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.
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.
In preterm infants, hypocoagulation is observed, which is most pronounced in deeply premature infants. The main mechanisms and stages of coagulation reflect ontogenetic differences in the formation of the coagulation system, when the hypocoagulation orientation of the indicators decreases significantly after the 32nd week of gestation. In newborns with a gestational age of up to 32 weeks, the intensity of plasma hemostasis is revealed, which may be due to the intensity of hemostasis and the variability of its components. In the dynamics of the early neonatal period, preterm infants did not show any coagulation changes in the APTTV and TV tests, and the test scores of external coagulation mechanisms were most reduced in the first days of life
Significant changes of the vascular-thrombocytic component of the hemostasis system were revealed in patients with different stages of diabetic retinopathy. Treatment with activated autoplasma contributed to approaching all investigated parameters of vascular-thrombocytic and procoagulant components to their initial values.
An automated monitoring system has been developed for the AFM “Protection” of the development and spread of pests of forestry crops. The system is designed in the form of a local computer network, operates on-line and has the following additional features: automatic integration of daily data required for services of regional departments and the Forestry Agency of the republic. Based on these data, weekly, monthly maps and summary tables will be compiled.
SUMMARY
In the main directions of sustainable development of forestry in the Republic of Uzbekistan at the present stage for the period up to 2030, it is envisaged to further increase the productivity of forests on the basis of technical re-equipment, the introduction of advanced techniques to increase the efficiency of forestry production, improve the protection of forests from fires and protect them from pests and diseases. According to the forestry agency of the Republic of Uzbekistan, the area of forest plantations is 3.2 million hectares. This is about 7% of the total area of the republic. Of these, 821.0 thousand hectares are forest plantations. This means that only 2% of the area is covered by forests.
When planning the necessary forest protection measures, it is required to identify complexes of the most important, most dangerous pest species and predict further changes in the number of pest populations. Therefore, when organizing a monitoring system, it is necessary to obtain reliable information about the level of the number of pests and the degree of their threat to crops and plantations. First, when organizing a systematic system of forestry monitoring, the territory should be zoned based on economic and ecological criteria. Secondly, due to the fact that the emergence of foci of mass reproduction of pests is usually confined to regions where critical weather situations are observed, then when designing forestry monitoring such areas should be given priority attention. Thirdly, it is necessary to strongly recommend the organization of stationary objects in all farms, which will annually assess the level of abundance, the qualitative state of the populations of the main species and the state of the growing stand.
In case of significant damage to forest stands, a detailed survey with an assessment of the dynamics of tree mortality, determination of the qualitative and quantitative characteristics of the dominant pest species and the development of a strategy for forest protection measures should be carried out by specialists-entomologists.
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.
In this article, the author, based on an analysis of a number of sources, tried to reveal the features of the education system of the Iranian state, which has its own history of development in the region, its historical stages and features. The author tried to objectively analyze the reforms and modernization work carried out at different periods in the education system of Iran, mainly using foreign sources. The 1979 revolution plays a very important role in the life of the Iranian state. Therefore, the article compares the education system for two periods: pre-revolutionary and post-revolutionary periods. An attempt was made to identify and show the results obtained using various tables. The education system was divided into preschool, secondary, vocational and postgraduate degrees. The reforms carried out at each stage were briefly, but substantively covered. Conclusions were made by analyzing the results of the reforms. The features of the education system in Iran were identified and the prospects for their use in the context of Uzbekistan were examined. With an emphasis on gender processes in the education system, the strengths and weaknesses of the two-tier school system were identified. Efforts were made to explain the post-revolutionary changes in the country, the Islamization of the education system and its impact on the quality of education. In conclusion, the results obtained as a result of the analysis were systematized and sorted. Suggestions were made about what aspects of the Iranian education system can be implemented in practice and in the education system of Uzbekistan. When writing an article, the author sought to develop and substantiate his conclusions using methods such as comparative analysis and the use of statistical data.
Изучить изменения в системе гемостаза у больных с переломами нижней челюсти в сочетании с пародонтитом на основании изучения клинических показателей и системы гемостаза крови.
Изучить изменения в системе гемостаза у больных с переломами нижней челюсти в сочетании с пародонтитом на основании изучения клинических показателей и системы гемостаза крови.
Гемолитико-уремический синдром наиболее частая причина острой почечной недостаточности (ОПН) у детей раннего возраста (Д. В. Зверев и соавт.2007 г), исток формирования хронической болезни почек в последующие годы с возможным переходом в терминальную почечную недостаточность (3.М. Еникеева и соавт.,2006). Установлено, что многие органы и системы включаются в патологический процесс при развитии ГУС, ОПН в том числе система гемостаза, кардиореспираторная, гастроинтестинальная, нервная система и другие.
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.
The banking system plays an important role in the development of the national economy and plays an important role in the financial support of economic entities and entrepreneurs. The article provides the author's description of customer orientation in banking practice. According to this definition, customer orientation provides support at all levels of management of the banking system within the framework of a special algorithm of interaction between the client and the Bank and the fulfillment of its requirements. Factors related to banks that apply the modern concept of customer orientation are presented. The article also analyzes the main directions of attracting customers to banks. Besides, the influence of the characteristics of banking services on the nature of banking marketing is shown.
In the given article the author focuses his
attention on concept of national legal system, exactly legal system of Uzbekistan which as the complex legal phenomenon not only reflects the legal policy of the state, but also serves as an effective means of regulation of various public relations.
The banking system plays an important role in the development of the national economy and plays an important role in the financial support of economic entities and entrepreneurs. The article provides the author's description of customer orientation in banking practice. According to this definition, customer orientation provides support at all levels of management of the banking system within the framework of a special algorithm of interaction between the client and the Bank and the fulfillment of its requirements. Factors related to banks that apply the modern concept of customer orientation are presented. The article also analyzes the main directions of attracting customers to banks. Besides, the influence of the characteristics of banking services on the nature of banking marketing is shown.