The relevance of the study is due to the growing need for psychiatric examination of children in the first years of life and objective difficulties in clinical and psychopathological examination of a young child. In particular, the main method of psychopathological diagnostics – clinical conversation turns out to be informative. In such conditions, a contextual analysis of the child's behavior, supplemented by a clinical and anamnestic method, should be considered a leading examination method
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The implementation of the program consists of a step-by-step process of diagnosing mental disorders in general somatic practice within the framework of the polyp-professional medical care model. This method shows that in the process of early diagnosis of mental disorders, specialists with one group are actively involved: a primary care doctor (PMSP), a nurse, a psychiatrist, a psychologist, a social worker. The main role in this process belongs to the general practitioner
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As part of everyday practice, the doctor is faced with a less and less specific disease, most often - with comorbid pathology. One such group of concomitant diseases is mental disorders. It is known that their prevalence in somatic patients, including cardiovascular diseases, is high and, according to various sources, is 1,5-5 times greater in the population
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Based on the results obtained, a special classification of hypertensive choroidopathy (HCP) was developed and proposed based on the central choroidal thickness (CCT) determined from OCT data. The peculiarity of this classification is that the CTC indicator should be determined using the appropriate method only when using OCT using Spectral technology domain ( SDOCT ) or Swep source ( SSOCT ), the resolution of which allows one to clearly visualize the boundaries of the choroid on sections and correctly set the “ruler” for measuring thickness. The table shows the correspondence of the degree of HCP to the stages of HAR according to the Keith-Wagener-Barker classification. The main practical significance of the proposed classification is that stage 1 HCP, regarded as an increase in CTC within 230-245 μm, corresponds to the stage of the pathological process in which, against the background of stage 1 HD, there are no ophthalmoscopic signs of HAP. Detection of a pathological process at this stage is of high significance since it dictates the need for more active drug intervention, as there is a high risk of the rapid development of GAD
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Currently, to identify various ophthalmological diseases, in addition to instrumental research methods, methods of laboratory analysis of tear fluid are used for practical and scientific purposes as an informative biological medium. The profile of changes in the biochemical parameters of this fluid is, as a rule, more pronounced and different in comparison with blood serum. It is known that tear fluid is mainly secreted by the accessory lacrimal glands and the main lacrimal gland, which is supplied with blood through the lacrimal artery, which is a branch of the ophthalmic artery
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When studying the level of endothelin-1 and D-dimers in the tear fluid, tears were collected according to the method described in Chapter 2. Moreover, in all patients with GAR, tear fluid was collected from the “worst eye,” that is, in the eye in which the stage of GAR was more advanced. In patients of control groups 1 and 2, tears were also collected from only one eye. The results of determining the levels of endothelin-1 and D-dimers are presented in Table 1
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The division into the studied subgroups is presented in Table 5.7. The duration of dynamic observation of patients in group 1 was 2 years. The first observation point was based on the data from the initial ophthalmological examination, as well as the results of assessing the level of endothelin-1 in the tear fluid of 15 patients in this group. A follow-up examination was carried out after 2 years, during which endothelin-1 levels in tear fluid were also re-examined in 15 patients in the group.
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Hypertension is a risk factor for many systemic pathological processes that cause serious morbidity and high mortality. The World Health Organization (WHO) defines hypertension as a systolic blood pressure greater than 140 mmHg and/or a diastolic blood pressure greater than 90 mmHg. According to statistics, approximately 1.15 billion people worldwide suffer from this condition. Hypertension can affect the eyes in several ways, including the development of retinopathy, chorioretinopathy, and optic neuropathy. It is also a risk factor for other vision-threatening conditions, including retinal artery occlusions, retinal vein occlusions, retinal artery microaneurysms, and anterior ischemic optic neuropathy
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Treatment of GR and chorioretinopathy is aimed at reducing systemic blood pressure and, if necessary, managing the underlying disease. The optometrist or ophthalmologist who discovers hypertensive chorioretinopathy in a patient with undiagnosed hypertension is in a position to reduce the patient's morbidity and mortality. There are no formal recommendations for routine screening for hypertensive retinopathy in asymptomatic patients diagnosed with systemic hypertension. However, if a patient without a diagnosis of hypertension presents with signs of mild hypertensive retinopathy, we recommend referral to a general practitioner within one week. For moderate HF, the patient should be assessed by a general practitioner within one or two days. Patients presenting with severe hypertensive retinopathy or hypertensive chorioretinopathy should have their blood pressure measured immediately and referred to the nearest emergency room for urgent blood pressure correction. There are no formal recommendations for screening women with pregnancy-induced hypertension; however, we recommend that pregnant women presenting with hypertensive retinopathy be referred to an obstetrician/gynecologist for evaluation of preeclampsia. Although optometrists and ophthalmologists do not routinely manage hypertension, close collaboration with general practitioners is necessary to ensure patients receive appropriate treatment.
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When analyzing the qualitative indicators of OCT, in most cases focal changes were identified that corresponded to those previously detected during ophthalmoscopy. Hyperreflective foci in the outer layers of the retina according to OCT data most often corresponded to foci of deposition of hard exudates according to ophthalmoscopy, areas of thickening of the layer of nerve fibers corresponded to the localization of “cotton-wool” foci
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