Heart diseases (heart disease)- a group of diseases manifested by disruption of the normal functioning of the heart. May be caused by damage to the epicardium, pericardium, myocardium, endocardium, valvular apparatus of the heart, and blood vessels of the heart.

Heart diseases can occur in a latent form for a long time, without clinically manifesting themselves. Along with various tumors, these diseases are today the main cause of premature death in developed countries.

The uninterrupted operation of the circulatory system, consisting of the heart as a muscle pump and a network of blood vessels, is a necessary condition for the normal functioning of the body.

According to research by the National Heart, Lung, and Blood Institute in Framingham (USA), the most important development factors cardiovascular diseases in humans are obesity, sedentary lifestyle and smoking.

Oncology(from ancient Greek ὄγκος - “bloating”, “swelling” and λόγος - “teaching”) - a branch of medicine that studies benign and malignant tumors, their etiology and pathogenesis, mechanisms and patterns of occurrence and development, methods of their prevention and diagnosis and treatment (including surgical, radiation, chemotherapy, hormonal, immunotherapeutic, photodynamic).

Acquired immune deficiency syndrome (AIDS)- a condition that develops against the background of HIV infection and is characterized by a decrease in the number of CD4+ lymphocytes, multiple opportunistic infections, non-infectious and tumor diseases. AIDS is the terminal stage of HIV infection.

AIDS was first described by the US Centers for Disease Control and Prevention in 1981, and its causative agent, human immunodeficiency virus (HIV), was described in the early 1980s.

1981 June 5 - report from the Centers for Disease Control and Prevention, USA (English Centers for Disease Control and Prevention, CDC) about 5 cases of Pneumocystis pneumonia and 28 cases of Kaposi's sarcoma. All patients were men who practiced homosexual intercourse.

Viral diseases- infectious diseases and tumors caused by a significant part of viruses.

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Cardiovascular diseases, oncology and HIV have become the main causes of mortality in the 21st century; it is likely that it will not be possible to completely defeat oncology in the near future, but it may be possible to cope with HIV infection by the end of the century, medical experts told RIA Novosti .

According to the World Health Organization, 41 million people worldwide die from noncommunicable diseases every year, accounting for 71% of all deaths. The largest share of deaths occurs from cardiovascular diseases - 17.9 million people.

“Now the main problem, why people all over the planet are dying, are non-infectious diseases, while cardiovascular diseases are still at the top, for Russia this is number one. The main cause of death is heart attacks and strokes,” RIA Novosti said. chief specialist on medical prevention of the Ministry of Health of the Moscow Region, expert of the National Health League Ekaterina Ivanova.

She noted that in many countries, technologies for the treatment and prevention of cardiovascular diseases have reached a very high level. Now people who have suffered these “vascular accidents” can live quite a long time, but this does not happen in all countries, so the mortality rate from these diseases remains very high.

“The whole world is making efforts to defeat non-communicable diseases, and the proof of this is that life expectancy is increasing. Here (in Russia) it has become more than 72 (years), and Europe has lived for more than 80 years, and this suggests that we are still trying to defeat (these diseases),” Ivanova explained.

There is no way to get rid of cancer yet

Cancer, according to WHO estimates, is the second leading cause of death in the world. In 2015, 8.8 million people died from the disease. Cancer causes almost every sixth death in the world. There are several reasons why cancer has become one of the leading causes of death in the 21st century, says the chairman Russian society clinical oncology (RUSSCO), professor Sergey Tyulyandin.

“Firstly, developed countries have better diagnostics, and the second reason is the aging of the population. Because cancer is a disease of the elderly, and with the increase in the life expectancy of healthy people, the chance of developing malignant tumors increases,” Tyulandin told RIA Novosti.

He also noted that in developing countries, the reasons for the increase in the number of patients with cancer are changes in diet, changes in activity and pollution environment.

“Diet may be one of the factors that increases the risk of developing a malignant tumor. This is due to the fact that we eat less plant foods, more protein, rich in fats, and carbohydrates. Obesity is now essentially an epidemic in developed countries and in those that are developing, such as China. This also includes the risk of developing malignant tumors,” Tyulyandin clarified. According to Tyulandin, it is still impossible to completely get rid of cancer as a problem. Although there will be local victories in the near term, doctors will learn to treat cancer at different stages and recognize it earlier than is currently possible.

“Cancer is a weakening of the control of the repair abilities of our DNA, as a result our genome accumulates a mutation, resulting in a malignant process. We can cope with the occurrence of a tumor and cure it, but we have not yet learned how to repair the genome. This means that we have cured a person of one tumor, and tomorrow he will have another tumor, the day after tomorrow a third, and so on,” explained Tyulyandin.

We will defeat HIV by the end of the century

According to WHO estimates, HIV remains another major global public health problem: to date, it has claimed more than 35 million human lives. At the end of 2016, there were approximately 36.7 million people living with HIV worldwide. All countries of the world have been conducting large-scale research to create means to combat HIV infection for more than 30 years, said the head of the immunochemistry laboratory of the Institute of Virology named after D.I. Ivanovsky, professor, doctor of biological sciences Eduard Karamov.

“We can assume that by the end of the century we will truly cope with HIV and AIDS. A key component will be the development of an effective HIV vaccine. Current vaccine candidates protect only 30% of people. This is not enough. A vaccine must protect at least 70-80% of people to be effective,” Karamov said.

Such drugs will be created in the next 10-12 years. “It is possible that they already exist, but tests have not yet been carried out to prove their effectiveness,” Karamov explained.

Despite the high level of medicine and the efforts of doctors, diseases of unknown nature continue to claim millions of human lives. Oncological diseases have become a real tragedy of modern society. IN European countries, according to mortality statistics, they rank second after cardiovascular diseases. It has been proven that cancer affects older people more often. Judging by how the incidence is growing, this phenomenon can be associated with the aging of the population and environmental deterioration. About six million people on the planet die every year from a malignant tumor. In 1996, 225 thousand Muscovites died from its various forms. At the end of the 1970s, AIDS “appeared” on the planet, engulfing almost all continents like a fire. For short time HIV infection has become the No. 1 problem for the World Health Organization, pushing cancer and cardiovascular diseases into second place. According to WHO, at the end of 1994, there were 17 million people living with HIV worldwide, 66 percent of them living in Africa (approximately 11 million people). There are about 3 million such people in South and Southeast Asia. In Australia and surrounding countries, only 12 thousand infected people have been registered. Consequently, taking into account the uneven spread of the AIDS virus, it can be argued that the disease has the nature of a pandemic. In addition, the frequency of detection of the virus among different segments of the population is uneven. For example, among homosexuals it is about 90 percent, drug addicts - 13–20 percent. However, through bisexuals, drug addicts and prostitutes, the epidemic spreads to the heterosexual part of the population.

Alcoholism interested psychiatrists back in the 18th century, although alcohol and intoxicants have been used since time immemorial. In the Stone Age, intoxicating drinks were used during religious ceremonies and ritual ceremonies. Later, people began to indulge in libations just for pleasure, not realizing that they were harming their body and destroying their offspring. Regular study of alcoholism, begun by Hippocrates, made it possible to formulate ideas about alcohol abuse as a disease.

Drug addiction is one of the global problems of the last century. Entire regions of the world - such as Colombia, Afghanistan, the countries of the Golden Triangle - are centers of the international drug mafia. In 1997, Russian internal affairs bodies identified 848 clandestine laboratories in which known drugs were produced and work was underway on the creation of new intoxicating drugs. In the fight against drugs, the United States has achieved the greatest success - over the past decade, the number of Americans using drugs has halved.

Cardiovascular diseases

A student at the Faculty of Medicine at the University of Prague, Hans Selye (1907–1982), once drew attention to the fact that almost all infectious diseases begin the same way: weakness, apathy, joint pain, lack of appetite. Symptoms change much later, when the disease completely takes over the body. The young man's useful observations were ignored due to the conservatism of the teachers. At that time, doctors made a diagnosis based on the characteristics characteristic of a given disease, without trying to compare them with the characteristics of other ailments.

The problem of the unity and difference of symptoms arose again 10 years later, when Selye was working in Canada, doing research in the laboratory of McGill University. During experiments on animals, the scientist noticed a single reaction of the body to the action of various chemicals. He called this reaction "general adaptation syndrome" or "stress" for short. The human body can react to any, external or internal, change: to a change in temperature; injuries; infections; excess stress, both physical and mental; nervous tension. As a result of many years of observations, Hans Selye realized that stress is a global biological phenomenon inherent in all living things. It is experienced by single-celled microorganisms, plants, animals, people; therefore, stress is life itself, and old age is the result of all the stress to which the body is exposed during life.

The factors that cause a physiological reaction of the body (stressors) include not only negative phenomena. Stress comes from taking medicine, from eating regular food, from listening to music, the sound of rain, from inhaling the aroma of a flower or the smell of suffocating burning. Selye's findings were published in 1936 and again remained unanswered, although they had extremely important practical significance. According to the scientist, a person cannot avoid stress, but he is able to choose the optimal life strategy for himself, which will determine the positive impact of stress. Being an element of life, it is necessary for a person, since it maintains the tone of the nervous system and muscles, strengthens the immune system, increasing the vitality of the whole organism.

According to Selye, the impact of stress must be considered from two sides. Its positive influence is a consequence of positive emotions, physical activity, feasible and enjoyable work. The opposite effect of stress occurs during emotional and physical stress. As it turned out, a person’s health directly depends on his work activity. The satisfaction of challenging and stressful work is much more beneficial than the feeling of choosing the wrong thing. The human body, as a rule, cannot withstand the constant feeling of anxiety, fear, struggle with one’s own personality or everyday troubles. “The stress of dashed hope,” warned the Canadian biochemist, “is much more likely than the stress of excessive muscular work to lead to illness.”

Hans Selye's research acquired particular relevance in the last decades of the 20th century. The accelerated pace of modern life and the amazing struggle for existence in the comfortable conditions of our time have determined the rapid increase in the number of cardiovascular diseases. Human losses from coronary heart disease, angina pectoris, myocardial infarction, and atherosclerosis are comparable to the sad statistics of world wars. Heart disease has become the leading cause of death in economically developed countries. At the beginning of the century, cardiovascular diseases occurred predominantly in older people. Today, myocardial infarction and angina pectoris are mistakenly called the scourge of civilization, without taking into account habits that contradict the biological nature of man.

Myocardial infarction began to be studied at the end of the 19th century. The first attempts to systematize observations of the work of the heart were made by foreign scientists K. Knoff in 1878 and W. Osler in 1892. Russian physician Vladimir Mikhailovich Kernig (1840–1917), chief physician of the Obukhov Hospital in St. Petersburg, described pericardial inflammation after severe attacks of angina pectoris and explained the mechanism of development of the disease, laying the foundation for the doctrine of myocardial infarction. Active study of this serious heart disease began with the work of V.P. Obraztsov (1851–1920), who described the clinical picture of myocardial infarction together with the Ukrainian therapist N.D. Strazhesko (1876–1952). Simultaneously with them in the USA, Professor Herik worked on the problem of the nature of the disease.

The main sign of myocardial infarction is increasing, sharp pain in the chest, which does not disappear after stopping physical activity and taking nitroglycerin. The pain is often accompanied by weakness, nausea, and heart rhythm disturbances. During the attack, which lasts from 30 minutes to several hours, the patient experiences a panicky fear of death. Risk factors for myocardial infarction apply to all cardiovascular diseases: nervous strain, negative emotions, fatty foods coupled with physical inactivity.

Myocardial infarction is a dangerous disease that threatens human life. Its treatment requires an individual approach and is carried out according to the patient’s condition and the specific course of the disease. The likelihood of death is largely determined by complications that arise in the first hours and days of illness: circulatory failure and cardiac arrhythmia. The most severe complication is considered to be cardiogenic shock, accompanied by changes in blood pressure. The patient experiences dampness and cooling of the skin; lethargy, confusion of mind that comes after anxiety and excitement. Cardiogenic shock develops in 10–15 percent of cases of large infarction. According to statistics, about 70 percent of patients die from a heart attack in the first 6 hours of an attack. Therefore, the patient’s life depends on how quickly he receives highly qualified medical care. Despite significant progress in the field of diagnosis and treatment of myocardial infarction, this terrible disease continues to hold the first position in the mortality lists of the population of developed countries to this day.

Badge "Excellence in Healthcare"

In most cases, the cause of irreversible processes during a heart attack is prolonged myocardial ischemia. This is what doctors call oxygen starvation, which is associated with a sharp limitation of blood supply. Thus, myocardial infarction is a consequence of coronary heart disease - a cardiovascular disease associated with changes in the functioning of this organ.

The clinic for coronary heart disease was first introduced by the English physician Heberden back in 1768. If in the calm 18th century this disease was rare, now its spread can be called a pandemic. It has been proven that the risk of the disease increases with age. Men over 50 years of age are especially at risk, but there is a trend towards “rejuvenation” of this disease. Most often, ischemia occurs in those who prefer high-calorie, cholesterol-rich and fatty acid-rich foods. People who are overweight are at great risk; representatives of sedentary professions; smokers; hypertensive patients and persons susceptible to hysteria.

Ischemia begins with chest pain, reflected in the left arm, shoulder, and under the shoulder blade. At the same time, it can occur without symptoms for quite a long time, when a seriously ill person feels normal. With severe and prolonged ischemia, a section of the heart muscle is destroyed, that is, myocardial infarction occurs.

The development of ischemia is based on the narrowing of the coronary vessels, which occurs due to the appearance of atherosclerotic plaques on their inner surface (coronary atherosclerosis). Therapeutic restoration of coronary blood flow is effective only after short-term ischemia. Oxygen starvation lasting more than 20 minutes leads to irreversible damage. Vasodilators may be ineffective here because the attack develops after further increase in the lumen of the vessels is not possible. In this case, surgery is required. An operation that creates an additional path to bypass the atherosclerotic plaque is called coronary artery bypass grafting. Many residents of Russia first learned about this procedure from the press, which informed the population of the country about how President Boris Yeltsin was healed.

Coronary artery bypass surgery involves increasing the lumen of the affected coronary artery using a catheter with an inflating balloon inserted into it. As a result, the atherosclerotic plaque is “crushed”, the lumen of the vessel expands and its throughput increases. The operation is performed on a beating heart. Despite all the perfection of the method, doctors encounter a serious problem: in 15–40 percent of cases, after 3–6 months, the dilated section of the vessel re-narrows. Mechanical dilation of the vessel probably does not eliminate the atherosclerotic lesion, which means that the increased sensitivity of this area to the formation of blood clots remains.

The problem of replacing clogged arteries was partly helped by the use of artificial vessels created by American scientists in the 1990s. Made from collagen, they expand and contract like real ones, controlling the flow of blood to the heart.

A small persistent tumor, a visit to the doctor, a devastating diagnosis, painful treatment, terrible pain, death. This is approximately how one can describe the path traveled by a person for whom fate has signed a sentence - cancer! Oncological diseases have been known since ancient times. In ancient manuscripts there were descriptions of a terrible illness, accompanied by severe pain and dooming the patient to unbearable torment. The term “cancer” (from Latin carcinoma, from Greek karkinos - “cancer, crab”) was introduced into medicine by Galen, who noticed the similarity between the appearance of a tumor and the appearance of a sea crab. Later, the version of the Roman doctor was confirmed by Pavel Aegina, but added that the disease, like real cancer, stubbornly clings to the affected part of the body. Residents of Europe learned about the malignant tumor in 1629 after reading a report in the English yearbook “Bill of Mortality.”

In conditions of incomplete understanding of the causes of tumor appearance, doctors know that cancer occurs as a result of metabolic disorders and weakening of control over intracellular processes by the body. A predisposition to cancer of a certain organ (lung, breast, stomach) can be inherited, but it is not the disease itself that is transmitted, but hormonal abnormalities in the body. The German pathologist Julius Friedrich Conheim (1839–1984) put forward a germ theory of the origin of tumors. In his opinion, cancer is often preceded by irreversible tissue deformation (oncogenesis), such as polyps in the stomach or birthmarks on the skin. Nevertheless, for the occurrence of a tumor, more serious reasons are necessary - such as changes in the hereditary apparatus of the cell. Inducing factors include increased production of hormones, ionizing or ultraviolet radiation, as well as exposure to chemicals or viruses. A normally functioning human immune system can partially or even completely destroy a tumor. It is capable of blocking cancer cells at the initial stage, preventing them from penetrating deep into the organ (“cancer in situ” - in situ). Functions immune system sharply weaken in old age; It is then that a terrible disease awaits a person.

Symptoms of cancer appear relatively late, when the tumor reaches an impressive size and disrupts the functions of the organ in which it grows. However, detection of the disease early stage can save a person's life. The most important principle of cancer diagnosis is its timeliness, detection of the tumor in the preclinical phase, until a secondary pathological focus, called metastasis (from the Greek metastasis - “movement”) has arisen.

Mass examination of part of the population at risk is a victory for doctors of the 20th century. Fluorography of the lungs, X-ray examination of the mammary glands, and biopsy are used to prevent cancer. Measures to improve the general health of the population, for example, resettlement from areas with high radiation, and the fight for cleanliness of rivers and air, have a good effect. Individual countries held original events that corresponded to their national mentality. The implementation of a social program to combat stomach cancer in a short period of time led to a sharp decrease in the incidence in Japan. The advent of household refrigerators, that is, the replacement of smoked meats and pickles with fresh products, determined a decrease in the incidence of the same stomach cancer in the USA and European countries.

The form and degree of morbidity largely depend on the place of residence. Residents of Japan and Russia are at risk of stomach cancer. In developed countries of America and Europe, as well as in large cities of Russia, lung cancer dominates. This is due to the passion for cigarettes, air pollution from industrial waste and exhaust gases. Breast cancer, which threatens the inhabitants of megacities, is the result of refusal to breastfeed infants. Liver cancer, which occurs due to a lack of dietary protein, has become a national disaster in African countries. The population of Mongolia, Kazakhstan, Buryatia and Altai, accustomed to scalding hot and fatty food, often suffers from esophageal cancer. A similar problem exists in South American countries.

The long-term habit of chewing a mixture of spicy pepper leaves leads part of the population of Central Asia to oral cancer. According to statistics, out of 900 million Indians, more than 12 million have cancer, but most see a doctor too late. In recent decades, so-called fast food has gained popularity in the United States. The addiction to easily digestible foods without fiber has led to an increase in the incidence of colorectal cancer. A change of place of residence gives a vague hope of salvation. At the same time, the danger of the traditional form of cancer is reduced, and in some cases the “hopelessly” patient is healed. However, after 2–3 generations, a predisposition to the type of malignant tumors that predominate in the new area of ​​residence is acquired.

Ancient medicine did not intend to “extend a hand” to those who had already been overcome by illness. Helping a hopelessly ill person was contrary to the will of the gods; ordinary person, even endowed with the ability to heal, had no right to challenge the verdict passed by the celestials. Christian charity reached the Latin world only in the mid-4th century, when the Roman matron Fabiola, a disciple of Saint Jerome, opened a home for dying pilgrims. The first houses of charity for sick or exhausted pilgrims were opened at monasteries, usually located along the roads to Jerusalem. The servants of these establishments were more concerned about the peace of mind of their guests, making a lot of efforts to ensure that the person left this mortal world calm and cleansed of sins. While surrounding pilgrims with care and attention, the monks did not accept local residents into their shelters. The idea of ​​​​creating special shelters for people dying of cancer arose on the basis of the commandments of the Apostle Matthew, who called on brothers in faith to “feed the hungry, give drink to the thirsty, welcome the stranger, clothe the naked, visit the sick or prisoner.”

During the Reformation, some medieval hospitals closed for ideological reasons. Many of them were reorganized into nursing homes for the crippled and the elderly. The dying were again left without help, because secular doctors treated only those who had a chance of recovery. Hopelessly ill patients were usually sent home to the care of relatives and priests. At that time, doctors sometimes did not even bother to ascertain death, entrusting this responsibility to officials.

The first use of the term “hospice” (from the English hospice - “monastic hotel; shelter”) in relation to caring for the dying dates back to the middle of the 19th century. In 1842, the Frenchwoman Janet Garnier established a hospice for the dying in Lyon. A young woman who lost her husband and children named her hospice Calvary. Soon such establishments operated in other cities of France. Following the example of J. Garnier, 37 years later, Irish nuns founded the Hospice of Our Lady in Dublin. In Ireland, already at the beginning of the century, there was a shelter of the Order of Mother Mary of Aikenhead, but they cared for the poor and sick. Unlike the Order Hospital, the Hospice of Our Lady was created specifically to care for the dying.

By the beginning of the new century, the Christian hospices “House of Rest” (1885) and “Hotel of God”, the Holy Trinity Hospice (1891) and St. Joseph’s Hospice (1905) were operating in London. The shelter, called St. Luke's Home for the Poor Dying (1893), was created by the Methodist mission on the initiative of Dr. G. Barrett in East London. While heading the shelter, Barrett published detailed annual reports, case histories, and wrote articles about his patients. In his stories, there was almost no mention of therapy, but the characters of the patients were vividly represented and their courage in the face of death was described.

Expressing deep sympathy for the families of the deceased, the doctor drew the attention of his compatriots to the poverty in which people who lost their breadwinner found themselves: “We do not want to talk about our patients as simple cases from our practice. We realize that each of them is a whole world with its own characteristics, its own sorrows and joys, fears and hopes, its own life story, which is interesting and important for the patient himself and the small circle of his loved ones. Often we are also privy to this story.”

The founder of the modern hospice movement, Cecilia Sanders, began work at St. Luke's Home for the Poor Dying in 1948. The young employee was traditionally asked to familiarize herself with the old annual reports, which were carefully preserved as an example of truly hospice activities. Impressed by Barrett's work, Dr. Sanders came up with the idea of ​​​​the need to expand the functions of the staff, founding the palliative medicine movement (from the French palliatif - “to protect”). The employees achieved the introduction of a regime of regular use of painkillers, in particular: upon the patient’s request, he was given morphine.

Fearing the narcotic effect of the medicine, doctors from other institutions could only observe the suffering of the dying person. A patient at St. Joseph's Hospice once expressed a judgment about total pain: “... this pain began in the back, but then it seems that everything hurts. I wanted to scream and beg for painkillers or an injection, but this was impossible. It seemed as if the whole world had turned against you, that no one understood how you felt.” Patients at St. Luke's Hospice left the world with dignity, without experiencing physical pain. Later, the Brompton cocktail was practiced here, which was a mixture of opioids, cocaine and alcohol. The recipe for the drug was borrowed from doctors at Brompton Hospital, who specialized in the late stages of tuberculosis. The regime for dispensing painkillers has become with a huge step moving forward in caring for patients with terminal cancer.

Significant work in the cause of mercy has been done by the staff of the Marie Curie Memorial Foundation. Employees of this organization set up inpatient and outreach services; Conducted targeted training for home nurses and created training programs based on statistical research. A 1952 report from the Marie Curie Foundation described stressful state cancer patients who were at home.

Dr. Alfred Worchester, author of the book “Care for the Sick and Dying” (1935), is rightfully considered the pioneer of palliative care. However, the ideology of modern palliative medicine was formed in 1948 based on conversations between Cecilia Sanders and the Polish pilot Dawid Tasma.

The first hospice in Poland appeared only in the late 1970s, so seriously ill Poles had to die in a foreign country. Thanks to the support of foreign colleagues, about 50 secular and church hospices operate in modern Poland. A forty-year-old patient with inoperable cancer had been at St. Luke's Hospice for several months and had long conversations with Dr. Sanders. Their thoughts about the possibility of reconciliation with the blow of fate, about the meaning of existence and the inevitability of death, about a dignified death from life were later enshrined by WHO in the form of the principles of the hospice movement. According to these rules, palliative medicine:

Affirms life and views death as a normal process;

Does not speed up or slow down death;

Provides relief from pain and other bothersome symptoms;

Integrates psychological and spiritual aspects of nursing;

Offers a support system to help patients live an active life to the end;

Offers a support system to help families cope during the illness of a relative and after the death.

In 1975, a hospice was founded in Montreal, created from a modest palliative medicine department with an outreach service and several consultant doctors. Canadians were surprised to accept the term "palliative" because in French it means care or insufficient care.

A frank conversation with the world community was started by E. Kübler-Ross, who published her work “On Death and Dying” in 1969. The content of the book was the author's many years of observations, who described a long death, panic, denial, depression, which, with the help of doctors, turned into a calm acceptance of fate.

Dr. Kubler-Ross worked with cancer patients at the University of Colorado Medical Center. She was the first to dare to assert that death is not a “flaw in medicine,” but is a natural process, a kind of final stage of existence. The book “On Death and Dying” became an occasion for discussion of the topic of death in the medical community. At that time, the author managed to convince his colleagues of the inability of even high-tech medicine to solve the problem of human lifespan.

Since 1977, an Information Center began operating at St. Christopher's Hospice, disseminating the ideas of the hospice movement throughout the world. The center's staff helped colleagues and voluntary groups with literature and gave advice on organizing day hospitals and outreach services.

During regularly held conferences, doctors and nurses had the opportunity to exchange experiences and contact representatives of different religions and governments different countries. At the Sixth International Conference, the head nurse of the Lagos clinic obtained the consent of the Nigerian Minister of Health to organize a hospice in Nairobi.

The story of Dr. de Souza from Bombay, who spoke at the First International Conference in 1980, introduced the audience to the problems of palliative care in developing countries: “It is bad enough to be old and frail. But to be old and sick in the last stage of cancer, hungry and poor, without loved ones to take care of you, this is probably the height of human suffering.” Thanks to the efforts of de Souza, the first hospice was opened in Bombay in 1986, where sisters from the Order of the Holy Cross took over the care of patients.

Medical rounds at the Chelyabinsk hospice

The first hospice in Russia appeared only in 1990. Help for Russian colleagues was provided by an active participant in the hospice movement, English journalist V. Zorza. Two years later, a group of Moscow doctors organized a mobile service to help people dying of cancer. A little later, the Russian-British Association was established in the capital to provide professional support to Russian hospices. Based on WHO principles, members of the association developed a national version of the Hospice Commandments:

Hospice is not a house of death, but a dignified life to the end. The doctor works with living people, only they die earlier.

The main idea of ​​hospice is to relieve pain and suffering, both physical and mental. In oncology, medicine helps little on its own and only together with the patient and his relatives does it find considerable opportunities.

Death cannot be rushed or delayed. Each person lives his own life; no one knows when it will end. Doctors are only fellow travelers at this stage of the patient's life.

Birth and death cannot be paid for.

If a patient cannot be cured, this does not mean that he will be denied help.

The patient and his relatives form a single whole. A physician must be sensitive when entering a family; should not judge, but help.

The patient is closer to death, so he is wise.

The reputation of the hospice is the reputation of the doctor.

Doctor, take your time when coming to the patient. Don't stand over him, but sit next to him. No matter how little time you have, there is enough time to do your best.

The doctor must accept everything from the patient, even aggression.

The doctor tells the truth if the patient wants it and if he is ready to listen to the diagnosis.

The hospice is a home for patients, and the doctor is the owner of the house, so he must change his shoes and wash the dishes after himself.

Physician, do not leave your goodwill, honesty and straightforwardness with the patient; always carry them with you. Remember that you know very little.

In 1997, the First Moscow Hospice opened in the center of the capital. The patients were housed in a new building, built with the support of the city administration and the Russian government. By the beginning of the new millennium, there were about 20 hospices operating in the country, including in Kazan, Chelyabinsk, Ulyanovsk and Yaroslavl.

AIDS

According to medical sources, AIDS, or AIDS in English, is a pathological condition in which the body's defenses are weakened as a result of damage to the immune system. Infection occurs mainly through sexual contact, and homosexuals are more often infected. Transmission of HIV infection can occur during pregnancy and childbirth from mother to child, as well as from child to mother during breastfeeding. Cases of infection through blood transfusions and injections have been reported.

The first symptoms of the disease, such as fever, diarrhea, skin manifestations, inflammation of the lymph nodes, occur 3 to 60 days after infection. Secondary manifestations (tumors, exhaustion, ulcers, septic processes, pneumonia) can be noticed after 8 - 10 years, when the formation of the disease is completed. Due to a sharp weakening of the immune system, various lesions occur in the body caused by viruses, bacteria and fungi. After this, AIDS leads to death within 1–5 years.

AIDS has been known since the late 1970s and is currently being reported in all countries of the world. According to one of the many versions, the birthplace of this disease is Africa, from where it came to America and Europe through infected merchant sailors.

American journalist Randy Shilts has been researching the spread of AIDS for a long time, reflecting his thoughts in the book “The Orchestra Continued to Play... People, Politics and AIDS.” According to the author, US residents “received” a fatal African disease on July 4, 1976, when the country celebrated its 200th anniversary: ​​“It seemed that the whole world had gathered near the Statue of Liberty. Ships from 55 countries brought sailors to Manhattan, who joined the crowd of millions to marvel at the extravagant pyrotechnics. All this was started in honor of America's two hundredth birthday. All night the bars of the city were crowded with sailors. Everyone admitted that the world had never known such a grandiose celebration as was held in New York at that time. Later, epidemiologists, painfully pondering the question of how it all began, will remember the bright night in New York Harbor, the crowds of sailors, and will note meaningfully: they then came to New York from all over the world.”

Randy Shilts became interested in the problem of AIDS not out of idle curiosity. The journalist was shocked by the death of his close friend, 46-year-old nurse Greta Rask, who worked for many years in Zaire. While caring for patients “in a hot and humid climate where new life forms are breeding,” the woman became infected with a strange disease, the nature of which no one yet knew.

The book “The Orchestra Continued to Play…” presents a story about the last months of Greta’s life. Not being a doctor, the journalist described in detail the symptoms of the mysterious illness, which later served as valuable material for study: “November 1977... She was losing weight; suffered from a constant intestinal disorder, every day the strength left this woman. Her lymph nodes were constantly inflamed, but there was no reason for infection. And also fatigue. This fatigue was not the result of work, she did not even have the strength to celebrate the holiday... Greta Rusk returned home to die. She frantically swallowed air from the oxygen cushion. Greta was dying, and that was the only thing the doctors understood; the rest was hidden under cover of secrecy. She could not breathe due to an unknown lesion in her lungs. A blood test showed an inexplicable absence of T-lymphocytes, which are responsible for protecting the body from infections. But the doctors could not say what disease the woman was dying from. Tired of endless examinations and tests, Greta left the Copenhagen clinic for home. A local doctor installed oxygen tanks in her bedroom; the nurse was caring for the patient. After her death, doctors learned that her lungs were filled with millions of microorganisms called pneumocystis: they caused pneumonia, which gradually suffocated the woman.”

Freddie Mercury

One of the most famous victims of AIDS was the English singer Farrukh Baldasar, who performed under the pseudonym Freddie Mercury (1946–1991). At the end of May, a festival was held at an outdoor concert venue on the island of Ibiza, where the audience applauded the magnificent duet: the lead singer of the rock group Queen and the opera diva Montserrat Caballe performed the song “Barcelona”. In the fall of the same year they performed together in Spain. The concert in Barcelona was last appearance Freddy in front of the audience. By that time, the singer had long been ill with AIDS, but carefully hid it from others. He locked himself in his London mansion and did not even allow the servants and postman into the house. Despite his serious condition (he developed bronchial pneumonia), Fredi continued to work. On November 23, 1991, he publicly announced that he had AIDS, and the next day he passed away.

Freddie Mercury

No disease has ever asked scientists so many serious questions in such a short time. The fight against the AIDS virus is being waged on Earth through the efforts of millions of doctors, scientists, representatives of culture and education. Every month, new information about HIV infection and its causative agent is published in the world press, sometimes forcing us to dramatically change our point of view on the nature of this disease. However, there are still more questions than answers. Scientists are concerned about the unexpectedness of the appearance and the rapid spread of the disease. To date, the question of the reasons for its occurrence has not been resolved; The exact duration of the latent period has not been established. Several varieties of the AIDS causative agent are known, but its variability is unique, so there is reason to expect the emergence of new pathogens in different areas of the planet, which greatly complicates diagnosis.

In the winter of 1981, several homosexuals were admitted to New York University Hospital with a form of Kaposi's sarcoma that was unfamiliar to doctors. In its usual form, the known disease was cured quite easily, but in new patients it developed a malignant course, driving everyone to the grave within 20 months. In the spring of that year, doctors in Los Angeles discovered another category of patients: homosexuals suffering from a malignant form of pneumonia. Doctors knew that this disease was extremely rare and occurred in people with compromised immune systems, such as those undergoing intensive care after an organ transplant. By summer, there were already 116 such diseases in the United States.

The clinical picture of all cases indicated immunodeficiency syndrome, but the cause and pathway of the disease remained unclear. Doctors were dismayed by the sudden appearance of the disease, its instant spread, and the connection between oncology and pneumonia and hemophilia. In addition, there was a clear connection with homosexuality, sexually transmitted diseases, and a long latent period and absence effective means treatments caused only bewilderment.

The virus, now known as the causative agent of AIDS, was discovered only in 1983. Scientists at the National Cancer Institute in the United States, led by renowned immunologist and virologist Robert Gallo, named their discovery human T-cell leukemia virus (HTLV-1). Then another virus of this group was isolated, causing a rare blood disease - HTLV-2.

Around the same time, the AIDS epidemic began in America, one of the modes of transmission of which was blood transfusion. Gallo therefore suggested that HTLV-1 was the causative agent of AIDS, but he was wrong. A group of scientists at the Pasteur Institute in Paris led by Luc Montagnier, much less equipped than the Americans, discovered a similar virus, calling it LAV. An intensive exchange of ideas and biological data began between both groups of scientists. In early 1984, Gallo's group reported the discovery of the virus to the press. It was then established that HTLV and LAV are identical.

The causative agent of AIDS was officially recognized 2 years after the publication of the first articles about the fatal disease, and at the same time scientists developed a method for diagnosing it. In 1986, the Committee on Taxonomy and Nomenclature of Viruses proposed giving the causative agent of AIDS a new name - HIV/HIV (human immunodeficiency virus). All these events gave people hope for the discovery of a life-saving medicine. At the First International AIDS Conference, held in April 1985 in Atlanta, there was an atmosphere of optimism. However, new concerns arose when studying the unique characteristics of the pathogen.

Regarding the origin of HIV, a lot of data is presented in the literature and the press, sometimes contradictory, chaotic and incomplete. As material accumulates, fierce debate does not subside; New hypotheses about the origin of HIV are emerging:

The virus was created artificially in the late 1970s using genetic engineering.

HIV has existed in people since ancient times and evolved along with humans as they settled on Earth.

In the remote corners of Central Africa, HIV circulated, causing endemics throughout the world.

In ancient times, mutants of the green monkey immunodeficiency virus transformed and found a new host, settling inside a person.

HIV can be transmitted vertically, that is, from mother to child, and horizontally, through sexual contact. The last form of transmission includes injections and transfer of the virus from an HIV-infected person to the injured skin and mucous membranes of a partner. An important factor influencing the degree of infection is the stage of the disease: a person becomes more dangerous when the infection progresses to illness.

One of the most important risk factors is the number of sexual partners. Homosexuals with AIDS, according to statistics, have more than 1,000 partners during their lives, and healthy homosexuals - 500. For heterosexuals, this figure is much lower, about 25. Sexually transmitted diseases accelerate the spread of the epidemic through the penetration of the AIDS virus through ulcers, characteristic, for example, of syphilis.

The body's immunity is weakened by various viral infections. First of all, we are talking about viral hepatitis B. There are now about 200 million carriers of this dangerous virus in the world. An infection such as tuberculosis sharply increases sensitivity to HIV. Other risk factors include gender and age. More than 90 percent of AIDS patients become infected between the ages of 20 and 45. AIDS most often kills men aged 25–44, which is associated with the greatest sexual activity and drug addiction. A more severe course of AIDS is observed in children; Doctors attribute this to the immaturity of the immune system. Repeated infections and blood transfusions in patients with hemophilia activate the immune system, which also contributes to the exacerbation of the sensitivity of these individuals to the immunodeficiency virus.

HIV multiplication in brain cells leads to loss of short-term memory, impaired coordination of movements, muscle weakness, speech and mental disorders. Failures in brain activity are often detected in patients with mild or completely absent symptoms. Therefore, it seems important to thoroughly examine all infected individuals, especially since the lives and health of others depend on them. However, removal from work is allowed only if those infected have certain changes in brain function. Doctors are concerned about the rapid spread of dementia among young people infected with HIV. Early and pronounced brain damage is observed in children, especially in those who become infected in the womb or immediately after birth.

While therapy is limited to the only effective drug, azidothymidine, doctors are offering the population to take preventive measures. The main guidelines are: correct sex education for children, limiting the number of sexual partners, and mandatory use of condoms. As a medical measure, it is proposed to examine donors, as well as high-risk groups, that is, homosexual men, drug addicts, and people with sexually transmitted diseases. Laws Russian Federation criminal liability for HIV infection has been established. This equally applies to the population and medical workers, who are obliged to use disposable syringes and ensure the thorough sterilization of all medical instruments.

According to doctors, a vaccine against AIDS will not be discovered in the next few years, so to stop the growth of the epidemic it is necessary to block the main routes of HIV transmission. In this regard, the World Health Organization has created special programs that include the following points:

Health education.

Preventing sexual transmission of the virus.

Preventing viral transmission through drug injection.

Preventing vertical transmission of the virus.

Combating transmission of the virus through blood, blood products, and donor organs.

Health professionals as advocates and rigorous epidemiological surveillance.

Poster by the All-Russian Research Institute of Medical Problems of Forming a Healthy Lifestyle for the Population of the USSR Ministry of Health. 1988

AIDS is one of the most tragic problems of our time. The disease appeared in the 20th century, but entered the present century with humanity. In order to survive by reducing the risk of infection and preventing its spread, people must learn a lot about this terrible disease. There are millions of people infected with HIV worldwide and more than 200 thousand have already died. Every five minutes around the globe, one person is infected.

AIDS is a problem for doctors and scientists. Even such theoretical approaches to solving this problem as cleaning the genetic apparatus of cells from foreign, in particular viral, information are still unknown. AIDS is a severe economic problem. Billions of dollars cost the maintenance and treatment of patients, the development and production of diagnostic and therapeutic drugs, and the conduct of fundamental scientific research. The complex problem of protecting the rights of people infected and sick with AIDS, their children, relatives and friends requires an immediate solution. It is not easy to find solutions to the psychosocial issues that arise in connection with this disease.