dispensarization means dispensarization is from uh French dispenser is a system of work of healthare system uh and establishment meaning active monitoring of patient Health providing proper physical development health promotion and prevention prevention of disease using appropriate prevention sanity and treatment measures the basis of dispensarization Sur dispensor methods work method of active surveillance of patients of action of individuals look here it's important to understand when we [ speak about theorization is not when we speak about uh situation when person come with some complaints symptoms and we make something but mostly we oriented for people without any complaint but it's necessary to find some pathology among them some screen test and so on I will speak about it in details and it will be more clear for you what dispensarization means in another words dispensarization is a method to work with healthy and Ill individuals and since which is exploring the health status of the population and FAS work with it for healthy individuals health promotion and preservation primary disease prevention active identification of individuals with risk factor is important for individuals with some disease diagnosic dis um diseases at La is rather nice uh so not when uh people come with some complaints but before it uh so in this case dispensarization include preclinical silent stages uh of diagnosis of them for example screening test uh also include prevention of a celebration Rehabilitation so secondary and F prevention if you don't remember what secondary and F prevention means look the first lecture the main aim of dispensarization is decreasing morbidity mortality hospitalization [invalidation uh increasing lifespan prolonging active longivity uh improving quality of life preserving workability and mization it's not one moment uh methods it's continuous process that you know different types of therapeutic social sent measures and health education so this is dynamic control Dynamic follow up our patients maybe I speak not uh use this phrase not in the first time but in another word in more simple way dispensarization it is it is periodic Health examination with primary secondary and elements of future [prevention including followups there are different stages of dispensarization individual evaluation of population health and Define of groups of dyamic dispensary uh surveillance healthy practice healthy and individuals with various disease annual Health examination and establish minum of laboratory and diagnostic test later I will describe you what we do for people of different age and gender in our country in your country it can be different but I'm really hope that in your Healthcare System in your country people come not only when they have any complaints but also for prevention screening a che CS uh because believe me it's really easier to treat some disease in L stage in compare with condition when people suffer from uh some symptoms Al a more truth examination and relation if people already need it also another stage is development [of and taking medical and social measures required for health promotion and preservation Dynamic surveillance afterwards annual analysis of a and quality of dispensarization also necessary and about all the stages we will speak when we speak about prevention Health examination or checkups uh if you speak about individual level uh it can be when person come to Clinic when sometime uh we see that person didn't visit you during very long period of time uh and um here it's more than one year we can call uh patient to come to our Clinic that it's time for checkups sometimes during home visit I don't know if you have a home visit in your country but here uh there is such possibility for people to call doctor to visit them at home when they condition not so severe to call ambulance and be hospitalized but um it's not possible to come to Clinic um mostly we speak about all people who can't move normally after stroke when patients are from severe fever and so on and then we have um preliminary checkups for example when uh you into University uh you also visit uh doctor not because you had any complaints but uh before applying to the job or Army when we speak about insurance educational establishment kid Garden School [ University and so on uh it's a necessary to check if your health condition normal uh if uh education working will not cause any damage for your condition or maybe it's a d for other people to communicate with you so it can be different and uh depending what exact job uh what is that studing uh different health condition can be education for it for example for people who work rather intensive physically cont dedication for this work will be more compared with office worker um and so if we speak about Mass uh we speak about some screening question Ries uh T it according some special groups periodical uh gain for certain coh so uh in our country we uh have some regulation uh in 2010 we had uh the main instructure we change particular every two years and now um modification of it uh was made to years ago uh which uh shows that uh there are some indication and uh for some type of work so some rtio profession holders applicants uh that undergo any biotic Health Examination for example if you speak about student teachers uh medical stuff this peric examination will be every year uh amount of This research will be different for each professions um for profession with risk of being infective or spread of [ infection and parasite disease uh for example restaurant workers or doctors uh we even uh have sary card where every year doctors write something and without the S card person can't work in this sphere so individuals who are subject of mandatory perior Health examination children in kid Garden in school uh adult people um students for some work for tell uh age women uh between 16 45 uh who have no more than one child because we want uh to have more babies [ in our country and and surely we should save woman um possibility to have uh baby for pregnancy and uh is why we give special accent for uh women of this age uh pregnant woman surely the same reason uh then invalides and people who participate in the great patri um it's the part of the second um world war um with every years much of such people became lower but um we try to give as much is our attention to control their health and surely we want them to live longer so such people um visit doctor or doctor visit them every year or not even one time uh so we just give our respect for them them and surely we control their health people who work in some uh in some place of work where there are some hazards uh for example noise pollution air pollution and so on when um condition of back can influence some disease in future uh soal decrete individuals people who work in F uh food industry uh employees of Public Service is people who communicate with big amount of other people uh special cohorts um also um government officials people who suffered from chobble nuclear power plant accident it's really catastrophe of our country and um such situation that great amount of oranization CA P here more than 25 years ago uh we see complication even now uh so um we control condition of such people more tally than others uh all citizens of our Republic have um the right to undergo dispenser examination or to refuse surely uh person answer for his health but we should give such opportunity uh and uh when we speak about dispensarization of adults it includes not only Health examination physical examination dyamic surveillance uh but also healthy lifestyle promotion you give uh education of uh improve education about health for such people we talked about in previous lecture uh development of interest in and responsibility of indiv individuals for their health it's very important because sometimes when a person not pay for Doctor consultation his motivation can be not so good uh but we should give another motivation uh person should save his life and um when we improve knowledge about healthy lifestyle it's really work so when we speak about um amount of test laborat um instrumental method ofch it can be different according the age of people if you speak about citizens of barus uh for people between 18 and uh 30 years old uh we uh as doctors should [ make physical examination full physical examination look when you see patient in first time or in first time during this year you make full physical examination uh from no lym Noles otation percussion pulation uh to the to the leg so you should check everything but then when person come in the second third CH during this year uh physical examination can be not so full but oriented what reason what disease [ cause this pathology accept physical examination we should uh measure blood pressure no measure for what reason this person come to you uh b m uh mass index calculation is necessary and uh not obligatory but it's will be rather useful if we measure uh waste circumference because it also show predisposition to Z disease if indicated we make blood test urine test glucose level uh make ACG uh chest if at it uh it's clear if we speak about chest xray once in three years uh expect people who uh work in medicine uh except students um teachers they should make chess xray one time in one year uh in this uh situation we make screening for tuberculosis and some another disease uh lung pathology uh which is necessary to find in the ls stage genology Examination for women including breast examination uh one time per year between 30 309 uh the same plus holesterol level uh if inducation presents some family story and so on after 40 everything that we already mentioned uh and uh plus uh we calculate cardiovascular risk um using score chart uh I will will speak about it a bit later also we uh measure in pressure when we speak about genology examination after uh 50 years old we make mamography one time in two years and orical examination included prostate uh gland for men um and plus PCA this is test for screen for PR um gland cancer one time in two years uh but after 61 every year uh FAL [blood chest also recommended so all of this um all of this research made for all people in our country for Citizens no matter have they disease or not so one more time physical examination blood pressure management body mass index control uh for people younger than 40 if indicated H blood test urine analysis glucose and fluorograph or chest x-ray genology Examination for everyone uh plus after 40 years old we check PCA um one time two years and after 60 every year mograph me uh just for uh canc it just for a citizen no matter there are complaints or not there are are three uh dispensary uh groups the first one D1 D first is a group of healthy people uh it include people without any complaints no problem in anamnesis normal physical examination normal analyses uh and professional work with such group include uh health promotion uh education about healthy lifestyle uh and annual Health examination so we work with respective of some disease development ask about smoking alcohol use inactivity and so on and work with Sous factors and make all research that we already mentioned in previous slide uh depending what age of this person this is the first group the second group include particular healthy people this uh um group about people um with um chronic disease but uh information when during uh 5 years last five years was no symptoms complaints changes in analysis for example chonic ptis but there is no pain disera there is no changes in analysis during five years we can't say that [ person doesn't have this parship but it's uh here will be in this group people with risk factors uh um this genetic predisposition uh people who um rather often recurent suffer from respiratory pathology normally we speak that adult person should suffer less than five uh times per year even less than four times per year prar pathology like if you catch cult six 10 times per surely your health is not normal even without chronic pathology uh people who recover after uh severe active disease for example ttis pneumonia P fries some [ trauma um some period after recovery uh they will be under control and will be the second uh group but some people uh m have predisposition to some disease development in future so uh when they recover absolutely uh they will return to first group but sometime after they will be in the second uh so for this group uh we um make examination one two times a year uh also prescribe all that um minimum level of research diagnostic test which we discuss for everyone we should make more accent for healthy lifestyle promotion uh we should indiv speak about individual features of Health activities for this exact paent um we should change uh or at least uh speak about respect exactly of this person uh so uh it's our work with such group of people uh be free people with chronic conditions uh there are two subgroups the uh the first or different a D3 a group patient with different chronic disease with um forur aeration subc compensated decompensated form um and d3b this people who has imidization not temporary disability but constant uh and surely we work with them in a different manner uh if we speak about dispensarization most common pathology with which we work in a patient Department this is respons pathology like a Chron bronchitis asthma brasis L AB CD we speak about um cardiovascular pathology asemic heart disease hyp tension gastri problem gastritis dyspepsia hepatitis ala colitis kidney pathology uh joint pathology yes and surely our management our plan will be different depends what sphere suffer uh this person uh very interesting group uh frequently and proximately ill people people who suffer six and more cases per year and the summarize day when the ill more than 40 uh such people has very high predisposition to chronization but also it can be caused by chronic stress uh some imuno deficit condition so if you see such people you should check their condition better in compare uh with uh healthy people uh it's not a sign of pathology but it show a severe predisposition for it uh so prevention work with people um of different group uh we should um see such people at least two but mostly four times per year uh diagnostic test will be also more common uh and specs of them will be wider sometimes we ask um specialist consult such people we work with race factor and about uh some another so-called healing measures uh we speak about working rest your gym sometimes we give some recommendation uh to work of this person if we see that it's influenced on its uh Health uh we speak about diet Physical Therapy um some infection size rication is there for example it also can uh influence on health condition of this person uh prescribing some medication drug um s term result treatment uh by the way if you speak about result treatment result it's territory which by climate by Nature condition can uh cause um are a good effect on our uh organism for example if you speak about see some Forest some anization some special mineral watches by natural reason uh this structure can cause rather nice effect on our health and sanatorium it's medical establishment which based on res we should use this uh natural nature conditions um plus some type of phys terapy and so on um we use it to improve health of uh our people and for example barus is very rich for sanatorium and Resort uh we have some rather unique places for example in salagor we have sold uh production uh fabrics and also uh there are some senatori on this church it's very um nice for people who suff from Asma and another respiratory pathology uh another methods is plan hospitalization maybe it's uh C ridiculous but sometimes some surgical manipulation can improve health of this person for example if we uh speak about bler disease uh kidney stones and so on some manipulation can improve quality of life and improve condition of this person rational work placement if person suffer from hypertension asemic heart disease working at night not rather nice or working uh when there is no mental we but uh rather severe physical activity so it's also necessary to remember uh if you see that there is chronic severe condition maybe it's necessary to send person for special commission which will make decision if there is signs of invalidation or not so it's also rather important uh if you make some manipulation with person we should analyze if it's effective or not so um there are some criteria of activity uh of dispensarization of every person for example there are no signs of um exacerbation of disease uh is person stay in remission um times of temporal disability became shorter for example if person suffering aritis uh when he suff from pain when he can't move normally he stay at home not go to work and if you see that after your treatment after dispensarization uh this period of uh losing possibility to work became shter it also shows that your work is rather nice uh elevation of clinical stages of disease absence of primary invalidation if person not um have constant disability yes he if he can can ) continue to work it's really rather nice for this person all of in group we have three groups um the f is the light form when person can do some work at home but uh mostly he can't work or um his place of work should be not as um difficult for this person without physical activity mostly mental uh not at night and something like this the second means that uh mostly uh person can't work but can do something at home he can't control himself the first group it means that person need uh somebody who can care about it he can't do it by himself and if he see that disase became not so severe person can care about himself surely it shows that we do everything correct uh another if you speak not about individual level but when we speak about group uh population level um percent of uh people who under our control uh in ideal situation should be about 100 so all people should be under dispensarization healthy or with some disease but really I hope you understand that it's not possible that all people will go to doctor at least one time per year but normally we have more than 80% of our population under dispensarization uh sometimes uh in some years even more than 90 uh percentage of employed it means uh people who continue to work but um under our control surely we make Accent on such group uh percentage of dispensarization people in every disase for example how many people who suffer from stroke or asemic heart disease underation surely it should be close to 100% percentage of exacerbation of the main disease in all patient with this pathology number of death and cases of temporary disability of each diagnosis in dispensor group during last year uh average case duration and so on um also we use such statistic U analysis as frequency of primary invalidation every 100 uh people under dispensarization um morality in dispensered group in percent and for every uh thousand people inv validation and so on um and every doctor makes such analysis uh for people whom he consult so so uh every doctor every organization and uh in the end of year we make such analysis about all healthare system in our country now we will speak about some um rather common pathologies and what dispensarization we will do according uh disase and we will start speak about chelitis uh firstly we will speak about stto Coco chelitis because it's one of the most common form of this pathology and can cause a lot of complication uh first of all if you make diagnosis of stepto Cal chelitis uh adequate treatment it's primary prevention of acute traumatic fail and uh ear diagnosis of uh postto cocal glam on fres uh in our country we control this person during one month after recovering uh every two weeks we ask paent to come to us make physical examination and also we take blood chest urine analysis and make [ ACG and uh repeat it every two weeks so for example person suffer from ttis he prescrib a MOX line for him he use it about 10 days after it after two weeks you will ask person to come to you to repeat this analysis and then uh one month so two weeks after last visit you will see this person one more time it help us to find the first changes which can um uh help us to prevent severe complication especially it's important among young people especially when we speak about children uh teenagers youth um complication happen more often um young people in compare with old also we can recommend vitamins probiotics uh um rication of infection sites uh and no physical extion during two weeks if you speak about pupils or students we give a special document to school or university um and person can avoid uh physical training classes or or we give some documents for adult that they shouldn't go to gym if they have um if they go usually yes so during uh two weeks after uh um ttis person should avoid physical accession next uh disease which we should discuss this is pneumonia uh duration and frequency of surveillance depends how severe this pneumonia was but mostly we speak that uh recation happen during one month uh and uh then uh during uh one year we will control this person uh two times we will repeat exray if a person not recover faster than one month so person are from from pneumonia if after one month we see some changes on x-ray uh we will repeat it uh one year uh later in this period we will send person to blood chest sputum analysis um if um person not recover as fast we see prolong form of pneumonia we sent we repeat chest xray and blun Analysis one month later after full recovery um and per uh pronology consultation uh U also indicated if you see problem form of pneumonia reabilitation rational temporary work placement if person work in refrigerator for example when temperature all slow or this severe um physical uh activity uh it's better to give some recommendation that sometime after pneumonia uh employees should change place uh of working Healthy Living physical therapy massage only if person not suffer from fever uh some briefing technique briefing exercises um influenza prevention not when there is a form of pneumonia but when personent start recover uh and sorum result treatment also recommended for this person next disase it's not accurate in compare with previous B uh chronic we will speak about one of the most common pathology atosis and asemic heart disease uh there are some risk factors which influence on speed of this pathology development firstly we speak about this Sid when uh total holol high low and very low density higher than should be uh and opposite high density low lower than uh it's necessary by the way for [ people without cardiovascular pathology total whell should be lower than 5.5 m per liter among people with asem high disease it should be lower than 5 mm per liter by European gu lines and lower than 4.5 by American lines but at least it should be lower than 5.5 for everyone if it's higher we speak about hypo holia low density should be lower than 17 for everyone if person has a lot of respects s from asemic heart disease diabetes it should be lower than 1.3 M mpes hypertension blood pressure should be lower than 140 to 90 by American gu lines uh nowadays hypertension is everything that high than [130 to8 everything that high this is hypertension by European G lines hypertension it's when blood pressure higher than 140 to 0 uh but no matter what classification we use it's better when it's 120 to8 and lower we should control uh glucose level because High um glucose or insuline resistance increase risk of aerosis and increase inflammation so asemic heart disease will develop faster smoking alcohol abuse influence on at development physical inactivity in previous lecture we spoke a lot about this moment uh if person uh not do a lot or at least enough uh risk of aerosis became really very high overweight and tesity it's like pandemia of uh 21st century uh so many people suffer from this pathology and even overweight not even obesity influence on risk predisposition of this disease unhealthy diet when person use a lot of saturated fats sugar high cholesterol Str fat fast food surely it's not TR nice and it's a increase speed of uh just go develop by the way when you eat a lot of simple carbohydrates sugar it cause atosis even faster in compare uh with products where there is high concentration of [ holesterol emotional stress um yes the right data that hypertension uh develop faster uh among people who under emotional stress and it trly influence [(00:39:31)](https://www.youtube.com/watch?v=vg70A7723Qk&t=2371) on schem heart disease development if you notice that your patient has [(00:39:39)](https://www.youtube.com/watch?v=vg70A7723Qk&t=2379) uh one or several risk factures surely uh you will work res suchar uh patient give uh him [(00:39:51)](https://www.youtube.com/watch?v=vg70A7723Qk&t=2391) recommendation what he can change to decrease risk of aeia cont disas and again uh met factors which we [(00:40:01)](https://www.youtube.com/watch?v=vg70A7723Qk&t=2401) mentioned can be modified by healthy lifestyle physical uh activity losing uh weight if [(00:40:09)](https://www.youtube.com/watch?v=vg70A7723Qk&t=2409) there is uh some problem with it with body mass um decrease amount of alcohol that person use stop [(00:40:17)](https://www.youtube.com/watch?v=vg70A7723Qk&t=2417) smoking uh use meditation or another way of relaxation uh sometimes it's necessary [(00:40:24)](https://www.youtube.com/watch?v=vg70A7723Qk&t=2424) to use some drug for example if you speak about hypertension to decrease level of blood pressure it's necessary [(00:40:29)](https://www.youtube.com/watch?v=vg70A7723Qk&t=2429) to use drug by the way uh by statistic particularly 30% of people who suffer from hypertension uh didn't know about [(00:40:38)](https://www.youtube.com/watch?v=vg70A7723Qk&t=2438) it uh and every third person who know about this diagnoses that he suffer from it doesn't use therapy constantly so [(00:40:48)](https://www.youtube.com/watch?v=vg70A7723Qk&t=2448) it's very important to describe based on how it's important what is necessary to do uh if you speak about this epidemia [(00:40:56)](https://www.youtube.com/watch?v=vg70A7723Qk&t=2456) sometimes not enough to change uh nutrition but it's necessary to use some Dr and one of the most common group of [(00:41:04)](https://www.youtube.com/watch?v=vg70A7723Qk&t=2464) Dr which we use PES is resistance even without diabetes uh lifestyle modification is [(00:41:13)](https://www.youtube.com/watch?v=vg70A7723Qk&t=2473) one of the best thing which person can do is works even better than metamine but [(00:41:19)](https://www.youtube.com/watch?v=vg70A7723Qk&t=2479) if person can control himself you can add metamine even without diabetes uh so as you see [(00:41:28)](https://www.youtube.com/watch?v=vg70A7723Qk&t=2488) uh healthy lifestyle or combination healthy lifestyle together with uh some additional medical measures uh can [(00:41:36)](https://www.youtube.com/watch?v=vg70A7723Qk&t=2496) improve prognosis and prevent asemic heart disease development there are some group of [(00:41:42)](https://www.youtube.com/watch?v=vg70A7723Qk&t=2502) people who in higher risk of atosis development um for example patient with establish [(00:41:50)](https://www.youtube.com/watch?v=vg70A7723Qk&t=2510) asem heart disease diagnosis or to scis or of another location for example in brain [(00:42:00)](https://www.youtube.com/watch?v=vg70A7723Qk&t=2520) in um bra atas and so on uh who needs low lowering lowering therapy not only drugs [(00:42:10)](https://www.youtube.com/watch?v=vg70A7723Qk&t=2530) patient without um all symptomatic asemic heart disease but with higher risk fa factors according score uh this [(00:42:20)](https://www.youtube.com/watch?v=vg70A7723Qk&t=2540) is system uh systemic coronary risk evolation chart um which use five indicators H6 [(00:42:29)](https://www.youtube.com/watch?v=vg70A7723Qk&t=2549) smoking uh systolic blood pressure level and cholesterol level people this uh rather bad family [(00:42:37)](https://www.youtube.com/watch?v=vg70A7723Qk&t=2557) history of aeic heart disease and uh this core uh table you can see here uh for [(00:42:46)](https://www.youtube.com/watch?v=vg70A7723Qk&t=2566) example um here you can see uh the level of blood pressure uh different tablets for [(00:42:55)](https://www.youtube.com/watch?v=vg70A7723Qk&t=2575) men and women for smoke and not smokers and according uh cholesterol level uh and age and R nice uh to show this uh [(00:43:07)](https://www.youtube.com/watch?v=vg70A7723Qk&t=2587) table for people with some risk factors for example usually it works rather nice for uh [(00:43:14)](https://www.youtube.com/watch?v=vg70A7723Qk&t=2594) people when you show like your age is 50 but because you're a smoker because you not control your level of blood pressure [(00:43:23)](https://www.youtube.com/watch?v=vg70A7723Qk&t=2603) and Hol level uh you have the same r as 65 Yes Men um without this respects yeah so um it's rather nice for motivation [(00:43:36)](https://www.youtube.com/watch?v=vg70A7723Qk&t=2616) for improving motivation for our people to change something [(00:43:44)](https://www.youtube.com/watch?v=vg70A7723Qk&t=2624) uh we use this uh chart uh for people even without asemic heart disease it just for people who in risk of it and to [(00:43:54)](https://www.youtube.com/watch?v=vg70A7723Qk&t=2634) show patience and also for your um usage you can see uh how some different risk factors influence on cardiovascular [(00:44:04)](https://www.youtube.com/watch?v=vg70A7723Qk&t=2644) disease development it can be different uh among women and men and by the way uh women suffer from cardiovascular disease [(00:44:13)](https://www.youtube.com/watch?v=vg70A7723Qk&t=2653) um not so common compar with men usually we have um about 10 years difference like um 50 years uh old man has the same [(00:44:25)](https://www.youtube.com/watch?v=vg70A7723Qk&t=2665) RIS factor of a disease development as 60 years woman there are a lot of [(00:44:34)](https://www.youtube.com/watch?v=vg70A7723Qk&t=2674) uh um parameters why women suffer from cardiovascular disease when [(00:44:42)](https://www.youtube.com/watch?v=vg70A7723Qk&t=2682) they older in compare with men um but in the first position estrogen level before menopause estrogen protect our vessels [(00:44:52)](https://www.youtube.com/watch?v=vg70A7723Qk&t=2692) from atos closis um but after menopause uh organism want to increase the amount of [(00:44:59)](https://www.youtube.com/watch?v=vg70A7723Qk&t=2699) estrogens and start produce cholesterol more and more and when there is no answer estrogen continue to be low organ [(00:45:08)](https://www.youtube.com/watch?v=vg70A7723Qk&t=2708) not stop and hypol appear there is no protection effect of estrogens and scis develop [(00:45:19)](https://www.youtube.com/watch?v=vg70A7723Qk&t=2719) um except uh that parameter that indicated the chart uh risk can be higher if person [(00:45:27)](https://www.youtube.com/watch?v=vg70A7723Qk&t=2727) has some conditions for example obesity uh especially when I speak about central obesity when um W circumference more [(00:45:39)](https://www.youtube.com/watch?v=vg70A7723Qk&t=2739) than 90 CM if you remember we already uh oh sorry um yeah if you remember we already uh [(00:45:50)](https://www.youtube.com/watch?v=vg70A7723Qk&t=2750) discussed uh in previous lecture about uh measuring of uh w conference um but I will repeat uh okay [(00:46:01)](https://www.youtube.com/watch?v=vg70A7723Qk&t=2761) uh one more time about um these parameters uh when we speak about [(00:46:12)](https://www.youtube.com/watch?v=vg70A7723Qk&t=2772) uh overweight we look not only for um Bud mass index it should be lower than 25 but W to conference for men it should [(00:46:22)](https://www.youtube.com/watch?v=vg70A7723Qk&t=2782) be lower than 85 for women low less than 80 cm and was Heap um ratio should be less [(00:46:32)](https://www.youtube.com/watch?v=vg70A7723Qk&t=2792) than uh 0.9 for men and uh uh for women less than 0.8 if it's more we speak about abdominal obesity [(00:46:44)](https://www.youtube.com/watch?v=vg70A7723Qk&t=2804) central obesity and this condition increase risk of um insul resistance uh hypotension and asemic heart disease [(00:46:55)](https://www.youtube.com/watch?v=vg70A7723Qk&t=2815) development people with strong family history not only one person but a lot of members of famili suffer from [(00:47:03)](https://www.youtube.com/watch?v=vg70A7723Qk&t=2823) cardiovascular pathology um socially depri individuals uh and people with some ethnic um [(00:47:12)](https://www.youtube.com/watch?v=vg70A7723Qk&t=2832) minorities they have higher risk that they can suffer from schem heart disease early in compare with [(00:47:19)](https://www.youtube.com/watch?v=vg70A7723Qk&t=2839) another people with diabetes uh if there is diabetes they have very very very high risk [(00:47:29)](https://www.youtube.com/watch?v=vg70A7723Qk&t=2849) of uh this pathology development no matter what uh the level of cholesterol blood pressure and so on people with low [(00:47:39)](https://www.youtube.com/watch?v=vg70A7723Qk&t=2859) high density lipides and increased level of Che glyceride fibrinogen level of um inflammation uh which can be find by uh [(00:47:51)](https://www.youtube.com/watch?v=vg70A7723Qk&t=2871) increased level of high sensitivity reactive protein um when there is [(00:47:58)](https://www.youtube.com/watch?v=vg70A7723Qk&t=2878) um chronic kidney disease and glal filation rate not ni especially when it's lower than [(00:48:07)](https://www.youtube.com/watch?v=vg70A7723Qk&t=2887) 60 uh so there are some extra risk factors but most important which we use uh uh in [(00:48:18)](https://www.youtube.com/watch?v=vg70A7723Qk&t=2898) score age smoking uh blood pressure level holer level so we use this [(00:48:28)](https://www.youtube.com/watch?v=vg70A7723Qk&t=2908) chart uh now one more time about some levels among healthy people total hosal should be lower than five or 5.5 if it's [(00:48:40)](https://www.youtube.com/watch?v=vg70A7723Qk&t=2920) lower than four it's great uh but for people without cardiovascular disease should be lower [(00:48:47)](https://www.youtube.com/watch?v=vg70A7723Qk&t=2927) than five uh for people with cardiovascular disease should be lower than 4 4.5 low density should be lower [(00:48:56)](https://www.youtube.com/watch?v=vg70A7723Qk&t=2936) than for everyone and lower than 1.3 for people with high cardiovascular risk high density should be more than 1.5 for [(00:49:06)](https://www.youtube.com/watch?v=vg70A7723Qk&t=2946) everyone and more than 1.3 for people with cardiovascular risk triglyceride should be less than 1.7 mm per lit and [(00:49:18)](https://www.youtube.com/watch?v=vg70A7723Qk&t=2958) we calculate the ratio between total Hol and high density the P it should be [(00:49:25)](https://www.youtube.com/watch?v=vg70A7723Qk&t=2965) lower than four this is cent of heterogenity is if uh the is situation the total holol normal by high Den lies [(00:49:35)](https://www.youtube.com/watch?v=vg70A7723Qk&t=2975) rather low it can develop so the ratio is also important [(00:49:48)](https://www.youtube.com/watch?v=vg70A7723Qk&t=2988) uh if um total hosal level higher than normal or is recommended to use stattin therapy [(00:50:01)](https://www.youtube.com/watch?v=vg70A7723Qk&t=3001) uh this moderate and High um cardiovascular risk and uh we look for low density liid it should be less than [(00:50:12)](https://www.youtube.com/watch?v=vg70A7723Qk&t=3012) three but for people who already suffer from cardiovascular disease it should be lower than [(00:50:20)](https://www.youtube.com/watch?v=vg70A7723Qk&t=3020) 1.3 uh by new GLI by American G it's less than 1.3 by European less than [(00:50:30)](https://www.youtube.com/watch?v=vg70A7723Qk&t=3030) 1.8 American has stricter rules in compared with Europeans [(00:50:38)](https://www.youtube.com/watch?v=vg70A7723Qk&t=3038) um low desity of the pice if they lower is better uh here in the slide you can see [(00:50:51)](https://www.youtube.com/watch?v=vg70A7723Qk&t=3051) some examples of the most common use stats in the first position r stat is one of the most strongest uh stattin [(00:51:02)](https://www.youtube.com/watch?v=vg70A7723Qk&t=3062) uh uh ratio of effect this um autov stating is uh one to two uh it means like 5 milligram of [(00:51:13)](https://www.youtube.com/watch?v=vg70A7723Qk&t=3073) Ros statins has the same effect as 10 milligrams of aov Statin the maximum do of Ros Statin 20 Mig of atin 18 Mig ltin [(00:51:25)](https://www.youtube.com/watch?v=vg70A7723Qk&t=3085) and stin they um recers they not so strong and compare with first two drugs and mostly uh we [(00:51:34)](https://www.youtube.com/watch?v=vg70A7723Qk&t=3094) use first to rostin and omega-3 fat acid also can decrease um total holesterol and increase high [(00:51:45)](https://www.youtube.com/watch?v=vg70A7723Qk&t=3105) density but endorse two 4 gr per day for healthy people to decrease if you don't want to prescribe stattin it's possible [(00:51:54)](https://www.youtube.com/watch?v=vg70A7723Qk&t=3114) to prescribe omega3 fi IND do 140 MGR per day it's rather effective uh to decrease total [(00:52:03)](https://www.youtube.com/watch?v=vg70A7723Qk&t=3123) holesterol and especially decrease triglyceride level uh fenofibrates decrease [(00:52:10)](https://www.youtube.com/watch?v=vg70A7723Qk&t=3130) triglyceride better than statins do it about nicotinic acid nowadays we don't use it but earlier it was used but in [(00:52:19)](https://www.youtube.com/watch?v=vg70A7723Qk&t=3139) such dose uh it usually cause uh itain redness of skin uh and it's not so [(00:52:27)](https://www.youtube.com/watch?v=vg70A7723Qk&t=3147) strong in compare with the previous group of drugs so in some old recommendation or in some national recommendation light you can find it but uh honestly we don't use it in um our practice because there are so many side [(00:52:44)](https://www.youtube.com/watch?v=vg70A7723Qk&t=3164) effects and we have better drug so just to prevent complication is better to use St Omega and noway also [(00:52:57)](https://www.youtube.com/watch?v=vg70A7723Qk&t=3177) popular uh which catch uh cholesterol in B and prevent absorption of it so um mostly we prescribe this group to [(00:53:10)](https://www.youtube.com/watch?v=vg70A7723Qk&t=3190) decrease level of stattin next moment when paent suff from anemic heart disease and angina angina [(00:53:18)](https://www.youtube.com/watch?v=vg70A7723Qk&t=3198) picture is happen there are different functional classes we will speak about stable and China because unstable [(00:53:27)](https://www.youtube.com/watch?v=vg70A7723Qk&t=3207) uh means that it's primier infection condition and it's we speak not about dispensarization but about emergency C [(00:53:35)](https://www.youtube.com/watch?v=vg70A7723Qk&t=3215) if we speak about angina we should see this PA at least two four times per year depends what functional class if we [(00:53:42)](https://www.youtube.com/watch?v=vg70A7723Qk&t=3222) speak about first second functional class it will be enough to visit two times per year if we speak about first [(00:53:49)](https://www.youtube.com/watch?v=vg70A7723Qk&t=3229) functional class we will see person every three month uh if it's necessary uh we [(00:53:58)](https://www.youtube.com/watch?v=vg70A7723Qk&t=3238) can send person to neurologist psychotherapist one cardiologist if right indication but mostly doc