The study of disability indicators by ophthalmopathology is of great importance for solving a wide variety of scientific and practical problems in healthcare. An analysis of the literature data showed that there are no regional studies on AMD that provide the main way to disability.The purpose of the study was to study the state and dynamics of disability due to AMD in the Republic of Uzbekistan and the city of Tashkent for the period from 2010 to 2019.Results. For the first time, indicators of general and primary disability in Uzbekistan are presented, which for 2019 are 3.44 and 0.61 per 100 thousand of the adult population, respectively. General and primary disability in the city of Tashkent for 2019 is 1.02 and 0.43 per 100 thousand population, respectively. The disability rate did not decrease during the study period from 2010 to 2019.Achieving the highest performance with an integrated approach is possible if these activities are carried out in a timely manner and in compliance with the phasing, continuity and continuity.
The study of the state of medical care on primary outpatient level to patients with diabetes to preventits о ph thalmic complications was conducted. A survey of general practitioners, endocrinologists and ophthalmologists from 74 clinics, as well as patients allowed evaluating the work of doctors in prevention and timely treatment of oftalmodiabetes as insufficiently satisfactory. The data is presented on disability due to opthalmodiabetes over a ten year period (2003- 2012), particularly its form depending on the type of diabetes, as well as frequency of detection according to the Tashkent city. The study showed that, despite the relatively low level of disability, among people with disabilities dominate persons of working age, which are characterized by a deep degree of permanent disability.
The most important medical and social problem in modern ophthalmology is the early diagnosis and treatment of glaucoma. Despite the known advances in the diagnosis and treatment of this disease, it remains one of the main causes of irreversible vision loss in people around the world. In the 70s of the last century, the total number of patients with glaucoma in the world was about 20 million (Nesterov A.P., 2007). At the moment, their number has increased to 105 million, and, according to WHO forecasts, by 2030. it can double (Kuroedov A.V., Gorodnichiy V.V., 2007). In Russia in 2003, about 800 thousand patients with glaucoma were registered (Kuroedov A.V., Gorodnichiy V.V., 2007). Glaucoma took the 1st place in the structure of blindness and primary visual disability (Libman E.S., Chumaeva E.A., 2004; Son I.M., Kalininskaya A.A., Sergeeva E.S., Chernenko E. .G., 2009).
Glaucoma is one of the most significant ophthalmic diseases, which, with late detection and lack of timely treatment, adjusted depending on the patient's condition, leads to blindness. Of particular value in the organization of monitoring is personalized accounting in the form of registers to optimize the provision of specialized medical care, including to persons suffering from socially significant diseases, which is primary glaucoma. The aim of this study is to improve the organization of medical care for primary glaucoma by creating an electronic program for medical examinations. To improve the quality of medical care for primary glaucoma, we have developed an electronic program "Card of medical examination of a patient with primary glaucoma", which is designed to record and analyze the main clinical and statistical indicators, and monitor this disease. The map clearly shows the dynamics of the patient's management process: when the diagnosis was made, what treatment was carried out, the transition from stage to stage, in what time frame he was observed, the results of research, when he applied to the primary link of health care, and when to the specialized link of health care, etc. The map makes it possible to conduct an expert assessment of the timing of the detection of the disease, the adequacy and timeliness of the treatment and diagnostic process and medical examinations, the competence of doctors. The automated electronic program "Map of clinical examination of a patient with primary glaucoma" contains such a statistical tool as an integrated query constructor for extracting any information about patients, in which the user can set conditions for any database fields in any combination and get the resulting table with fields that can be configured for visualization.
В настоящее время отмечается увеличение распространенности среди детей школьников Первичная Артериальная Гипертензия в сочетании различными заболеваниями.
Кариес, заболевания пародонта, инфекции и травмы могут вызвать резорбцию корней и альвеол постоянных зубов. Эти условия могут привести к отрыву зуба или даже к необходимости удаления зуба. Одним из способов лечения потери зубов является хирургическая имплантация зубов. Остеоинтеграция является ключевым фактором, определяющим успех имплантации зубов, а начальная стабильность имплантата является хорошим показателем эффективности остеоинтеграции. Остеоинтеграция относится к естественной связи между имплантатом и альвеолярной костью. Другими словами, первичная стабилизация имплантата способствует успеху последующей остеоинтеграции, тем самым способствуя долгосрочному успеху. Перед проведением операции по имплантации зубов также необходимо учитывать биомеханические факторы, чтобы повысить первичную стабилизацию после установки.
Первичная открытоугольная глаукома (ПОУГ) и «сухая» форма возрастной макулярной дегенерации (ВМД) являются распространенными заболеваниями органа зрения, приводящими к снижению качества жизни пациентов в результате слепоты и слабовидения [1,5,10]. В настоящее время рассматривается большое количество факторов риска развития и прогрессирования ПОУГ и ВМД, многие из которых схожи: возраст, наследственная предрасположенность, курение, сердечно-сосудистая патология, нарушение питания. Однако уровень взаимного влияния ПОУГ и ВМД до конца не изучен, особенно при условии, что ПОУГ в ряде случаев прогрессирует, несмотря на стабилизацию внутриглазного давления (ВГД) [2-6]..
У шбу лойиха Ўзбекистон Республикаси Президенти нинг “2017-2021 йилларда Ўзбекистон Республикаси ривожланишининг беш устувор йўналишларида ҳаракатлар стратегиясини амалга ошириш Давлат дастури тўғрисида" ги фармони [1,4], "Фан, таълим ва рақамли иқтисодиётни ривожлантириш йили " ва "Рақамли Ўзбекистон – 2030" дастури [2,4]; 2018 йил 30 августдаги ПП-3925 сонли "Аҳолига неврологик ёрдамни ошириш чора-тадбирлари тўғрисида" [3,4] ва шу соҳага оид бошқа меъёрий-ҳуқуқий ҳужжатлар доирасида амалга оширилади.
Мавзунинг долзарблиги: Аҳолининг стоматологик соғлигини сақлаш ва мустаҳкамлаш тиббиётдаги стратегик йўналишлар сирасига киради.Ҳозирги даврдаги илмий тараққиётга қарамай,кариес интенсивлиги ва тарқалиши,шунингдек пародонт тўқималари касалликлари доимо юқори ўринда туради. Юрак-қон томир касалликлари муаммоси клиник шаклларнинг хилма-хиллиги, диагностика ва даволашнинг мураккаблиги, шунингдек, умумий юрак нуқсони (УЮН) шаклланишига мойиллиги туфайли педиатрия амалиётида энг муҳим муаммолардан бири ҳисобланади. Ҳозирги вақтда умумий юрак нуқсони болаликдаги ногиронлик ва ўлимнинг асосий сабабларидан биридир.
Защита социально уязвимых слоев населения является выражением гуманности и социальной ориентированности во всех государственной политике любой страны. Мероприятии принимаемые государством в данном направлении влияют на каждого из нас и от их эффективности зависит предупреждение возникновения социальных проблем. Поэтому в Узбекистане социальная политика имеет статус государственной политики. В Стратегии действий по пяти приоритетным направлениям развития Республики Узбекистан в 2017–2021 годах развитие социальной сферы указано в качестве приоритетного направления.
Down syndrome (DS) (trisomy, trisomy on chromosome 21) - "... this is a genetic abnormality in development and the most common chromosomal anomaly affecting mental development and mental development with a statistical occurrence of 1 in 700-800 newborns" [19,22,42 ]. There is no gender difference in the incidence of DM, it is stated regardless of the ethnic group, race and economic class of the family. The concept of "syndrome" defines the presence of specific signs or traits characteristic of a particular condition, so this pathology is commonly referred to as the term "Down's syndrome" and not "Down's disease" [1,38].
Доказано, что возрастная макулярная дегенерация (ВМД) представляет собой серьезную медико-социальную проблему, так встречается от 25 до 40% среди другой глазной патологии и является одной из наиболее частых причин слепоты и инвалидности по зрению в мире среди населения в возрасте 65 лет и старше. Частота встречаемости этого заболевания составляет от 21% в трудоспособном и до 32% - в пенсионном возрасте. Кроме того, известно, что у лиц работоспособного возраста выход на первичную инвалидность вследствие инволюционных изменений сетчатки в макулярной области отмечается в 11 % случаев, а среди людей старше 60 лет - в 28 % случаев (Либман Е. С., Шахова Е. В. 2013). В ближайшем будущем увеличение числа людей старше 60 лет неизбежно вызовет увеличение распространенности ВМД.
The article provides an analysis of the literature on the process of post-stroke rehabilitation, timing and types. Neurorehabilitation is a process aimed at restoring lost or reduced function in patients with stroke. Early initiation of neurorehabilitation leads to the achievement of the necessary level of selfcare of the patient, his social, psychological, physical adaptation and finally restoration of ability to work in the post-stroke period, as well as reduction of post-stroke disability in society and improvement of patients' quality of life
On the basis of the eye department of the TashPMI clinic, a retrospective study of the case
histories of 42 (84 eyes) patients with congenital cataracts was carried out. The age of the patients
ranged from 1 month to 13 years. All patients underwent a comprehensive clinical, ophthalmological, laboratory and instrumental examination and consultations of related specialists. The reasons for the late surgical treatment of children with congenital cataracts are: late diagnosis associated with clinical
forms of cataracts that are difficult to detect during external examination, the presence of concomitant somatic pathology, which is a contraindication to surgical treatment.
Возрастная макулярная дегенерация (ВМД) – прогрессирующее заболевание центральной зоны сетчатки и являющееся медико-социальной проблемой. Поскольку ВМД является хронически текущим заболеванием, установление данного диагноза обусловливает необходимость пожизненной качественной диспансеризации этой группы пациентов. Разработка современных электронных приложений по мониторингу состояния пациента является востребованной задачей для профилактики слепоты и инвалидности.
Topicality and demand of the subject of dissertation. In the world lat days chanchcd structures of trauma, increase the number of heavy combined traumas, which resulting in more heavy nature of simultaneous injuries of three , four or more anatomical regions, which creates difficulties in determining of the order of care and surgical tactics in patients with combined traumas of the facial skeleton bones (CTFSB). The syndrome of mutual burdening injuries of various anatomical regions, variety, hcavity and speed of the development of pathological process did difficulty of diagnosis of the CTFSB. Complexity of the clinical picture, features of the progress of post-traumatic shock, the development of traumatic disease cause difficulties which arise in the course of examination of patients and put tasks to the experts to find new ways of developing diagnostic algorithms and early surgical treatment of the CTFSB.
Frequency of CTFSB ranges from 34,8 to 63,3%. Fractures of orbit has been observed with an extremely high frequency (98%) in CTFSB, injury of the orbit is accompanied by damage of the eyeball and its subsidiary bodies has been observed in 66 % of eases. Consequences of eye injuries arc becoming the leading cause of disability and in 50% of eases could cause permanent loss of vision. By reason of death combined trauma take the third part after coronary heart diseases. Frequency of disfiguring defects and deformities of face occurs in 12 and 57%, disability in CTFSB reaches up to 23%. CTFSB, combined with TBI, causes up to 60% of deaths.
The causes of unsufficient results is non-availability of a diagnostic algorithm, which includes the most informative research methods, determining the order of interaction and priority of work of doctors of various specialties in CTFSB.
In some eases, requires specified an indications, character, scope, sequence and timing of surgical interventions, depending of the objective assessment of heaviness of injuries to various anatomical regions, prognosis criteria, the nature and heaviness of life-threatening consequences of combined trauma. The research work earned out within the framework of the achievement of the set by the Decree of the President of Republic of Uzbekistan “About measures on the further deepening reform the health care system” November 28, 2011, № PD-1652, maintenance of high-quality medical aid to the population under modem requirements and standards.In this regard the need for the development of algorithms of diagnosis and early methods of surgical treatment of patients with CTFSB constitute one of the important criteria demand the theme of dissertation.
Purpose of research is improvement of the diagnostic tactics and therapeutic interventions in patients with acute combined injuries of the facial bones according to the severity and location of the injury.
Scientific novelty of disscrtational research consists in the following: revealed the structure and features provide consistent care to patients with combined injuries in Republic of Uzbekistan;
The sequence of diagnostic and therapeutic measures, depending on the patient's general condition with CTFSB first determined by using created CT program "ADIL
developed innovative methods for early reduction and fixation of bone fragments in CTFSB;
identified endogenous factors, affecting on the wound process, disclosed the mechanisms of post-traumatic complications in CTFSB;
proved, that at 2 - 3rd days after the injury occurs the depression of cell and humoral immunity in the blood. Increases the level of proinflammatory cytokines, reduced the level of anti-inflammatory cytokine (in 2,8 at patients with heavy commonl condition. Increased levels of pro - and reducing anti - inflammatory cytokines is a poor prognostic factor in the development of inflammatory complications (bone wound suppuration, osteomyelitis of the jaw bones, soft tissue abscess);
patients with CTFSB at 2 - 3rd days after the injury occurs the depression of the content of protein and micronutrients (calcium, potassium and phosphorus) in the blood, which is a prognostic factor of the development of complications;
a scheme was developed for integrated medical correction of endogenous factors affecting on the development of posttraumatic complications;
1. CTFSB in 100% of cases combined with TBI, in 27.7 % with injuries of skeleton and internal injuries. In the diagnosis and treatment of patients with CTFSB should participate resuscitator, maxillofacial surgeon, neurosurgeon, ophthalmologist, and otolaryngologist. Primary debridement of wounds, reduction and fixation of bone fragments in patients in compensated state should be done within 3 hours after injury, while at subcompensated state - during the first day, and at the decompensated state - within 3 days.
2. With the CT program "ADIL" can determine the overall condition of patients in a short time. The most informative diagnostic criteria arc the general condition of patients, level of consciousness, hemodynamic stability, shock index and temperature gradient. The severity of the general condition of patients is directly dependent on the localization of the fracture of the facial bones. Multiple fractures of the upper and middle areas of the face arc the most serious injury in patients.
3. Patients with CTFSB in compensated and subcompensated state emergency surgical aid and diagnostic procedures should be performed in full volume (maxillofacial surgery, traumatology, neurosurgery, surgery, ophthalmology and otorhinolaryngologist), including the reduction and fixation of bone fragments in the first day. To patients with CTFSB in state decompensated should be performed at least diagnostic procedures, limiting the amount of emergency surgery. Reduction and fixation of bone fragments should be done after the restoration of function of vital organs and systems.
4. The method of choice for the treatment of depressed large bone fragments of facial bones is a titanium distractor, the use of which gives a good clinical and functional outcome.
5. When depressed fracture of the zygomatic arch application of the developed device will allow us to produce reduction and fixation of bone fragments in the early stages (within one day) with a good cosmetic result.
6. At patients with CTFSB in posttraumatic period (7- 14th day.) there arc a deep depression of CD3, CD4 cell composition, humoral factors and secretory immune system, increased necrosis factor CD95, increasing the levels of proin-flammatory (IL-6 ) and a decrease - anti- inflammatory (IL -10) cytokines. On 9-10th day reduced total protein, calcium, potassium and phosphorus in the blood .
7. Reduction of cellular and humoral immunity, increased proinflammatory cytokine and tumor necrosis factor, reducing the anti-inflammatory cytokine , the protein concentration in the blood, calcium, potassium and phosphorus arc predictors of complications.
8. Application of complex drug therapy within the 1-3 days after the injury with the inclusion of immune ( immunomoduline, ribomunil ), enzyme ( Voben-zym ) drugs osteoplastic materials allows to correct the violation of homeostasis, also used to prevent complications.
Objective: To study the dynamics o f the nosological structure o f eye diseases in children based on the materials o f the ophthalmological department o f the clinic o f the Tashkent Pediatric Medical Institute. Material and methods: A
retrospective analysis o f the reporting medical documentation o f the work o f the ophthalmological department o f the
TashPMI clinic in 2018-2021 was carried out. Results: For 4 years in the structure o f diseases, the leading positions (from 10 to 33.15%) were occupied by diseases o f the lens, injuries, pathologies o f the oculomotor apparatus and intraocular pressure. Analysis o f the dynamics o f each nosological group during 2018-2021 revealed a steady upward trend in the number o f children with congenital cataracts (from 23.7 to 30.57%) and congenital glaucoma (from 17.25 to 34.05%), a slight decrease in thefrequency o f injuries (from 29.02 to 21.77%), the number ofpatients with strabismus, which, after a sharp decrease to 10.31% in 2020, increased again to 26.82% in 2021. Conclusions: The obtained data should be taken into account in order to optimize the planned and emergency children’s ophthalmological service in
the regions o f the republic, improve the screening o f congenital and genetic diseases, and prevent childhood injuries.
Проблемы изучения структуры и распространенности инвалидности определяется не только значительным ростом показателей заболеваемости и инвалидизации населения, особенно трудоспособного, наиболее экономически и творчески активного возраста, но и недостаточным вниманием к поиску факторов, влияющих на данные негативные тенденции.