Turtkul, Biruniy, Amudarya and Ellikkala district) population density is more than 3 times higher than the republican level. For the coastal zone (Muinak district) is characterized by an absolute and relative decrease in population. In the northern zone (Kungrad, Kegeyli, Chimbay, Karauzyak,
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