Mieli kolegos

Mieli kolegos

jatuzis-rMieli kolegos,

 

po metų ir vėl jūsų rankose – Internisto priedas Neurologijos aktualijos. Pernai vykęs neurologijos aktualijų renginys šeimos gydytojams sulaukė gausių teigiamų atsiliepimų, todėl šių metų vasario 23 dieną vėl kviečiame į konferenciją 2017 metų neurologijos  klausimai ir atsakymai šeimos  gydytojams, o dalį svarbesnių diskusijų ir apžvalgų skelbiame ir šiame jums skirtame proginiame leidinyje. Tikimės, kad jis logiškai papildys konferencijos pranešimus ir bus naudingas tiek praktikuojančiam gydytojui, tiek rezidentui ar medicinos studentui, ketinančiam pagilinti savo žinias neurologijoje.

Tobulėjant biotechnologijoms, intensyvėjant naujų vaistų paieškai ir klinikiniams tyrimams, daugelyje neurologijos sričių atsiveria naujos, gerokai platesnės gydymo galimybės. Kartu atsiranda naujų iššūkių gydytojui, kuriam dabar nebepakanka tiksliai diagnozuoti – dažnai reikia priimti svarbius sprendimus dėl gydymo taktikos, naujų ir neretai brangių vaistų skyrimo, išmanyti jų privalumus ir potencialius pavojus.

Leidinyje rasite keletą straipsnių, skirtų insulto šiuolaikiniam gydymui ir naujoms profilaktikos galimybėms. Ūminio insulto gydymo rezultatai iš tiesų džiugina – nuo 2014 metų Lietuvoje vykdoma Integruotos sveikatos priežiūros strategija insulto srityje leido padidinti trombolizių skaičių nuo 160 (2012 metai) iki 802 (2016 metai), trombektomijų – atitinkamai nuo 4 iki 267, insulto centruose reikšmingai pagerėjo pagalbos sergančiam insultu organizacija ir rodikliai (Šiuolaikinis išeminio insulto reperfuzinis gydymas). Deja, sergamumas insultu išlieka didelis. Norint jį sumažinti, reikia pagerinti tiek pirminę, tiek antrinę insulto profilaktiką, kuri apima tiek insulto rizikos veiksnių žinojimą ir išaiškinimą, tiek jų nemedikamentinę ir medikamentinę kontrolę. Nors nuo 2016 metų statinai jau yra kompensuojami ir insulto profilaktikai, tačiau jų profilaktinio poveikio kol kas potencialą išnaudojame per maži. Siekiant išspręsti kai kuriuos statinų kompensavimo tvarkos neaiškumus, 2016 metais buvo papildytos jų kompensacijos indikacijos – nuo šiol po smegenų infarkto bei praeinančiojojo smegenų išemijos priepuolio šiuos vaistus galima skirti neribotą laiką. Plačiau apie tai skaitykite intervių su prof. Daliumi Jatužiu. Klinikinėje praktikoje dažnai verda diskusijos, nuo kada galima pradėti skirti antikoaguliantus dėl prieširdžių  virpėjimo po jau įvykusio insulto. Įvairių naujausių tarptautinių rekomendacijų ir šaltinių apžvalga apie antikoaguliantų skyrimą po insulto, stentavimo, ūminio koronarinio įvykio, antikoaguliantų keitimą ir kita – straipsnyje Antikoaguliantai po insulto: ką turėtų žinoti gydytojas? Žurnalo puslapiuose taip pat rasite medžiagos apie kraujagyslinės kilmės pažinimo funkcijų sutrikimų prevenciją ir gydymą, apie kardiovaskulinių rizikos veiksnių sąsajas su kognityviniais sutrikimais.

Vienos dažniausių sveikatos problemų, varginančių įvairaus amžiaus asmenis, dėl kurių jie dažnai kreipiasi tiek į šeimos gydytojus, tiek į gydytojus specialistus ir ligoninių priėmimo skyrius – galvos skausmas ir svaigimas. Šiame numeryje išsamiai, su iliustracijomis, supažindiname su bene dažniausio svaigimo varianto – gerybinio pozicinio paroksizminio svaigimo – diagnostikos ir gydymo metodais, kurie remiasi otolitų repozicijos principais. Tai tikrai saugios, veiksmingos ir nieko nekainuojančios priemonės, kurias turėtų žinoti ir taikyti ne tik neurologas, otorinolaringologas, bet ir šeimos gydytojas – savo žiniomis ir rankomis greitai išgydysite ne vieną svaigstantį pacientą! Visi žino, kad migrena pasireiškia stipraus galvos skausmo priepuoliais, kurie sukelia ne tik fizinę kančią, bet ir apriboja darbinę, laisvalaikio ir kitą socialinę veiklą. Bet ar girdėjome apie lėtinę migreną? Dviejuose straipsniuose supažindiname, kaip ją diagnozuoti, gydyti ir kokios yra naujos lėtinės migrenos gydymo onabotulino toksinu galimybės.

Šeimos gydytojai ras įdomios medžiagos apie nemigos, diabetinės polineuropatijos profilaktikos ir medikamentinio gydymo principus, šiuolaikinę pagalbą sergant Huntingtono liga, magnetinio rezonanso tomografijos pritaikymo neurologijoje plėtrą. Manyčiau, kad dėmesio turėtų susilaukti ir straipsnis apie objektyvų darbingumo lygių, specialiųjų poreikių nustatymą ir teisingą siuntimų į Neįgalumo ir darbingumo nustatymo tarnybą rengimą – savo patirtimi ir įžvalgomis dalijasi Neįgalumo ir darbingumo nustatymo tarnybos prie Socialinės apsaugos ir darbo ministerijos specialistai.

Laimingų ir sėkmingų prasidėjusių 2017 metų!

 

Prof. Dalius Jatužis

Lietuvos neurologų asociacijos prezidentas


147 mintys apie “Mieli kolegos

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