Острый тонзиллит у детей является одним из самых распространённых острых инфекционных заболеваний верхнего отдела дыхательной системы у детей. Несмотря на усилия педиатров, встречаемость заболевания в год составляет от 16% до 28% среди детей, в зависимости от региона приживаемости (Stelter К, 2018). При этом по данным специалистов, в 75% случаев первичным патогенным фактором развития острого тонзиллита является вирусная инфекция, с последующим обсеменением бактериальной флорой слизистых миндалин (Горбачева Е.В., Николаев А.М., 2019). Эффективность лечения патологии во многом зависит от рационального подбора антибактериальной терапии с учётом характеристики бактериальной флоры при данной патологии.
Воспалительные заболевания небных миндалин у детей являются наиболее часто встречающимся в амбулаторной и стационарной практике отоларинголога. К наиболее часто встречающимся бактериальным агентам, вызывающим данную патологию относятся Streptococcus pneumoniae, Haemophilis influensae, Proteus, Streptococcus pyogenes, Staphylococcus aureus.
In this article studied and analyzed issues associated with purpose of bankruptcy law, the relations are regulated by the legislation on bankruptcy of the Republic of Uzbekistan
The results of surgical treatment of 126 patients with acute obstructive calculous cholecystitis were analyzed. Depending on the nature of performed operations all patients were divided into 2 groups: control group - 50 patients who underwent traditional cholecystectomy and main group - 76 patients who underwent LCE.
In the main group in case of impossibility to identify the elements of the gallbladder neck the author developed an original technique of LCE performance, which was performed in 37 patients, that allowed to perform even technically difficult operations by laparoscopic way, reducing the percentage of conversions to a minimum.
The author developed a technique of gallbladder and its bed sanation with 0.4% EVR of sodium hypochlorite and ozonized solutions, which allowed to prevent contamination of the abdominal cavity with infected gallbladder contents, and sanation of its bed and subhepatic space with ozonized solution, spread of the pathological process into the abdominal cavity.
The author developed the tactics of management and surgical treatment of patients with acute obturation cholecystitis, which allowed to improve the results of treatment of this category of patients and reduce the frequency of postoperative complications and lethality.
Based on the analysis of clinical results, indications and contraindications for laparoscopic interventions on the gallbladder in acute cholecystitis were developed.
The developed method of LCE, sanation of the gallbladder cavity and its bed by the proposed antiseptics, application of the developed tactics of treatment of patients with acute obturation cholecystitis allowed to reduce the treatment time from 18.2 + 5.6 to 6.1 + 1.9 days, to reduce the incidence of postoperative complications from 26% to 1.3%.
В этой статье изучены и анализированы вопросы защиты прав предпринимателей, восстановления платежеспособности должника и удовлетворения требований кредиторов с применением процедур банкротства в соответствии с законодательством о банкротстве Республики Узбекистан.
В последние десятилетия в качестве биомаркеров сепсиса было предложено более 200 соединений, в том числе маркеры острой воспалительной реакции - СРБ и про воспалительные цитокины, маркеры врожденного иммунного ответа, а также предшественники гормонов - прокальцитонин. При сравнении диагностической значимости ПКТ и СРБ пришли к заключению, что большая надежность в диагностике сепсиса все же принадлежит ПКТ-тесту. Обсуждается диагностическая значимость пресепсина, субстанции Р, лактата, тканевого фактора (TF) как ранних предикторов сепсиса. Однако, ввиду сложности патогенеза сепсиса и его гетерогенности, маловероятно, что единственный подходящий биомаркер будет когда-то найден [25]. Из-за схожести формирования ответа на рецепторы ассоциированных клеток ни один маркер не
сможет со 100% специфичностью и чувствительностью отличить неспецифическое повреждение клеток от инфекционного процесса.
BACKGROUND: Sepsis is one of the leading causes of hospital mortality in children. a decisive role in improving the results of treatment of this group of patients belongs to early diagnosis and pathogenetic therapy. AIM: this study optimizes the diagnosis and intensive care of surgical sepsis in children based on clinical and laboratory criteria and bacteriological monitoring.
MATERIALS AND METHODS: the study period is 2018–2020. the study subjects were children (n = 73) with surgical pathology (diffuse purulent peritonitis, bacterial destruction of the lungs, post-traumatic brain hematomas, injuries of the abdominal organs, and others). clinical and laboratory parameters were analyzed, and microbiological monitoring was performed to determine antibiotic sensitivity.
RESULTS: Patients who developed sepsis had a pronounced hypermetabolic syndrome, which was manifested by tachycardia and tachypnea, hyperthermia, low levels of albumin, and total protein in the blood. Protein catabolism in patients was accompanied by a decrease in globulins (IgG) synthesis and the development of a secondary immunodeficiency state. Both gram-positive and gram-negative microorganisms were involved in developing surgical sepsis in children, increasing the proportion of the latter. Given the high proportion of multi-resistant flora, empirical combined de-escalation antibiotic therapy (aBt) with broad-spectrum antibiotics was prescribed. this was followed by its revision based on microbiological monitoring and clinical and laboratory data of the patient with sepsis. Studies have shown the effectiveness of complex intensive care in 86.3% of cases. Mortality occurred in 13.7% of cases. Patients with severe surgical pathology died: fecal, generalized peritonitis, severe traumatic brain injury + coma with irreversible neurological disorders, and urosepsis against the background of chronic renal failure after repeated surgical interventions.
CONCLUSIONS: early diagnosis of sepsis, rational aBt under the control of microbiological monitoring, non-aggressive infusion therapy, and active sanitation of the surgical infection focus contributed to a decrease in mortality in this category of patients.
The results of the application of photodynamic sanitation of the abdominal cavity with the use of the photosensitizer methylene blue at a concentration of 0.05% with widespread peritonitis in the experiment are presented. It was found that when using the "FDU-1" device with a wavelength of 640 ± 20 nm as a source of LED radiation, the following parameters are required: exposure time 3-5 minutes for each irradiation area, output radiation power in continuous mode 100 mW / cm2, energy density from 25 to 35 J / cm2. The use of the developed method of sanitation of the abdominal cavity in experimental animals made it possible to reduce postoperative mortality from 25% to 7.5%.
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.
Мазкур мақолада корхоналарни банкротлик ҳолатидан чиқариш ва молиявий соғломлаштириш (санация) шароитида молиявий таҳлилнинг усулларидан оқилона фойдаланиш юзасидан илмий таклиф ва амалий тавсиялар берилган.