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.
Conceptual Field tests were attempted on sandy soils with three trimming frameworks at India for a very long time during 2011-2013. The trials were executed in split plot plan by relegating h2o dissolvable phosphorus composts in primary plot and suggest ed portion of phosphorus in sub-plot with three replications. The most extreme practical yield of rice, child corn and Chickpea were recorded with the utilization of . The most extreme efficient yield of progressive harvests - wheat, mustard and groundnut were recorded with the application of treatment. Practically comparable patterns were seen as far as side-reaction yield, supplement take-up and leftover soil richness status. Every one of the degrees of in compound manures were discovered to be similarly successful for grain yield, straw yield, supplement take-up, and leftover soil richness.
Hearing loss is a socially significant problem. In a significant number of cases, it is based on sensorineural hearing loss. Given the polyetiology of the disease, the approach to treating patients should be comprehensive. Over the past decades, there has been a steady increase in the number of patients with hearing impairment due to the development of sensorineural hearing loss, which, in turn, leads to social and labor maladaptation, deterioration in the quality of life of patients, and in children to a violation of the psycho-emotional , speech and intellectual development. The treatment of acute sensorineural hearing loss (ASNHL) remains an important and problematic task of modern otolaryngology. Thus, in acute sensorineural hearing loss, therapy is aimed at combating edema, inflammation, circulatory disorders, and tissue metabolism.
Ectopic pregnancy is the most common pathology in gynecological practice, which leads to a decrease and loss of reproductive function. After ectopic pregnancy surgery, about 35 percent of women had early complications, such as systemic inflammatory reaction syndrome and inflammatory process suppuration of the uterine appendages. Reproductive dysfunction was observed in 58,9% of women and the frequency of repeated ectopic pregnancy was 20,0%, which is the problem under studyindicates the relevance of.
Pregnancy at an advanced maternal age presents unique challenges and considerations for both mothers and their infants. This study offers a comprehensive assessment of maternal and perinatal outcomes in the context of advanced maternal age, examining various factors that may influence the health and well-being of expectant mothers and their newborns. Through a multi-dimensional analysis, we explore the implications of delayed childbearing on maternal health, obstetric complications, neonatal outcomes, and the broader socio-cultural aspects that shape this experience. Our findings shed light on the complexities of pregnancy at an advanced age, informing healthcare providers and policymakers for improved care and support for older mothers.
This research encompasses a diverse cohort of women aged 35 and above who underwent prenatal care and delivery in various healthcare settings. Data analysis includes a wide array of factors, including maternal health, gestational complications, fetal development, and neonatal outcomes. Additionally, psychosocial and emotional aspects are explored to understand the emotional well-being and stressors experienced by older expectant mothers.
Initial findings suggest that advanced maternal age is associated with an increased risk of certain pregnancy complications, such as gestational diabetes, hypertension, and cesarean deliveries. However, maternal age alone does not determine the overall pregnancy experience. Factors such as pre-pregnancy health, lifestyle choices, and access to quality healthcare also play pivotal roles in maternal and perinatal outcomes. Furthermore, older mothers exhibit resilience and a strong commitment to their child's well-being, resulting in favorable psychosocial outcomes.
This holistic assessment underscores the importance of personalized and age-sensitive prenatal care. Tailored interventions that address the specific needs of older expectant mothers, including nutrition, exercise, and psychological support, can significantly enhance overall pregnancy experiences and mitigate certain associated risks. Furthermore, it is crucial to empower women with evidence-based information to make informed decisions about family planning and reproductive health.
Acute sensorineural hearing loss is an urgent condition that can develop irreversible and serious complications if is not treated on time. Hearing loss can develop suddenly or over several hours. Patients complain of congestion in the affected ear, noise in the ears, and often dizziness. Hearing loss is usually unilateral, and in 2% of cases it is bilateral. According to epidemiological data, the disease rate is 5-27 cases per 100,000 population. Unlike conductive tinnitus, sensorineural tinnitus is characterized by damage to the sound-receiving part of the unilateral auditory analyzer. The cranial artery is the only terminal artery that supplies the cranium with blood. A.auditivae is separated from the internal basilar artery in different situations. It separates from the lower anterior cerebral artery in 65% of cases, from the main one in 29%, and from the lower posterior cerebral artery in 6% of cases.
The article presents the results of assessing the quality of life of 54 patients with bilateral chronic sensorineural hearing loss. The parameters of the SF-36 questionnaire were studied in patients with sensorineural hearing loss, depending on the degree of hearing impairment. The relationship between the quality of life of patients and the degree of hearing loss was revealed.
This case study presents a rare instance of cytomegalovirus (CMV) seroconversion in a primiparous woman during her first trimester of pregnancy, accompanied by a significant increase in CMV-specific antibody avidity. The emergence of CMV seropositivity in pregnancy raises concerns due to potential vertical transmission risks. However, the intriguing aspect of this case lies in the unusually high avidity of the CMV-specific antibodies developed post-seroconversion. This phenomenon suggests a previous immune priming event or cross-reactive responses. The case underscores the complexity of CMV infections during pregnancy and the need for careful monitoring and research to comprehend the implications of heightened antibody avidity in the context of maternal-fetal health.
in our country, the number of pregnant women with rhesus sensibility every year remains unchanged and does not have a downward trend. This is due to insufficient prophylaxis after the termination of pregnancy (spontaneous abortion, ectopic pregnancy, the birth of a rhesus-positive fetus) with the use of immunoglobulin against antiretroviruses. Previously effective methods of treatment, such as desensitization of antigens, plasmapheresis, hemosorption and intravenous administration of immunoglobulins, have only historical significance.
Objective: to study and analyze the literature data of foreign and local authors on the diagnosis of hemolytic disease of the fetus, the use of non-invasive methods of Prevention of Rh-immunization.
Search strategy: the search for information contained information such as regulatory documents, diagnostic protocols, and the conduct of RH-controversial pregnancy. Also in the databases Google Scholar, the Cochrane Library, PubMed, Library full-text scientific articles were used.
Inclusion criteria: randomized, cohort study data, systematic reviews, diagnostic protocols, and Rh-conflict pregnancy.
Exception criteria: practice, report, newspaper publications, articles describing theses.
Results: studies have shown that the prophylactic purpose and administration of anti-D-immunoglobulin, which is used during 28-30 weeks of pregnancy, significantly reduces the development of immunization after childbirth. Conclusion: due to the wide application of anti-D-immunoglobulin in pregnant women and family planning, it will be possible to reduce the frequency of immunization, but the goal will be achieved only if a clear сomplex prevention of Rh-immunization is developed, in which the appearance of hemolytic disease of the fetus occurs. Nevertheless, the diagnosis and treatment of hemolytic disease remains an urgent problem and requires the use of new possibilities of modern medicine in the field of genetics, ultrasound diagnostics, invasive and non-invasive methods.
The results of a comparative study of the oral cavity of pregnant women with hypertrophic gingivitis and without inflammatory diseases of the oral cavity (ESD) were studied on the example of the Samarkand region as a risk factor for the development of hypertrophic gingivitis in pregnant women. It has been shown that during pregnancy, the negative influence of local factors of hypertrophic gingivitis significantly increases. Keywords: hypertrophic gingivitis, pregnancy, dental indicators, risk factors Despite numerous studies, the etiology of inflammatory periodontal diseases in pregnant women has not been sufficiently studied. Thus, the prevention, diagnosis and treatment of gingivitis in pregnant women remains insufficiently effective. In addition, many medications and effects cannot be used during pregnancy (or perhaps, but there is only a risk comparable to the health of a mother with gingivitis).The fruit depends on the means used). On the other hand, hypertrophic gingivitis negatively affects the course of pregnancy and increases the likelihood of perinatal complications [1,2]. In particular, periodontitis often contributes to premature birth and intrauterine infection of the fetus, since it complicates the course of pregnancy and is a focus of infection in the mother's body.[3] Many inflammatory diseases have regional peculiarities of development, course and treatment related to its iodine state, the state of ecology, the epidemiological situation and the organization of medicine, as well as the genetic characteristics of the population of this territory [4,5]. It is reasonable to assume the presence of such signs in hypertrophic gingivitis. However, at the moment there are no special publications dedicated to this disease in the Samarkand region.
Recurrent miscarriage (RMP) is an unsolved problem in modern gynecology and obstetrics. A growing body of experimental research suggests that endometrial immune dysregulation may be responsible for many, if not all, cases of PNL of unknown etiology. This article discusses the main immunological disorders that occur in PNL.
In modern abdominal surgery, one of the current areas for research continues to be the improvement of various options for plastic surgery of postoperative hernias. More than 2,100,000 operations for ventral hernia are performed annually in the world, and 42% of them are postoperative hernias. In recent years, there has been a clear trend toward the expanded use of various types of biological meshes in hernioplasty. “A pooled analysis of seven PCSTAR studies for incisional hernias using retromuscular mesh showed a hernia recurrence rate of 5.7%”[1]. The use of standard surgical interventions such as alloplasty in the onlay position does not solve the problem of early postoperative complications: seroma discharge, mesh migration, adhesive disease, high frequency of hernia recurrence, etc. At the same time, hernia repair with local tissue creates the problem of increased intra-abdominal pressure and late complications in the form of recurrent hernias. “An increase in postoperative intra-abdominal pressure leads to multiple organ failure, then abdominal compartment syndrome, and even death.” [2]. Currently, there is no consensus on the surgical approach for giant postoperative abdominal wall hernias, and therefore the need to continue to develop new technologies and improve There is no doubt about the tactics. In world practice, at present, the most relevant studies continue to be studies aimed at studying the morphological and functional aspects of recurrent postoperative ventral hernias; electron microscopy reveals ultrastructural destructive changes in skin cells, aponeurosis and muscles, which indicates morphofunctional insufficiency of abdominal wall tissues; issues of cell engineering are discussed new innovative materials, experimental studies are being carried out on animals testing the biotechnical properties, texture and elasticity of new polymers, research is being conducted on open approaches with division of the posterior component with the release of the transverse abdominis muscle and a retrograde mesh, robotic operations have begun. Modern aspects of the development of domestic healthcare include many measures aimed at improving the results of treatment of patients with postoperative ventral hernias and associated pathological conditions through the introduction of modern principles of intensive care and surgical tactics. The development strategy of New Uzbekistan for 2022-2026 in seven priority areas includes tasks to improve the quality of provision of qualified medical services to the population[3]. The implementation of these tasks, including by optimizing tactical and technical approaches to the choice of hernioplasty method, as well as the development of methods for the prevention of purulent-inflammatory complications in the field of alloplastic material, is one of the current areas of abdominal surgery and medicine in general, due to the high medical and social the significance of this pathology.
This dissertation research to a certain extent serves to fulfill the tasks approved by the Decree of the President of the Republic of Uzbekistan “On comprehensive measures to radically improve the healthcare system of the Republic of Uzbekistan” No. UP-5590 dated December 17, 2018, the Resolutions of the President of the Republic of Uzbekistan “On measures to transform the surgical service, improving the quality and expanding the scale of surgical operations in the regions" for No. PP-5254 dated October 4, 2021 and "On additional measures to ensure public health by further increasing the efficiency of medical prevention work" for No. PP-4891 dated November 12, 2020, and as well as other regulatory documents adopted in this area. Compliance of the research with the priority directions of development of science and technology of the republic. The dissertation research was carried out in accordance with the priority direction of development of science and technology of the VI Republic “Medicine and Pharmacology”. Review of foreign scientific research on the topic of the dissertation.[4] Research work aimed at improving the quality of therapeutic and preventive care for patients with ventral hernias, carried out by many leading scientific centers and higher educational institutions in the world, including the Department of Surgical and Perioperative Sciences, Umeå University, Umeå (Sweden), Department of Surgery, Kingston General Hospital, 76 Stuart Street, Kingston (Sweden). nada), Department of Surgery, Helsinki University Hospital, Helsinki ( Finland), Service de chirurgie digestive et oncologique, CHU d'Amiens (France), Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Tulsa (USA), Department of Surgery, Howard University College of Medicine, Washington (USA) , Yong Loo Lin School of Medicine, National University of Singapore (Singapore), Department of Surgery, Michigan Medicine, Ann Arbor, MI, USA; University of Calgary, Calgary (Canada), Division of Plastic Surgery, Perelman School of Medicine at the University of Pennsylvania, University of Pennsylvania Health System, Philadelphia (USA), Brigham and Women's/Faulkner Hospital, Harvard Medical School, Boston (USA) , Department of Surgical Sciences, Uppsala University Hospital, Uppsala (Sweden), Department of Surgery, University of Texas Health Sciences Center at Houston, Houston (USA), Department of Surgery, Erasmus University Medical Center Rotterdam, Rotterdam (Netherlands), Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka (Japan), National Medical Research Center for Surgery named after A.V. Vishnevsky" (Russia), Republican Scientific Center for Emergency Medical Care (Uzbekistan), Tashkent Medical Academy (Uzbekistan), Republican Specialized Scientific and Practical Medical Center for Surgery named after Academician V. Vakhidov (Uzbekistan).
As a result of studies conducted around the world to increase the effectiveness of alloplasty for postoperative ventral hernias and reduce the risk of complications in the postoperative period, a number of scientific results were obtained, including: it was determined that patients who underwent reconstruction of the abdominal wall have an increased risk of postoperative respiratory failure, understanding the epidemiology of this complication can improve prevention (the Division of Plastic and Reconstructive Surgery, Department of Surgery, Oregon Health & Science University, USA); It has been proven that the larger the hernia, the higher the risk of early surgical complications, including such as respiratory decompensation, since hernias often increase in size over time, delaying surgery can lead to an increase in the size of the hernia and, therefore, a greater risk of complications (CentreforDigestiveDiseases, KarolinskaUniversityHospital, Stockholm, Sweden); it has been shown that the ratio of the hernia volume to the volume of the abdominal cavity <20% is an independent factor in tension-free closure, which justifies the interest in preoperative volumetry to adapt the tactics of surgical care (Servicedechirurgiegénérale, digestiveetendocrinienne, CHU LyonSud, HospicescivilsdeLyon, France); It has been determined that in patients undergoing elective laparoscopic hernia repair, predictors of mortality are older age and certain concomitant diseases: congestive heart failure, pulmonary circulatory disorders, coagulopathy, liver disease, metastatic cancer, neurological disorders and paralysis (Department of Surgery, College of Medicine, University of Oklahoma, Tulsa , USA); Older age, ascites, preoperative renal and pulmonary insufficiency have been found to be independent predictors of 30-day mortality, and in the presence of these risk factors, conservative treatment should be seriously considered (Department of Surgery, University of Kentucky College of Medicine, Lexington, USA); The American College of Surgeons (ACS) Universal Surgical Risk Calculator has been shown to accurately predict thirty-day outcomes, including major complications: venous thromboembolism, medical morbidity, surgical site infection, unplanned reoperation, mortality, and length of hospital stay (Department of Plastic Surgery, Brown University and Rhode Island Hospital, Providence, USA). At the present time in the world, the most relevant research in surgery continues to be the development of new methods of hernioplasty for large and giant ventral hernias, each of which has its own pros and cons depending on the complexity of implementation, the risk of postoperative complications and relapse, large randomized clinical trials are being conducted, comparing existing methods of traditional hernioplasty with laparoscopic access and robotic surgery, which has become increasingly widespread in the last 10 years, a search is being made for new synthetic and biological materials developed for the production and use of composite meshes that have the necessary strength and the ability to prevent fatal local complications in a contaminated environment. However, despite technical advances in this field, no modern hernia repair method or prosthesis meets all the requirements. One of the key problems is that existing synthetic endoprostheses do not have sufficient elasticity, resistance to infection, high mechanical strength and integrity over a long period of time. Further research into these clinical aspects will undoubtedly improve the current understanding of the capabilities of biocompatible endoprostheses and will make it possible to develop an optimal method for their placement during allohernioplasty. The degree of knowledge of the problem. The current period of development of abdominal surgery is characterized by an emphasis on the problems of the effectiveness of introducing new installation methods and techniques for attaching bioprostheses, options for various suture materials to determine the most promising directions for the development of these technologies [5]. Researchers led by BittnerR.[6] (2019) state that a giant postoperative abdominal wall hernia, the maximum diameter of which exceeds 12 cm or the ratio of the volume of the hernial sac to the abdominal cavity more than 20%, is difficult to treat, with a high recurrence rate and a large number of complications. One of the most challenging problems is that after the hernia contents return to the abdominal cavity, postoperative intra-abdominal pressure will increase, leading to multiple organ failure, then abdominal compartment syndrome (ACS), and even death. There is currently no agreement on the surgical approach for these giant incisional abdominal wall hernias. To prevent recurrences, some articles recommend placing the hernia mesh in the sublayer position and or linings (KirkpatrickAW.)[7]. According to CornetteB.[8], to prevent recurrence, it is recommended to place the hernia mesh in a sublayer or underlay position, and to achieve better mesh expansion, a component separation technique (CST) may be a suitable solution, but with a significant risk of complications and recurrence. JensenKK, et al. believe that truly successful giant hernia repair requires effective bridging or augmentation that will prevent recurrence with an acceptable risk of complications[9]. Another pressing issue in abdominal surgery is that patients with incisional hernias are extremely difficult to treat due to a number of factors including obesity, previous hernia repair, previous mesh placement, domain loss, and other variables.
The approach to patients with incisional hernias has changed significantly over the past 20 years due to both advances in mesh technology and surgical approaches. Key factors for successful outcome include modification of risk factors preoperatively, such as smoking cessation and weight loss, selection of mesh appropriate for the type of hernia and planned mesh location, and wide mesh coverage beyond the hernia defect. New techniques such as transabdominal muscle release and component separation with retrograde mesh placement and robotic approaches to abdominal wall hernia are increasingly being used in these patients[10]. Recent years have seen an increase in the number of biological meshes available for abdominal wall hernia repair. Biological meshes typically consist of materials obtained from humans, pigs, or cattle. The rationale for using biological meshes is that they can act as a scaffold for the growth of natural tissues. In addition, there are absorbable synthetic meshes that have properties similar to those of biological meshes, but with theoretically less risk because they are not derived from animal or human material. The choice of mesh for a ventral hernia depends on many factors, which include both the properties of the mesh and its location, for example, whether it should be placed intraperitoneally, preperitoneally, or retrorectus. BaierKF[11](2021) believes that the guiding principle should be to avoid placing uncoated polypropylene mesh in an intraperitoneal location where it may be in direct contact with internal organs. In addition, the type of hernia defect is another risk factor, such as whether the wound is clean or dirty, and whether the repair is performed with a bridge or abutment. Lightweight or biologic meshes to bridge the defect should be avoided due to increased recurrence rates. Holihan JL [12] (2016), Hodgkinson JD [13] (2018) believe that the principle of anatomical restoration to achieve a reliable, tension-free repair with reinforced mesh reduces the incidence of early postoperative complications and late recurrence of hernia compared with bridging mesh. The analysis of the literature concerning the theoretical aspects and clinical experience of using technologies for improving modern synthetic and biological prostheses that can provide a better plastic effect, as well as methods for preventing recurrence of ventral hernias, indicates that this is one of the priority areas in modern abdominal surgery. An unresolved issue remains the choice of the optimal endoprosthesis, which is highly effective and meets international standards for such properties as biological inertness and mechanical strength, as well as the method of positioning the mesh in relation to the layers of the abdominal wall. Considering that many of the allohernioplasty methods used today are not without drawbacks, the current direction is the development of new methods of repair for giant ventral hernias and methods for the prevention of postoperative complications in conditions of a contaminated wound, with justification of their effectiveness in a clinical experimental study. The connection between the dissertation research and the research plans of the research institution where the dissertation was completed. The dissertation research was carried out within the framework of the research work plan of the State Institution “RSNPMCH named after. acad. V. Vakhidov" under the project AL-422105574 "Development of new biocompatible mesh implants made of composite materials for reconstructive surgery of abdominal and diaphragmatic hernias" (2022-2024).
The purpose of the study is to improve the results of surgical treatment of large and giant postoperative ventral hernias by introducing new laser technologies and improving the tactical and technical aspects of surgical treatment. Objectives of the study: to study the structure of immediate complications after various types of prosthetic plastic surgery; to clarify the influence of obesity factors, primary or repeat hernioplasty on the incidence of immediate and long-term complications; to evaluate the role of the immediate complicated course of the postoperative period in the incidence of long-term complications of hernioplasty; to improve the technical aspects of alloplasty for large and giant postoperative ventral hernias (POVH); to improve the technique of photodynamic therapy (PDT) of the wound surface after prosthetic plastic surgery; to study in an experiment the effectiveness of using the proposed technique of alloplasty and PDT; evaluate the morphological features of the condition of tissues during prosthetic plastic surgery using the proposed method; in a comparative aspect, evaluate the clinical effectiveness of the proposed alloplasty options in the immediate and long-term periods. The object of the study was the results of allohernioplasty in 448 patients with extensive (large) and giant POVH, who were operated on at the surgical department of the 1st clinic of the Samarkand State Medical Institute in the period from 2012 to 2021, as well as experimental animals on which the effectiveness was assessed developed a technique for prosthetic repair of postoperative ventral hernias and applied the technique of photodynamic therapy.
The subject of the study is to analyze the effectiveness of the developed alloplasty of postoperative ventral hernias and intraoperative photodynamic therapy in abdominal surgery in experiments and in the clinic. Research methods. To achieve the goal of the study and solve the assigned problems, general clinical, instrumental, biotechnological, experimental, histomorphological, microbiological and statistical research methods were used. The scientific novelty of the study is as follows: it was established that the need for extensive tissue mobilization and, as a consequence, the intersection of lymphatic capillaries during implantation of the prosthesis in the onlay position, as well as the lack of sufficient resorption function of the hernial sac in the inlay position causes a high risk of the formation of clinically significant seromas; It was determined that with prosthetic hernioplasty, along with the volume of the defect, the type of plastic surgery and the degree of obesity, the most significant predictor of the risk of developing immediate complications is the factor of re-intervention in case of recurrent hernia with the presence of a “dormant infection” hidden in the remaining ligature granulomas or scar tissue; the structure and clinical features of the course of long-term complications of hernioplasty for giant and extensive hernias were clarified, taking into account the results of the immediate postoperative period, as well as the option of fixing the prosthesis, primary or repeated hernioplasty and the degree of obesity; the method of surgery for large hernias of the anterior abdominal wall has been improved, characterized by a combination of factors such as the formation of tension-free prosthetic repair, preservation of local resorptive function to prevent the development of fluid accumulations and reducing the risk of infection; the method of preventing the development or progression of wound infection during alloplasty of ventral hernias has been improved, aimed at enhancing the antibacterial effect and stimulating reparative activity through the photosensitizing and photodynamic effect of low-energy laser radiation; It was determined in an experimental model of prosthetic plastic surgery that the proposed method of fixing the prosthesis in combination with the use of the effect of photodynamic therapy through laser radiation helps to enhance reparative processes with a reduced risk of wound complications; It has been proven that all methods of antiseptic exposure and laser stimulation of the wound surface after prosthetic plastic surgery enhance preventive measures against the development of local infection, but are ineffective in the case of an already developed purulent-inflammatory process against the background of the use of alloplastic material. The practical results of the study are as follows: it has been determined that the implantation of synthetic materials for giant and extensive hernias is accompanied by a significant number of wound complications caused by both the surgical technique itself and the reaction of surrounding tissues to a foreign body, requiring improvement of tactical and technical approaches when performing hernioplasty; it was clarified that scar-degenerative changes in the tissues of the aponeurosis in giant and extensive hernias are a predisposing factor to the occurrence of post-prosthetic hernias, especially when implanting the prosthesis in the “inlay” position and, accordingly, require increasing the efficiency of their fixation and engraftment, as well as reducing the risk of developing local complications; it was determined based on the data of an experimental study that the proposed method of alloplasty for large ventral hernias makes it possible to achieve adequate reconstruction of the anterior abdominal wall, reduce the incidence of infection in the wound, and also use a smaller size of prosthetic material; it was determined that the proposed method of tension-free repair of large hernias of the anterior abdominal wall with strengthening of the aponeurosis with a mesh implant allows maintaining physiology, reducing the number of complications, shortening treatment time and reducing the risk of hernia recurrence; It has been determined that the proposed method for preventing the development or progression of wound infection during alloplasty of ventral hernias can reduce the frequency of suppuration, shorten the treatment time and the likelihood of relapse; It has been proven that the use of the proposed tactical and technical aspects of prosthetic repair for postoperative ventral hernias can reduce the incidence of specific complications, reduce rehabilitation time and the risk of hernia recurrence. Reliability of the research results. The reliability of the results is justified by the use of objective criteria for assessing the condition of patients, modern methods of diagnosis and treatment, the correct application of methodological approaches and sets of statistical analysis, methods for solving the problems discussed in the dissertation are based on modern scientific and practical concepts and approaches to the diagnosis and surgical treatment of patients with giant postoperative hernias. Scientific and practical significance of the research results. The results obtained make a significant contribution to the expansion of irradiation of existing ideas about the structure and clinical features of complications of hernioplasty for giant and extensive ventral hernias by identifying the morphological features of the development of a purulent-inflammatory process against the background of the use of alloplastic material, studying predictors of the risk of developing immediate complications, mechanisms for enhancing reparative processes through the use of an improved method of fixing the prosthesis in together using the effect of photodynamic therapy through laser radiation, which made it possible to enhance the antibacterial effect and improve the wound healing process. The practical significance of the study is that, based on the results obtained, the tactical and technical aspects of prosthetic hernioplasty have been optimized, the features of methods of antiseptic exposure and laser stimulation of the wound surface after prosthetic repair have been revealed, enhancing preventive measures for the development of local infection, and the method of surgery for large anterior abdominal hernias has been improved walls, characterized by a combination of factors such as the formation of tension-free prosthetic plasty, preservation of local resorptive function to prevent the development of fluid accumulations, thereby reducing the risk of developing postoperative complications, reducing the frequency of unsatisfactory results, length of hospitalization and the likelihood of relapse. Implementation of research results. According to the results of a scientific study to optimize the tactical and technical aspects of surgical treatment of large and giant postoperative ventral hernias: the “method for plastic surgery of giant hernias of the anterior abdominal wall” has been improved (invention patent No. IAP 2022 0148 dated April 18, 2022). The proposed method of tension-free repair of large hernias of the anterior abdominal wall with strengthening of the aponeurosis with a mesh implant made it possible to reduce the number of complications, shorten the treatment time and reduce the risk of hernia recurrence; the “method for preventing the progression of infection during alloplasty of infected hernias” has been improved (certificate of the Ministry of Health No. 08-32071 dated October 17, 2022). The proposed method made it possible to reduce the frequency of wound purulent-inflammatory complications and shorten the period of rehabilitation of patients after allohernioplasty; methodological recommendations “Tactical and technical aspects of prosthetic repair for large and giant postoperative ventral hernias” have been developed (certificate of the Ministry of Health No. 08-32071 dated October 17, 2022) . The developed recommendations made it possible to optimize the tactical and technical aspects of allohernioplasty in patients with large and giant postoperative ventral hernias; The scientific results obtained were introduced into the practical activities of healthcare, in particular, in the departments of surgery of the Khorezm and Andijan regional multidisciplinary medical centers, the clinic of the Samarkand State Medical University (certificate of the Ministry of Health No. 08-32071 dated October 17, 2022). Improving the tactical and technical aspects of prosthetic repair for postoperative ventral hernias has made it possible to reduce the incidence of specific immediate complications from 40.9% to 15.6%, to reduce rehabilitation time from 8.6±2.7 to 7.1±1.5 days, and also reduce the likelihood of long-term complications from 11.7% to 3.1%. Approbation of research results. The results of this study were discussed at 8 scientific and practical conferences, including 5 international and 3 republican ones. Publication of research results. 26 scientific works have been published on the topic of the dissertation, including 9 journal articles, 4 of which in republican and 5 in foreign journals recommended by the Higher Attestation Commission of the Republic of Uzbekistan for publication of the main scientific results of doctoral dissertations. Structure and scope of the dissertation. The dissertation consists of an introduction, seven chapters, a conclusion, conclusions, practical recommendations and a list of cited literature. The volume of work is 200 pages.
According to the World Health Organization, in recent years there has been an increase in the incidence of acute respiratory viral infection. In this regard, the attention of pediatricians and otolaryngologists is attracted by acute stenosing -laryngotracheitis (ASLT). According to the data of many years of research, the number of patients with ASLT ranges from 0.1 to 0.4% of all children hospitalized with a diagnosis of acute respiratory viral infection. The development of stenosing laryngotracheitis in acute respiratory viral infection (AR.VI) dramatically aggravates the condition of sick children, and sometimes the life of a child depends on its attachment to the underlying disease.
Since the first days of independence , large-scale reforms have been consistently implemented in our country in order to improve the quality of medical care for the population . Thus, effective medical care for children ensured timely detection, early diagnosis and treatment of patients with ASLT, which made it possible to reduce the duration of their treatment in the hospital by 3-4 days.
Despite numerous scientific studies devoted to the study of the patterns of the infectious process in stenosing laryngotracheitis, the role of dysbiocenosis of the mucous membranes of the upper respiratory tract, the process of endogenous intoxication (El), which develops as a result of illness in children and its relationship with the course of the disease, as well as the state of the system of local and general immunity dictate the need to improve the methods of their correction in the light of modern requirements. At the same time, the causes of recurrence of acute stenosing laryngotracheitis have not been fully determined; an important task is to develop prognostic criteria for assessing the outcomes of OSLT.
Given the dissertation research to a certain extent serves to solve the problems provided for in the resolutions of the President of the Republic of Uzbekistan No. PP-2133 dated February 19, 2014 “On the State Program" The Year of a Healthy Child ’’and No. PP-2221 dated August 1, 2014 “On the State Program for Further Strengthening reproductive health of the population, protection of the health of mothers, children and adolescents in Uzbekistan for the period 2014-2018”, as well as in other legal documents adopted in this area.
Scientific research aimed at improving the methods of complex diagnostics, treatment and prevention of stenosing laryngotracheitis in children was carried out in many leading medical centers, such as the Schneider Children's Medical Center (Israel), Giessen University Hospital (Germany), St. Mary's Children's Clinic (Germany), Center of Innovative Medicine Interbalkan (Greece), Generale Clinic (Switzerland), Royal Clinic (Great Britain), Queens Medical Center (Great Britain), IDIBAPS Clinic (Spain), St. Luke's Hospital (Japan), Federal Scientific and Clinical Center of Otorhinolaryngology FMBA of Russia (Russia) , as well as the Tashkent Pediatric Medical Institute and the Republican Specialized Scientific and Practical Medical Center for Pediatrics (Uzbekistan).
As a result of the studies, criteria for assessing the risk of occurrence and recurrent course of OSLT were developed, the mechanisms that determine the sensitivity of the respiratory tract were identified (Freiburg Clinic, Germany); established endocrine dysfunction in children with primary and recurrent acute stenosing laryngotracheitis (Children's Hospital, Ireland); the influence of the composition of the microflora of the main loci of the body, connective tissue dysplasia, regulatory systems on the function of external respiration, the formation of threshold sensitivity and reactivity of the respiratory tract in children with recurrent stenosing laryngotracheitis (RSLT) was proved (Melbourne University, Australia).
At present, the goal of many studies in the world is to further determine at the immunomolecular level the role of specific and non-specific factors of immune protection in the pathogenesis of acute stenosing laryngotracheitis; assessment of the state of non-specific protection during OSLT; study of significant changes in the cellular link of immunity, changes in T-suppressors and partially B-lymphocytes; as well as the prevention of relapses and the improvement of methods for diagnosing and treating the disease.
As the analysis of special literature showed, a number of researchers studied the role of the allergic component and the autonomic nervous system in the pathogenesis of the development of primary and recurrent OSLT. According to the results obtained, more than 90% of sick children in the pathogenesis of primary and recurrent acute stenosing laryngotracheitis is dominated by allergic component with the identification of common and allergen-specific IgE . In addition, it has been proven that the development of OSLT in parainfluenza infection is associated with a significant increase in IgE titer and specific IgA in nasopharyngeal secretions in children with ARVI. The mechanisms of OSLT recurrence based on a significant change in the immunological reactivity of the body, which are associated with its allergization by both infectious and non-infectious agents, including adverse environmental, seasonal, meteorological and even social conditions, have been studied. It has been proven that OSLT proceeds with vegetative disorders, which, in turn, have a significant impact on the course and outcome of the underlying disease. An improved treatment of OSLT at the height of the disease is proposed, based on the use of drags, taking into account the type of initial vegetative tone of the body.
Despite numerous works devoted to the study of acute stenosing laryngotracheitis, its diagnosis and methods of treatment, the trend towards an increase in the recurrence of the disease persists, which dictates the need to study the general patterns of the infectious process in stenosing laryngotracheitis, assess the significance of the microbiocenosis of the mucous membranes of the upper respiratory tract, disorders of the immune and interferon statuses and development of ways to correct them, predict the disease on the basis of a prognostic map, as well as improve the effectiveness of treatment and preventive measures.