Topicality and demand of the subject of dissertation. Bronchial asthma (BA) is one of the most common and serious diseases, which in the world suffer from 3 to 12% of the child population of the globe. Proportion of adolescents with asthma, is one third of all children with this disease. High prevalence of asthma in the numbers of teenagers, characteristics of the disease, age-related aspects of the functioning of the endocrine and immune systems of teenagers that cause difficulties which arise in the course of the diagnostic process, highlight the need to find innovative approaches to diagnosis and treatment of this disease.
It is known that the key immune mechanisms in the pathogenesis of the vast majority of AD cases is real and indisputable fact. Currently, considerable interest to researchers involved in the pathogenesis of positions of allergic diseases, especially asthma, along with IL-4 and IL-13 causes a number of other (IL-6, IL-8, IL-10, IL-5, INF-a and INF-y) immunoregulatory cytokines.
Genetic predisposition plays an important role in the development of allergic diseases. Currently available data on the relationship with asthma and associated with disease symptoms polymorphism approximately 150 genes. Important role as the main contender for the predisposition to asthma gene is a gene encoding flchain of high affinity receptor IgE. Interaction elevated levels of antigen-specific IgE with FceRip plays a central role in the pathogenesis of allergic asthma. Particularly attractive candidate gene asthma is also one of the enzyme genes biotransformation - GSTirl, encoding glutathione S-transferase and л1 express almost exclusively in the pulmonary tissue. This gene is located at the locus 11 ql 3, for which repeatedly shown clutch with atopic symptoms. Accumulated in the literature say about the relationship of gene polymorphism FceRI, GSTnl with different allergic diseases.
From this perspective, the study of immunological and genetic mechanisms of the pathogenesis of this disease for the construction of rational treatment and prevention emphasizes the relevance of this thesis research.
From the earliest days of independence, the country has successfully implemented state programs aimed at reforming the health care system. As a result, the targeted implementation of organizational health and research activities aimed at effective diagnosis, prevention and treatment of asthma among adolescents, with some success in the treatment of this disease in the country. However, now the problem of early diagnosis and the development of effective programs for treatment and prevention among adolescents with asthma remain one of the most important issues of modern health care. This research work was carried out in the framework of the tasks set by the Resolution of the Cabinet of Ministers of the Republic of Uzbekistan "On additional measures to improve the health of women and the younger generation," dated 25.01.2002 for the №32. In this regard, the need to deepen the information received about the state of cellular and humoral immunity among adolescents, asking pathogenetic informative immunogcnctic studies in asthma arc one of the important criteria demand the dissertation topic.
Purpose of research is study the immunological and genetic mechanisms of the pathogenesis of asthma in adolescents and form the basis of this plan rational diagnostic and therapeutic measures in this pathology.
In To achieve this goal the following tasks of research is solved:
to establish the clinical course of asthma in the population of adolescents living in the Samarkand region, in the early stages of the pathological process in the bronchopulmonary system.
explore the features of the state of cellular and humoral immunity, as well as activation markers in asthma in adolescence by determining the immunophenotype of lymphocytes in the peripheral blood.
to examine the level of production of immunorcgulatory cytokine interleukin-6 and interfcron-y and install them pathogenetic informative in asthma among adolescents.
to determine the features of distribution of allele and genotype frequencies of polymorphic variants of genes and FceRip GSTnl population Uzbek people with asthma, compared with the healthy part of the population.
examine the clinical and immunological aspects effectiveness of therapies using drugs and polioksidony tsikloferon in patients with asthma in adolescence.
on the basis of studies to develop a multivariate model of formation of bronchial asthma and develop an optimal algorithm for the diagnosis, treatment, prevention in adolescents with this pathological condition.
Scientific novelty of dissertational research consists in the following:
proposed introduction to the work of doctors teen clinics layered approach testing can significantly improve the detection rate of asthma in adolescence and optimize treatment and preventive measures in high-risk groups;
first defined the peculiar characteristics of the quantitative parameters of the immune status of patients with asthma in the cohort of adolescence and the corresponding proposed regulations and guidance documents for the healthy part of the adolescent population;
for the first time presents a comprehensive assessment of the cytokine profile of blood serum in bronchial asthma in adolescents. Specific features of products immunorcgulatory cytokines IL-6 and INF-y and their pathogenetic and regulatory information content in asthma among adolescents;
first analyzed the distribution of alleles and genotypes of polymorphic gene variants and gene FceRip GSTirl among patients with different phenotypic variants of AD and healthy individuals of Uzbek nationality, which resulted in the identified markers of increased risk or, conversely, resistance to the development of asthma in adolescents Uzbek ethnicity;
algorithms for phase diagnosis, treatment and prevention of asthma in adolescence in terms of disclosure of important moments of the pathogenesis of the disease, allowing to build a rational sequence of diagnostic search, aimed at verifying the diagnosis and expedient construction of preventive measures.
Conclusion
1. Set the frequency of occurrence of the disease and the structure of "asthma" in the arid zone among teens. Said pathology is recorded in 9,6% of the population surveyed adolescents, while the disease is more common among females. In the structure of the disease prevails periodical exposure and mild persistent form.
2. Identified by clinical features of asthma among adolescents living in the arid zone, indicate a high frequency of lesions of the bronchial tree association with allergic processes in other organs and tissues: in 73,9% of the AR, 53,7% with AK. 16,6% with BA and 14% with urticaria/angiocdcma.
3. Found that in the study population of patients with asthma adolescence occur expressed disturbances of the immune status, manifested deficit indicators as cell (CD3‘, CD4+, CD8 , CD16+), and humoral immunity (CD19 , IgA, IgG, IgM) and activation markers (CD23+, CD95). The immune status of patients with asthma in young people, adolescence has distinctive features, the depth of detected violations immunoreactivity was most pronounced in the younger age group.
4. In patients with bronchial asthma in adolescence revealed distinct changes in cell-cell interactions in the immune system: a significant increase in the content of Th2-cclls secreted IL-6 is a regulator of maturation of antibodies and immunoglobulin production itself, and vice versa reducing regulator activity of Th 1-cell cytokine INF-y.
5. It was found that the contents of cytokines IL-6, INF-y and in the peripheral blood is in communication with one pathogenic disease. It is shown that the lowest level of INF-y production in the scrum is characteristic of allergic clinical pathogenic variant asthma in adolescence. Adolescents suffering from predominantly infectious form of asthma, there is a sharp trend towards increased production of IL-6 in peripheral blood.
6. Revealed that markers of increased risk of allergic forms of asthma in adolescents Uzbek ethnicity arc genotype FceRip-109T/T allele FceRip-109T, low-risk markers - FcsRip-109C/C and allele Fc£Rip-109C. A high degree of cohesion genotype FcsRip-109T/T allele and FcsRip-109T with hereditary burden of asthma in the Uzbek population.
7. Among females ethnic Uzbek Association revealed lie-105 allele and genotype Ilc-105/Ilc-105 polymorphic gene locus GSTkI at high risk for asthma. Revealed that the genotype associated with the development Ilc-105/Ilc-105 allergic form of asthma in adolescents Uzbek population.
8. Complex therapy with adolescents’ patients with asthma ciklofcron and polyoxidonium, providing immunocorrective effect, enhances the clinical efficacy of basic therapy. In the study of prophylactic efficacy of immunomodulators positive indicators prevailed in the group of patients receiving polioksidony, necessitating its inclusion in the priority scheme of integrated treatment and prevention of asthma in adolescents.
Most of allergic diseases are caused by allergic skin lesions.The aim of the study was to assess the effectiveness of the enzyme agents in the correction of pancreatic insufficiency in children with atopic dermatitis.As a result of the study clinical and laboratory markers of relative pancreatic insufficiency were identified in 69.7% of the patients, who required the prescription of enzyme agents. The results also showed that in 92.5% of patients the correction of exocrine function disorders to a certain extent affects the regression of dermal manifestations. In the scatological tests the loss of neutral fat, normalization of the amount of elastase in feces serve to be a marker of the effectiveness of the enzymatic therapy.
The analysis of prehospital factors influencing the severity of the course of odontogenic purulent- inflammatory diseases and its outcome was carried out. The total number of patients during the study period was 1305 patients (2018-675, 2019-630 patients). The most common cause of the development of pyoinflammatory diseases is the lower molars. A detailed study showed that in 5 5 % of cases the tooth was removed during surgery, which indicates a low level of therapeutic and surgical debridement among the population. In patients with acute toothache, from the first day of illness, pathological changes are observed in the tissues surrounding the tooth, underestimation of this fact can lead to the development of severe purulent-inflammatory complications.
To date, it has been established that 70% of people involved in tobacco growing have various diseases [4,6,]. Comparison of morbidity rates with temporary disability of workers employed in tobacco growing and the control group shows that tobacco growers get sick more often than others. The number of diseases they have is 37%, and the number of days of disability is 30% higher than in other types of agricultural work [8,4,1]. Diseases of the respiratory and gastrointestinal tract, infectious and allergic diseases, nervous and cardiovascular systems, skin and subcutaneous tissue occupy the leading place in the structure of tobacco growers' morbidity.
In the course of the study, the need and degree of participation of narrow-profile specialists in the treatment ofparadontal diseases was determined for the timely detection of comorbid pathology and the appointment of adequate therapy.
We studied 225 patients with generalized parodontitis of varying severity. 40 patients without generalized parodontitis (GP) and pathology of the oral mucosa (POM) formed a control group.
Statistically significant differences in the frequency of registered pathology in patients of the compared groups with control indicators, as well as correlations between the frequency of detected diseases and the severity ofparadontal pathology, were established. Thus, the total incidence of previously existing diseases increased in the series of mild generalized parodontitis (MGP), moderate generalized parodontitis (MODERGP) and severe generalized parodontitis (SGP) from 32.47 ± 5.34% with MGP; up to 51.25 ± 3.83% with MODERGP up to 86.96 ± 3.14% in patients with SGP (linear correlation coefficient χ² = 96.167; P ≤ 0.001); the corresponding dynamics of the newly discovered pathology was 42.86 ± 5.63%; 47.65 ± 3.83% and 13.04 ± 3.14% (χ² = 65.087; P ≤ 0.001); and the corresponding frequency of all somatic pathology requiring systematic drug correction was 75.32 ± 4.93%; 99.41 ± 0.52% and 100.00 ± 0.00% (χ² = 235.351; P ≤ 0.001).
Based on the studies performed, local therapy tactics should be determined for the following pathogenetic mechanisms of the development of parodontitis: microcirculation disorders, the prevalence of lipid peroxidation processes, an increase in cytokine aggression and an increase in bone resorption.
When making a diagnosis, the scope and methods of therapy should be maximally individualized based on an assessment of the patient's individual clinical and laboratory parameters, by identifying markers that determine the priority mechanisms of the development of the disease.
The oral cavity plays a special role in the perception of undesirable factors of tobacco smoke, and the state of the oral organs is an informative indicator that dynamically reflects and reacts to its effects. This article examines the peculiarities of the influence of tobacco smoke components on the development of major dental diseases of the oral cavity in young people. The specifics of the occurrence and course of the main dental diseases - caries, inflammatory diseases of the ligamentous apparatus of the periodontal and oral mucosa are discussed. It was found that in young smokers, compared with non-smokers, dental caries is more common, mild chronic generalized periodontitis is more often diagnosed, and diseases of the oral mucosa with hyperkeratosis as the main sign are more common. Almost all (98.7%) smokers were diagnosed with cheilitis. Oral hygiene was "unsatisfactory" in the non-smokers group and "poor" in the smokers group.
The aim of the study to improve the results of surgical treatment of patients with ventral hernias and concomitant abdominal pathology by optimizing the tactical and technical aspects of the simultaneous performance of simultaneous operations with the priority use of endovideosurgical technologies and tension-free plasty methods.
The object of the study were 331 patients with ventral hernias and concomitant simultaneous pathology of the abdominal organs, who were hospitalized in the surgical departments of the clinic of the Samarkand State Medical University for a period from 2012 to 2021.
The scientific novelty of the research is as follows: laparoscopic technologies were applied at certain stages of surgical intervention, which justified itself, since at the same time it allows to eliminate the hernia of the abdominal wall and the simultaneous pathology of the abdominal organs and correct it in a minimally invasive way; it was found that more than ½ (52.8%) of patients with ventral hernias have concomitant abdominal pathology that requires a one-time surgical correction, since the performance in a subsequent repeated operation levels out the results of hernioplasty; justified the use of laparoscopic technologies at certain stages of the operation, which allows correcting the simultaneous pathology of the abdominal cavity in a minimally invasive way with a significant removal of it from the hernial defect of the abdominal wall; the effectiveness of endovideosurgical technology for performing alloplasty in W1 and W2 hernias has been proven; the high information content of CT-hernioabdominometry has been proven, which makes it possible to identify defects in the topography of the anterior abdominal wall before surgery, determine the relative volume of the hernia to the volume of the abdominal cavity and choose the optimal method of hernioalloplasty; improved technical and tactical aspects of non-tension methods of hernioplasty for ventral hernias W3 and W4; the study of the dynamics of stress hormones proved that the implementation of the simultaneous stage of the operation does not significantly affect the degree of surgical aggression and thus justifies the expediency of a one-time correction of the combined pathology of the anterior abdominal wall and abdominal organs; optimization of tactical and technical aspects of one-time surgical correction of ventral hernia and combined abdominal pathology with the priority use of endovideosurgical technologies and tension-free alloplasty methods significantly improved the results of treatment.
The practical results of the study are as follows: According to the results of a scientific study to improve the diagnosis and surgical treatment of patients with ventral hernias and concomitant abdominal pathology: a methodological recommendation “Surgery of abdominal hernias and combined pathology of the anterior abdominal wall” was developed (certificate of the Ministry of Health 8н-р / 1080 dated October 7, 2022); a methodological recommendation "Surgical correction of combined abdominal pathology in ventral hernias" was developed (certificate of the Ministry of Health 8н-р / 1086 dated October 7, 2022). The proposed recommendations made it possible to optimize the choice of tactics for surgical treatment of patients with ventral hernias and concomitant surgical diseases of the abdominal organs; the obtained scientific results on improving the quality of diagnosis and surgical treatment of patients with ventral hernias and simultaneous surgical diseases of the abdominal organs have been introduced into the practice of healthcare, in particular, in the departments of surgery of the Samarkand city medical association, the Samarkand regional multidisciplinary medical center, the multidisciplinary clinic of Samara State Medical University, Shakhrisabz city medical association, Surkhandarya regional diversified medical center, Jizzakh regional diversified medical center (certificate of the Ministry of Health 8н-д / 570 dated October 24, 2022). The introduction of the results of research on improving the tactical and technical aspects of the surgical treatment of patients with ventral hernias and simultaneous surgical diseases of the abdominal organs substantiated the possibility of simultaneous performance of simultaneous operations in the combined pathology of the abdominal organs and the anterior abdominal wall, avoiding repeated operations after hernia alloplasty.
The structure and scope of the dissertation. The dissertation consists of an introduction, seven chapters, a conclusion, and a list of references. The volume of the main material is 153 pages.
Хирургическое лечение глаукомы, особенно на ранних стадиях заболевания, применение вазореконструктивных операций для стабилизации глаукоматозного процесса, экстракция катаракты у больных, перенесших антиглаукоматозные операции (АГО) продолжает интересовать офтальмохирургов, как одна из актуальных проблем.
The detection of concomitant surgical diseases of the abdominal organs during the examination of the patient or during laparotomy raises the question of the necessity and possibility of its elimination by performing a simultaneous operation. If we take into account that in recent years 20-30% of patients admitted to surgical hospitals have been diagnosed with combined diseases of the abdominal organs requiring surgical correction, then the urgency of the problem is beyond doubt.
The improvement of surgical techniques, the successes of anesthesiology allow [to expand the indications for performing simultaneous operations in abdominal surgery.
Simultaneous surgical correction of several diseases is in many ways preferable to multi-stage treatment, since it relieves the patient from two or more diseases, from the need for repeated surgery and possible postoperative complications associated with it.
Simultaneous operations also have certain economic advantages due to a reduction in the duration of the patient's stay in a medical institution and temporary disability in comparison with multi-stage surgical treatment.