THE RATIONALITY OF USING NOKAMEN IN A FAMILY PRACTICE DOCTOR
V. I. Velichko, V. I. Synenko, D. O. Lagoda.
Odessa National Medical University, Odessa, Ukraine
Summary. General practitioners and family doctors most often face the problem of comorbidity of patients. Polypharmacy, as a consequence of polymorbidity, leads to an increase in the probability of systemic and undesirable effects due to drugs intake as a result the compliance between the doctor and the patient reduces. Kidney pathology is one of the common comorbid diseases. Urolithiasis takes the second place in prevalence, the third place in mortality and the fourth place in disability among urological diseases. The modern medicine must solve the problems of treating the patient by using drugs containing many components in order to simultaneously affect various links of the pathogenesis of the disease. One of such remedies on the Ukrainian market is the herbal-mineral complex Nokamen. The composition of Nokamen includes eight plant components and two minerals, which together produce a nephroprotective effect.
Keywords: family doctor; kidneys; urolithiasis; nephroprotection; prevention
Modern Ukrainian medicine is undergoing rationalization changes. Today these changes have mostly affected primary care doctors - general practitioners and family doctors. General practitioners and family doctors most often face the problem of comorbidity of patients. A number of studies have shown that patients with chronic and comorbid diseases more often turn to primary care doctors, and the costs of their treatment constitute a significant amount both from the budget of the country in which the patients live and from the patient's own funds [1 - 3].
It has been established that in the USA more than 80% of insurance funds are spent on providing medical care to patients who have more than 4 diseases with a chronic course [4]. The study by H.S. Kim et al. has shown a correlation between a visit
to a doctor and the appointment of treatment and the presence and number of concomitant diseases in patients who were diagnosed with diabetes. That is, the more comorbid diseases, the more visits to the doctor and the more prescribed drugs [5].
Polypharmacy is another problem faced by doctors and patients. Polypharmacy, as a consequence of polymorbidity, leads to an increase in the probability of systemic and undesirable effects due to drugs intake as a result the compliance between the doctor and the patient reduces [6, 7].
Among comorbid diseases, the most common are ischemic heart disease, dyscirculatory encephalopathy, arterial hypertension, chronic obstructive lung diseases, neoplastic processes, chronic gastritis with secretory insufficiency, chronic pyelonephritis, prostate adenoma, diabetes mellitus and spinal osteochondrosis, arthrosis.
Most of the listed diseases are systemic. They affect target organs, one of which is the kidneys. Treatment of kidney diseases is a long process, and drugs have side effects on other organs. It is expedient to use herbal preparations for the treatment of polymorbid patients.
According to the National Registry of the Netherlands, patients with such a threatening disease as diabetes mellitus also have a comorbid disease in 44% of cases [8]. It is well known that, in addition to comorbid diseases, patients with diabetes have problems with target organs. In our article, we will focus on the kidneys.
Even before the clinical symptoms occur, the presence of proteinuria and other changes in the analysis of urine indicate that kidney function is impaired. This is a stage when the therapy is needed to prevent kidney disease. If the clinical symptoms occur, a more severe course of the disease should be prevented. The study by R.G. Singh has shown a comparative analysis of the effectiveness of Punarnava, containing Boerhavia diffusa root and ACE inhibitor (ramipril), in patients with diabetic nephropathy [9]