The Effect of L-Arginine on the Clinical and Immunological Parameters in Patients with Asthma

The purpose of this study was to study the effects of L-arginine on the clinical course and some immunological parameters in patients with asthma. Material and Methods: In this study, we examined 56 patients with moderate and severe persistent asthma. The duration of the disease ranged between 15+2. 3 years. The patients were divided into two groups. The patients of the study group (n=25) were subjected to the standard treatment and nitric oxide (NO) donor L-arginine. The patients of the comparison group (n=31) received the standard treatment only. All patients underwent a complete physical examination including a determination of serum cytokine levels (IL-4, IL-8, and TNF-α) both prior and post treatment. Results: In both groups, the baseline serum levels of IL-4, IL-8 and TNF-Fα were greater than the normative values. Direct correlations were observed between the level of the interleukins and clinical symptoms. Daily intravenous infusion of L-arginine at 4.2 g for 30 min over 10 days significantly reduced the serum levels of IL-4, IL-8 and TNF-α. No significant changes were noted in the levels of these parameters in the control group. Conclusion: The addition of L-arginine to the basic treatment in asthmatic patients contributed to the earlier improvement of clinical symptoms and a significant reduction of the IL-4, IL-8 and TNF-α serum levels

Medical education reform in Tajikistan: comparison of the conventional one-year family medicine residency program and the new two-year residency program for postgraduate medical education

INTRODUCTION: The last two decades have seen a shift in former Soviet countries from highly specialized to more family medicine-focused systems. Medical education has slowly adjusted to these reforms, although the region is still at risk to have a chronic shortage of family doctors. This paper presents the evaluation of a new post-graduate family medicine program in Tajikistan, focused on competency-based training. The findings are relevant for policy makers, international organizations and practitioners participating in similar medical education reform programs. METHODS: We employed a quasi-experimental control group design and compared intervention residents, control group residents with traditional training, and 1st year residents with no training in two outcomes, clinical knowledge and competencies. We employed two objective measures, a written multiple-choice question test (MCQT) and an Objective Structured Clinical Examination (OSCE), respectively. We report reliability and validity of the measures along with ANOVA, planned contrasts and effect size estimates to examine differences across groups. RESULTS: We found statistically significant differences in both clinical knowledge and competencies between intervention and control groups. We also detected a large intervention effect size. Participants in the intervention outperformed control group participants in the two measures. Our analysis suggests that intervention and control group participants are comparable in terms of initial knowledge and competencies, strengthening the argument that the intervention caused the improvement in the program outcomes. DISCUSSION: Receiving tailored training and structured opportunities to practice knowledge and competencies in clinical settings have a positive effect on the education of family medicine doctors in Tajikistan. Our results support curriculum reform and investment in medical education in the form of longer and supervised on-the-job preparation designed to be more in line with international standards. We discuss suggestions for future studies and potential requirements to inform replicability in other countries. CONCLUSION: Family medicine is well recognized as central to health systems throughout the world, but high quality residency training lags behind in some countries. Our study showed that investing in family medicine residency programs and structured training is effective in increasing critical clinical competencies. We encourage promoting comprehensive post graduate family medicine doctor training so that the goals of a family medicine centered health system are attainable

Investment case for two-year post university speciality training in family medicine in Tajikistan: how much is needed for continuing and scaling up the improved education of family doctors?

Background: A new two-year Post University Specialty Training (PUST) programme in family medicine was introduced to improve the quality of postgraduate speciality medical education in Tajikistan. Postgraduate education of family doctors (FDs) needs to be urgently scaled up, as 38% of FD positions in Tajikistan remained unfilled in 2018. Moreover, the international financial support for the PUST programme is ending. This investment case assesses the minimum funding needed for the continuation and scale-up of PUST and establishes the rationale for the investment in the light of a recent evaluation. Methods: The costs of the programme were calculated for 2018 and a scale-up forecast made for the period 2019-2023. The impact of the scale-up on the shortage of FDs was assessed. An evaluation using a Multiple Choice Questionnaire and Objective Structured Clinical Examination (OSCE) assessed and compared theoretical knowledge, clinical skills and competencies of PUST trained and conventionally trained FDs. Results: The annual costs of the programme were US$228,000 in 2018. The total investment needed for scaling up PUST from 31 new FDs in 2018 to 100 FD graduates each year by 2023 was US$ 802,000.However, when the retirement of FDs and population growth are considered, the scale-up will result only in maintaining the current level of FDs working and not solve the country's FD shortage. The PUST FDs demonstrated significantly better clinical skills than the conventionally trained interns, scoring 60 and 45% of OSCE points, respectively. Theoretical knowledge showed a similar trend; PUST FDs answered 44% and interns 38% of the questions correctly. Conclusions: The two-year PUST programme has clearly demonstrated it produces better skilled family doctors than the conventional one-year internship, albeit some enduring quality concerns do still prevail. The discontinuation of international support for PUST would be a major setback and risks potentially losing the benefits of the programme for family medicine and also other specialities. To guarantee the supply of adequately trained FDs and address the FD shortage, the PUST should be continued and scaled up. Therefore, it is essential that international support is extended and a gradual transition to sustainable national financing gets underway

Анализ результатов применения аналога простагландина F2α в терапии хронического глазного ишемического синдрома

PURPOSE: Evaluation of latanoprost efficacy and safety in patients with ocular ischemic syndrome.METHODS: The material for this study comprised the results of comprehensive examination and treatment of 27 patients diagnosed with ocular ischemic syndrome (OIS). The average age of patients was 59.3±5.61 y., 11 women and 16 men. The main group included 12 patients, who received standard treatment in combination with once daily topical application of latanoprost: 1 drop into the conjunctival sac of one or both eyes affected with ischemic process. 15 patients of the control group received standard treatment.RESULTS: After the treatment visual acuity of the affected eye improved by 29.8% in the main group and by 7.2% in the control group, while intraocular pressure in both groups remained within normal range. After the treatment the main group showed a significant improvement in standard automated perimetry (SAP) parameters: MD and PSD equaled -8.37±1.23 and -0.13±3.59 dB (p <0.05) respectively, while in the control group the same parameters amounted to 9.73±1.87 and -5.15±0.18 dB (p<0.05). Optical coherence tomography showed a decrease in edema of the optic disc and peripapillary zone. Kinetic perimetry showed a decrease in absolute scotoma size in both groups. The main group showed an improvement in blood flow parameters of the ophthalmic artery compared to baseline values: post-treatment increase by 36.9%, 37.1% at 1 month and 38.2% at 6 months. The control group hemodynamic parameters showed a post-treatment increase by 9.2%, 9.7% and 9.8% at the corresponding time points.CONCLUSION: The use of standard therapy combined with latanoprost in the treatment of ocular ischemic syndrome has a positive effect on the course of the disease. It contributes to visual acuity increase, field of view limits expansion, reduced visual field sectoral loss, OCT parameters positive dynamics and ultrasonic Doppler examination hemodynamic parameters improvement.ЦЕЛЬ. Оценка эффективности и безопасности латанопроста в терапии пациентов с глазным ишемическим синдромом.МЕТОДЫ. Материалом для настоящего исследования послужили результаты комплексного обследования и лечения 27 больных с диагнозом «глазной ишемический синдром» (ГИС). Средний возраст больных (11 женщин, 16 мужчин) составил 59,3±5,61 года. В основную группу вошли 12 пациентов, они получали стандартное лечение в сочетании с местным применением латанопроста. Контрольную группу составили 15 пациентов, которые получали стандартное лечение. Пациентам основной группы латанопрост инстиллировали по 1 капле в конъюнктивальный мешок одного или обоих глаз, пораженных ишемическим процессом, один раз в сутки.РЕЗУЛЬТАТЫ. После лечения в основной группе острота зрения пациентов в пораженном глазу улучшилась на 29,8%, внутриглазное давление (ВГД) находилось в пределах нормальных значений. В контрольной группе острота зрения в пораженном глазу улучшилась на 7,2%, ВГД в пределах нормальных значений. После лечения у пациентов основной группы наблюдалось значительное улучшение параметров компьютерной периметрии (КП) MD и PSD: -8,37±1,23 дБ, -3,59±0,13 дБ (р<0,05) соответственно, в то время как у пациентов контрольной группы MD и PSD составили -9,73±1,87 дБ, -5,15±0,18 дБ (р<0,05). На оптической когерентной томографии отек диска зрительного нерва и перипапиллярной зоны в динамике уменьшился. При кинетической периметрии абсолютные скотомы в динамике уменьшились в обеих группах.После лечения в основной группе отмечалось улучшение показателей кровообращения в глазной артерии на 36,9%, через 1 месяц — на 37,1%, через 6 месяцев — на 38,2% от исходного уровня. В контрольной группе гемодинамические показатели в глазной артерии после лечения улучшились на 9,2%, через 1 месяц — на 9,7% и через 6 месяцев — на 9,8%.ЗАКЛЮЧЕНИЕ. Применение стандартной терапии в сочетании с латанопростом при лечении глазного ишемического синдрома оказывает позитивное влияние на течение данного заболевания, тем самым способствует повышению остроты зрения, увеличению суммарных границ полей зрения, уменьшению секторального выпадения в поле зрения, положительной динамике показателей оптической когерентной томографии (ОКТ), улучшению гемодинамических показателей на офтальмодопплерографии в динамике

THE INFLUENCE OF ALLOYING ELEMENTS ON THE PROPERTIES OF THE MATRIX

В статье исследуются факторы, влияющие на износостойкость металлических связок в АКМ. К числу таких факторов прежде всего следует отнести температуру образования композиций и физико-химические взаимодействия в системе алмаз-металл.In the article the factors influencing to a wear resistance metal bond of diamond composite are investigated. To number of such factors, first of all, it is attribute temperature of formation of compositions and physical and chemical interactions in a system diamond – metal

PECULIARITIES OF THERMAL PROCESSING OF POWDER HIGH-SPEED STEELS

В работе изучаются проблемы применения порошковых быстрорежущих сталей различного способа получения. В частности, рассматриваются особенности термообработки, вызванные способом производства и формой частиц порошковой стали.The paper studies the problems of the use of powder high-speed steels of a different production method. In particular, the peculiarities of heat treatment caused by the production method and the shape of the powder steel particles are considered

Clinical features of post-COVID-19 period. Results of the international register “Dynamic analysis of comorbidities in SARS-CoV-2 survivors (AKTIV SARS-CoV-2)”. Data from 6-month follow-up

Aim. To study the clinical course specifics of coronavirus disease 2019 (COVID-19) and comorbid conditions in COVID-19 survivors 3, 6, 12 months after recovery in the Eurasian region according to the AKTIV register. Material and methods.The AKTIV register was created at the initiative of the Eurasian Association of Therapists. The AKTIV register is divided into 2 parts: AKTIV 1 and AKTIV 2. The AKTIV 1 register currently includes 6300 patients, while in AKTIV 2 — 2770. Patients diagnosed with COVID-19 receiving in- and outpatient treatment have been anonymously included on the registry. The following 7 countries participated in the register: Russian Federation, Republic of Armenia, Republic of Belarus, Republic of Kazakhstan, Kyrgyz Republic, Republic of Moldova, Republic of Uzbekistan. This closed multicenter register with two nonoverlapping branches (in- and outpatient branch) provides 6 visits: 3 in-person visits during the acute period and 3 telephone calls after 3, 6, 12 months. Subject recruitment lasted from June 29, 2020 to October 29, 2020. Register will end on October 29, 2022. A total of 9 fragmentary analyzes of the registry data are planned. This fragment of the study presents the results of the post-hospitalization period in COVID-19 survivors after 3 and 6 months. Results. According to the AKTIV register, patients after COVID-19 are characterized by long-term persistent symptoms and frequent seeking for unscheduled medical care, including rehospitalizations. The most common causes of unplanned medical care are uncontrolled hypertension (HTN) and chronic coronary artery disease (CAD) and/or decompensated type 2 diabetes (T2D). During 3- and 6-month follow-up after hospitalization, 5,6% and 6,4% of patients were diagnosed with other diseases, which were more often presented by HTN, T2D, and CAD. The mortality rate of patients in the post-hospitalization period was 1,9% in the first 3 months and 0,2% for 4-6 months. The highest mortality rate was observed in the first 3 months in the group of patients with class II-IV heart failure, as well as in patients with cardiovascular diseases and cancer. In the pattern of death causes in the post-hospitalization period, following cardiovascular causes prevailed (31,8%): acute coronary syndrome, stroke, acute heart failure. Conclusion. According to the AKTIV register, the health status of patients after COVID-19 in a serious challenge for healthcare system, which requires planning adequate health system capacity to provide care to patients with COVID-19 in both acute and post-hospitalization period