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<strong>aversis</strong> <strong>klinikis</strong> <strong>Jurnali</strong><br />
● klinikuri kvlevebi<br />
● bronquli asTma<br />
● yelis tkivili<br />
● egzogenuri alergiuli alveoliti<br />
● postdiareuli hemolizur-uremiuli sindromi<br />
● lipiduri cvla da dislipidemia<br />
● rentgenodiagnostika<br />
● klinikuri SemTxveva<br />
● saeqimo Secdoma<br />
● saqarTvelos kanoni pacientis uflebebis Sesaxeb<br />
●●<br />
klinikuri da fotokiTxvari<br />
ISSN 1987-5665<br />
#4 (4) oqtomberi 2008
Cveni mizania praqtikos eqimTa uwyveti samedicino ganaTleba<br />
<strong>aversis</strong> <strong>klinikis</strong> <strong>Jurnali</strong><br />
s a e q i m o<br />
p r a q t i k a<br />
samecniero-praqtikuli<br />
<strong>Jurnali</strong> eqimebisTvis<br />
# 4<br />
o q t o m b e r i<br />
2 0 0 8
saeqimo praqtika<br />
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opebs!fnvywbsj!<br />
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opebs!mpnj[f!<br />
ovh{bs!vcfsj!<br />
hjpshj!zjgjboj!<br />
ejnjusj kpscfob[f!<br />
benjojtusbupsj<br />
bob!tywjubsj[f<br />
ufrojlvsj!sfebrupsj<br />
tpmpnpo!epoSv{bTwjmj<br />
ebngv[ofcfmj!eb!hbnpndfnfmj<br />
Tqt!!!“”bwfstjt!lmjojlb<br />
sfebrdjjt!njtbnbsUj<br />
Ucjmjtj-!1271-!wbKb.gTbwfmbt!38c<br />
ufm;!4:9478<br />
gbrtj;!4::481<br />
e-mail: mpjournal@aversi.ge<br />
hbsflbo{f<br />
robert tomi (1915-1979), wbrdjobdjb<br />
yvela ufleba avtorebisagan masalis miRebis momentidan<br />
ekuTvnis Jurnal “saeqimo praqtikis” redaqcias.<br />
JurnalSi gamoqveynebuli masalebis sruli an<br />
nawilobrivi kopireba an gavrceleba dasaSvebia mxolod<br />
redaqciis werilobiTi nebarTvis Semdeg.<br />
redaqcia pasuxs ar agebs sareklamo masalebis Sinaarsze.<br />
ebcfXejmjb;<br />
Tqt!qpmjhsbgj<br />
tbrbsUwfmp-!Ucjmjtj-!128:/!kbobTjbt!$5<br />
ufm;!:2!46!78
sarCevi<br />
s a e q i m o p r a q t i k a<br />
28. klinikuri kvlevebi -------------------------------------------------------- 523<br />
29. bronquli asTma --------------------------------------------------------------- 543<br />
30. yelis tkivili ----------------------------------------------------------------- 557<br />
31. egzogenuri alergiuli alveoliti ------------------------------ 571<br />
32. postdiareuli hemolizur-uremiuli sindromi ---------- 583<br />
33. lipiduri cvla da dislipidemia ------------------------------- 595<br />
34. rentgenodiagnostika ------------------------------------------------------ 619<br />
35. klinikuri SemTxveva ---------------------------------------------------------- 623<br />
36.iuridiuli gverdi ------------------------------------------------------------ 633<br />
saeqimo Secdoma ---------------------------------------------------------------- 634<br />
saqarTvelos kanoni pacientis uflebebis Sesaxeb ------ 637<br />
klinikuri da fotokiTxvarebis pasuxebis baraTi --------------- 651<br />
<strong>Jurnali</strong>s saredaqcio politika ----------------------------------------- 653<br />
klinikuri kiTxvari ------------------------------------------------------------ 659<br />
fotokiTxvari --------------------------------------------------------------------- 675<br />
inglisurenovani abstraqtebi -------------------------------------------- 685<br />
saeqimo praqtika #4 oqtomberi, 2008 weli 521
pativcemulo kolegebo<br />
Cven kvlavac vcdilobT, <strong>Jurnali</strong> saintereso<br />
da kiTxvadi gavxadoT, ris<br />
gamoc Tematikis SerCevisas maqsimalurad<br />
viTvaliswinebT Tqvens azrsa<br />
da survilebs. rasakvirvelia, upiratesobas<br />
praqtikuli Rirebulebis informacias<br />
vaniWebT, informacias, romelic<br />
Tqveni praqtikuli saqmianobisTvis<br />
sasargeblo, samaxsovro da<br />
gansjadi iqneba.<br />
samwuxaroa, rom ukanasknel xans gax-<br />
Sirda savalalo SedegebiT dasrulebuli,<br />
gaxmaurebuli saeqimo Secdomebi.Kkidev<br />
ufro samwuxaroa, rom ase-<br />
Ti Secdomebi meordeba da maT Sesaxeb<br />
eqimTa sazogadoebis mxolod mcire nawilma icis. iqmneba STabeWdileba, rom eqimebi cudad<br />
erkvevian kanonmdeblobis sakiTxebSi, cudad arian informirebulni, ris gamoc ver iTvaliswineben<br />
kolegebis Secdomebs da, maSasadame, cudad arian daculni. aqedan gamomdinare, gagviCnda survili,<br />
davnergoT axali rubrika _ saeqimo Secdoma, romelSic konfidencialurobis dacviT gagacnobT<br />
eqimTa Secdomebs _ informacias gansjisaTvis, aRniSnul SemTxvevebTan dakavSirebul saeqsperto<br />
daskvnebs, dokumentaciasa da Semowmebis masalebs. imedi gvaqvs, es informacia gansjisken<br />
gibiZgebT. Tqven mier gamoTqmuli mosazrebebi saintereso iqneba ara marto redaqciisa da<br />
Cveni kolegebisTvis, aramed saqarTvelos Sromis, janmrTelobisa da socialuri dacvis saministrosa<br />
da samedicino saqmianobis saxelmwifo regulirebis saagentos TanamSromlebisTvis, radgan<br />
swored maT dauWires mxari Cvens ideas aseTi diskusiis wamowyebis Sesaxeb da didi daxmareba<br />
gagviwies saTanado masalis mopovebaSi, risTvisac maT did madlobas vuxdiT.<br />
moxarulni varT, rom <strong>Jurnali</strong> misaRebi aRmoCnda ara marto qarTveli eqimebisTvis, aramed Cveni<br />
araqarTulenovani kolegebisTvisac. gamogvexmauren ucxoelebic – ukrainidan, germaniidan... holandiis<br />
eqimTa asociaciam gamoxata interesi Cveni <strong>Jurnali</strong>s mimarT, amitom am nomerSi gTavazobT<br />
inglisurenovan abstraqtebs.<br />
redaqcia SegaxsenebT, rom am wlis miwuruls gamovaqveynebT konkursis Sedegebs, klinikuri da<br />
fotokiTxvaris swor pasuxebs. axlovdeba nominantebis gamovlenisa da dajildoebis dro.<br />
veliT Tqvens gaaqtiurebas da gamoxmaurebas. gisurvebT warmatebas.<br />
keTili survilebiT<br />
aleqsandre Telia<br />
<strong>Jurnali</strong>s mTavari redaqtori<br />
medicinis mecnierebaTa doqtori, profesori<br />
522<br />
saeqimo praqtika<br />
saeqimo praqtika #4 oqtomberi, 2008 weli
i u r i d i u l i g v e r d i<br />
Jurnal “saeqimo praqtikis” redaqcia iTvaliswinebs mravalricxovani<br />
mkiTxvelis survils da interess - Cveni <strong>Jurnali</strong>s mier<br />
gaSuqdes saeqimo saqmianobasTan dakavSirebuli iuridiuli sakiTxebi,<br />
sakanonmdeblo da kanonqvemdebare normatiuli aqtebi, aseve samedicino<br />
SemTxvevebis iuridiuli aspeqtebi. <strong>Jurnali</strong>s am nomerSi gTavazobT:<br />
pacientis uflebebis Sesaxeb saqarTvelos kanonis saboloo variants,<br />
masSi Setanil cvlilebebsa da damatebebTan erTad; saqarTvelos<br />
Sromis, janmrTelobisa da socialuri dacvis ministris brZanebas<br />
#238/n, zogierTi samedicino Carevis Catarebamde pacientisagan<br />
werilobiTi informirebuli Tanxmobis miRebis Sesaxeb da gagacnobT<br />
samedicino saqmianobis saxelmwifo regulirebis saagentos samedicino<br />
momsaxurebis xarisxis kontrolis samsaxuris mier Seswavlil masalebs<br />
eqimTa profesiuli pasuxismgeblobis Taobaze. stili daculia.<br />
konfidencialurobis dacvis mizniT samedicino dawesebulebis saxelwodebasa<br />
da pirTa vinaobas ar vuTiTebT.<br />
TanamSromlobisa da daxmarebisTvis guliTad madlobas vuxdiT<br />
samedicino saqmianobis saxelmwifo regulirebis saagentos ufross<br />
baton gia TvalavaZes, samsaxuris ufross baton merab uruSaZes da<br />
mTel koleqtivs.<br />
saeqimo praqtika #4 oqtomberi, 2008 weli 633
636<br />
iuridiuli gverdi<br />
ÒÄÂÉÓÔÒÉÒÄÁÖËÉÀ ÓÀØÀÒÈÅÄËÏÓ ÉÖÓÔÉÝÉÉÓ ÓÀÌÉÍÉÓÔÒÏÛÉ<br />
ÒÄÂÉÓÔÒÀÝÉÉÓ ÍÏÌÄÒÉ 470.230.000.11.119.004.535<br />
ÓÀØÀÒÈÅÄËÏÓ ÛÒÏÌÉÓ, ãÀÍÌÒÈÄËÏÁÉÓÀ ÃÀ<br />
ÓÏÝÉÀËÖÒÉ ÃÀÝÅÉÓ ÌÉÍÉÓÔÒÉÓ<br />
Á Ò Þ À Í Ä Á À N 238/Í<br />
2000 ßËÉÓ 5 ÃÄÊÄÌÁÄÒÉ Ø. ÈÁÉËÉÓÉ<br />
ÆÏÂÉÄÒÈÉ ÓÀÌÄÃÉÝÉÍÏ ÜÀÒÄÅÉÓ ÜÀÔÀÒÄÁÀÌÃÄ<br />
ÐÀÝÉÄÍÔÉÓÀÂÀÍ ßÄÒÉËÏÁÉÈÉ ÉÍ×ÏÒÌÉÒÄÁÖËÉ<br />
ÈÀÍáÌÏÁÉÓ ÌÉÙÄÁÉÓ ÛÄÓÀáÄÁ<br />
ãÀÍÌÒÈÄËÏÁÉÓ ÃÀÝÅÉÓ Ó×ÄÒÏÛÉ ÊÀÍÏÍÌÃÄÁËÏÁÉÈ<br />
ÂÀÈÅÀËÉÓßÉÍÄÁÖËÉ ÌÏØÀËÀØÄÈÀ Ö×ËÄÁÄÁÉÓ ÃÀÝÅÉÓ ÖÆÒÖÍÅÄËÓÀÚÏ×ÀÃ,<br />
”ãÀÍÌÒÈÄËÏÁÉÓ ÃÀÝÅÉÓ ÛÄÓÀáÄÁ“ ÓÀØÀÒÈÅÄËÏÓ ÊÀÍÏÍÉÓ II ÈÀÅÉÓ ÌÄ – 8<br />
ÌÖáËÉÓ ÛÄÓÀÁÀÌÉÓÀÃ<br />
ÅÁÒÞÀÍÄÁ:<br />
1. ÓÀÌÊÖÒÍÀËÏ – ÐÒÏ×ÉËÀØÔÉÊÖÒ ÃÀßÄÓÄÁÖËÄÁÄÁÛÉ ÓÀÌÄÃÉÝÉÍÏ<br />
ÐÄÒÓÏÍÀËÌÀ, ØÅÄÌÏÈ ÜÀÌÏÈÅËÉËÉ ÓÀÌÄÃÉÝÉÍÏ ÜÀÒÄÅÄÁÉÓ ÜÀÔÀÒÄÁÀÌÃÄ,<br />
ÐÀÝÉÄÍÔÉÓÀÂÀÍ ÌÉÉÙÏÓ ßÄÒÉËÏÁÉÈÉ ÉÍ×ÏÒÌÀÝÉÖËÉ ÈÀÍáÌÏÁÀ:<br />
À) ÍÄÁÉÓÌÉÄÒÉ ØÉÒÖÒÂÉÖËÉ ÏÐÄÒÀÝÉÀ, ÌÝÉÒÄ ØÉÒÖÒÂÉÖËÉ<br />
ÌÀÍÉÐÖËÀÝÉÄÁÉÓ ÂÀÒÃÀ:<br />
Á) ÀÁÏÒÔÉ;<br />
Â) ÓÉÓáËÞÀÒÙÅÄÁÉÓ ÊÀÈÄÔÄÒÉÆÀÝÉÀ;<br />
Ã) ÄÍÃÏÓÊÏÐÉÀ;<br />
Ä) ÒÄÍÔÂÄÍÏÊÏÍÔÒÀÓÔÖËÉ ÂÀÌÏÊÅËÄÅÄÁÉ;<br />
Å) äÄÌÏÃÉÀËÉÆÉ ÐÄÒÉÔÏÍÄÖËÉ ÃÉÀËÉÆÉ;<br />
Æ) ÄØÓÔÒÀÊÏÒÐÏÒÖËÉ ÂÀÍÀÚÏ×ÉÄÒÄÁÀ;<br />
È) ÂÄÍÄÔÉÊÖÒÉ ÔÄÓÔÉÒÄÁÀ;<br />
É) ÂÄÍÖÒÉ ÈÄÒÀÐÉÀ;<br />
Ê) ÓáÉÅÖÒÉ ÈÄÒÀÐÉÀ;<br />
Ë) ÀÅÈÅÉÓÄÁÉÀÍÉ ÓÉÌÓÉÅÍÄÄÁÉÓ ØÉÌÉÏÈÄÒÀÐÉÀ;<br />
2. ÃÀÄÅÀËÏÓ À×áÀÆÄÈÉÓÀ ÃÀ ÀàÀÒÉÓ ÀÅÔÏÍÏÌÉÖÒÉ ÒÄÓÐÖÁËÉÊÄÁÉÓ<br />
ãÀÍÌÒÈÄËÏÁÉÓ ÃÀÝÅÉÓ ÓÀÌÉÍÉÓÔÒÏÄÁÓ, ÛÒÏÌÉÓ, ãÀÍÌÒÈÄËÏÁÉÓÀ ÃÀ<br />
ÓÏÝÉÀËÖÒÉ ÃÀÝÅÉÓ ÒÄÂÉÏÍÀËÖÒ ÃÄÐÀÒÔÀÌÄÍÔÄÁÓ, Ø. ×ÏÈÉÓ ÃÀ ÃÀÁÀ<br />
ÌÄÓÔÉÉÓ ÌÏÓÀáËÄÏÁÉÓ ÛÒÏÌÉÓ, ãÀÍÌÒÈÄËÏÁÉÓÀ ÃÀ ÓÏÝÉÀËÖÒÉ ÃÀÝÅÉÓ<br />
ÓÀØÀËÀØÏ ÓÀÌÓÀáÖÒÓ ÖÆÒÖÍÅÄËÚÏÍ ÁÒÞÀÍÄÁÉÓ ÃÀÚÅÀÍÀ ÚÅÄËÀ<br />
ÓÀÌÊÖÒÍÀËÏ-ÐÒÏ×ÉËÀØÔÉÊÖÒ ÃÀßÄÓÄÁÖËÄÁÀÌÃÄ ÃÀ ÖÆÒÖÍÅÄËÚÏÍ ÌÉÓÉ<br />
ÛÄÓÒÖËÄÁÉÓ ÊÏÏÒÃÉÍÀÝÉÀ<br />
3. ÊÏÍÔÒÏËÉ ÁÒÞÀÍÄÁÉÓ ÛÄÓÒÖËÄÁÀÆÄ ÃÀÄÅÀËÏÓ ÌÉÍÉÓÔÒÉÓ<br />
ÌÏÀÃÂÉËÄÓ À. ÂÀÌÚÒÄËÉÞÄÓ.<br />
À. ãÏÒÁÄÍÀÞÄ<br />
saeqimo praqtika #4 oqtomberi, 2008 weli
<strong>Jurnali</strong>s saredaqcio politika<br />
s a e q i m o p r a q t i k a<br />
“tb!f!rj!np!qsbr!uj!lb” aris perioduli qarTulenovani tb!nf!ej!dj!op!Kvs!ob!mj/ misi<br />
mizania, miawodos sxvadasxva specialobis frj!nfct Tanamedrove da xarisxiani samecniero-praqtikuli<br />
informacia da xeli Seuwyos maT dauswrebel uwyvet samedicino<br />
ganaTlebas. am mizniT redaqcia upiratesobas aniWebs mtkicebiT medicinaze dafuZnebul<br />
qsbr!uj!lv!mj!Sj!sf!cv!mf!cjt naSromebs, romlebic maqsimalurad mokled da<br />
amave dros srulyofilad aSuqeben maTSi warmodgenil Tematikas.<br />
Zi ri Ta di Te ma ti ka<br />
redaqtoris saxelze avtors SeuZlia warmoadginos Semdegi saxis xelnawerebi:<br />
romelime avadmyofobis, sindromis an simptomis mecnieruli mimoxilva, gaidlaini,<br />
SemTxveva klinikuri praqtikidan, klinikuri da laboratoriuli testi,<br />
farmakologiuri saSualebebis mimoxilva, samecniero kvlevis meTodologia, fotokiTxvari,<br />
samedicino kanonmdebloba da samedicino menejmenti. statiis moculoba<br />
ar unda aRematebodes 5 000 sityvas. <strong>Jurnali</strong> ar gamoaqveynebs originaluri samecniero<br />
kvlevis Sedegebs.<br />
Jur na lis sa re daq cio po li ti ka<br />
<strong>Jurnali</strong>s mTavari amocanaa eqimisTvis maRali xarisxis praqtikuli Rirebulebis<br />
iseTi informaciis miwodeba, romelic xels Seuwyobs mis dauswrebel uwyvet<br />
samedicino ganaTlebas. JurnalSi warmodgenil informaciasa da mosazrebebze<br />
pasuxismgebloba ekisrebaT avtorebs. sareklamo politikac aseve TanxmobaSia <strong>Jurnali</strong>s<br />
miznebTan.<br />
<strong>Jurnali</strong>s saredaqcio strategia mTlianad iziarebs vankuveris deklaraciis<br />
principebsa da moTxovnebs, romlebic waeyeneba biosamedicino Temaze gamosaqveynebel<br />
naSromebs.<br />
Cven miviCnevT, rom mkiTxveli gaTviTcnobierebuli unda iyos im urTierTobebsa<br />
Tu finansur valdebulebebSi, romlebic arsebobs avtorsa da ama Tu im organizacias<br />
Soris (urTierToba damqiravebelTan, masalis flobis ufleba, honorari,<br />
konsultacia da sxva).<br />
saeqimo praqtika #4 oqtomberi, 2008 weli 653
654<br />
saeqimo praqtika<br />
rubrikebi<br />
Ta na med ro ve me di ci na<br />
mimoxilviTi statiebi praqtikuli klinikuri medicinis aqtualur sakiTxebze.<br />
me di ci na da sa zo ga do e ba<br />
periodulad redaqcia gamoaqveynebs avtoritetuli eqimebis Sexedulebebs Tanamedrove<br />
medicinisa da jandacvis aqtualur sakiTxebze. statiis moculoba ar<br />
unda aRematebodes 1 000-1 200 sityvas da miTiTebuli iyos minimum 12 literaturuli<br />
wyaro.<br />
sa re daq cio fos ta<br />
mkiTxvelebs SeuZliaT waradginon SekiTxvebi JurnalSi gamoqveynebul masalasTan<br />
dakavSirebiT, romlebzec redaqcia uzrunvelyofs avtoritetuli eqspertebis<br />
konfidencialur an sajaro (survilisamebr) pasuxs.<br />
re daq to ris gver di<br />
nebismieri Sinaarsis saredaqtoro statias arCevs redaqtori. misi moculoba<br />
ar unda aRematebodes 300-750 sityvas da miTiTebuli iyos 6 literaturuli<br />
wyaro.<br />
ga id la i ne bi<br />
warmodgenili iqneba erovnuli da saerTaSoriso klinikuri da diagnostikuri<br />
gaidlainebi.<br />
fo to kiTx va ri<br />
fotokiTxvarSi avtors SeuZlia warmoadginos nebismieri teqnologiiT Sesrulebuli<br />
vizualuri masala da ara umetes 250-750 sityvis Semcveli Tandar-<br />
Tuli teqsti.<br />
mtkicebiTi medicina<br />
am rubrikaSi sistematurad gaSuqdeba samecniero kvlevebis sxvadasxva tipis<br />
dizainebi, protokolebi, statistikuri analizis meTodebi, kvlevebis sarwmunooba<br />
da sxva aqtualuri sakiTxebi, romlebic ukavSirdeba Tanamedrove samedicino samecniero<br />
kvlevebis meTodologiebsa da zogadad mtkicebiT medicinas.<br />
diagnostikuri medicina<br />
warmodgenili iqneba daavadebaTa da mdgomareobaTa Tanamedrove diagnostikuri<br />
meTodebis aRwera da diagnostikuri Rirebulebebis Sefaseba, maTi gamoyenebis<br />
Cvenebebi da Sedegebis klinikuri interpretacia.<br />
Sem Txve ve bi kli ni ku ri praq ti ki dan<br />
warmodgenili iqneba saTanadod aRwerili da gaformebuli klinikuri Sem-<br />
Txvevebi.<br />
saeqimo praqtika #4 oqtomberi, 2008 weli
iuridiuli gver di<br />
Jurnal “saeqimo praqtikis” redaqcia iTvaliswinebs mravalricxovani<br />
mkiTxvelis survils da interess - Cveni <strong>Jurnali</strong>s mier gaSuqdes saeqimo<br />
saqmianobasTan dakavSirebuli iuridiuli sakiTxebi, sakanonmdeblo da kanonqvemdebare<br />
normatiuli aqtebi, aseve samedicino SemTxvevebis iuridiuli<br />
aspeqtebi.<br />
uwy ve ti sa me di ci no ga naT le bis gver di<br />
JurnalSi gamoqveynebulia klinikuri SemTxvevisa da TiToeuli publikaciis<br />
Sesabamisi kiTxvari, situaciuri amocanebi, fotokiTxvari da maTze pasuxis gasacemi<br />
specialuri baraTi. kiTxvebis umravlesobaze pasuxis gacema SesaZlebeli iqneba<br />
statiebis damuSavebis Semdeg. TiToeuli swori pasuxi Sefasdeba erTi dadebi-<br />
Ti (+1) quliT, TiToeuli araswori pasuxi - erTi uaryofiTi (-1) quliT, pasuxisgan<br />
Tavis Sekaveba - nuli quliT. gadasworebuli pasuxi baTildeba.<br />
mkiTxveli pasuxebgacemul baraTs gzavnis (an Tavad miaqvs) <strong>Jurnali</strong>s redaqciaSi,<br />
misamarTze: Tbilisi 0160, vaJa-fSavelas 27/b, ~<strong>aversis</strong> klinika”, SekveTili<br />
weriliT an ~<strong>aversis</strong>” afTiaqebis meSveobiT. redaqcia mkacr meTvalyureobas awesebs<br />
pasuxebis sisworesa da gagzavnis vadebze. swori pasuxebi gamoqveyndeba 2008<br />
wlis bolos. Tanabari qulebis SemTxvevaSi upiratesoba mieniWeba pasuxis gamogzavnis<br />
operatiulobas. mkiTxvelebs, romlebic met qulas daagroveben, kompania<br />
”aversi” daajildoebs fuladi premiebiT:<br />
qjs!wf!mj!qsf!njb!–.!21!111!mb!sj!)fs!Uj!op!nj!ob!dj!b*<<br />
nf!p!sf!qsf!njb!–.!6!111!mb!sj!)p!sj!op!nj!ob!dj!b*<<br />
nf!tb!nf!qsf!njb!–.!4!111!mb!sj!)tb!nj!op!nj!ob!dj!b*<<br />
xb!nb!yb!mj!tf!cf!mj!qsf!njb!–.!2!111!mb!sj!)b!Uj!op!nj!ob!dj!b*/<br />
nominantebis dajildoeba Sedgeba 2008 wlis bolos sazeimo viTarebaSi.<br />
<strong>Jurnali</strong>s aqtiur mkiTxvelebs eliT siurprizebi.<br />
mkiTx ve lis ko men ta ri<br />
~werili redaqcias” SeiZleba gamoqveyndes yovel nomerSi. is unda Seicavdes<br />
wina nomerSi gamoqveynebuli masalis komentarebs an Tavisufal stilSi daweril<br />
werils ama Tu im klinikuri mniSvnelobis Tematikis irgvliv. werili unda Seicavdes<br />
ara umetes 500 sityvisa, erT cxrils da erT suraTs.<br />
aver sis kli ni ka<br />
warmodgenili iqneba informacia ~<strong>aversis</strong>” klinikebis saqmianobis Sesaxeb.<br />
s a e q i m o p r a q t i k a<br />
sta ti is war dge na<br />
statiaze muSaobis dawyebis win avtori <strong>Jurnali</strong>s redaqciisgan konsultacias<br />
iRebs misTvis saintereso sakiTxTan dakavSirebiT, ris saSualebiTac igi ayalibebs<br />
Tematikas, statiis dawerisa da misi redaqciaSi wardgenis formats. studentebis<br />
mier daweril naSromebs redaqcia ar ganixilavs.<br />
redaqcia uflebas itovebs, avtorTan SeTanxmebiT Secvalos statiis vizualuri<br />
da Sinaarsobrivi formati, agreTve daicvas avtoris saavtoro uflebebi vankuveris<br />
deklaraciis Sesabamisad.<br />
saeqimo praqtika #4 oqtomberi, 2008 weli 655
656<br />
saeqimo praqtika<br />
sa pub li ka ci od war mod ge ni li ma sa lis sar wmu no o ba<br />
redaqcia gansakuTrebul yuradRebas aqcevs, ramdenad aisaxeba avtoris mier<br />
warmodgenil naSromSi mtkicebiT medicinaze dafuZnebuli informacia. am mizniT<br />
igi avtorebs urCevs:<br />
1. literaturuli wyaroebis SerCevisas winaswar Seafason literaturuli<br />
wyaroebis mtkicebulebaTa doneebi aRiarebuli meTodologiebis saSualebiT;<br />
2. masalaze muSaobisas ixelmZRvanelon mimoxilviTi statiebis Seqmnisa da<br />
maTi Sefasebis aseve cnobili meTodologiebiT (“How to Write an Evidence-Based Clinical<br />
Review”, by Jay Siwek, M. D., Margaret L. Gourlay, M. D., David C. Slawson, M. D.,<br />
and Allen F. Shaughnessy, Pharm. D. (Am Fam Physician 2002; 65:251-9); “Getting the Most<br />
from Review Articles: A Guide for Readers and Writers”, by Allen F. Shaughnessy, Pharm. D.,<br />
and David C. Slawson, M. D. (Am Fam Physician 1997; 55:2155-60). bn!nj{!ojU!sf!ebr!djb<br />
esp!hb!npT!wf!cjU!hb!np!br!wfz!ofct!tb!nfd!oj!f!sp!lwmf!wjt!xbs!np!f!cj!tb!eb!njtj!yb!sjt!yjt!Tf!.<br />
gb!tf!cjt!nf!Up!ep!mp!hj!vs!sf!lp!nfo!eb!dj!fct-!sbd!nojT!wof!mpw!obe!hb!b!be!wj!mfct!!{f!npU<br />
npz!wb!oj!mj!npUy!pw!of!cjt!Tft!sv!mf!cbt/<br />
xel na we ris mom za de ba<br />
xelnaweris momzadebis dros avtorma unda ixelmZRvanelos biosamedicino<br />
JurnalebSi xelnaweris wardgenis unificirebuli moTxovnebiT (vankuveris deklaracia).<br />
xelnaweri ibeWdeba Semdegnairad:<br />
teq ni kur moTx ov na Ta aR we ra<br />
ma sa le bi pub li ka ci e bis Tvis war mod ge nil un da iq nes na beW di sa xiT (4 eg zem pla -<br />
rad) da dis ke ta ze in gli sur da qar Tul eneb ze Sem de gi Tan mim dev ro biT: sa ti -<br />
tu lo gver di, re zi u me, sak van Zo sity ve bi, teq sti, mad li e re bis ga mo xat va (sur vi -<br />
li sa mebr), li te ra tu ris nus xa, cxri le bi, su ra Te bi war we re bi TurT. gver de bis<br />
nom re bi, sa ti tu lo gver di dan dawy e bu li, mi e Ti Te ba fur clis ze da mar jve na<br />
kuTx e Si.<br />
su ra Te bi sa da uCar Coo fo to e bis zo me bi ar un da aRe ma te bo des 203X254 mm-s.<br />
na beW di Ses ru le bu li un da iyos A4 for ma tis sa beWd qa Ral dze, 1,5-2 in ter va -<br />
liT. da So re ba na beW di fur clis Ti To e u li ki di dan _ 1.5-2 in ter va li. sta ti -<br />
is yo ve li axa li kom po nen ti un da da i beW dos axal gver dze.<br />
Ca na we ri Se ta ni li un da iyos sa Ta na dod da cul CD dis kze, ro mel zec Ca we ri -<br />
lia mxo lod sa mec ni e ro naS ro mi stan dar tul for mat Si (wor d-is fa i lis sa -<br />
xiT). qar Tu li teq sti ak re fi li un da iyos stan dar tu li Srif tiT (Lit Nusx<br />
fon tiT), xo lo in gli su ri da ru su li _ fon tiT ari al. zo ma _ 12, in ter va li _<br />
1,5. dis ki un da iyos gar kve viT mar ki re bu li: av to re bis gva re bi, fa il (eb )is sa -<br />
xe li, fa il (eb )is for ma ti.<br />
fa ils un da mi e ces ga sa ge bi sa xel wo de ba.<br />
yve la war mod ge ni li ma sa lis as li un da ina xe bo des av tor Tan.<br />
saeqimo praqtika #4 oqtomberi, 2008 weli
sa ti tu lo gver di<br />
unda Seicavdes:<br />
sta ti is da sa xe le bas, ro me lic un da iyos mok le, mag ram in for ma ci u li;<br />
av to ris (-e bis) gvar sa da ini ci a lebs, sa mec ni e ro xa ris xi sa da wo de bis mi Ti Te biT;<br />
im kli ni kis, la bo ra to ri is an sa mec ni e ro- kvle vi Ti in sti tu tis gan yo fi le bis<br />
da sa xe le bas, sa dac Ses rul da war mod ge ni li naS ro mi;<br />
av to ris (-e bis) gvars, mi sa marTs, te le fo nis no mers (Ema il-s da Fax-s);<br />
sta ti is dam kve Tis an im da fi nan se bis wya ros da sa xe le bas, rom elic da ex ma ra av -<br />
tors sta ti is da we ra Si.<br />
sta ti is mok le Si na ar si<br />
unda Seicavdes:<br />
150-250 sityvas. is unda gvaZlevdes faqtobriv, ara aRwerilobiT informacias,<br />
romelic reziumirebas ukeTebs xelnawerSi mocemul ZiriTad mosazrebebs.<br />
klinikuri mimoxilvebisTvis ganxilul unda iqnes daavadebis diagnostikisa da<br />
mkurnalobis sakvanZo sakiTxebi.<br />
teq sti<br />
unda Seicavdes:<br />
ara umetes 5000 sityvisa.<br />
s a e q i m o p r a q t i k a<br />
av to ro ba<br />
avtorTa Tanmimdevrobas adgenen TviT avtorebi. maTi ricxvi ar unda aRematebodes<br />
3-s. yvela piri, romelic aRniSnulia rogorc “avtori”, unda akmayofilebdes<br />
ZiriTad kriteriumebs: misi monawileoba SromaSi sakmarisi unda iyos imisaTvis,<br />
rom avtorma sakuTar Tavze aiRos statiis Sinaarsze pasuxismgebloba.<br />
cxri le bi<br />
aucileblad unda dainomros. TiToeul svets cxrilSi unda hqondes mokle<br />
dasaTaureba (SesaZloa abreviatura). yvela ganmarteba Tavsdeba SeniSvnebSi da ara<br />
cxrilis saxelwodebaSi. unda mieTiTos, romeli statistikuri sazomebi gamoiyeneboda<br />
monacemTa variabelurobis warmosadgenad, magaliTad, standartuli gadaxra<br />
an saSualo cdomileba.<br />
ilus tra ci e bi (na xa te bi)<br />
mkafiod Sesrulebuli ilustraciis zomebi ar unda aRematebodes<br />
203X254mm-s (sasurveli zomebia 127X173 mm). dasaxeleba da detaluri aRwera<br />
Tavsdeba ilustraciis qveS, minawerSi. naxatebi unda dainomros.<br />
sa zo mi er Te u le bi<br />
yvela hematologiuri da bioqimiuri maCvenebeli warmodgenili unda iyos SI<br />
sistemis erTeulebSi. sigrZis, simaRlis, siganis, masisa da moculobis ganzomilebebi<br />
warmodgenili unda iyos metrul erTeulebSi (metri, kilogrami, litri) an<br />
maT meaTed nawilebSi, temperatura _ °C-Si, arteriuli wneva _ mm.vwy.sv.-Si.<br />
saeqimo praqtika #4 oqtomberi, 2008 weli 657
658<br />
saeqimo praqtika<br />
Se mok le be bi da sim bo lo e bi<br />
rekomendebulia:<br />
sargebloba mxolod standartuli SemoklebebiT (abreviaturebiT), romelTa<br />
gamoyeneba statiis saTaursa da reziumeSi dauSvebelia. sruli termini win uswrebs<br />
teqstSi Semoklebis pirvelad xmarebas.<br />
Se saZ lo gan me o re bi Ti pub li ka ci e bi<br />
ganmeorebiTi publikaciis SemTxvevaSi:<br />
avtors unda hqondes orive <strong>Jurnali</strong>s redaqtoris (an saredaqcio kolegiis)<br />
Tanxmoba. <strong>Jurnali</strong>s (krebulis) redaqtors unda gadaeces pirveli versiis asli<br />
an xelnaweri.<br />
ganmeorebiTi versia zustad unda asaxavdes monacemebs da maT interpretacias<br />
pirvel versiaSi.<br />
ganmeorebiTi versiis satitulo furcelze moyvanili unda iyos SeniSvna an<br />
damowmeba pirvelad publikaciaze.<br />
gan xil vis pro ce du ra, sa re daq cio Ta vi suf le ba, re cen zen te bi<br />
redaqtori masalebis gacnobis Semdeg gansazRvravs damoukidebeli recenzentis(-ebis)<br />
daniSvnis sakiTxs. es ukanaskneli valdebulia warmoudginos redaqtors<br />
yvela argumentirebuli mosazreba publikaciis miRebis (armiRebis) Sesaxeb. redaqtori<br />
statiis Sinaarss recenziasTan erTad gaacnobs saredaqcio kolegiis wevrebs,<br />
ris Semdegac avtors ecnobeba im SeniSvnebisa da argumentebis Sesaxeb, ris<br />
gamoc statia SeiZleba ar gamoqveyndes.<br />
pa ci en tis uf le be bis dac va<br />
pacientis (kanonieri warmomadgenlebis) informirebuli Tanxmobis gareSe<br />
konfidencialobis darRveva ar SeiZleba. akrZalulia nebismieri im informaciis<br />
gamJRavneba, romelic iZleva pacientis identifikaciis saSualebas (werilobiTi aRwera,<br />
fotografiebi, warmoSoba), im gamonaklis SemTxvevaTa garda, romlebsac aqvs<br />
didi samecniero Rirebuleba, xolo pacienti (misi mSoblebi an kanonieri warmomadgenlebi)<br />
iZleva werilobiT Tanxmobas publikaciaze.<br />
pacientis Tvalebis mfaravi Savi zoli fotosuraTze anonimurobis arasakmarisi<br />
garantiaa. dauSvebelia monacemTa falsifikacia anonimurobis misaRwevad.<br />
saeqimo praqtika #4 oqtomberi, 2008 weli<br />
saredaqcio kolegia
SemCneuli Secdomebis gasworeba<br />
saeqimo praqtika #3 (3), oqtomberi, 2008 weli<br />
samaxsovro<br />
Jurnal saeqimo praqtikis redaqcia SegaxsenebT, rom gamosulia <strong>Jurnali</strong>s oTxi<br />
nomeri, romelTa SeZena SegiZliaT “<strong>aversis</strong>” afTiaqebSi. Tu Tqven jer kidev ar<br />
gamogigzavniaT wina nomrebis baraTebi, SeiZineT <strong>Jurnali</strong>s oTxive nomeri,<br />
gamogvigzavneT Sevsebuli baraTebi da moigeT 10 000 lari!<br />
bgUjbrfctb!eb!sfebrdjbTj!cbsbUjt!xbsehfojt!xftj;!<br />
baraTi, SekveTili werilis msgavsad, unda moTavsdes konvertSi da dawebdes.<br />
adgilze mitanisas xels aweren: baraTis warmomdgeni an konkursis monawile,<br />
afTiaqis an redaqciis TanamSromlebi (aranakleb orisa), xelmZRvaneli _ pasuxismgebeli<br />
piri<br />
konverti dawebebis adgilze damowmdeba afTiaqis beWdiT<br />
konvertze unda dafiqsirdes:<br />
baraTis Semvsebis saxeli da gvari;<br />
Cabarebis zusti dro _ TariRi, saaTi, wuTi;<br />
warwera _ <strong>aversis</strong> <strong>klinikis</strong> Jurnal saeqimo praqtikis redaqcias.<br />
gisurvebT warmatebebs.<br />
gverdi, sveti, abzaci aris unda iyos<br />
gv. 509, testi #92 limpostazi limfostazi<br />
gv. 511, testi #94 potodermatiti fotodermatiti<br />
gv. 512, testi #95 urkikaria urtikaria<br />
gv. 516, testi #99 drematiti dermatiti<br />
684<br />
fotokiTxvari<br />
saeqimo praqtika #4 oqtomberi, 2008 weli
Our aim is continuous medical education of practicing physicians<br />
M E D I C A L<br />
P R A C T I C E<br />
Aversi Clinic’s peer-reviewed and<br />
evidence-based clinical journal<br />
#4<br />
OCTOBER<br />
2008
Medical Practice<br />
Editor-in-chief<br />
Alexander Telia<br />
Editorial Board:<br />
Zaza Avaliani<br />
Nikoloz Gongadze<br />
Guram Davitaia<br />
Nodar Emukhvari<br />
Tengiz Telia<br />
Boris Korsantia<br />
Giorgi Lachkepiani<br />
Nodar Lomidze<br />
Nugzar Uberi<br />
Giorgi Kipiani<br />
Dimitri Jorbenadze<br />
Administrator:<br />
Ana Skhvitaridze<br />
Technical Editor:<br />
Solomon Donghuzashvili<br />
Published by:<br />
LTD Aversi Clinic<br />
Address of the editorial board office:<br />
Tbilisi, 0160, Vazha-Pshavela Ave. 27/b<br />
Tel: 398 367<br />
Fax: 399370<br />
E-mail: mpjournal@aversi.ge<br />
On the Cover:<br />
Robert Thom (1915-1979), Vaccination<br />
Journal “Medical Practice” has all rights from the<br />
author after submitting materials. Total or partial<br />
copying and spreading of the journal is allowed<br />
only by publisher’s written permission. Publisher is<br />
not responsible for the content of advertisements.<br />
Printed by LTD “Polygraph”<br />
Georgia, Tbilisi, 0179, Janashia N 4<br />
Tel: 91 35 67: 33 04 27<br />
Fax: 25 34 88<br />
E-mail: poly@gol.ge<br />
THE JOURNAL IS PUBLISHED EVERY<br />
TWO MONTH SINCE APRIL, 2008<br />
UDC 614.23<br />
s-156<br />
saeqimo praqtika® ISSN 1987-5665
EDITORIAL POLICY<br />
Medical Practice<br />
Journal Medical Practice is Georgian-language medical journal. It aims at providing<br />
up-to-date and reliable high-quality scientific information for Georgian physicians of<br />
various specialties, as well as supporting CME. The journal gives preferences to evidence-based<br />
medical articles of practical value which would concisely, but<br />
thoroughly cover the subject.<br />
Main themes<br />
The author should submit an article, which can be a scientific review of a disease,<br />
syndrome or symptom, guidelines, case reports, reviews of clinical and laboratory<br />
tests and pharmacologic agents, research methodology, photo-quiz, medical<br />
legislation, and management. An article must consist of no more than 5000 words.<br />
The journal will not publish the results of an original scientific research.<br />
Editorial policy<br />
The main purpose of the journal is to provide doctors with high quality information<br />
of practical value, which will support distant continued medical education. Authors<br />
are responsible for information and ideas published in the journal. Advertising<br />
policy should also be in accordance with the objectives of the journal.<br />
We fully accept Vancouver Declaration unified requirements for manuscript in<br />
biomedical journals.<br />
We believe that readers should be informed about relationship and financial<br />
obligations between author(s) and various organization(s) (relationship with employer,<br />
rights to publish materials, author’s fee and etc.).<br />
Headings<br />
Up-to-date Medicine<br />
Review articles dealing with the problems of clinical medicine<br />
Medicine and Society<br />
The journal will systematically publish viewpoints of highly-qualified physicians on<br />
current problems of medicine and healthcare. The text should not exceed 1,000-<br />
1,200 words and at least 12 references.<br />
A Letter to Editor<br />
Reader can submit questions regarding the problems discussed in the journal.<br />
Subsequently, editors will provide confidential or public response (as requested by<br />
the author) from authoritative experts.<br />
Medical Practice #4 2008, October 687
Medical Practice<br />
Editor’s Page<br />
An article of any content is selected by the editor. It must consist of no more than<br />
300-750 words and at least 6 references.<br />
Guidelines<br />
National and international clinical and diagnostic guidelines will be published under<br />
this heading.<br />
Photo Quiz<br />
In the photo quiz, the author can present a visual work done by any technique with<br />
an attached text of no more than 250-700 words.<br />
Evidence-based Medicine<br />
Study designs, protocols, statistical analysis, validations of research, and other<br />
problems, associated with medical research methodologies and evidence-based<br />
medicine in general, will be reviewed regularly under this heading.<br />
Diagnostic Medicine<br />
Current diagnostic methods of diseases and medical conditions will be described.<br />
There will be discussed diagnostic value of the methods, indications and clinical<br />
interpretations of results.<br />
Clinical Cases<br />
Properly described and designed case studies will be presented under this heading.<br />
Continued Medical Education Page<br />
Quiz, cases, photo quiz and a special quiz answer card will be published in each<br />
issue of the journal. The questions will be based on each article published in the particular<br />
issue. Therefore, reading through all these articles is important to answer<br />
significant number of the questions. Each correct answer is judged as +1 score,<br />
incorrect answer – 1 score, unanswered question 0 score. Corrected answers will not<br />
be considered.<br />
Readers can send filled quiz answer cards by mail or can bring it at the journals<br />
office address of which is the following: “Aversi Clinic”, Vazha-Pshavela Ave 27/b,<br />
0160 Tbilisi. Alternatively reader can leave the answer cards at Aversi pharmacies.<br />
Timing of submission is strictly regulated by the editorial stuff. The correct answers<br />
will be published in the end of year 2008. Applicants with high scores will receive<br />
following monetary awards from company “Aversi”:<br />
1st Prize – 10 000 lari (one nomination);<br />
2nd Prize – 5 000 lari (two nominations);<br />
3rd Prize – 3 000 lari (three nominations);<br />
Encouraging Prize – 1 000 lari (ten nominations).<br />
Award ceremony will be held in the end of year 2008. In addition regular readers<br />
can win surprise gifts.<br />
688 Medical Practice #4 2008, October
Reader’s Comment<br />
The letter to the editorial board can be published in every issue. It must consist of<br />
comments about the articles published in the journal previously, or it must be a letter<br />
written in an independent style about subjects having clinical importance. Word<br />
count should be around 500 words and no more than one table and one photo.<br />
Aversi Clinic<br />
There will be information about Aversi clinics.<br />
Submission of an article<br />
Before starting writing an article an author consults with the editorial board about<br />
the subject, writing style and layout. Reports written by students will not be<br />
considered. The editorial board reserves rights to change layout or content of the<br />
article with authors’ permission. The editorial board protects author(s) copyright as<br />
defined by Vancouver declaration.<br />
Validity of submitted article<br />
The editorial board pays extreme attention to evidence-based information presented<br />
in each article. For that purpose it advises author:<br />
1. To evaluate the strength and validity of the evidences while choosing references;<br />
2. Using methodologies of creating and evaluating review articles. ("How to Write<br />
an Evidence-Based Clinical Review," by Jay Siwek, M.D., Margaret L. Gourlay,<br />
M.D., David C. Slawson, M.D., and Allen F. Shaughnessy, Pharm.D. (Am Fam<br />
Physician 2002;65:251-9). ("Getting the Most from Review Articles: A Guide for<br />
Readers and Writers," by Allen F. Shaughnessy, Pharm.D., and David C. Slawson,<br />
M.D. (Am Fam Physician 1997;55:2155-60). For that purpose editorial board will<br />
periodically publish recommendations for conducting scientific research and<br />
evaluating their level of validity, which will make easier to fulfill the requirements.<br />
Submission of a manuscript for publication<br />
A manuscript should be written using unified requirements for manuscript in<br />
biomedical journals (Vancouver declaration).<br />
Manuscript must be printed by following rules:<br />
Description of technical requirements<br />
• Manuscript must be printed in 4 copies and burned on a CD both in English and<br />
Georgian languages. It must consist of: title page; abstracts; key words; main<br />
text; acknowledgements (optional); references, diagrams, photos (with their<br />
comments); the number of a page must be written in a top right corner of the<br />
page, including the title page.<br />
• Size of pictures and photos without frames must not be more than 203X254 mm.<br />
Medical Practice #4 2008, October<br />
Medical Practice<br />
689
Medical Practice<br />
• Articles must be printed in A4 format, on a printing paper, with intervals of 1.5-2.<br />
Margins must be 1.5 -2 cm. Each section should begin on a new page.<br />
• Manuscript must be burned on the protected CD as a single Microsoft Word<br />
document. Georgian text must be printed in “LitNusx” font, English and Russian<br />
text - “Arial” font, size 12, interval of 1.5. The CD must have name(s) of<br />
author(s), file name and format on its cover.<br />
• File must be named clearly.<br />
• Authors should retain copies of all documents.<br />
Title page<br />
Must consist of:<br />
• Title, which must be short, but informative;<br />
• Names and surnames of authors and their abbreviated highest academic degree;<br />
• The name of a clinic, laboratory or department(s) of the research institution<br />
where the study was conducted;<br />
• Authors surnames, addresses, telephone and fax numbers, and emails;<br />
• Name of organizations that financially helped author to prepare the article.<br />
Abstract<br />
It must consist of 150 to 250 words. It must consist of factual not descriptive<br />
information, which summarizes the main of a paper. Important details of diagnosis<br />
and treatment must be discussed in clinical reviews.<br />
Text<br />
Must consist of:<br />
No more than 5000 words.<br />
Authorship<br />
Succession in which authors are listed is decided by the authors themselves. Total<br />
number should not exceed 3 and all of them must meet basic criteria about<br />
authorship: each author’s participation should be enough to take responsibility for<br />
the content of the article.<br />
Tables<br />
Tables should be numbered. Each colon in a table should have short title<br />
(abbreviations are also possible). Explanations must be written in notice, and not in<br />
the title of the table. It should be indicated which statistical measures were used to<br />
present data variability, for example: standard deviation or error.<br />
Illustrations<br />
Illustrations should be numbered and their size must not exceed 203X254 mm<br />
(recommended size 127X173 mm). Title and detailed description should be placed<br />
at the bottom.<br />
690 Medical Practice #4 2008, October
Units<br />
Hematology and biochemistry results must be in SI units. Length, height, width,<br />
weight and volume must in metric units, temperature – degrees Celsius, arterial<br />
blood pressure – mmHg.<br />
Abbreviations and symbols<br />
Only standard abbreviations are recommended. They can not be used in the title or<br />
the abstract part of an article. The abbreviation should be spelled out on the first use<br />
and followed with the abbreviation in parentheses to prepare readers for subsequent<br />
use of the abbreviation.<br />
Duplicate publication<br />
Author should get consent from the editors or the editorial board of both journals.<br />
The editor should be provided with a copy of the first time published article.<br />
There should not be difference between publications in terms of data or its<br />
interpretation.<br />
Information about previous publication must be included in the title page of the<br />
second time published article.<br />
Reviewing of the submitted manuscript<br />
The editor after studying the manuscript assigns independent reviewer(s). The<br />
reviewer(s) is responsible to present arguments whether or not to accept the<br />
manuscript for publication. Then the editor presents the article and the reviewer’s<br />
arguments to the editorial board. After that author is informed about the reasons for<br />
what the article may not be published.<br />
Protecting the Privacy of Patients' Health Information<br />
Without informed consent obtained form patient (or legal representatives)<br />
confidentiality can not be breached. It is forbidden revealing any information<br />
(written description, photos, origin) that may identify the patient except in cases<br />
where such information has significant scientific value and written permission is<br />
obtained from the patient (patient’s parents or legal representatives).<br />
A traditional way of preserving anonymity when a photograph includes a patient’s<br />
face is by blacking out the eyes. This may not be enough to successfully disguise<br />
identity. Falsification of data in order to preserve anonymity is forbidden.<br />
The editorial board of journal Medical Practice takes into consideration readers’<br />
interest in legal issues related to medical practice. In this issue we published current<br />
law about patient rights in Georgia and order (# 238/n December 5, 2000 Tbilisi) of<br />
minister of Labor, Health and Social Affairs of Georgia about obtaining written<br />
informed consent from a patient before performing some medical procedures.<br />
In the new heading “Malpractice or ...?” will be presented cases investigated by<br />
medical service quality control department of medical practice regulation state<br />
agency about doctors’ professional responsibility. In order to preserve anonymity,<br />
doctors’ and medical institutions’ names will not be disclosed. Style is preserved.<br />
Medical Practice #4 2008, October<br />
Medical Practice<br />
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Medical Practice<br />
CLINLICAL TRIALS<br />
CONCEIVING THE RESEARCH QUESTION<br />
Alexander Telia, MD, PhD, Proffesor<br />
All studies should start with research question that addresses what the investigator<br />
would like to know. The goal is to find an important one that can be transformd into<br />
a feasible and valid study plan.<br />
In this aspect it is very important scholarship and experience. Before committing<br />
much time and effort to writing a proposal or carrying out a study, the investigator<br />
should consider whether the research question and study plan are : feasible,<br />
interesting, novel, ethical and relevant. Developing the research question and study<br />
plan is an iterative process that includes consultations with advisors a growing<br />
familiarity with the literature, and pilot studies for testing the recruitment and<br />
measurement approaches. The qualities needed in the investigator are judgment,<br />
tenacity and creativity.<br />
BRONCHIAL ASTHMA<br />
Alexander Telia, MD, PhD, Proffesor<br />
Asthma is a chronic condition involving the respiratory system in which the airways<br />
occasionally constrict, become inflamed, and are lined with excessive amounts of<br />
mucus, often in response to one or more triggers. These episodes may be triggered<br />
by such things as exposure to an environmental stimulant such as an allergen,<br />
environmental tobacco smoke, cold or warm air, perfume, pet dander, moist air,<br />
exercise or exertion, or emotional stress. In children, the most common triggers are<br />
viral illnesses such as those that cause the common cold. This airway narrowing<br />
causes symptoms such as wheezing, shortness of breath, chest tightness, and<br />
coughing. The airway constriction responds to bronchodilators. Between episodes,<br />
most patients feel well but can have mild symptoms and they may remain short of<br />
breath after exercise for longer periods of time than the unaffected individual. The<br />
symptoms of asthma, which can range from mild to life threatening, can usually be<br />
controlled with a combination of drugs and environmental changes. Asthma is<br />
defined simply as reversible airway obstruction. Reversibility occurs either<br />
spontaneously or with treatment.<br />
The most effective treatment for asthma is identifying triggers, such as pets or<br />
aspirin, and limiting or eliminating exposure to them. If trigger avoidance is<br />
insufficient, medical treatment is available. Desensitization is currently the only<br />
known "cure" to the disease. Other forms of treatment include relief medication,<br />
prevention medication, short and long-acting β 2 -agonists, anticholinergic<br />
medications, Inhaled glucocorticoids.<br />
692 Medical Practice #4 2008, October
Nana Turava, MD, PhD<br />
Ana Skhvitaridze, MD, PhD<br />
SORE THROAT<br />
Sore throat is one of the most common medical conditions. It may develop with<br />
various diseases. Common causes are pharyngitis and tonsillitis. It may also be associated<br />
with life-threatening diseases such as: peritonsillar abscess, acute epiglottitis,<br />
diphtheria, angina, myocardial infarction, malignancy, human immunodeficiency<br />
virus, blood diseases - agranulocytosis, acute leukemia. Other conditions are: upper<br />
respiratory tract infection, foreign body, infectious mononucleosis, candidal<br />
stomatitis, sexually transmitted diseases (gonorrhea, syphilis), acute thyroiditis,<br />
upper respiratory tract irritation (allergy), immunosuppression, trauma. Rare causes<br />
are: systemic lupus erythematosus, sarcoidosis and tuberculosis.<br />
Pharyngitis is inflammation of mucus layer. Fifty percent is caused with viral<br />
infection. Other causes include: group A streptococcus (Streptococcus pyogenes),<br />
Neisseria gonorrhoeae, Corynebacterium diphtheriae, Haemophilus influenzae,<br />
Moraxella catarrhalis, Mycoplasma pneumoniae, Chlamydia pneumoniae, chemical<br />
irritants, gastroesophagial reflux, allergy, neoplasia, immunosuppression, fungi<br />
(candidiasis).<br />
Sore throat is diagnosed according to clinical signs and laboratory tests. It is<br />
important to differentiate between viral and bacterial (especially streptococcal)<br />
infection. It is done with the following signs and symptoms: tonsillar exudate,<br />
regional lymphadenitis, cough, pharyngeal erythema, fever. When 3 or 4 of them are<br />
present, diagnosis is confirmed in 40-60% and overdiagnosed in 20-40%.<br />
1. If clinical symptoms indicate viral pharyngitis it is not recommended doing rapid<br />
antigen test or bacteriological study and antibiotic treatment.<br />
2. If clinical symptoms indicate bacterial pharyngitis an antibiotic should be<br />
prescribed (penicillin, if allergic them its alternative). But it is not necessary rapid<br />
antigen test or bacteriology.<br />
3. In adult patient who can not be allocated either 1 or 2 above described groups,<br />
rapid antigen test and bacteriology is necessary. If result is positive penicillin is<br />
prescribed (or adequate alternative).<br />
The most common cause of tonsillitis is Streptococcus pyogenes, but it may be also<br />
associated with other bacterial or viral infection.<br />
In children sore throat is usually viral.<br />
Infectious mononucleosis is caused with Epstein-Bar virus (EBV) and characterized<br />
with: fever, intoxication, sore throat, tonsillitis, hepatosplenomegaly, lymphadenitis,<br />
and atypical lymphocytes (mononuclears) in the peripheral blood.<br />
Sore throat should be emergently referred to specialist with following conditions:<br />
peritonsillar abscess, acute epiglottitis, diphtheria.<br />
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Medical Practice<br />
EXTRINSIC ALLERGIC ALVEOLITIS<br />
Ketevan Machavariani, MD, PhD<br />
Extrinsic allergic alveolitis (EAA) (syn. hypersensitivity pneumonitis - HP, diffuse<br />
interstitial pneumonia, interstitial granulomatous pneumonitis, extrinsic pulmonary<br />
granulomatosis, diffuse pneumonophathy, extrinsic allergic bronchoalveolitis) – The<br />
group of an immunologically mediated (III type of allergic reactions by Gell and<br />
Coombs classification) interstitial granulomatous inflammatory lung deseases, caused<br />
by repeated inhalations of large variety of inhaled particles (
HEMOLYTIC UREMIC SYNDROME<br />
Tengiz Telia, MD, PhD<br />
Hemolytic uremic syndrome (HUS) is a disease primarily of infancy and early childhood.<br />
It is characterized by the triad of microangiopathic hemolytic anemia,<br />
thrombocytopenia, and acute renal failure. Diarrhea is the most common<br />
precipitating factor of this syndrome. HUS is generally subdivided into two<br />
presentations that differ in cause and outcome. Sporadic HUS or D- HUS in which<br />
renal failure, developing in the absence of an obvious precipitating factor and D+<br />
HUS the epidemic, "typical" or "childhood" variant of HUS associated with verotoxin-producing<br />
or shiga toxin(STEC) E. coli infection. Shiga toxins (also called<br />
verotoxins) are related bacteriophageencoded cytotoxins that induce host cell death<br />
by destroying the ribosomal protein synthesis machinery. Strains that produce Shiga<br />
toxins can cause disease of varying severity, including watery diarrhea, bloody<br />
diarrhea, hemorrhagic colitis, hemolytic uremic syndrome (HUS), and death. The<br />
principal virulence factors of STEC strains are a group of related cytotoxins called<br />
Shiga toxins. Stx1 and Stx2. ). Enterohemorrhagic (EHEC) strains, especially those<br />
belonging to serotype O157:H7, have been responsible for larger outbreaks of<br />
infection, have higher rates of complications, and appear to be more pathogenic than<br />
non-EHEC STEC strains. STEC infection should be suspected in any patient with<br />
grossly bloody diarrhea, and should be considered in any individual with diarrhea<br />
and cramps. The diagnosis of infection with STEC is extremely important because<br />
of the importance of recognizing potential outbreaks and of taking action to prevent<br />
further infections. Treatment of EHEC infection is entirely supportive. Antibiotics<br />
are currently contraindicated because they can induce the expression and release of<br />
Shiga toxins and because some studies have indicated that their use is associated<br />
with a higher risk of HUS in children with EHEC infection.<br />
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Medical Practice<br />
METABOLISM OF LIPIDS AND DYSLIPIDEMIA<br />
(part 2)<br />
Svanidze Natia, PhD. MD.<br />
Dyslipidemia is abnormal levels of lipids (cholesterol, triglycerides, or both) carried<br />
by lipoproteins in the blood. This term includes hyperlipoproteinemia<br />
(hyperlipidemia), which refers to abnormally high levels of total cholesterol, low<br />
density lipoprotein (LDL), or triglyceroles, as well as an abnormally low level of<br />
high density lipoprotein (HDL). There are two forms of dyslipidemia: primary<br />
(genetic) or secondary (some disorders, including some hereditary disorders, some<br />
drug-therapy). The primary types are classified by Fredrickson Classification. There<br />
are 5 phenotypes (I, II-a,b, III, IV, V). Levels are normally slightly higher in men<br />
than in women, but levels increase in women after menopause. The increase in<br />
levels of lipoproteins that occurs with age can result in dyslipidemia and increase<br />
the risk of atherosclerosis. The risk-factors of dyslipidemia are: having close<br />
relatives who have had dyslipidemia (having a family history of the disorder), being<br />
overweight, consuming a diet high in saturated fats and cholesterol, being physically<br />
inactive, consuming large amounts of alcohol, cigarette smoking. Adverse clinical<br />
sequelae of the lipoprotein disorders most commonly manifest as disorders of the<br />
vascular (CAD, et al.), dermatologic (xanthomas), gastrointestinal systems<br />
(abdominal pain, nau¬sea, vomiting, borborygmi and diarrhea), and other clinical<br />
concomitants. Diagnosis of dyslipidemia based on the clinical manifestations and<br />
laboratory tests. Treatment includs lifestyle modification and drug-therapy.<br />
Treatment the patients with or without CAD is different and based primarily on LDL<br />
choles¬terol levels (NCEP-ATP III guidelines). The guidelines emphasize the need<br />
to as¬sess CAD risk for patients with more than two risk factors (The Framingham<br />
scoring system). Drug therapy is suggested for patients who have a 10-year risk of<br />
developing ischemic heart dis¬ease of more than 10%.<br />
696 Medical Practice #4 2008, October
Magda Simonia, MD, PhD<br />
Solomon Donghuzashvili<br />
CASE REPORTS<br />
CLOSTRIDIUM DIFFICILE INFECTION<br />
Clostridium difficile (CD)-associated diarrhoea and colitis may relapse in up to 20%<br />
of treated patients. We present a patient<br />
who failed to respond over a 6-month period to treatment either singly or in combination<br />
with metronidazole, vancomycin,<br />
rifampicin, cholestyramine and probiotics. Her diarrhoea rapidly resolved after a 3day<br />
course of intravenous immunoglobulin.<br />
This treatment may compensate for a failed immune response to CD toxin and should<br />
be considered for relapsing CD-associated<br />
diarrhoea where there is no response to conventional treatment strategies.<br />
AN UNUSUAL CAUSE OF PLEURAL EFFUSION<br />
Primary effusion lymphoma (PEL) is a unique clinicopathological entity associated<br />
with human herpesvirus-8 (HHV-8)<br />
infection, occurring almost exclusively in human immunodeficiency virus (HIV)infected<br />
individuals. We report a rare case<br />
of HHV-8-negative PEL in an HIV-negative elderly patient who presented with pleural<br />
effusion. The patient was treated<br />
with CHOP and Rituximab. As opposed to the general poor outcome of this disease,<br />
our patient achieved complete remission<br />
and is still without signs of disease 11 months after the last treatment.<br />
ENDOVASCULAR INTERVENTION FOR SYMPTOMATIC BILATERAL<br />
CAROTID ARTERY STENOSIS IN AN<br />
OCTOGENARIAN<br />
An 89-year-old man presented with two separate minor stroke episodes due to high<br />
grade bilateral carotid stenoses, which<br />
were successfully treated with endovascular angioplasty and stenting. The role of<br />
operative interventions for high grade<br />
symptomatic carotid stenosis in patients aged over 80 years is discussed.<br />
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Medical Practice<br />
READ THE JOURNAL MEDICAL PRACTICE AND<br />
BECOME THE WINNER OF 10000 LARI<br />
For the first time in Georgia, physicians are given an opportunity to participate in<br />
continuous medical education program by correspondence. With this objective,<br />
Aversi Clinic established the scientific-practical journal “Medical Practice”. The<br />
journal will be published once in two months, where you can find reliable<br />
information of practical values with a special quiz. The reader will be able to answer<br />
quiz questions after thoroughly studying the articles published in the journal.<br />
To further motivate doctors Aversi Clinic offers monetary awards in 16 nominations,<br />
with total amount of 39 000 lari.<br />
Regular readers can win surprise gifts.<br />
The journal “Medical Practice” is available at Aversi Pharmacies network in any<br />
region of Georgia.<br />
This multidisciplinary medical journal published in Georgia meets all the<br />
international standards determined by Vancouver declaration. The journal is unique<br />
on the publishing market of Georgia. We hope it will be of significant importance<br />
for all physicians in this country, both in clinical practice and for professional<br />
development.<br />
Journal “Medical Practice” is intended for true professionals.<br />
Healthcare Law of Georgia<br />
The editorial board of journal Medical Practice takes into consideration readers’<br />
interest in legal issues related to medical practice. In this issue we published<br />
current healthcare law of Georgia.<br />
Medical Practice #4 2008, October
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