Comorbidnі destruction. Comorbidnih - tse scho also? Comorbid lesion of the heart-vascular system

“It is not guilty of ailment itself, for which part it is not known, it is innocent of the cause of the ailment, as it is often not for us, not for the sick, but for the sickness of the sickest, of the body, of the ".

Professor M. Ya. Mudrov

for a dyyalny likarskogo mystestva in case of sick people ", 1820)

Shanovny colleagues, among therapists and practitioners of foreign practice, are often faced with the problem of comorbidity of velmas and universities. It's a pity that the stench in the region is a bit of a bit of respect for helping one sick person to a whole spectrum of ailments and for taking care of the problems of a professional ailment. In the modern practice urologists, gynecologists, otorhinolaryngologists, ophthalmologists, surgeons and іnshі fachіvtsі -ologists often blame for diagnostics depriving "their own" of a disease. An unspoken rule of any kind of professional education has become a consultative robot therapist, which takes on a syndromic analysis of a patient, as well as the formulation of a diagnostic and diagnostic concept, such as the potential risk of ailing and other prognosis.

Everything in organizm is tied (thank God, I’ll keep this fact very little). Zhodna function, zhodna organ, zhodna system is not efficiently isolated. їх without interruption spіlna dіyalnіst pіdtrimє homeostasis, preserving the prosperity of the processes, how to see, seize organism. However, in real life The whole mechanism, which is ideal from the point of view of nature, is controlled by the absence of pathological agents; Yakbi won - hundreds of adaptations and mechanisms to launch thousands chemical reactions and physiological processes, directing on the suppression, intercourse and on the outside of the ailments, as well as on the reduction and acceleration.

One should not pass without trace. The destruction of the robots of one, building b, a wretched Lanka, unaffected by its own defect, pulling behind itself in the interruption of bagatoch processes, mechanisms and functions. The beginning of the appearance of new ailments, the debut of which can be seen through the rich rock. In addition, it is not necessary for the body to be impacted by a pathological agent, either. Yogo get lost in vіkom, and also fade out on aphids a wide range reasons.

Okremikh ailment is mute. However, most often they prevent, diagnose and eliminate the disease in a patient's illness, and the lack of respect for suffering ailments and diseases of the patient is also lacking. The practical process from fate to the river is drawn by its own chergoy, just like there is one sickness in the patient, it’s dumb likuvati needlessly. Medicine tends to become banal. From the point of view of modern medicine, such a state of speech cannot be made far away, but it would be more correct to see more accurately the disease and shukati go to the new one in terms of analyzing the transfer of ailments, factors in the risk of disease, predicting such potential You may be quicker.

Individual pidhid to a bad dictate the need for a versatile clinical picture of the main, subordinate and transplanted ill, And also oh complex diagnostics and rational treatment. The principle of Russian doctors, which has become an overhaul of medical medicine and the subject of sophisticated discussions of modern and foreign scholars and classics. However, back to Mudrov, Zakhar'ina, Pirogov and Botkin, who voted in Russia the principle of Ancient China was born Folk medicine I started a comprehensive approach to the liking of human organisms, I will re-diagnose illnesses from health and wellness from nature. In Ancient Greece, the great misler and lykar Hippocrates wrote: "Look at the tila - the tsila on the right: vin vimagaє knowledge, hearing, scent, dotiku, movi, mirkuvannya." Win, against his opponents, having passed over in need of a joke about the cause of the ailment, and not the deprivation of the symptoms. Likars of Ancient Egypt, Babylon and Middle Asia were also told about the interconnection of some ailments with others. It is more important to diagnose ailments by heart rate, to diagnose ailments by heart rate. A generation ago, a generation of people promoted the completeness of a comprehensive approach to diagnosing ailments and diagnosing a sick person, protesting medicine, and being aware of a great number of diagnostics specific methods and diagnostic procedures. At the connection with the cym, food was ripe - like a universal assessment of a sick person, as if a sick person would immediately become ill, why would they want to see the situation and on how to send the search for the first time?

Alvan Feinstein is a prominent American doctor, an old-timer and an epi- at once, morbus-ailment). Having invested in the whole term of the statement about the manifestation of a complementary clientele picture, as it is already possible to appear independently, apart from the flow of discomfiture, and to see it all. The manifestation of comorbidity professor A. Feinstein demonstrating on the butt of somatic ailments on the Gostru rheumatic fever, Viyavivshi the best prognosis of the patients, who suffer one hour at a time when they become ill.

Bezposeredno nebarom pіslya vіdkrittya comorbidity won Bula is seen in the quality of a close scientific-pre-Slіdnitskiy straight. The widespread development of somatic and mental pathology was known to the world in psychiatry. I. Jensen (1975), JH Boyd і JD Burke (1984), WC Sanderson (1990), Yu.L. Nuller (1993), L. Robins (1994), A. B Smulevich (1997), CR Cloninger (2002), and the leading psychiatrists assigned some of the rockies to a number of comorbid stanzas among the ailing people psychotic... The pre-gliders themselves have broken the first models of comorbidity. Some of the models looked at the comorbidity as the manifestation of the people in the singing period of life more than one discomfort, and the other as the common rizik of the people with the same discomfiture. Some people saw trans-indromal, trans-nosological and chronological comorbidity. The first is a combination of two or more syndromes in one patient, or a sickness, pathogenetically related to each other, but the last type of vimag of a tim-hour zbigu. This classification is rather inaccurate in some ways, it did not allow for intelligence, but the comorbidity may be due to a single reason, either by the same mechanisms of the pathogenesis of these masses, but it is only possible to explain exactly the similarity of certain types of disease.

The problem of injecting comorbidity into key overrun main somatic disease, efficiency drug therapy, The most recent and updated prognosis of the ailments were engaged in the talanovit of clinics and in the most recent medical specialties in the Bagutian lands of the world. Among them are boules MH Kaplan (1974), ME Charlson (1987 p), FG Schellevis (1993), HC Kraemer (1995), M. van den Akker (1996), T. Pincus (1996). ), A. Grimby (1997), S. Greenfield (1999), M. Fortin (2004), A. Vanasse (2005) і C. Hudon (2005), L.B. Lazebnik (2005) , A. L. Vertkin and O. V. Zayratyants (2008), GE Caughey (2008), F. I. Bulyalov (2009), L.A. Luchikhin (2010 r) and a lot of them. The term "comorbidity" is injected with the term "comorbidity", "polypathy", "polypathy", "polypathy" ... The leaders of the viconious robots in the deyaky world have become sensible reasons for comorbidity: anatomical proximity, single pathogenetic mechanism, causal-inherited connection and acceleration. However, unimportant for a great number of values and synonyms, only one classifica tion and globally accepted terminology of comorbidity for a given day.

Acts of authorization oppose one single understanding of comorbidity and multi-morbidity, which, by virtue of the fact that many people are involved, we bring one pathogenic mechanism, and to another, we’re aware of many times of non-possession. It’s a matter of multi-morbidity є the end of lifeless chronic ailments and medical conditions in one people, and not to shy away at the same or a rise in pathogenesis. However, the principle of clarification of the term "comorbidity" was given by H. C. Kraemer and M. van den Akker, who made a single case for one sick person, the most chronic, sick. The stench proponated the first classification of comorbidity. It is obvious that due to the facts, factors that contribute to the development of comorbidity, there may be chronic infection, inflammation, innovative and systemic metabolic changes, iatrogenism, social status, and ecology.

causal comorbidity viclikan to parallel lesions of various organs and systems, which is accompanied by a single pathological agent, for example, alcoholic visceropathy in patients with chronic alcoholic intoxication, pathology, association with colonic diseases.

accelerated comorbidityє As a result of the main disease і wake up the last day after a ten hour of the destruction of the organs? targets. By the attachments of this type of comorbidity, is there a chronic nirkova lack of diabetic nephropathy in patients with diabetes 2? It is a type of development of cerebral infarction as a result of an accelerated hypertensive crisis in patients with hypertensive ailments.

iatrogenic comorbidity manifest with vimushenny negative injections Likarya for the patient, for the memory of the established problems of this medical procedure. Glucocorticosteroid osteoporosis is widely seen in ailments, when it is a trivial hour to take therapy with systemic hormones, as well as hepatitis as a result of chemoprophylaxis of tuberculosis of the lungs, which is caused by the increase in the number of samples.

comorbidity unspecified transferring the evidence of single pathogenetic mechanisms to the development of ailments, which is given to the combination, and a number of times are carried out to confirm the hypothesis of a friend or a clinician. As an adjunct of comorbidity, to serve as the development of erectile dysfunction in patients with atherosclerosis and arterial hypertension, as well as the diagnosis of erosive-viral lesions of the mucous membrane of the upper form shlunkovo-intestinal tract among the "judgmental" ailments.

Butt of the so-called "vipadkovoi" type of comorbidity ischemic ailments heart (ІХС) that gum ailment for the combination of a dumb heart and psoriasis. However, the "vipadkovity" and the oddity of these combinations of unbeatable can be explained from the key and scientific positions.

Comorbidities associated with two and / or more syndromes in case of anxiety, pathogenetically related to each other, or in one patient's case, regardless of the activity of the hospital, among them, the middle of them is widely represented, At the stage of the primary medical assistance, the patient immediately becomes ill at once, sooner a rule, less a vinyat. It is worth mentioning the data of M. Fortin, we will study 980 histories of ailments on the analysis, taken from the usual practice of a family drug, the comorbidity rate becomes 69% in ailments young vik(18-44 years) up to 93% of the middle of the middle age (45-64 years) and up to 98% - among the patients of the senior age group (over 65 years). With a whole number of chronic ailments vary from 2.8 in young children to 6.4 - in people with kidney disease. The author of the robot has indicated that the main advances in medical documentation, aimed at increasing the extent of comorbidity and the emergence of the structure, have been carried out until the 1990s. ... Nimi bully history of ailments, outpatient pictures of patients and medical documentation, it is obvious from family members, In insurance companies and in the archives of boarding schools for the elderly. The revised methods of rejecting medical information in a large number of their bullets were based on the clinical information and qualifications of clinicians, as they put the ailments in a classically, instrumental and laboratory-based way. The very fact, with its insane competence, the stench was even more sub'active. It is a wonderful fact that in one of them there were no signs of comorbidity without carrying out analyzes of the results of pathologists' rosters, the ailments died, but it would be even more important. "Posada likarіv rozkrivati yakogo lіkuvali" - said Professor Mudrov. Autopsy allows one to reliably establish the structure of comorbidity and the non-mediated cause of death of a skin patient, regardless of the status of gender characteristics. Statistical data on comorbid pathologies, which spiral on the data of the section, in the meaning of the world, amid sub'activism.

Prevention and elimination of chronic ailments due to the All-Holy Organizational Health Protection as a priority project of another ten years of the XXI century, straightening the life of the population to the light... Tsim was informed about the general tendencies before the large-scale epidemiological studies were carried out in the other fields of medicine, as well as the large-scale statistical projects.

An analysis of the decimal Australian pre-delayed patients with extended chronic ailments demonstrating that close to half of the children with arthritis may have arterial hypertension, 20% - heart-damned sickness, And 14% - cuckold diabet 2nd type. More than 60% of patients bronchial asthma indicated for suppurative arthritis, 20% - for heart disease and 16% - for type 2 diabetes mellitus. In young patients with chronic nircovy deficiency, the frequency of IXC is 22%, and in new coronary pod_y- in 3.4 development in normal conditions with patients with normal functioning of the laboratory. When developing thermal nirkova lack, SCHO VIMAGAє ZONE THERAPY, FREQUENCY chronic formsІХС become 24.8%, and myocardial infarction - 8.7%. The number of comorbid illnesses is growing rapidly. Comorbid people move from 10% in those up to 19 years up to 80% in individuals 80 years and older.

In the Canadian literature, which included 483 ailments for obesity, it was established, that the widening of the associated with obese supporters was a problem for the middle women, not the cholovikiv. Pre-alumni found that close to 75% of patients with obesity mali, who are ill, such as dyslipidemia in the majority of cases, arterial hypertensionі small diabetic 2? th type. Noteworthy is the fact that the middle of young children with obesity (from 18 to 29 years) is more than two chronic illnesses, 22% of people and 43% of women.

According to our data, we will base on materials three thousand pathological anatomical sections (n = 3239) with ailments of somatic pathology, who had to go to a highly professional hospital with a drive for decompensation of chronic illness (67.8 ± 11.2 incidence) %. Most often, in the robot of a doctor, a combination of two and three nosologies is developed, or in single cases (up to 2.7%) one patient will have up to 6-8 ailments at one time.

The number of patients with idiopathic thrombocytopenic purpura, carried out in Great Britain, showed that this disease is associated with a wide range of somatic pathologies. Structures of comorbidity of cych patients are most likely to develop evil new, Ailments of the support-roche apparatus, shkiri ta sectional system, And also hemorrhagic acceleration and autoimmune disease The development of five rockets in the form of a cob of the main disease changes in 5%.

In a follow-up held in the United States, 196 ailments for laryngeal cancer were included. In some robots, it was shown that the visibility of patients with advanced stages of cancer of the larynx grows in the incidence of evidence of comorbidity. At the first stage of cancer, the survival rate becomes 17% with the presence of comorbidity and 83% - at every day, by another 14% and 76%, at the third 28% and 66%, and at the fourth 0% and 50% apparently. In general, the incidence of comorbid ailments for cancer of the larynx is 59% lower than that of comorbid ailments without comorbidity.

Yak can be seen from the rest of the robots, from therapists and doctors of foreign practice, because of the problem of comorbidity of velmi, it is often found in high schools. It's a pity that the stench in the region is a bit of a bit of respect for helping one sick person to a whole spectrum of ailments and for taking care of the problems of a professional ailment. In the current practice urologists, gynecologists, otorhinolaryngologists, ophthalmologists, surgeons, and others often blame for the diagnosis of a lack of "free" disease, as a result of a suspicion of supportive pathology. An unspoken rule of any kind of professional education has become a consultative robot therapist, which takes on a syndromic analysis of a patient, as well as the formulation of a diagnostic and diagnostic concept, such as the potential risk of a sick and other prognosis.

In such a rank, injecting comorbid pathologies into cleverly show, Diagnostics, prognosis and diagnosis of the disease in a wide range and individual way. Vzaєmodia zhvoryuvan, vіku і lykarskogo pathomorphosis means zmіnyu cool pictureі by extension of the basic nosology, the nature and the severity of the acceleration, to ruin the quality of the sick person's life, to flank or to accelerate the diagnostic process.

Comorbid injections into the forecast for life, the increase in the mortality rate. Recognition of comorbid illnesses in the course of an increase in the number of lingering days, invalidization, in rehabili- tation, in the increase in the number of accelerated incidents surgical engagement, Spriy zbіlshennyu ymovіrnostі fall in lіtnіkh ailments.

However, in most of the randomized clinical trials, the author included patients with an area of refined pathology, timid comorbidity criteria. The very same pererakhovani until recently, appropriated assessments after they quietly captured ailments, it is important to bring to work, how to develop comorbidity in general. The duration of a single complex scientific approach to the assessment of comorbidity is behind a glade in CLINIC PRACTICE... It is impossible to miss the inconsistency of comorbidity in the taxonomy of ailments, presented in the International Classification of ailments X glance (ICD-10). Already one fact is given before for sale English classification of ailments.

Nezvazhayuchi on bezlіch nerozgadanih zakonomіrnostey comorbidity on vіdsutnіst її єdinoї termіnologії i trivaє Poshuk novih kombіnatsіy zahvoryuvan on osnovі nayavnih klіnіchnih that Naukova danih mozhna zrobiti visnovok scho comorbidity pritamanny range bezsumnіvnih vlastivostey, SSMSC harakterizuyut її yak neodnorіdne often zustrіchaєtsya yavische, yak zbіlshuє tyazhkіst I will become and pogirshu forecast ailments. The heterogeneity of comorbidity is accompanied by a wide range of reasons.

There are a number of rules for the formulation of clinical diagnoses of comorbidity to ailing, which should be noticed by a practical drug. The main rule is to see in the structure the diagnosis of the main and background illnesses, as well as the acceleration of the secondary pathology.

If the ailment is awful, then one of them is the main one. It’s a nosological form, as it’s like it’s a bit faster for the Victory to pershochergov, the need for a visit in this hour at the touch of the greatest threat to life and praise. Basically, the disease is itself by itself, or through acceleration, it can be the cause of a lethal result. The main thing is є getting sick, yake was the reason for the brutality for medical aid... In the world of obsolescence of the main sta, the diagnosis of a prognostically sympathetic ailment, at the same time, ailments become supportive.

The main ones can be a sprinkle of competing important illnesses. Competing illnesses - at once at a sick nosological form, interdependence on etiology and pathogenesis, but in the old world are considered the criteria of the main illness.

In the background, a disagreement with a disagreement, for an unwelcoming interruption of the main discomfiture, a promotion of a problem, a development, an acceleration. Dane got sick, also like and basically, vimagaє non-useful lіkuvannya.

All the accelerated pathogenetic tied to the main ailments, the stink of the unpleasant result of the ailment, the wickedness of the death in the camp of the ailing. The stench itself is introduced to the discharge of accelerated comorbidity. In a number of individuals, the acceleration of the main ailment, related pathogenetic factors, Poznachayut yak tied ailments. In the whole range of їх it is necessary to bring to the level of the causal comorbidity. Uskladnennya pererahovoyutsya in the order of decreasing prognostic or heavy significance.

It’s hard to get overwhelmed, it’s just a moment at a patient’s, to be overhauled in the order of significance. suputnє getting sick not linked ethiologically and pathogenetically with the main illnesses and to get involved, but at the same time not pouring in on the other.

Evidence of comorbidity of traumas in the vibration of the diagnostic algorithm and the scheme for the treatment of this ailment. Dany category of ailments it is necessary to specify the steps functional breakdowns and morphological status of all manifestations nosological forms... With the appearance of a new skin, including a mild symptom, it is necessary to carry out a more thorough examination of the cause. It is also necessary to remember that comorbidity can be brought to polypragmas, that is, one-hour sign of a great amount drugs I will not be able to control the effectiveness of therapy, will reduce the material vitra of patients, and thus will reduce their compliance. In addition, polypharmacy, especially among the patients of the abducted and old age, with the rapid growth of the growth of the population and systemic side effects drug products. Some of the side effects do not need to be taken by drugs until they are respected, some of them grow out because they show one of the factors of comorbidity and pull behind themselves the sign of even more drugs, which are “viciously colossal”.

A one-time treatment for decilkoh ailments in the state of the art of obtaining drugs and a thorough understanding of the rules of rational pharmacotherapy, based on the postulates of E.M. Votchala "Yakshcho preparation of additions of side effects, then think about it, if you have a problem".

« Special for flux - one-sided", - wrote a group of authors under the pseudonym Kozma Prutkov (yeah, for quiet, who does not know - K. Prutkov is not a real person, if he is alive on our land), regularities, as well as associated with it appearances and phenomena - the prelude to a sick person and at the sectional table. The school of robots can be used to establish a universal tool, which allows the practical doctor to assess the structure, heaviness and may inheritance comorbidity, to carry out the problem of ailments and to indicate that they are adequately treated.

Most of the civilians and unprecedented terms know the different areas of human life. A lot of them are on hearing, but about how many people visit and not chuli. by the way,comorbidity. This is a medical term that denotes even more the sphere of professional diagnostics and therapy.

History of term

If you follow the path of a well-read professional vocabulary, then in medicine, the term, which means the suck of ailment behind the singing signs, is comorbidity. Viznachennya tse, traditionally for medicine, to their roots syagaє in latin language. Two warehouses were taken from itself - coniunctimі morbus - "spilno" and "ailments", which became the basis of terms that are not inviting for a simple upholstery, which means a complex of chronic ailments in one patient, as the singing rank of those tied together.

Similarly, the sight of the sick person was visible from the found hours, at the dawn of the birth of sickness. The ancient Greeks, and the citizens of the Old-Time Descent were not caught up in the disease itself, as if from the Kremlin, but the entire body, which was suffering from the manifestation of a specific ailment. About the interconnection of decile problems in the health of people, which are manifested by singing symptoms, and, it means, about the elimination of the whole complex of ailments, talked about the children of the older generations. At the first time, comorbidity - the methodology of setting an adequate diagnosis and competent treatment, as well as preserving health, has been introduced clinically.

The term "comorbid" itself was proclaimed in 1970 by the American doctor-epidemiologist and pre-adolescent Alvan R. Feinstein (AR Feinstein). The companion of the priest vikoristovuvalas in the main in the clinical epidemiology, in a few hours it became the main scientific and pre-adolescent methodology of the modern medicine.

denannya ailment

Fighting to the risk of driving specific health problems, people are most often and not suspicious of those who are not just one, but a whole complex of problems. І for the bagatokh fahivtsіv, when staging an adequate diagnosis, the level of intelligence, however, in a particular type of problem, we can lead to the same about comorbidity. Ale at the same hour, for the other physicians, in a direct way to diagnose ailments and the sign of a disease, it’s multi-morbidity, so that it’s not just a disease on a pathogenetic problem, but it’s often a picture of a bad moment.

Ale mezh tim, for absolutely great practicing drugs, in the whole world, even after getting sick, it will be the most important to diagnose this problem. by the way,comorbidity in the cardiology of the heart-vascular system of the two main problems of the heart-vascular system - arterial hypertension and ischemic ailment of the heart - the other problem of the mental and secular systems.

For what reason?

For medical practice, comorbidity is the process of acquiring decilkoh recipients of ill health, which is a specific person. NSeffective medicine is a special thing, like a polyag at that, when the first brutal patient before a special medical mortgage, the call in the absolute greatness of the established vypadkіv is conducted about one specific start of a lust, a preoccupation. Alle the axis in high-profile hospitals, the picture is radically changed, so patients will recognize the diagnosis of comorbidity, which allows for more obvious signs of treatment, depending on the pathology to complex diseases. It’s tied together with that, so that more care is taken and the care of the sick person behind the children’s profiles is on all sides, on the display of which there is a message about some other sick people:

anatomical peculiarity - close one to one ailment of organisms;
One pathogenetic mechanism of development of the disease;
fall ill with one causal link and ob'ednani by one team-hour threshold;
odne zhvoryuvannya "viplya" from іnshogo, yak accelerated.

Mayuchi on respect for the visibility of the patient's comorbidity, the fakhivets start thinking on the emerging potential factors:

ignition process;
genetic strength;
infection;
metabolic changes are involutive of a systemic nature;
social situation;
ecology of the region of permanent residence;
iatrogenia - the death of a sick person (physical and / or emotional because of the blame of a medical doctor).

What is the problem?

On the current stage of development of medicine, as a science in the other spheres of life of the human body, the understanding of "comorbidity" is the price of congestion, tied together by the pathogenetic mechanism of development, manifestation. Being cautious for a long time behind the camp of a sick person allowed the drug workers to grow visnovoks about those who obviously want to show ailments, without a weakening of the cause, it is impossible to blame, until then, the organisms are most often affected by a systemic environment. On the day, there is a little bit of ailment, and the stench between itself is interconnected. The most accurate and ancient method of implanting such a combination is autopsy. The very posthumous vyvchennya sickness, like suffering from the cholovik, allowed the creation of visnovka against those who are rich in their spillovers, and in such a rank to evoke the manifestation of comorbidity.

How can I get sick?

Due to the presence of illnesses in the field of medicine. І cleverly їх it is possible to divide on comorbidity in psychiatry and on the basis of clinical internal illnesses. Medical doctors in charge of the intercourse will get sick in two straight lines:

transsindromal - syndromes of interconnection among themselves by pathogenetic reasons;
transnosologicheskoe - sickness, evidently in the patient, not to blame for spilny pathogenetic reasons.

The very same kind of growth gives the possibility of differentiating the combination of ailments for other reasons, or for similar key manifestations.

Comorbidity also lasts for the next time:

causal;
accelerated;
iatrogenic;
unspecified;
"Vipadkova" comorbidity.

Diagnostics and treatment of the complex Zahvoryuvan

Problems of comorbidity are introduced by medicine from different points of view on the outskirts of ten years. For an hour, the price of food is known to be growing at new levels, the potential of the robot is being carried out on the basis of diagnostics, methods of treatment, and forecasting. Svitova medicine has broken down already a number of methods for the reduction of comorbidity, skin conditions in a specific direction. І the main problem of the field is in the fact that such a skin technique can produce results for one and the same sick person. In terms of the obviousness of comorbidity, and that means the prognosis of mortality, for the quality of the life of the patient, the practitioner does not think of a single instrument that operates with specific arguments, but allows them to correct the most accurate result. The very fact of all the tsi methods is not enough vikoristovyutsya in the practical therapy of different strains.

At the current stage of the development of medicine, comorbidity is the sphere of inculcation of obvious illnesses in one patient, who are interconnected for reasons of either symptomatology, potentially meaningful, but a little stagnation in the practice of robotics through these.