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Еңгізу дәрежесі. Клиникалық және эпидемиологиялық көріністері жазылған, практика жұмысына біріншілік тері аффектісімен жүретін ауруларды аңықтау үшін алгоритмі бастапқы этитропты емдеу протоколы қолдануы ұсынды.
Диссертацияның материалдары Қ.А.Ясауи атындығы Халықаралық қазақ-түрік универсітетінің жұқпалы және тері-венерология кафедрасында, С.Д.Асфендияров атындағы Қазақ ұлттық медицина университетінің жұқпалы және тропикалы аурулар кафедрасында, білімін жетілдіру факультетінде және институтының дәріс беру жағдайында пайдаланылады.
Зерттеу жұмысының нәтижелері ҚР денсаулық сақтау министрлігі № 623 15.12.2006ж. бұйрыққа «Аса қауыпты жұқпалы ауруларды тіркеу кезінде медицина саласында стандарттарды бекіту» еңгізілді.
«Сібір күйдіргісі».-Шымкент, 2004 ж.-50 б; «Жұқпалы аурулардағы негізгі синдромдар және симптомдар». - г.Шымкент, 2009. - 60с.; «Аса қауыпты инфекцияларда стандартты оқиғаларының аңықтамасы қолдану». - г.Шымкент, 2008. – 600б. оқу- әдістемелік кұралдар жарық көрді.
Зерттеу материалы бойынша «Сібір жарасының тері формасын емдеу»
№ 21615 2006/1063.1; «Сібір жарасының ауыр түрін емдеу» инновациялық №21318 2007/0126.1 ҚР предпатенті алынды.
Қолдану аймағы. Алғашқы медико-санитарлық көмек көрсету; жұқпалы аурулар, дерматология, хирургия, ішкі аурулар, эпидемиология, микробиология.
Utepbergenova Gu lmira Alkenovna
Clinical and epidemiological manifestations, rational approaches to diagnosis and treatment of primary cutaneous syndrome affect
14.00.10 - infectious diseases
For the degree of Doctor of Medical Sciences
Object of the research. In a comprehensive study included 137 patients with cutaneous anthrax, 76 - with cutaneous pasteurellosis, 52 - with cutaneous leishmaniasis, 51 - with cutaneous listeriosis, 70 - with suppurative bacterial infections of skin, were present in infectious diseases, dermatology and surgical departments of the South Kazakhstan region.
The hurpose of the work. To study clinical and epidemiological manifestations of diseases that occur with the syndrome of primary cutaneous passion for the development of rational approaches to their diagnosis and treatment.
Methods of work carrying out. a questionnaire survey of the population of South Kazakhstan regions for 2006-2009. (N= 300), analysis of archival data for 1970 to 1996; clinical, epidemiological, laboratory and etiological (microscopy, bacteriological, serological, and molecular-genetic), statistical methods.
Results of the research. The syndrome of primary cutaneous affect characterized by mild - 93% (279/300), and therefore the patients do not seek medical care - 74% (222/300), or they are given outpatient treatment at the Primary health care level - 19% ( 57/300), without etiologic laboratory examination and without reference to an emergency notice, which leads to a lack of surveillance syndrome PCA (Primary cutaneous affect).
In all diseases PCA through the same stages of development: papule → vesicle → pustule → ulcer. In this case only on the basis of clinical manifestations can be put presumptive diagnosis of anthrax (painless, black eschar) and cutaneous leishmaniasis (absence of intoxication, fever, granulating ulcer). Syndrome of primary cutaneous affect clinically can not be differentiated among listeriosis, pasteurellosis and purulent bacterial skin lesions. From suppurative bacterial infections of the skin most commonly affects primary cutaneous Staphylococcus caused -57%, 10% of Klebsiella, Pseudomonas aeruginosa - 2,9%, Сitrobakteriae - 2,9% .
More often develop single primary cutaneous affections (with suppurative bacterial infections of the skin - 91,5%, with anthrax - 78%: in the open areas of the body - from 65 to 73%).
Cutaneous forms of purulent bacterial, listeriosis and pasteurellosis infection is difficult to differentiate at the stage of probable case.
RCA developed significantly more often in men among patients with anthrax and listeriosis - 65±5,8% and 64,7±5,7% respectively for persons employed in slaughtering and meat cutting for anthrax ; in all age groups, most often in the age group 30-39 years, patients with pasteurellosis - 36,9±2,9%, anthrax - 24±1,7%; suppurative bacterial infection - 20±1,4% and patients with leishmaniasis - 15,4± 0,7%; and professional groups, among patients with pasteurellosis fairly often ill workers employed in agriculture - 27,6±2,1% students in leishmaniasis - 30,7± 2,2%; year-round, with the largest number accounted for 48% of the summer, while RCA due pasterellami and leishmania often recorded in autumn 94,8±8,9% and leishmaniasis - 84,6 ± 7,8%.
On seasonality Disease Registry reliably often fall ill leishmaniasis-84,6 ± 7,8% of patients and pasteurellosis - 94,8±8,9%.
During the summer, often reliably detected anthrax - 54,7±4,8% and disease suppurative bacterial infection of the skin - 48,6±4,2%.
In connection with the foregoing, the syndrome of primary cutaneous passion is to examine the laboratory methods for etiologic all possible etiologic pathogens.
Protocol of a comprehensive study should include the following stages: microscopy to confirm that cutaneous leishmaniasis, bacteriological examination of the PCA, to diagnose suppurative bacterial infection -77%, listeriosis - 86,6%, pasteurellosis - 79%, anthrax - 76,6%. With a negative result of bacteriological research - to conduct serology (TPHA, ELISA) for listeriosis, pasteurellosis, anthrax.
The practical significance of the work. Clinical manifestations, developed and implemented in practice determine the presumptive, probable, confirmed diagnosis of infectious diseases associated with the development of primary cutaneous affect (anthrax, pasteurellosis, listeriosis, leishmaniasis, staphylococcal infection). Developed and implemented in practice algorithm for diagnosis of diseases that occur with the syndrome of primary cutaneous affect. Develop a protocol of the primary stage etiotrop treatment of primary cutaneous syndrome affect.
Implementation of research results into practice.
Order of the Ministry of Health of Kazakhstan № 623 from 15.12.2006 "On the approval standards of medical practice to identify cases of especially dangerous infections of man when they registered in the register."
Received innovative provisional patents for the invention № 21615 2006/1063.1 "Method for treating cutaneous anthrax»; № 21318 2007/0126.1 "A method of treating a severe form of anthrax."
The field of usage. primary health care, infectious disease and dermatology, surgical diseases, internal medicine, epidemiology, microbiology.
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