ДИСБАЛАНС КИШЕЧНОЙ МИКРОБИОТЫ КАК ФАКТОР РИСКА КАРДИОМЕТАБОЛИЧЕСКИХ ЗАБОЛЕВАНИЙ

The review shows the role of the intestinal microflora in the development of atherosclerosis, coronary heart disease, overweight / obesity and diabetes. It is well known that consumption of foods rich in saturated fats and cholesterol (meat, egg yolk and milk products with high fat content) is associated with an increased risk of cardiovascular disease. However, new studies show that the atherogenic properties of these products are also due to the high content of L-carnitine and its structural analog choline, which, after entering the body is metabolized by intestinal bacteria up to trimethylamine (TMA), and then converted in the liver to trimethylamine-N-oxide (TMAO) having direct atherogenic action. It was found that elevated levels of TMAO increases the risk of myocardial infarction, stroke, cardiac failure and death, including the common causes. In the center of international attention is also the question of the role of the intestinal microbiota imbalance in the development of insulin resistance, endothelial dysfunction, increase of the adhesive properties of macrophages, the appearance of dyslipidemia, elevated blood pressure, overweight. Attention of the doctors is focused on the extremely importance of maintaining a normal balance of the intestinal microbiota to prevent cardiometabolic diseases apart from implementation of already well-known and generally accepted preventive measures.В обзоре подчеркивается роль кишечной микрофлоры в развитии атеросклероза, ишемической болезни сердца, избыточного веса /ожирения и сахарного диабета. Хорошо известно, что потребление продуктов, богатых насыщенными жирами и холестерином (мяса, яичного желтка и молочных продуктов с высоким содержанием жира), связано с повышенным риском сердечно-сосудистых заболеваний. Новые исследования показывают, что атерогенные свойства этих продуктов также обусловлены высоким содержанием L-карнитина и его структурного аналога холина, которые после поступления в организм метаболизируются кишечными бактериями до триметиламина (TMA), а затем преобразуются в печени до триметиламин-N-оксида (ТМАО), обладающего прямым атерогенным действием. Оказалось, что повышенный уровень ТМАО увеличивает риск развития инфаркта миокарда, инсульта, сердечной недостаточности и смерти, в том числе от общих причин. В центре мирового внимания также находится вопрос о роли дисбаланса кишечной микробиоты в развитии инсулинорезистентности, эндотелиальной дисфункции, нарастании адгезивных свойств макрофагов, появлении дислипидемии, повышении артериального давления, увеличении веса. Внимание врачей акцентируется на том, что для предотвращения кардиометаболических заболеваний, помимо реализации уже хорошо известных и общепринятых профилактических мероприятий, крайне важно поддержание нормального баланса микробиоты кишечника

Imbalance in the intestinal microbiota as a risk factor of cardiometabolic diseases

The review shows the role of the intestinal microflora in the development of atherosclerosis, coronary heart disease, overweight / obesity and diabetes. It is well known that consumption of foods rich in saturated fats and cholesterol (meat, egg yolk and milk products with high fat content) is associated with an increased risk of cardiovascular disease. However, new studies show that the atherogenic properties of these products are also due to the high content of L-carnitine and its structural analog choline, which, after entering the body is metabolized by intestinal bacteria up to trimethylamine (TMA), and then converted in the liver to trimethylamine-N-oxide (TMAO) having direct atherogenic action. It was found that elevated levels of TMAO increases the risk of myocardial infarction, stroke, cardiac failure and death, including the common causes. In the center of international attention is also the question of the role of the intestinal microbiota imbalance in the development of insulin resistance, endothelial dysfunction, increase of the adhesive properties of macrophages, the appearance of dyslipidemia, elevated blood pressure, overweight. Attention of the doctors is focused on the extremely importance of maintaining a normal balance of the intestinal microbiota to prevent cardiometabolic diseases apart from implementation of already well-known and generally accepted preventive measures

Analysis of the Needs of the Visually Impaired in the Social Rehabilitation Services and Technical Means of Rehabilitation According to the Medical and Sociological Research

Purpose: to conduct an analysis of the needs for social rehabilitation services and technical means of rehabilitation for visually impaired people in St. Petersburg. Materials and methods. A medical-sociological study was carried out on a specially developed questionnaire, which makes it possible to analyze the needs of the visually impaired in socio-rehabilitation activities and technical means of rehabilitation. Also, the official state statistical reporting data were used: «forms 7-sobes» for 2015–2016. The study included 250 people. at the age of 18–80 years, who had a disability in sight. Results. The overwhelming majority of visually impaired people (98.4 %) have disabilities of groups I and II. The proportion of disabled people in group II is the highest and amounts to 62.2 %, the proportion of disabled people in group III is the lowest — 1.6 %. Among the total number of employees, the greatest share was occupied by the disabled of the I group (41.7 %), more than half of whom (54.9 %) had no professional education. The majority of visually impaired people (62.8 %) preferred to receive social and rehabilitation services in a center specialized in the Center for Medical and Social Rehabilitation of the Visually Impaired in St. Petersburg. The need for sanatorium treatment for disabled people was significant — 73.2 %, but it was satisfied in 7.2 %. It is established that the real needs of the visually impaired in various types of technical means of rehabilitation are much greater than those suggested in the «Federal List of Rehabilitation Measures, Technical Remedies and Services Provided to the Disabled». In St. Petersburg, about 50.0 % of the visually impaired need high-tech rehabilitation equipment, for example, in a mobile phone, computer or laptop, etc. But due to their absence in the federal and regional lists, they are forced to purchase at their own expense. The conclusion. It is advisable to provide social and rehabilitation services for visually impaired people on the basis of specialized centers (departments) that have a more diverse set of services for the most complete satisfaction of their needs. The needs for sanatorium treatment are minimally satisfied, which makes it necessary to improve the system of organization of sanatorium-and-spa treatment. For the visually impaired, the need for technical means of rehabilitation is satisfied at 75.0 %, which is the basis for considering the issue of expanding the range of the Federal List

ХАРАКТЕРИСТИКА БОЛЬНЫХ ТУБЕРКУЛЕЗОМ И ВИЧ-ИНФЕКЦИЕЙ, РЕЗУЛЬТАТЫ ЛЕЧЕНИЯ В ДНЕВНОМ СТАЦИОНАРЕ ПРОТИВОТУБЕРКУЛЕЗНОГО ДИСПАНСЕРА

To assess the efficiency of therapy for combined TB/HIV infection, 424 clinical cases were reviewed, including 97 mixed TB/HIV cases and 327 pure TB cases. Mixed-infection patients hospitalization to day-time clinic was caused not as much by the need for primary therapy for TB (42,3%) as by the continuation of treatment after discharge from a TB hospital and by waiting in queue for admittance to a TB hospital. The prevalence of intrathoracic lymph node TB was 4 times higher in mixed TB/HIV (18,6 vs. 4,9%), and chronic viral hepatitis marker were found in these patients more often (82,5% vs. 4,9%). Mixed patients were the most socially handicapped, and the efficacy of treatment of such cases proved to be by one third lower compared with pure TB patients. The day-time inpatient clinic make it possible to increase the duration of controlled therapy even compared with a stationary hospital (137,7±9,07 days vs. 88,6±12,4 days, p<0,001).С целью оценки эффективности лечения больных с сочетанной инфекцией рассмотрены 424 случая заболевания активным туберкулезным процессом. Проведен сравнительный анализ показателей больных с микст-инфекцией (ТБ и ВИЧ-инфекция) (97) и больных туберкулезом (327). Госпитализация в ДС ПТД больных с микст-инфекцией обусловлена не столько проведением основного курса лечения (42,3%) больных туберкулезом (74,9%), сколько продолжением лечения после стационара (47,4%) и ожиданием очереди до поступления в стационар (9,3%). Больные с микст-инфекцией в 4 раза чаще страдали туберкулезом ВГЛУ (18,6% против 4,9%) и у них чаще выявлены маркеры хронических вирусных гепатитов (82,5% против 4,9%). Больные туберкулезом и ВИЧ-инфекцией оказались наиболее социально дезадаптированными, а эффективность лечения их на одну треть меньше, чем у больных туберкулезом. Дневной стационар позволяет увеличить длительность контролируемой терапии даже по сравнению со стационаром (137,7±9,07 вместо 88,6±12,4 и дней; р<0,001)