J.EXPERIMENTAL & CLINICAL MEDICINE
2017, ą 5
I.CHKHIKVISHVILI1,, N.GOGIA1, M.ESAIASHVILI1, D.CHKHIKVISHVILI2
ANTIOXIDANT ACTIVITY AND TOTAL PHENOLS AMOUNT OF DIFFERENT VARIETIES COMMERCIAL BREADS pp-9-14
1Tbilisi State Medical University, V.Bakhutashvili Institute of Medical Biotechnology;
2Company “Bioantioxidant”, Tbilisi, Georgia,
This article presents data on the total phenols content and antioxidant activity of the commercial breads. The high total phenols content and antioxidant activity are in “Lithuanian” (398mg total phenolic content in 100g bread) and “Vilnius” (348mg/100g) bread samples of Lithuanian bakery. This is made in the case of “Lithuanian” bread with sunflower seeds. The presence of rye flour in commercial bread is important because of higher antioxidant activity than wheat flour. It is noteworthy that antioxidant activity and total phenols content also higher in samples of bran bread cereals but are less than in other samples. Especially important is the high antioxidant activity of Traditional Georgian Bread “Tonis Puri” and total phenols content (273mg/100g) that are twice as high as white bread data (127mg/100g). Antioxidant activity in the samples of commercial bread are correlated with the total phenols content. Exceptional is “Tonis Puri” a thin bread in which antioxidant activity exceeds the other samples of the total phenols content, which produce more bread crust than the ordinary bread and the presence of non-phenols antioxidants.
S.V.SHADLINSKAYA, D.B.NIKITYUK, B.M.HUSEYNOV
AGE AND REGIONAL FEATURES FORM OF SMALL GLANDS VESTIBULE
OF THE VAGINA pp-15-18
Department of human anatomy of Azerbaijan Medical University, Baku, Azerbaijan
The purpose of the study was to identify age and regional features of the shape of small glands of the vestibule of the vagina in different age periods of postnatal ontogeny. The study was conducted on 72 total preparations of vestibule obtained from corpses of women of different ages. The glands were stained with a solution of methylene blue (the method of R.D. Sinelnikov).
The results of the study showed that glands on the total preparations of the vestibule of the vagina are defined as dark blue (black) anatomical formations, located on a lighter (pink) background of the surrounding wall. They are located either singly or in short rows oriented in an antero-posterior direction. On the age groups among the glands of the vestibule prevail in the number of glands with one primary department. Their percentage, compared with the newborn gradually decreases. In comparison with newborns at the age of 22-35 years, the gland content increases with two, three, four or more initial departments. In the old age, the form of the gland is further simplified, which is expressed in an increase in the proportion of glands of simple form and in reduction - complex. Regardless of age, the content of glands with one initial section in the anterior-posterior direction decreases somewhat, and with two or three initial divisions, on the contrary, in the main, slightly increase in this direction.
RISK FACTORS OF WHEEZING FORMATION IN YOUNG CHILDREN pp-19-24
SDASU, Evex Diagnostic Centre, Clinic “Curacio”, I.Tsitsishvili Children’s New Clinic, Tbilisi, Georgia
The aim of this study is to determine the risk factors of wheezing formation in young children. A retrospective study case-control has been conducted. In the case group were involved 120 patients with wheezing syndrome and in the control group - 38 conditionally healthy children.
Based on the study results statistically significant risk factors have been identified: overmature fetus (OR-1.5, 95% CI: 0.3-10.3), stress during pregnancy (OR-4.7, 95% CI: 1.9-11.7), natural nutrition up to 3 months (OR-1.7, 95% CI: 0.6-5.0), family conflict (OR-1.5, 95% CI: 0.5-4.9) tobacco consumption by mother (OR-1.1 95% CI: 0.3-4.3). As for the concomitant atopic reactions: concomitant medication/drug allergy (OR-4.1, 95% CI: 0.5-88.6), rhinitis (OR-11.7.95% CI: 4.3-32.5), conjunctivitis (OR-10.2, 95% CI: 2.8-44.1 ), urticaria (OR-3.2, 95% CI: 0.8-14.3) and atopic dermatitis (OR-3.4, 95% CI: 1.5-8.2). Early detection of unmodified and manageable risk factors and their early correction can change the natural course of the disease and prevent asthma.
YU.D.HODOVANETS1, A.G.BABINTSEVA1, L.V.AGAFONOVA1, I.V.KOSHURBA1, O.V.MAKAROVA2, A.V.FRUNZA1
NEONATAL ACUTE KIDNEY INJURY: DIAGNOSTIC AND PREDICTIVE
VALUE OF SERUM CYSTATIN C pp-24-28
1 Department of Pediatrics, Neonatology and Perinatal Medicine, Higher State Educational Establishment of Ukraine “Bukovinian State Medical University”, Chernivtsi, Ukraine
2 Department of Nursing and Higher Nursing Education, Higher State Educational Establishment of Ukraine “Bukovinian State Medical University”, Chernivtsi, Ukraine
Background. Neonatal acute kidney injury (AKI) is common, partially due to incomplete renal maturation and due to frequent exposure to risk factors for AKI such as perinatal asphyxia, extracorporeal-membrane-oxygenation, cardiac surgery, sepsis, prematurity and nephrotoxicity. The objective of the work was to determine diagnostic and predictive value of serum cystatin C (SCysC) in case of AKI in full-term newborns with severe perinatal pathology. Methods. A prospective cohort study was performed. 67 full-term neonates with severe perinatal pathology were enrolled in the study including 31 newborns with AKI (group I) and 36 newborns without AKI (group II). The control group included 42 healthy full-term neonates (group III). SCysC level was measured by immune-nephelometric methods. Results. In the newborns of the group I SCysC was 1.75±0.02 mg/L, in the group II – 1,56±0.02 mg/L, in the group III – 1,54±0.03 mg/L, đI-II<0,05, đI-III<0,05. A cut-off level of SCysC which is indicative of the formation of AKI in full-term newborns with severe perinatal pathology was detected to be higher than 1,59 mg/L, AUC 0.83 (95% CI 0.74; 0.83, p<0.001). For AKI sensitivity and specificity of SCysC were 88.9% (95% CI 75.9%; 96.3%) and 64.0% (95% CI 49.2%; 77.1%) respectively, with negative predictive value 86.5% (95% CI 73.2%; 93.8%). Conclusions. Considering a high predictive and diagnostic value the authors recommend to measure SCysC level for identification of AKI in full-term neonates with severe perinatal pathology into the practical work of neonatal intensive care units.
M.GONGADZE, M.MACHAVARIANI, M.ENUKIDZE, N.GOGIA, I.CHKHIKVISHVILI
PROTECTIVE EFFECT OF FRENCH MARIGOLD (TAGETES PATULA L.) FLOWER EXTRACT FROM INFLAMMATION IN MADIN-DARBY CANINE KIDNEY CELLS pp-29-34
TSMU Institute of Medical Biotechnology, Tbilisi, Georgia
The aim of our study is to evaluate the mechanisms of anti-inflammatory property of Tagetes patula L. (French Marigold) flower extracts and its protective effect on renal epithelium against uropathogenic E. coli infection. Thus, in this study, a number of in vitro assays were performed to evaluate the antioxidant and anti-inflammatory activities of Tagetes patula L flower extract (water soluble part of French Marigold flower, extracted with chloroform).
MTT assay was performed to determine the effect of French Marigold flower extract on cell viability in MDCK cells activated with 100ng/mL of LPS. We investigated the effect of Tagetes patula L. extract on LPS-stimulated levels of NO and TNF-a production by Griess reaction based colorimetric assay and ELISA respectively. Also, we analyzed content of the French Marigold flower extract by HPLC.
Our results demonstrated that TPE protected MDCK cells and increased their viability. Also, TPE had a strong inhibitory effect on NO secretion. These effects were due to inhibition of TNF-á induced pro-apoptotic pathway. The Tagetes patula L extract represents a rich source of lutein and its antioxidant property can be caused by lutein. Our results suggest that TPE could be developed as an anti-oxidant and anti-inflammatory agent derived from natural products.
M.JGHARKAVA, I.PANTSULAIA, T.CHIKOVANI, K.CHELIDZE
CELLULAR SENESCENCE, VASCULAR AGING, GUT MICROBIOTA AND ATHEROSCLEROSIS pp-35-38
Tbilisi State Medical University, V.Bakhutashvili Institute of Medical Biotechnology, Georgia
Atherosclerosis is associated with premature biological aging and cellular senescence characterized by reduced cell proliferation, irreversible growth arrest and apoptosis, elevated DNA damage, epigenetic modifications, and telomere shortening and dysfunction. Not only is cellular senescence associated with atherosclerosis, there is growing evidence that cellular senescence promotes atherosclerosis.
Recent developments in research dedicated to early vascular aging and new emerging aspects bring new perspectives related to genetics, telomere biology, and the role of gut microbiota.
ANATOMICAL VARIATIONS OF THE PELVIS OF MATURE WOMEN BY MEANS OF PELVIOMETRIC INDICES pp-39-42
Department of human anatomy of Azerbaijan Medical University, Baku, Azerbaijan
The aim of the study was to study the anatomical variations of the pelvis by means of pelviometric indices on the collection of bones of mature women. The material of the study was 30 preparations in the form of mounted female pelvis from the anatomical museum of the human anatomy of the department of AMU. After pelvic osteometry, three pelvic indexes were determined: pelvic ring index (PRI), pelvic height-width index (PHWI) and transverse-longitudinal pelvic index (TLPI). The results of the study showed a strong variability in the occurrence of pelvic forms with different indices. For example, if by the index of the pelvic ring the studied population was divided into three morphotypes of approximately the same proportion, the TLPI better and more revealed the dominant type among the forms of the pelvis. According to the results of study is derived that the application of one any index for clinical medicine is the low-informative procedure and more optimal approach there will be complex use of several indexes.
J.CHEISHVILI, I.ZARNADZE, SH.ZARNADZE
ASSESSMENT OF SOCIO-DEMOGRAPHIC POLICY OF GEORGIA pp-43-45
Tbilisi State Medical University, Georgia
The severe socio-economic crisis experienced during the last decade or so in the country due to several political and military conflicts has resulted in the increase of unemployment and an influx and exodus of refugees, which has resulted in a dramatic affect on the demographical status of Georgia and has had a negative impact on the growth of this great Nation.
In undertaking this policy analysis, a rationalist model was utilized with the intention of analyzing where rationale decision making had been adhered to within a recent government Social Demography study.
CORRELATION OF ASYMPTOMATIC (SILENT) ISCHEMIA WITH MODERATE DILATATION OF THE LEFT VENTRICLE pp-45-51
David Aghmashenebeli University of Georgia, Tbilisi
Goal of the study: Defining correlation of syimptomatic (silent) ischemia with moderate dilatation of the left ventricle.
Materials and methods: The report was based on the investigation results of 185 patients, aged 35-55, from “Tbilisi Heart & Vascular Clinic” contingent, who did not have typical stenocardia pain. Out of the given contingent, 117 patients who had the mild and moderate dilatation of the left ventricle were united under the name of moderate dilatation group. Another group of 68 patients, who did not have this pathology, was used as a control group. The statistical analysis was performed, using the program packet SPSS 22.
Results: Our study showed that the majority of those asymptomatic patients, who showed moderate dilatation, had the positive exertion test on treadmill and the ischemia signs during holter’s monitoring. Among them, ST segment depression (ST“!) or ST segment elevation (ST) and ventricular extrasystoles were credibly high.
As the result of investigation, it was found, that the frequency of those people whose coronography showed more than 50% stenosis of any coronary and 30 to 50% stenosis, was convincingly high. The intact coronaries were found in only 11% of those patients, who had moderate dilatation, whereas in the contingent with no dilatation, it was 76% (p<0.05).
Conclusions: Thus, dilatation of the left ventricle correlates with silent ischemia and we can use for the primary diagnosing of silent ischemia. The test is simple and non-invasive. It is characterized by high sensitivity and specificity and can be used for early diagnosing of silent ischemia and the prevention of cardiac cases, both in inpatient and outpatient clinic settings.
A.MALAZONIA, T.ZEREKIDZE, E.GIORGADZE, N.CHKHEIDZE, K.ASATIANI
METABOLIC DISORDERS AND MELATONIN SECRETION VARIATIONS IN OBESE REPRODUCTIVE AGE WOMEN pp-51-55
Tbilisi State University - Department of Endocrinology, Tbilisi, Georgia
Obesity is one of the major problems of modern civilization in all groups, including reproductive age women. With the growing prevalence of obesity, increases the number of its comorbid conditions. One of the underlieng mechanism of metabolic disorders is thought to be disturbences in melatonin production and action. Therefore, it is important to identify the comorbid metabolic disorders of obesity and melatonin secretion characteristics in separate phenotypes. Consequently, our research focused on phenomenological analysis of metabolic disorders and studies of peculiarities of melatonin secretion in obese reproductive age women.
In total, 120 female patients were enrolled in the study and divided into two groups according the body mass index. Detailed history, anthropometric measurments, urine and blood samples were eveluated for each patient.
In study group, insulinresistance was observed in 61.3% of participants, and it showed positive corellation with body mass index (p=0.038), body weight (p=0.045) and different levels of liver steatosis (p=0.001). Dyslipidemia was second mostly observed metabolic disorder that was seen in 33.8% of participants in the study group. Dyslipidemia was positively correlated with duration of obesity (p=0.027), genetical predisposition of miocardial infarction (p=0.005) and stroke (p=0.024), increased intake of food rich in fat (p=0.019) and disturbanses in eating schedule (p=0.045). Melatonin levels were 17% higher in study group, compared to control group. Higher levels of melatonin were observed in patients with liver steatosis (132.5±124.4 ng/ml) and insulin resistance (144.7±135.0 ng/ml).
Our study confirmed the close relation of metabolic abnormalities, especially insulin resistance, liver adiposity and dyslipidemia, with melatonin hypersecretion in reproductive age women.
M.MAKHARADZE, R.SULUKHIA, M.TSIKLAURI, L.ALADASHVILI, I.TABORIDZE
MICROBIOLOGICAL CHARACTERISTICS OF SPONTANEOUS ABORTION pp-56-58
University of David Aghmashenebeli, Medical Center of O.Gudushauri, University Geomedy, University of Gr. Robakidze, Tbilisi, Georgia
Our research is aimed on studying the microbial properties of spontaneous abortion. Morphological diagnosis: 15 (50%) patients had cervicocytes and 2 (6.7%) of endometrial polyps. The study of microbial analysis has been studied in 30 patients aged 24 to 36 which had arbitrary abortions.
According to our data level of the highest miscarriage was infection of chlamydia(23%), mycoplasmosis (20%) and ureaplasma (20%), therefore it shows the role in etiopathogenesis of miscarriage.
For prevention of spontaneous abortion is recommended screening and treatment of sexual infections.
S.KUPRADZE, B.KORSANTIA, I.GVELESIANI, L.KAJAYA
USING SOME PROPERTIES OF NATURAL ZEOLITES FOR THE PRODUCTION OF INFLUENZA VACCINE pp-58-61
Tbilisi State Medical University, V.Bakhutashvili Institute of Medical Biotechnology, Georgia.
The authors analyzed 15 years of experience with zeolites. The work shows the urgency and necessity of reducing the production time’ of influenza vaccine, which is possible with the use of natural zeolites. An experiment was conducted to determine the optimal parameters of zeolite volumes and the influenza virus transmitted through it, to neutralize its infectious activity.
E.KVARATSKHELIA, M.GAGUA, M.GHUGHUNISHVILI, E.MAISURADZE,
EPIGENETIC MODULATION OF DNA METHYLATION BY CURCUMIN IN CYSTIC FIBROSIS CD4+ T CELLS pp-61-65
Tbilisi State Medical University, V.Bakhutashvili Institute of Medical Biotechnology, Dept of Molecular and Medical Genetics, G.Zhvania Pediatric Clinic, Tbiblisi, Georgia
Cystic fibrosis (CF) manifests as a multiorgan disease, although chronic airway dysfunction and inflammation are the main cause of morbidity and mortality among patients. Airways inflammation in CF is characterized by elevated number and proportion of neutrophils, lymphocytes and their products, high level of the pro-inflammatory cytokines, especially IL-8 and low concentration of immunosuppressive cytokines, like IL-10, suggesting that an intrinsic cytokine dysregulation might exist in immunoregulatory cells functionally expressing mutant CFTR. The mechanisms responsible for cytokine dysregulation are not well defined, epigenetic factors such as DNA methylation or histone modifcation might contribute. CpG methylation is established and maintained by DNA methyltransferases (DNMTs), which transfer a methyl group from S-adenosylmethionine (SAM) to cytosine. Three mammalian DNMTs have been described: DNMT1 maintains the existing methylation patterns during DNA replication while DNMT3a and DNMT3b DNMT1 maintains the existing methylation patterns during DNA replication while DNMT3a and DNMT3b are responsible for de novo CpG methylation.
In this study we have analyzed the levels DNMT1, DNMT3a in the lymphocytes derived from patients with CF and healthy subjects under influence of natural epigenetic agent curcumin, active component of the herb Curcuma longa.
We found that T-lymphocytes from CF patients express elevated level of DNMT3a. After threatment of T-cells with curcumin the level of DNMT3a was decreased significantly while no significant changes was observed in levels of DNMT1.
Our data suggest that natural epigenetic agents such as curcumin might be useful for normalization of immune responses in Cystic Fibrosis disease.
L.BUGADZE, L.ZHORZHOLIANI, N.MANJAVIDZE
BRONCHIAL ASTHMA, COMORBIDITIES AND RISK FACTORS IN
PEDIATRIC PATIENTS pp-65-69
David Aghmashenebeli University of Georgia, Tbilisi
300 million people worldwide suffer from asthma. Asthma, as a heterogeneous disease, is associated with several comorbidities, but the magnitude of the association has not been clearly defined. We aimed to examine the relationship between asthma and comorbidities.
Study was performed in Sachkhere medical center. 30 patients with confirmed diagnosis of asthma, was included in the study. Questionnaires were used to identify the most common comorbid conditions and risk factors. All patients underwent laboratory test to study: spirometry, IgE total and skin prick tests.
In our study showed that most important comorbidities in asthma patients are allergic rhinitis – N-25, (P-0.004, OR-17.25 ); sinusitis – N-19, (P-0.094, OR-7.08 ) and allergic conjunctivitis – N-16, (P-.031, OR- 5.4).
Early recognition of modifiable risk factors and medical intervention can play important role to prevent development of comorbidities in patients with asthma. Therefore, the identification of comorbidities must become an integral part of the core management of asthma.
EFFECTIVENESS OF BACTERIAL POLY-ANTIGENIC LYSATE IN PATIENTS
WITH BRONCHIAL ASTHMA pp-69-73
V.Bakhutashvili Institute of Medical Biotechnology of Tbilisi State Medical University, Georgia
It has been investigated the effectiveness of polyvalent lysate of bacterial origin (Ismigen; 7 mg), consisting from antigens derived via mechanical lysis of eight different bacterial strains of upper respiratory system (Streptococcus pneumoniae, Haemophilus influenzae, Klebsiella pneumoniae, Klebsiella ozaenae, Staphylococcus aureus, Streptococcus viridans, Streptococcus pyogenes, Neisseria catarrhalis) for the treatment of steroid-dependent asthmatic patients. Peroral immunization of patients with polyvalent lysate after 3 monts resulted in significant improvement of their symptoms, reduction of oral and inhaled steroid dosage, decrease in frequency of exacerbations, requiring patient hospitalization and marked improvement of spirometric values. After ending of treatment these effects were retained at least for 3 months.
n.i.tSISKARIsVILI , a.kATSITADZE, n.v.tSISKARISHVILI ,
Melatonin concentration in the blood and peculiarities of cytokine Status in patients with vitiligo and stress in anamnesis pp-74-76
tbilisi State Medical University, Dept of Dermatology and Venereology,
Georgian Association of vitiligo, Tbilisi, Georgia
Clinical and experimental studies indicate that the hormone melatonin, wich is one of the links in a stress defense mechanism of the body, has antioxidant and immunomodulatory properties. There is a growing evidence that the basis of autoimmune pathology are disorders having place in immune regulation due to violation of cytokine production. The aim of our study was to investigate the content of some proinflammatory cytokines (IL-2, IL-6) in the serum and to determine plasma level of melatonin in the blood of vitiligo patients ( with strss in anamnesis) depending on the clinical form and duration of the disease. The cytokines in the blood serum of vitiligo patients were determined by ELISA using the corresponding monoclomal antibodies. The level of melatonin in the blood plasma was determined ELISA (IBL-international - reagent).
In patients with nonsegmental form of vitiligo lowering the level of melatonin is associated with significant increase in the content of cytokines. We must assue that the significant reduction of melatonin and increase cytokines in blood, observed in some patients with segmental form of vitiligo has a poor prognostic sign, indicating the possibility of transition segmental form of vitiligo to nonsegmental form.
M.AKHVLEDIANI, E.VOROBIOVA, B.KORSANTIA, G.TSIVTSIVADZE, D.GACHECHILADZE
RELATIONSHIP OF BASIC MARKERS OF THROMBOSIS, HOMOCYSTEINE, CRP AND MULTIDETECTOR COMPUTED TOMOGRAPHY IN PULMONARY EMBOLISM pp-76-82
Tbilisi State Medical University, V.Bakhutashvili Institute of Medical Biotechnology;
Research Institute of Clinical Medicine – F.Todua Medical Center, Tbilisi, Georgia
Nowadays, an arsenal of diagnostic methods are used in diagnosis of pulmonary embolism, which includes x-ray, angiography, perfusion-ventilation scintigraphy, CT and magnetic resonance imaging, Doppler and laboratory studies.
Purpose of our study was to evaluate the diagnostic significance of determination of basic parameters of hemostasis (D-dimer, Soluble fibrinmonomer complexes, fibrinogen), homocysteine, hs-CRP and multidetector computed tomography in suspected pulmonary embolism. We have examined 64 patients, aged 18 to 76 years, with a characteristic for pulmonary embolism.
G.GURGENIDZE, D.LABARTKAVA, N.URUSHADZE
IN VITRO SYNERGISTIC INHIBITORY EFFECT OF MACROLIDE ANTIBIOTICS AND DEXAMETHASONE ON THE PROLIFERATIVE ACTIVITY OF PERIPHERIAL BLOOD MONONUCLEAR CELLS OBTAINED FROM STEROID-RESISTANT ASTHMATIC PATIENTS pp-82-85
V.Bakhutashvili Institute of Medical Biotechnology of Tbilisi State Medical University, Georgia
Addition of in vitro pharmacologic concentrations of Azithromycin (10 – 20 µmol) together with physiologic (1 nmol – 1 µmol) and pharmacologic (10 µmol – 1 mmol) concentrations of Dexamethasone to the mitogen-stimulated PBMC cultures, obtained from the steroid-resistant patients, resulted in the significant dose-dependent amplification of Dexamethasone-induced inhibition of cell proliferation as compared with the same cell cultures, incubated with Dexamethasone and without of Azithromycin.
NATO KORSANTIA, A.KATSITADZE, NINO KORSANTIA, B.KORSANTIA
CLINICAL AND IMMUNOTROPE EFFICIENCY OF LICOPID DURING ORAL HERPES pp-85-88
Licopid possessed immunomodulating effect for interferon system, sIgA and lysozyme in healthy volunteers. The inclusion of preparation in the complex treatment of herpes of lips and mouth contributed significant acceleration relief of infection and prolong remission. Licopid enhances the activity of endogenous interferon in patients. A recommendations is given for the wider use of the drug in viral infections.
V.SIMONIDZE, O.SAMUSHIA, M.GOGSADZE
ROLE OF GENETIC FACTORS IN PARKINSON’S DISEASE pp-89-92
Tbilisi State Medical University, Neuromedical Dept; A.Tsereteli State University,
The purpose of the research was to identify and diagnose patients with Parkinson’s disease. It also aimed at studying the clinical features of the dynamics and determining genetic mood.
33 relatives out of the 18 members of the Proband family have had clinical signs characterized by Parkinson’s disease. In 12 cases, the inheritance transfering was autosomal-recessive, in 6 case autosomal-dominant. In 4 cases, inheritance happens from female to both sexes, in 9 cases – from male to both sexes. In the inheritance occasions the disease has been reported in patients with up and later 60 years, in rapid and slow ongoing cases of illness. Any correlation between inheritance and Parkinson’s disease forms has not been revealed by our studies.
THE STUDY OF THE LEVEL OF POPULATION SATISFACTION
WITH MEDICAL SERVICES pp-93-99
Shota Rustaveli Batumi State University, Georgia
In connection with the current economic reorganization and the implementation of health reforms in the country, the question of satisfaction with medical services is more actual. It is recognized that the patients opinion is one of the most relevant, sensitive indicator of the level of appraisal of the medical service. The determination of the level of satisfaction / dissatisfaction and its causes of patients is important for medical institutions.
The question of the patients showed that both the clinic and the doctor are selected on the basis of information and recommendations received from relatives/friends. During the second visit is an important the personal experience received from the previous visit;
The patients attach great importance to the modern equipment of the clinic, the professionalism and competence of doctors, the complex approach to treatment, the teamwork of the staff of the clinic and the positive attitude to the patient, the protection of the hygiene standards.
The patient satisfaction indicator also determines the access to the medical services. It can be said, that this problem is solved today. The general insurance system provided the medical services to all equally accessible. However, the significant part of the population have not the complete information about the health risks. They go to the doctor in the last resort. This problem can be solved by improving outpatient services.