The aim of the study is to development of an algorithm for managing pregnancy and childbirth by studying the functional state of the mother-placenta-fetus system in pregnant women who have undergone COVID-19 in different trimesters of pregnancy.
The object of the study was 105 pregnant women who, were treated at the Samarkand Regional Perinatal Center and a specialized maternity center for pregnant women with COVID-19
Тhe scientific novelty of the research consists of the followings: for the first time in pregnant women infected with COVID-19, a relationship was established between the course of pregnancy, childbirth, the postpartum period and the development of complications depending on the trimester and severity of the disease; a direct correlation has been established between the state of the vessels of the mother-placenta-fetus system (resistance and pulsation indices, Endothelin-1 indicators), disorders in the hemostasis system (D-dimer, platelet aggregation) and the clinical course of the disease in pregnant women who underwent COVID-19; it has been established for the first time that the developed scale for assessing risk factors for non-developing pregnancy in women infected with COVID-19 (age, BMI, obstetric history, gestation period, hemostasis system status, endothelial function and severity of the disease) can serve as a prognostic marker of the degree of risk of pregnancy complications; it was proved for the first time that the choice of effective therapy for restoring hemodynamics in the mother-placenta-fetus system, in women who underwent COVID-19 at different stages of pregnancy, leads to a decrease in the number of thrombophilic complications.
Implementation of the research results. The results of the scientific research were introduced into the practical activities of the Samarkand Regional Perinatal Center by Order No. 128/1 of 01.09.2022 and the Samarkand City Maternity Complex No. 1 by order No. 58/1 of 03.10.2022. In pregnant women who underwent COVID-19 at different periods of pregnancy, changes in the mother-placenta-fetus system were determined using simple and effective research methods, such as ultrasound and Dopplerography, and this saved 53,000 soums; obstetricians and gynecologists, as well as neonatologists and therapists, are needed to diagnose signs of complications in the echocartin, that is, it has been proven that there is no need for other highly qualified specialists for this, due to the lack of need to train new personnel, state budget funds have been saved. With early detection of disorders in the hemostasis system in pregnant women with COVID-19: the period of stay of patients in the hospital was reduced from 10.5 days to 7.5 days and the number of hospital bed days was reduced; due to the reduction of the period of stay in the hospital for several days, the number of necessary drugs was reduced (on average, drugs are used for 1 day in the amount of 130,000 soums). Examination of pregnant women infected with viral diseases using simple and effective research methods such as ultrasound and Dopplerography served to save 85,000 soums: in the early stages up to 16 (10-11 weeks. - fetometry), 19-21, 32-34, 38-40 weeks of pregnancy; due to the absence of the need to use other research methods, it was possible to reduce costs by 23.5%; early detection of changes in the hemostasis system and endothelial dysfunction using fast, budgetary and effective research methods, contributed to the prevention of possible pregnancy complications, as well as the absence of the need to use long-term and expensive research methods, and this saved 106 000 soums: the coagulogram was checked in 105 (100%) patients, time was saved and efficiency was increased; endothelin-1 was also determined in 105 (100%) patients, efficiency was increased by 78.6%.
Improving the functionality of blood circulation in the uteroplacental and fetal-placental systems, a comprehensive analysis of possible complications during pregnancy and childbirth in women who have had viral infections, improving diagnostic, preventive and prognostic measures for managing pregnancy and childbirth contributed to the birth of live, full-term and healthy newborns in women who experienced COVID-19 during pregnancy, as well as a decrease in maternal mortality and perinatal mortality, 43% of women underwent rehabilitation in the postpartum period, 23.8% of women who underwent severe COVID-19 improved their quality of life.
To introduce scientific novelty on the topic “The impact of COVID-19 on the state of hemodynamics in the mother-placenta-fetus system in pregnant women”, a letter was sent to the Ministry of Health from Samarkand State Medical University on November 9, 2022 under No. 4295 (Conclusion of the Ministry of Health No. 8 n-z / 679 of December 15, 2022).
The structure and volume of the dissertation. The content of the dissertation consists of an introduction, five chapters, conclusion, list of used references. The volume of the dissertation consists of 113 pages.
o date, there are many unexplored aspects in the pathogenesis of cognitive impairment (CI) associated with COVID-19. It is as- sumed that many factors are involved in the development or deterioration of CI in patients who have undergone COVID-19. Such factors include the direct impact of viral infection on the nervous system, the systemic inflammatory reaction of the human body to the virus, cerebrovascular ischemia due to endothelial dysfunction or pronounced coagulopathy, ARDS in severe COVID-19, the use of artificial ventilation, drug sedation in ARDS, dysfunction of internal organs.
The absence of statistical correlation suggests that CI develops after COVID-19 as a neurological complication of the disease. A number of studies have reported impaired attention and executive functions, apathy. In this article, the authors paid special attention to the study of cognitive impairment in patients with chronic cerebral ischemia who had a coronavirus infection.
The relevance of CVD (Cerebrovascular Diseases), in particular strokes, is due to the high prevalence, disability and mortality.
The degree of medical, social, psychological rehabilitation of patients after Ischemic Stroke depends on the regression of the clinical picture and cerebral disintegration.
Objectives of the study: detection of the entire spectrum of clinical manifestations from examined patients, corresponding to damage to the structures of the brain supplied by the vessels of the Vertebrobasilar basin, the relationship with regression of the primary focus and the subtype of Ischemic Stroke, and determination of the presence of a statistically significant dependence of clinical manifestations on COPD.
To achieve the goal and solve the set tasks, 126 patients, 60 men and 66 women were examined in the recovery period of stroke in the in the vertebro-basillar system, at the age of 50-80. The Blindemark scale was used to assess the neurological status. To assess neuropsychological status, the Montreal Cognitive Assessment Scale, the Hospital Anxiety and Depression Scale, the Rankin scale were used, as well as for objectification of MRI data and Dopplerography.
Results of the study: In patients with Ischemic Stroke in the vertebro-basillar system, paresis and paralysis prevailed in the structure of clinical manifestations, 68 patients had them, which is 54%, 43.7% of patients had dysarthria, coordination disorders were observed in 48.4% of patients, 26.2% had vertigo, 24.6% had sensory impairments and 5.6% had neglect.
In patients with Ischemic Stroke in the vertebro-basillar system, a correlation was found between the scores of Renkin scale. Various pathogenetic subtypes of ischemic stroke in vertebro-basillar system were analyzed. They have a significant correlation between NIHSS scores at the time of hospitalization and at the end of rehabilitation. In patients with AT Ischemic Stroke in the vertebro-basillar system the incidence of oculomotor disorders is significantly lower. Based on the above mentioned, the following conclusions can be drawn:
1. A certain localization of the focus of ischemic stroke in the vertebra-basilar system is more likely to be characteristic of the corresponding stroke subtype.
2. The rate of reduction and reorganization of the focus does not depend on the stroke subtype, localization of the hearth, comorbidphone, rehabilitation methods and is proportional to the initial size of the heart attack site.
3. The degree of severity of COPD has a correlation with the blood flow indices of posterior cerebral arteries and vertebral arteries, as well as the asymmetry coefficient.
Subject of the inquiry: 994 women, delivered by operative way under subarachnoid anaesthesia for period since 1998 to 2004. In addition, 16 women’s corpses of fertile age, died from accident and during pregnancy, were examined.
Aim of inquiry: Increase of safety of combined subarachnoid anaesthesia during surgical delivery by finding out and estimating the risk factors, determining the groups of risk on the base of prognostic index, development of the algorithm of rational choice of the anaesthesia method.
Method of inquiry: Retrospective analysis and statistical processing of the clinical observations, produced in the analysis of the patient’s history, protocols of anaesthesia and cards of intensive care, as well as morphological and dura mater of the died women histochemical examinations.
The results achieved and their novelty: Complications and side effects of different variants of combined subarachnoid anaesthesia of the pregnant women were detail studied and classified; the anatomico-physiological factors, promoting the development of the neurological complications of subarachnoid anaesthesia were revealed; new prognostic indexeses of the risk of development complications and side effects afterf subarachnoid anaesthesia in pregnant women , as well as severity complications indexes were developed; the algorithm of the choice of the anaesthesia method in pregnant women was developed, allowing to reduce frequency and severity of anaesthesia complications and to improve the quality of anaesthesia.
The main advantages of developed indexes arc using simple clinical data and the absence of need in using the special methods of the examination or special equipment.
Practical value: Developed complex introduced into clinical practice and practical recommendations on prognosis, preventive maintenance and treatment of the complications of combined subarachnoid anaesthesia, allowed the 1,5 times as much reduction of the frequency and severity of the complications and their outcomes, improvement in the quality of anaesthesia 3,5 times as much. Due to its accessibility and simplicity, the technique can be used in all types of hospitals including central district hospitals.
Degree of embed and economic effectivity: The technique can be used in all obstetric clinics, including republican, regional, district hospitals.
Sphere of usage: medicine, anesthesiology.
In this study, in order to assess the prognostic efficiency of integral scales in assessing the severity of critical conditions in children, 143 children aged 12 to 18 years old were selected who were admitted to the TashPTI clinic through the emergency medical service of the city of Tashkent. Sick children arc divided into two groups. The first group included 63 deceased patients, and the second group included 80 surviving patients. When assessing the state and timing of fire outbreaks in children with critical conditions between mortality and the total number of points of assessment on the MODS scale, only three systems determined the presence of an exact correlation. It was determined that the use of the MODS assessment method for only three systems in the early stages of intensive care is important in determining the effectiveness of therapy.
Subjects of the inquiry: the patients with nonspecific ulcerative colitis
Aim of the inquiry: an improvement of the results of the treatment of patients with nonspecific ulcerative colitis by the perfection of diagnosis and a choice of the scope of surgical intervention.
Method of inquiry: clinical, laboratory, instrumental, surgical and statistical.
The results achieved and their novelty: algorhythm of diagnosis and choice of the method of treatment of the patients with non-specific ulcerative colitis has been developed. Indications to intraoperative colonofibroscopy for the choice of the method and scope of the operation in complicated forms of non-specific ulcerative colitis have been formulated for the first time. Its efficiency has been proven. Intraoperative colonofibroscopy gives a possibility to determine borders of the inflammatory-ulcerative process exactly and provides threefold decrease of the postoperative complications and significantly more often positive outcomes of the operation (88,5% of the cases). A quantitative scale for evaluation of the severity of various forms of non-specific ulcerative colitis was offered. It permits to obtain more objective information.
Practical value: the developed algorhythm of diagnosis of nonspecific ulcerative colitis, including intraoperative colonofibroscopy, considerably improves results of surgical treatment, decreasing the number of postoperative complications and resulting in good outcomes more frequently. Use of quantitative scale for evaluation of the severity of various clinical forms of nonspecific ulcerative colitis provides an adequate estimation of the patient’s state
Degree of embed: the developed scheme of diagnosis in the form of algorhythm and an offered method of a choice of a scope of operation -intraoperative colonofibroscopy - in nonspecific ulccrus colitis is introduced into practice of work of the Research Center of Coloproctology of the Ministry of Public Health of the Republic of Uzbekistan. Results of the research arc included in the course of lectures at the department of surgery for doctors of general practice of Tashkent Medical Academy.
Sphere of usage: coloproctology and gastroenterology.
The article talks about CSF and the occurrence of cognitive disorders in them, their diagnosis, treatment methods. In recent years, there has been an increase in cerebrovascular diseases. All patients were evaluated for the severity of stroke by NIHSS scale and the daily activity level by Bartel scale (Barthel ADL index). To exclude patients with depressive disorders from the study, a scale of de- pression assessment was used in Gamiltona (Hamilton depression rating scale, HDRS-17). Tricortin as a nootropic drug was used to improve cognitive impairment in patients who participated in the study and its effects were evaluated.
This article presents clinical, neurological and biochemical research methods in sick children with hereditary motorsensory neuropathy. It is known that some trace elements (Ca2 +, Mg2 +, P5 +) are characterized by high energy intensity and have a high penetrating ability into the bodies of neurons through ligand-mediated receptors and sites for the cooperation of these trace elements. Against the background of pathogenetic therapy and physiotherapeutic rehabilitation measures, it is possible to limit the severity of hereditary motor-sensory neuropathy, which is especially important in pediatric neurology.
Subjects of research: 815 patients with the various forms acute pancreatitis, 235 patients with primary erronous diagnosis of acute pancreatitis.
The purpose of research: improve the treatment results of the patients with acute pancreatitis by upgrading existing and developing new diagnostic methods in the treatment complex.
Methods of research: clinical, biochemical investigation.
The results achieved and their novelty. On the basis of the analysis of occurance frequency of various clinical symptoms, diagnostics system of the acute pancreatitis is offered, the criteria of the laboratory and ultrasonic diagnostics for given disease arc advanced, for a quantitative estimation of severity of a condition of the patients the ball scale is offered; the complex conservative therapy is advanced, the technique of realization of long intraarterial catheter therapy is optimized, the optimum indications to realization of retrograd and pcrcutanc endobiliar interventions in treatment of acute biliar pancreatitis arc determined, drainage and sanation of omental bag for open operative interventons is offered, the technique of treatment of the patients in postoperative period is advanced and the algorithm of medical measures is offered at acute pancreatitis.
The developed diagnostic and treatment complex has allowed to reduce frequency of diagnostic errors from 28,4% to 16,8%, to increase efficiency of conservative therapy from 89,8% up to 95,3%, long intraarterial catheter therapy -from 72,0% up to 82,8%, to reduce mortality from 7,4% to 3,4%.
The practical importance. The offered clinical system for diagnostics and the advanced criteria of laboratory diagnostics promote to increase reliability of diagnostics, the systematized ultrasonic criteria allows verify the form of acute pancreatitis. The offered scale of definition of severity of the acute pancreatitis allows quantitatively characterize a condition of the patients, dynamical changes of pathological process and efficiency of used of a complex of medical measures. The advanced complex conservative therapy, technique of realization long intraarterial catheter therapy, definition of the indications to performance retrograd and pcrcutanc endobiliar interventions, advanced draining method and sanation of omentum bag at pancrcanccrosis, combined treatment in postoperative period allow to improve results of treatment of the given category of the patients.
Degree of introduction and economic efficiency: the received results arc introduced into practical activity of surgical branches of second clinics TMA.
Area of application: emergency and abdominal surgery.
This article presents the results of a study of pain syndrome in patients with severe stenosis of the carotid and vertebral arteries (group 1, 50 patients) and patients without stenosis (group 2, 50 patients) using scales and questionnaires. When assessing the sensory, emotional, and evaluative components of the McGill questionnaire, it was found that the pain syndrome in the first group was more pronounced than in the second. A significant correlation was found between the results on the Beck Depression Scale and VAS, which shows that patients of older age groups with stenosis have a significantly stronger pain syndrome.
Down syndrome is the most common chromosomal pathology. It occurs when another chromosome appears in the 21st pair as a result of a random mutation. Often, children with Down syndrome (DS) and related disorders have a lower IQ level, severe forms of stereotyped behavior. The purpose of this article was to study the neurological conditions of children with DS. Clinical, neurological, neurophysiological and audiological studies were performed in 34 children (16 boys, 18 girls) with DS. The Stanford-Binet intelligence scale was used to determine the intellectual status in children with DS. The manifestation of autistic disorders, somatic pathology and lack of speech activity are predictive adverse factors in children with DS.
Ischemic stroke is a serious medical and social issue due to deep and prolonged disability, as well as social maladjustment of patients. In this regard, the aim of the research was to study the influence of pathogenetic subtypes of ischemic stroke on the rehabilitation possibilities.
Based on the presence of COPD (Chronic Obstructive Pulmonary Disease) we divided all patients into 2 groups
Patients with IS in VI (Vertebrobasilar Insufficiency) and COPD - 62 people (group I) - 29 men and 33 women aged 50 to 74 (59.8 ± 5.8). Patients with IS in VI - 64 people (group II). Of these, 31 are men and 33 are women aged 51 to 80 (62.4 ± 5.4). All patients received traditional treatment in the most acute and severe periods of IS, patients with COPD received and treatment for COPD simultaneously with traditional IS therapy. The Barthel index was used to assess the patient's self-care capabilities. The degree of disability after IS was studied using the Rankin scale. In patients of subgroup II b, by the end of the ED (Eating Disorders), the indicators of the Lindmark B scale for the patient's general mobility differed significantly from the baseline at the beginning of the ED (p = 0.44). At that time, in the II a subgroup, only the indicators of the B. Lindmark scale were reliable.
In patients of subgroup II b, the difference in indicators at the beginning and at the end of ED was significant according to the Barthel index. Recovery in ED depends on many factors, including the subtype of IS, so the IS CE is the most severe, which is reflected in the Rankin scale. The timing and extent of patient recovery depends on the localization of the process, the subtype of IS, the presence of COPD, and the method of rehabilitation. Patients with the lacunar subtype, a single small or medium focus in the cerebellar hemispheres and midbrain recover most fully after complex rehabilitation.
Учитывая скорость возникновения и изменчивость симптомов COVID-19, а также его тяжесть, он стал причиной стрессового расстройства у большого числа населения.