The purpose of the study is to determine the significance of genetic factors in the development of chronic nephritic syndrome in children and to clarify the features of the clinical course
The оbject of research were 129 children aged 4-15 years who were treated for chronic nephritis in the nephrology department of the Samarkand Regional Multidisciplinary Paediatric Medical Centre.
The scientific novelty of the study is as follows:it has been established that the severity of chronic nephritic syndrome in children is associated with clinical manifestations (gradual development, dyspepsia, abdominal pain) and an increase in the amount of Cystatin C in the blood;for the first time, it was revealed that the development of sclerotic lesions due to increased proliferation in patients with the presence of the MMP-9 (A-8202G) rs 11697325 genotypes in chronic nephritic syndrome leads to a worsening of the clinical course of the disease; established early diagnostic marker MMP-9 (A-8202G) rs 11697325 and its tissue inhibitor TIMP-2 (C536T) rs 11551797 in chronic nephritic syndrome in children in the diagnosis of the disease; for the first time, the prognostic value of the alleles of the MMP-9 (A-8202G) rs 11697325 genes and the homozygous G/G genotype in determining the risk of developing the disease in children with chronic nephritic syndrome has been proven.
Implementation of the research results. Based on scientific results of evaluation of the role of polymorphic genes of matrix metalloproteinase and its tissue inhibitors in chronic nephritic syndrome in children: methodological recommendation “The role of polymorphic genes of matrix metalloproteinase and its genetic inhibitors in the development of chronic nephritic syndrome in children” was developed and approved (reference of the Ministry of Health of the Republic of Uzbekistan No. 8n-r / 554 of 30.02.2022).
This methodological recommendation made it possible to predict the development of chronic nephritic syndrome in children and improve preventive measures; approved and developed on the basis of scientific results of research on early diagnosis and prognosis of chronic nephritic syndrome “Dynamics of clinical and laboratory parameters in nephritic syndrome in children”, (reference of the Ministry of Health of the Republic of Uzbekistan No. 8n-r / 555 of 30.02.2022).
This methodological recommendation made it possible to optimize the diagnosis and treatment tactics for various forms of nephritic syndrome in children;
The results obtained were implemented in the practice of health care, in particular, in the Republican Children's National Medical Center, in the 1st clinic of the Samarkand State Medical University, in the Samarkand Regional Children's Multidisciplinary Medical Center (conclusion No. 8 n-r/324 of 21.06.2022 of the Ministry of Health of Uzbekistan).
The application of the obtained results to practice has made it possible to reduce the frequency of recurrence of the disease in children, prevent complications of the disease, improve the quality of life of patients, diagnose and prevent the disease.
The structure and scope of the dissertation. The dissertation consists of an introduction, 4 chapters, conclusions, practical recommendations. The volume of the dissertation is 120 pages.
Законом Республики Узбекистан «О поддержке грудного вскармливания и требованиях к продуктам питания для младенцев и детей раннего возраста» №ЗРУ-574 от 23.10.2019 г., определены полномочии государственных органов в сфере поддержки грудного вскармливания и обеспечения продуктами питания младенцев и детей раннего возраста, в том числе и по проведению разъяснительной работы по рациональному питанию матерей, младенцев и детей, а также о важности дополнительного питания для детей с шестимесячного возраста и продуктов прикорма.
To develop a method of modified set bronchophonography and set a diagnostic criteria of bronchial obstruction syndrome in young children. The study involved 60 patients with acute bronchiolitis and 60 healthy infants. We have developed the method of modified bronchophonography consisting of the registra-tion system of the respiratory noises and the personal computer. The analysis of respiratory noise was conduct-ed using the special software. Method of modified bronchophonography is important in the diagnosis of bron-chial obstruction syndrome in infants because of its objectivity, simplicity and accessibility of use in pediatric practice. New informative diagnostic criteria of bronchial obstruction syndrome in children has been estab-lished - E:I index, bronchial obstruction is diagnosed at E:I index≥1,20, bronchial obstruction is absent if E:I index≤1,19
Object of research: formation process of elements of graphic literacy at children of the senior and preparatory groups of children's preschool institutions.
The purpose of work: to develop pedagogical system to the doctrine of elements of graphic literacy of senior and preparatory groups pupils.
Methods of research: the theoretical analysis, individual, group oral and written conversations, questioning, experiment, innovative and interactive methods, the mathematic -statistical analysis.
Novelty of research: the problem formation of elements of graphic literacy at children of the senior preschool age is first developed in a scientific way by proceeding and opening features of Uzbekistan. The theoretical and practical basis, pedagogical system and system of problems tasks included into it is developed; scientifically proved technique of elements formation of graphic literacy at children of the senior preschool age is developed.
Network of introduction and economic efficiency: the point of research and pedagogical system developed on ins basis, methodical recommendations and workbooks’ will help teachers and chiefs of graphic activity courses in formation of graphic literacy elements at children.
The practical importance: an essence research and on the basis of it’s the developed pedagogical system, methodical recommendations and the grant will help teachers and heads of a circle on graphic activity in formation at children of elements of graphic activity. Ideas stated in disscrtational work is possible to use in teaching lessons of graphic activity in pedagogical High schools and colleges. Proceeding from conclusions the developed methodical recommendations will help to organize and increase the efficiency of lessons of graphic activity.
Scope: conclusions and the basic ideas of the dissertation can be used at faculties of preschool education of High schools, professional colleges whey teaching «Pedagogics of preschool age", at the organization of lessons heat arc included into the in that arc included into the group of graphic activity in children's preschool institutions.
The aim of the research work is to improve the results of surgical treatment of chronic anterior-medial dislocations of the radial head in children based on the improvement of the method of surgical treatment.
The object of the study was 83 patients with chronic antero-medial dislocations of the head of the radius, treated in the department of the consequences of childhood injuries of the Samarkand branch of the RSSPMC of Traumatology and Orthopedics for the period 2017-2020. The scientific novelty of the research work is the following: it is proved by histological examination that, in case of injuries from up to 1 month ago, the anterior wall of the joint capsule is thin and elastic, which is easily stretched, and from 3 months ago, it thickens, scars and forms fibrous tissue; the possibility of using a fibrous-modified joint capsule for annular ligament plasty in the surgical treatment of chronic antero-medial dislocations of the radial head from 3 months ago was proved; the tactics of surgical treatment of chronic antero-medial dislocations of the head of the radius depending on the deformity of the bones of the forearm were determined; a direct relationship between the results of surgical treatment of chronic antero-medial dislocations of the head of the radius, depending on the duration of the injury, has been proven.
The introduction of research results. Based on the obtained scientific results on the optimization of surgical treatment of chronic antero-medial dislocations of the radial head in children:
based on the results of the development of a method for annular ligament plasty, a patent for an invention was obtained from the Intellectual Property Agency of the Russian Federation “A method for the surgical treatment of chronic anterior medial dislocation of the radial head in children by capsuloplasty according” (patent № 2749870 dated 06/17/2021). The results obtained made it possible to improve the results of surgical treatment, to reduce the period of penetration in the hospital and after the surgical rehabilitation period; based on the results of scientific research on the surgical treatment of chronic anterior medial dislocations of the radial head, the guidelines “Surgical treatment of chronic dislocations of the radial head in children” were approved (Conclusion of the Ministry of Health of the Republic of Uzbekistan 8 n-z / 81 dated February 21, 2022). The results obtained have improved the quality of early diagnosis and treatment of patients with chronic anterior medial dislocations of the radial head in children; based on the results of scientific research on the surgical treatment of chronic antero-medial dislocations of the head of the radius, the methodological recommendations “Conclusion of the Ministry of Health of the Republic of Uzbekistan 8 n-z / 289 of August 31, 2021” were approved. The results obtained have improved the quality of early diagnosis and treatment of patients with chronic anterior medial dislocations of the radial head in children;
Scientific results have been introduced into the practice of healthcare (Conclusion of the Ministry of Health 08-32955 of October 24, 2022), in particular, the Samarkand branch of the Republican Specialized Scientific and Practical Medical Center for Traumatology and Orthopedics, the Bukhara branch of the Republican Scientific Center for Emergency Medical Care, and the Samarkand Regional Children's Multidisciplinary Medical Center. The proposed method for the treatment of chronic anterior-medial dislocations of the radial head in children allowed to reduce the frequency of relapses, increase excellent and good results from 75.6% to 92.9%.
The structure and scope of the dissertation. The dissertation consists of an introduction, 5 chapters, conclusion, conclusions, practical recommendations, a list of references and applications. The volume of the dissertation is 109 pages.
Early detection of purulent inflammatory diseases in young children and proper performance of qualified surgical care and prevention of complications is one of the medical requirements. There are relative guidelines for the treatment of acute surgical infection in an outpatient setting. The aim of the study is to identify the indications for early diagnosis and treatment of acute purulent inflammation that occurs in children of this age. In 2015 - 2020, we treated patients treated in the surgical infection department of the clinic of the Tashkent Pediatric Medical Institute. The anamnesis of 474 patients with purulent inflammatory diseases in young children was studied.
Object of research: formation process of elements of graphic literacy at children of the senior and preparatory groups of children's preschool institutions.
The purpose of work: to develop pedagogical system to the doctrine of elements of graphic literacy of senior and preparatory groups pupils.
Methods of research: the theoretical analysis, individual, group oral and written conversations, questioning, experiment, innovative and interactive methods, the mathematic -statistical analysis.
Novelty of research: the problem formation of elements of graphic literacy at children of the senior preschool age is first developed in a scientific way by proceeding and opening features of Uzbekistan. The theoretical and practical basis, pedagogical system and system of problems tasks included into it is developed; scientifically proved technique of elements formation of graphic literacy at children of the senior preschool age is developed.
Network of introduction and economic efficiency: the point of research and pedagogical system developed on ins basis, methodical recommendations and workbooks’ will help teachers and chiefs of graphic activity courses in formation of graphic literacy elements at children.
The practical importance: an essence research and on the basis of it’s the developed pedagogical system, methodical recommendations and the grant will help teachers and heads of a circle on graphic activity in formation at children of elements of graphic activity. Ideas stated in dissertational work is possible to use in teaching lessons of graphic activity in pedagogical High schools and colleges. Proceeding from conclusions the developed methodical recommendations will help to organize and increase the efficiency of lessons of graphic activity.
Scope: conclusions and the basic ideas of the dissertation can be used at faculties of preschool education of High schools, professional colleges whey teaching «Pedagogics of preschool age", at the organization of lessons heat are included into the in that are included into the group of graphic activity in children's preschool institutions.
There were studied histories of disease 38 children, revealed by method tuberculin
diagnostics and 49 children, revealed by method digital fluorography, at age 7-14 years. We have
been special questionnaire. The study of factors was built on study nonspecific and specific
factors. The method tuberculin diagnostics were more often revealed primary forms of the
disease, method digital fluorography alongside with primary forms, become be revealed and
secondary forms tuberculosis specific gravity which in structure has formed 12%. We to manage
to install that in modern condition are saved, as well as enlarge its specific gravity social factors
risk of the development of the tuberculosis such as many children family, factor of the stress,
incomplete families, residence in boarding-school, in house without amenities. For present-day
day gain special urgency such factors risk as HIV-infection beside child and parents, contact
with patients, who have multidrug resistance forms of tuberculosis.
In children’s tuberculosis inpatient departments of the PMCforPhandP and the Tashkent city tuberculosis hospital, 272 children and adolescents with various forms of tuberculosis were examined. Among children with various forms of tuberculosis, 28(10,3%) patients were diagnosed with complicated forms and 244 (89,7%)-uncomplicated forms of tuberculosis. When studying the risk factors for the disease, it was revealed that there were 225 (87,7%) children vaccinated with BCG, of which 58 (25,8%) children (76,8%), of whom anemia was found in 35 (12,9%) patients. In the structure of clinical forms in childrenand adolescents with tuberculosis, tuberculosis of the intrathoracic lymph nodes (57,0%) and primary tuberculosis complex (11,0%) predominate. Most of the children hada positivity to tuberculin (77,5±2,5%) and to the test for Diaskintest (69,5±2,7%).
По данным Всемирной организации здравоохранения, в последние годы наблюдается рост заболеваемости острой респираторной вирусной инфекцией. В связи с этим внимание педиатров и отоларингологов привлекают острые стенозирующие ларинготрахеиты (ОСЛТ). Согласно данным многолетних исследований, число пациентов с ОСЛТ колеблется от 0,1 до 0,4% от всех госпитализированных в стационар детей с диагнозом «острая респираторная вирусная инфекция». Развитие стенозирующего ларинготрахеита при острой респираторной вирусной инфекции (ОРВИ) резко отягощает состояние больных детей, а порой от присоединения его к основному заболеванию зависит жизнь ребенка.
С первых дней независимости в нашей стране с целью повышения качества медицинской помощи населению последовательно реализуются широкомасштабные реформы. Так, эффективное медицинское обслуживание детей обеспечило своевременное выявление, раннюю диагностику и лечение больных с ОСЛТ, что позволило на 3-4 дня сократить сроки лечения их в стационаре.
Несмотря на многочисленные научные исследования, посвященные изучению закономерностей инфекционного процесса при стенозирующем ларинготрахеите, роли дисбиоцсноза слизистых оболочек верхних дыхательных путей, процесс эндогенной интоксикации (ЭИ), развивающийся в результате болезни детей и его связь с течением заболевания, а также состояние системы местного и общего иммунитета диктуют необходимость совершенствования методов их коррекции в свете современных требований. Вместе с тем, причины рецидивирования острых стенозирующих ларинготрахеитов до конца не определены, важной задачей представляется разработка прогностических критериев оценки исходов ОСЛТ.
Данное диссертационное исследование в определенной степени служит решению задач, предусмотренных в постановлениях Президента Республики Узбекистан № ПП-2133 от 19 февраля 2014 года «О Государственной программе «Год здорового ребенка» и № ПП-2221 от 1 августа 2014 года "О Государственной программе по дальнейшему укреплению репродуктивного здоровья населения, охране здоровья матерей, детей и подростков в Узбекистане на период 2014-2018 годы», а также в других нормативноправовых документах, принятых в данной сфере.
Научные исследования, направленные на совершенствование методов комплексной диагностики, лечения и профилактики стенозирующих ларинготрахеитов у детей проводились во многих ведущих медицинских центрах, таких как детский медицинский центр Шнайдера (Израиль), Университетская клиника Гиссена (Германия), Детская клиника Святой Марии (Германия), Центр инновационной медицины Интербалкан (Греция), клиника Женераль (Швейцария), клиника Роял (Великобритания), Медицинский центр Куинс (Великобритания), клиника ИДИБАПС (Испания), госпиталь Святого Луки (Япония), Федеральный научноклинический центр оториноларингологии ФМБА России (Россия), а также Ташкентский педиатрический медицинский институт и Республиканский специализированный научно-практический медицинский центр педиатрии (Узбекистан).
В результате проведенных исследований были разработаны критерии оценки риска возникновения и рецидивирующего течения ОСЛТ, выявлены механизмы, определяющие чувствительность дыхательных путей (Фрейбург-ская клиника, Германия); установлена эндокринная дисфункция у детей с первичной и рецидивирующей формой острого стенозирующего ларинготрахеита (Детский госпиталь, Ирландия); доказано влияние состава микрофлоры основных локусов организма, соединительнотканной дисплазии, регулирующих систем на функцию внешнего дыхания, формирование пороговой чув-
ствительности и реактивности дыхательных путей у детей с рецидивирующим стенозирующим ларинготрахеитом (РСЛТ) (Мельбурнский университет, Австралия).
В настоящее время в мире целью многих исследований становится дальнейшее определение на иммуномолекулярном уровне роли специфических и неспецифических факторов иммунной защиты в патогенезе острого стенозирующего ларинготрахеита; оценка состояния неспецифической защиты при ОСЛТ; изучение достоверных сдвигов в клеточном звене иммунитета, изменений Т-супрессоров и частично В-лимфоцитов; а также профилактика рецидивов и совершенствование методов диагностики и лечения заболевания.
Как показал анализ специальной литературы, ряд исследователей изучали роль аллергического компонента и вегетативной нервной системы в патогенезе развития первичных и рецидивирующих ОСЛТ. Согласно полученным результатам, более чем у 90% больных детей в патогенезе первичного и рецидивирующего острого стенозирующего ларинготрахеита преобладает аллергический компонент с выявлением общих и аллергенспецифических IgE. Кроме того, доказано, что развитие ОСЛТ при парагриппозной инфекции связано с существенным повышением титра IgE и специфического IgA в назофарингеальных секретах у детей с ОРВИ. Изучены механизмы рециди-вирования ОСЛТ, основанные на значительном изменении иммунологической реактивности организма, которые связаны с его аллергизацией как инфекционными, так и неинфекционными агентами, включая неблагоприятные экологические, сезонные, метеорологические и даже социальные условия. Доказано, что ОСЛТ протекает с вегетативными расстройствами, которые, в свою очередь, оказывают существенное влияние на течение и исход основного заболевания. Предложено усовершенствованное лечение ОСЛТ в разгар заболевания, основанное на применении лекарственных препаратов с учетом типа исходного вегетативного тонуса организма.
Несмотря на многочисленные работы, посвященные изучению острого стенозирующего ларинготрахеита, ее диагностике и методам лечения, тенденция к росту рецидивирования заболевания сохраняется, что диктует необходимость изучения общих закономерностей инфекционного процесса при стенозирующем ларинготрахеите, оценки значения микробиоценоза слизистых оболочек верхних отделов респираторного тракта, нарушений иммунного и интерфероновых статусов и разработки способов их коррекции, прогнозирования заболевания на основе прогностической карты, а также повышения эффективности лечения и профилактических мероприятий.