Urinary incontinence in middle-aged women is a complication of severe vaginal delivery, large fetuses or multiple pregnancies, urinary incontinence, intermittent injuries and operations on the pelvic organs, obesity, diabetes, smoking. Urinary incontinence is divided into three types depending on its cause: these are stress urinary incontinence, urgent urinary incontinence, and the inability to manage full urine. Of these, a lot of women suffer from this type of stress urinary incontinence and it begins mainly after forty-five years, it happens when women sneeze or cough, laugh a lot, so women complain of involuntary urination. In turn, it is one of the first signs of the disease and also plays an important role in diagnosis. Urinary incontinence causes discomfort and stress in women, their tightness when smoking and joining in a team
Purpose of the study. Based on a retrospective analysis, to determine prognostic markers for the progression of fibrosis of the pulmonary parenchyma and the development of unfavorable endpoints in patients with postcovid syndrome.
Material and research methods. The material of the study was the case histories of 128 patients who underwent COVID-19 and are in early medical rehabilitation. A retrospective analysis of the data of case histories and their statistical processing were carried out.
Research results. Patients with progressive pulmonary fibrosis were more comorbid (p<0.001). BA (p <0.05), CIPD (p <0.05), obesity and steatohepatitis (p <0.001) and thromboembolic events within a month after discharge from the infectious hospital (p <0.001) were significantly more frequent in them. Thromboembolic events occurred in 66 patients (51.56%), 12 patients died (9.38%), the combined endpoint (death + thromboembolism) occurred in 70 patients (54.69%). The risk of adverse endpoints is significantly higher in patients with severe and extremely severe COVID-19. In these patients, the average number of background pathologies was significantly higher (p <0.001), among which COPD (p <0.001), type 2 diabetes (p <0.05), obesity and steatohepatitis (p <0.001), Parkinson's syndrome ( p <0.05). Also, the group of patients with the development of thromboembolism and deaths was distinguished by more pronounced lung damage (p <0.05), a higher incidence of severe and extremely severe infections (chi square = 6.98, p <0.01).
Conclusion. Retrospective analysis showed that the risk of progression of fibrosis of the pulmonary parenchyma in patients with COVID-19 increases in the presence of AD by 1.83 times (p<0.05), CIBD - 2.46 times (p <0.05), obesity and steatohepatitis - 7.22 times (p <0.001), the development of thromboembolic events during the first month - 9.39 times (p <0.001). The risk of developing a combined unfavorable endpoint (death and thromboembolic events) COVID-19 increases 1.63 times in severe and extremely severe disease, 2.33 times in the presence of COPD (p <0.001), 1.63 times - in the presence of type 2 diabetes (p <0.05), 3.64 times - in the presence of obesity and steatohepatitis (p <0.001).
Viral hepatitis C (HCV) is one of the most important problems of modern medicine. According to WHO statistics, there are between 500 and 700 million HCV carriers worldwide. The aim of the study was to study the clinical and immunological features of the course of chronic viral hepatitis C, depending on the genotype of the virus, and to assess the diagnostic and prognostic value of immunological disorders. The clinical and laboratory features of the course of chronic viral hepatitis C depending on the genotype of the virus, the immunological features of the course of chronic viral hepatitis C depending on the genotype of the virus were studied, the diagnostic and prognostic value of immunological indicators as objective criteria for assessing the severity of the disease and the prognosis of the disease was determined. We examined 83 patients with chronic viral hepatitis, 35-50 years old with chronic viral hepatitis C, and 20 practically healthy individuals of the same age and gender.
Early diagnosis of Myeloproliferative diseases (MPD) is one of the serious problems of oncohematological practice. MPD efers to multifactorial diseases, the development of which is influenced by both environmental factors and genetic predisposition. The study studied the association of the carriage of the genotype for the polymorphic marker encoding glycoprotein-P and the development of MPD. The homozygous T / T genotype of the rs1045642 polymorphism of the MDR1 gene is a significant determinant of the increased risk of developing MPD in Uzbekistan (P<0.05). Conclusion. Genotype association the rs1045642 polymorphism of the MDR1 gene is associated with the risk of developing MPD.
In the article discussed the fungal plant diseases detected in cotton crops in our country and biological control measures against them. Studies have shown that the main pathogens of root rot in cotton are microscopic fungi Rhizoctonia solani, Thielariopsis basicola, Fuzarium spp, Pythium spp. are included.
According to the study, in terms of damage caused by seedling diseases, on average for the last 3 years, 22.6% of the cotton crop that died the highest of all diseases was caused by seedling diseases. In the second place, verticillosis mortality was 19.23%, cos sack rot was 19.1% and the lowest fusarium wilt mortality was 7.48%.
Based on the data obtained, it was concluded that the development of root rot diseases in cotton is caused by low soil and air temperatures, deeper sowing of seeds than recommended, hardening, excess moisture, poor loosening of the soil, contamination with pathogenic fungi.
Проведены клинические, бактериологические исследования у детей в возрасте от 6 месяцев до 3 лет, находившиеся на лечении в стационаре по поводу диареи неясной этиологии. Отягощающим фактором для роста грибов рода Candida, является часто нерациональное применение антибиотиков широкого спектра действия. Ассоциации грибов рода Candida с острыми диареями способствует более длительному сохранению интоксикации, кишечной дисфункции и удлиняют сроки выздоровления.
Relevance of the problem.Despite the great successes of angiosurgery, the problem of surgical treatment of abdominal aortic aneurysms does not lose its relevance. World health statistics records a steady increase in the incidence of abdominal aortic aneurysm (ABA). According to L.J. Melton et al. (1984) and L.K. Bickerstaff et al. (1984) in the USA the number of patients with abdominal aortic aneurysm has increased 7 times in 30 years since 1951. In England and Wales, according to F.G. Fowkers et al. (1989) for the same period revealed a 20-fold increase in abdominal aortic aneurysms in men and 11-fold in women. According to the results of multicentre screening studies ABA was detected in 8% of the examined (E.S. Vourvouri, 2001), and in the age group of 64-69 years ABA was detected in 5.7% of the examined, and in the age group of 75-81 years - in 8.9% (R.A.P. Skott et al., 2001). A similar trend is observed in other countries. Accordingly, mortality from ABA is also increasing - aneurysm rupture in a number of countries is one of the ten most frequent causes of death among elderly and senile people (F.A. Lederle et al., 1990)
Currently, planned aneurysm resection has become a recognised standard of radical treatment of ABA patients and the number of these operations is steadily increasing. For example, about 40,000 ABA resections are performed annually in the USA (J.J. Grange et al., 1997). In Sweden during the period from 1987-89 to 1993-95 the number of ABA operations increased 5 times and currently 10 operations per 100,000 population are performed (A.Hallin et al., 2001), although this is 1.5 - 2 times less than the required number. However, postoperative lethality is still quite high and makes 5-7% (A.V.Pokrovskiy et al., 1992; Y.V.Belov et al., 1992; V.V.Vakhidov et al., 1992; A.W. Bradbury et al. Bradbury et al., 1997; A.Hallin et al., 2001).
E.W. Steyeberg et al. (1995) summarised the data of literature on 17238 ABA resection operations and gave an average mortality of 6.8%.
Multicentre studies in five major hospitals in the Netherlands found that only 74% of patients underwent ABA resection without complications; 26% had some complications, 9% of which were severe and 4.1% of which were fatal (G.J. Akkersdijk et al., 1998). Similar results were obtained in the Canadian Cooperative Study (K.W. Johnston et al., 1990). It was established that the peculiarity of complications in the majority of patients was their systemic character (L.L. Lau et al, 2001) The course of the postoperative period is most often complicated by cardiac, respiratory, renal, cerebrovascular, as well as complications associated with thrombosis and bleeding (W.E. Lloyd et al., 1996; R.D. Sayers et al., 1997; J.D. Blankenstein et al., 1998; R. Ayari et al., 1998). Ayari et al., 2001)
The undisputed leadership, without doubt, belongs to cardiac complications, the incidence of which varies from 10% to 20%. Moreover, cardiac complications account for 50-70% of total mortality. Cerebrovascular complications, although not uncommon, account for no more than 1-1.5%, but their mortality reaches 40%. Complications associated with thromboses and haemorrhages in the perioperative period reach 2-5% (M.M.Reigel et al., 1987; K.W.Johnson et al., 1990; N.Franklin et al., 1993; A.A.Milne et al., 1994).
Certainly, a large number of complications after resection of abdominal aortic aneurysms is caused by the initial severity of patients' condition, however, many unresolved tactical and technical issues of patients' preparation for the operation, stage of performance in case of combined lesions of several vascular basins play a practically significant role. Adequate management of the operation itself and the immediate postoperative period is no less important, taking into account the possibility of such dreadful complications as thrombosis and embolism, cerebral and cardiac death. Until now there is no unified complex analysis of the results of treatment of uncomplicated abdominal aortic aneurysms and, accordingly, recommendations for the prevention of possible complications.
All this determined our aim and objectives of the study.
The aim of the study is to improve the results of surgical treatment of ABA by developing an effective system for determining the main risk factors of surgical treatment and optimal surgical tactics to prevent possible complications.
Scientific novelty.For the first time a complex analysis of indications and contraindications to surgical treatment of abdominal aortic aneurysms was carried out
The most significant concomitant pathology capable to lead to formidable complications and lethality during the intervention and in the nearest postoperative period was revealed. Adequate measures of their prevention and treatment were proposed.
The algorithm of surgical treatment tactics for patients with combined pathology of coronary arteries and aortic arch branch lesions was developed
The state of haemostasis system at all stages of reconstructive surgery on abdominal aorta, starting from skin incision to wound closure, was studied for the first time.
Conclusions:
1. The proposed original classification of ABA, based on mutual dependence on the etiology of the disease, localisation, concomitant diseases, clinic and its course, allows to determine the strategy of early diagnosis, to estimate the most significant risk factors, the stage of intervention in combined lesions of adjacent and distant vascular basins and, ultimately, to determine the ways to reduce complications and mortality in patients with ABA.
2. The most informative methods of ABA diagnostics are duplex scanning and computed tomography. Non-invasive diagnostics capabilities are enough to determine the aneurysm size, its relation to the renal arteries, as well as to find out the state of visceral branches and aortic bifurcation. Abdominal aortography is indicated in patients with concomitant arterial hypertension to identify the state of the renal arteries.
3. Significant risk factors in these patients are ischaemic heart disease (44.1%), arterial hypertension (49%), haemostasis disorders (almost 100%).
4. The leading concomitant disease in the development of postoperative complications is ischaemic heart disease. Its share in abdominal aortic aneurysms is 40%. Postoperative cardiac complications reach 14.9%. Diagnostics of ischaemic heart disease should be based on the stage-by-stage detection of coronary lesions and its functional-compensatory abilities.
5. The main complications of the postoperative period after ABA resections are acute heart failure (14,9%), cerebral circulatory disorders (1,5%), acute renal failure (3,33%).
6. When significant coronary vascular channel lesions are detected in patients with ABA, it is fundamental to solve the issue of intervention staging. At 3-4 functional classes of circulatory insufficiency, appearance of new zones of hypo- or akinesia, decrease of ejection fraction below 40%, the first stage should be myocardial revascularisation surgery
7. In patients with combined lesions of brachiocephalic vessels in patients with ABA it is reasonable to assess the cerebral blood flow. In the presence of 70% or more stenosis of VCA, presence of embologenic plaque, bilateral haemodynamically significant stenosis it is necessary to perform carotid artery intervention as the first stage.
8. One of the most difficult problems of reconstructive operations in ABA is the contiguous lesion of renal and visceral branches of the abdominal aorta. The principle is their one-stage reconstruction. The types of reconstruction of these branches should be variable depending on the volume and extent of the pathological process.
9. Patients with aneurysmal lesion of abdominal aorta initially always have significant disorders of haemostasis system. In 30% of patients with occlusive diseases of aorta and its branches in the preoperative period the activity of thrombocytic-vascular link of hemostasis is increased, antithrombotic ability of vascular wall endothelium is decreased and blood rheological properties are disturbed. Activation of fibrinolysis was noted in patients with aneurysmal lesion of abdominal aorta.
10. During the operation for abdominal aortic aneurysmal lesion, after starting the blood flow the level of plasminogen increases additionally by 30%, which is a risk factor for haemorrhagic complications in the perioperative period. On the 1-3 day after the operation there is a significant decrease of blood anticoagulant potential - antithrombin-Sh by 25-27%, protein C by 23-25%. This period is the most dangerous in terms of thrombohemorrhagic complications development.
11. When using standard heparin during the operation there is a consumption of antithrombin-Sh by 30-45% and increase of platelet aggregation by 10%, which is a threatening condition for the occurrence of thrombosis of deep veins of the lower extremities with subsequent TELA. When using fraxiparin during reconstructive vascular surgeries the consumption of antithrombin-Sh and increase in platelet aggregation do not occur, prothrombin time, activated partial thromboplastin time, thrombin time are lengthened insignificantly that testifies to expediency of its use for prevention of thrombohemorrhagic complications.
12. Application of the diagnostic methods proposed by us to detect the main risk factors during the operation and in the nearest postoperative period, use of the algorithm of stage and volume of intervention allowed to reduce significantly the number of threatening complications, thus the lethality decreased 4 times, and the number of non-fatal complications - 4 times non-fatal complications - 1.5 times.