The aim of the study was to identify predictors of decreased glomerular filtration in patients with chronic obstructive pulmonary disease (COPD). Materials and methods. We analyzed 145 case histories of patients diagnosed with COPD. The majority (84.1%, n = 122) of them are males (the average age of men is 60.7 ± 0.9 years, the average age of women is 62.0 ± 2.7 years). A comparative analysis of the prevalence of risk factors for chronic kidney disease (CKD) in patients with COPD: age, gender, smoking, arterial hypertension, overweight, etc. The glomerular filtration rate (GFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD – EPI) formula, according to which the patients were divided into 6 groups: group 1 - hyperfiltration, group 2 - GFR CKD – EPI ≥ 90 ml / min / 1 , 73 m2, 3rd - GFR CKD – EPI 60–89 ml / min / 1.73 m2, 4th - GFR CKD – EPI 45–59 ml / min / 1.73 m2, 5th - GFR CKD – EPI 30 - 44 ml / min / 1.73 m2 and 6th-GFR CKD-EPI <30 ml / min / 1.73 m2. Results. Patients with COPD have a high incidence of CKD risk factors. A correlation was found between the prevalence of CKD risk factors and the severity of COPD. The main predictors of the development of CKD in patients with COPD: duration of COPD> 9 years, body mass index> 26.5 kg / m2, smoking index> 51.3, albumin> 44.0 g / l, total protein> 70.0 g / L, forced expiratory volume in the first second ≤ 1.6 L, right atrial size> 35.5 mm, systolic pressure in the pulmonary artery> 36.6 mm Hg. Art., the thickness of the posterior wall of the left ventricle> 10.5 mm, Tiffno's index ≤ 62%. Conclusion. It was found that patients with COPD
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.
The purpose of the study is to determine the significance of genetic factors in the development of chronic nephritic syndrome in children and to clarify the features of the clinical course
The оbject of research were 129 children aged 4-15 years who were treated for chronic nephritis in the nephrology department of the Samarkand Regional Multidisciplinary Paediatric Medical Centre.
The scientific novelty of the study is as follows:it has been established that the severity of chronic nephritic syndrome in children is associated with clinical manifestations (gradual development, dyspepsia, abdominal pain) and an increase in the amount of Cystatin C in the blood;for the first time, it was revealed that the development of sclerotic lesions due to increased proliferation in patients with the presence of the MMP-9 (A-8202G) rs 11697325 genotypes in chronic nephritic syndrome leads to a worsening of the clinical course of the disease; established early diagnostic marker MMP-9 (A-8202G) rs 11697325 and its tissue inhibitor TIMP-2 (C536T) rs 11551797 in chronic nephritic syndrome in children in the diagnosis of the disease; for the first time, the prognostic value of the alleles of the MMP-9 (A-8202G) rs 11697325 genes and the homozygous G/G genotype in determining the risk of developing the disease in children with chronic nephritic syndrome has been proven.
Implementation of the research results. Based on scientific results of evaluation of the role of polymorphic genes of matrix metalloproteinase and its tissue inhibitors in chronic nephritic syndrome in children: methodological recommendation “The role of polymorphic genes of matrix metalloproteinase and its genetic inhibitors in the development of chronic nephritic syndrome in children” was developed and approved (reference of the Ministry of Health of the Republic of Uzbekistan No. 8n-r / 554 of 30.02.2022).
This methodological recommendation made it possible to predict the development of chronic nephritic syndrome in children and improve preventive measures; approved and developed on the basis of scientific results of research on early diagnosis and prognosis of chronic nephritic syndrome “Dynamics of clinical and laboratory parameters in nephritic syndrome in children”, (reference of the Ministry of Health of the Republic of Uzbekistan No. 8n-r / 555 of 30.02.2022).
This methodological recommendation made it possible to optimize the diagnosis and treatment tactics for various forms of nephritic syndrome in children;
The results obtained were implemented in the practice of health care, in particular, in the Republican Children's National Medical Center, in the 1st clinic of the Samarkand State Medical University, in the Samarkand Regional Children's Multidisciplinary Medical Center (conclusion No. 8 n-r/324 of 21.06.2022 of the Ministry of Health of Uzbekistan).
The application of the obtained results to practice has made it possible to reduce the frequency of recurrence of the disease in children, prevent complications of the disease, improve the quality of life of patients, diagnose and prevent the disease.
The structure and scope of the dissertation. The dissertation consists of an introduction, 4 chapters, conclusions, practical recommendations. The volume of the dissertation is 120 pages.
The problem of pulmonary hypertension (PH) is very essential for a large number of clinical conditions. It naturally occurs in many internal diseases, especially in patients with valvular heart disease, chronic lung pathology, vasculitis with vascular lesions of the pulmonary circle, pulmonary embolism, heart defects and many others. Increased blood pressure within the pulmonary artery (PA) is a natural step in the progression of chronic heart failure.
Purpose: transition of anemia chronic disease along with other chronic diseases
Materials and methods: 82 patients with chronic anemia were observed
Results: Anemia occurs in infectious diseases, non-infectious diseases, asthma, and autoimmune diseases. The frequency of anemia in chronic diseases is 100%. In terms of prevalence, anemia ranks second after iron deficiency anemia in the elderly, from 2.9 to 61% in men and 3.3 in women. from 41%. Chronic anemia occurs in half of all patients with systemic diseases of the connective tissue. In chronic diseases of the kidney, the hemoglobin level is below 100 g/l. In the treatment of anemia in this category, the main disease is treated first (in infectious diseases, antibacterial treatment against infection, basic and anti-inflammatory treatment in rheumatic diseases, surgery treatment if there is an indication (abscess in the head of the abdomen, purulent pyelonephritis, etc.
Recommending iron preparations and vitamin 12 to these patients will be ineffective because the underlying disease must be treated:
Conclusion: Anemia aggravates the course of a chronic disease if it is accompanied by other chronic diseases.
Chronic obstructive pulmonary disease (COPD) and severe bronchial asthma (BA) are some of the main causes of pulmonary arterial hypertension and account for more than 50% in the structure of pulmonary hypertension formation. The paper studies the state of central hemodynamics and endothelial function of peripheral vessels in patients with chronic obstructive pulmonary disease, bronchial asthma complicated by pulmonary hypertension (LH).
Viral hepatitis (VH) belongs to the category of infectious diseases of the human body that develop under the influence of viruses, which are diverse in nature, in the ways of their spread and transmission from a patient to a healthy person and have one identical attribute - liver damage. VG is an atroponous infection, which means that their pathogens in natural conditions can only be present in the human body.
In hepatitis of viral origin, pathogens have a selective similarity (tropism) to liver cells. For this reason, the early location of viruses and their replication (reproduction) are manifested mainly in the liver tissue, primarily in liver cells (hepatocytes).
According to the nature and duration of development, hepatitis of viral origin is divided into acute and chronic. The threshold among these two types of disease is relatively taken into account 6 months from the onset of the disease or in certain patients from the onset of infection (if the disease does not develop) and up to 6 months - acute hepatitis B or acute virus carrier, after 6 months - chronic hepatitis or chronic virus carrier. [4; 8].
According to WHO, in different countries of the world more than 2 billion people are infected with viral hepatitis (VH), while about 350 million are carriers of hepatitis B and 500 million of hepatitis C [3; 5].
All known hepatitis viruses are present in the CIS countries. In relation to parenteral infections of viral hepatitis, the CIS countries belong to the region with a moderate incidence rate (35.2 cases per 100,000 people). In Tatarstan, the share of viral hepatitis "B" and "C" in the total number of viral hepatitis is 80%. According to some authors [1], the number of so-called "virus carriers" of infection is growing in our republic, more than 10,000-12,000 primary carriers of hepatitis B and C viruses are registered annually. However, the registered incidence is only a part of the true incidence and only the visible part of the "iceberg". This is due to the fact that most cases of hepatitis B occur outside the scope of medical diagnosis, without jaundice and with minor clinical symptoms. However, the anicteric form of parenteral hepatitis is less dangerous than the icteric form in terms of infection and consequences [10].
Viral hepatitis B and C belong to the group of viral hepatitis with a parenteral transmission mechanism. These pathogenic viruses are taxonomically distinct. Common features are the parenteral transmission mechanism and the obligatory circulation of the virus in the blood [7].
Viral hepatitis B is a strictly parenteral infection caused by the IIBV virus, including CMV; IIBV is highly resistant to cold, heat, chemical and physical attack. It persists for 3 months at room temperature and 25 years in dried plasma; a direct correlation has been demonstrated between IIBV duration and blood levels. [6].
The source of transmission of the virus (HBV) can be all forms of acute and chronic HBV, as well as virus carriers. More important as the main source of infection for the epidemic potential are chronic forms of HBV infection than acute ones. An important role is played by chronic carriers of HbsAg and patients with clinically icteric form of IIBV; the ability of IIBV to persist for a long time, often for life, in the human body is considered as an ecological form of its existence [3; 5].
The most fully studied artificial (artifacial) ways of HBV infection as a result of various parenteral therapeutic, diagnostic, therapeutic and non-medical manipulations, leading to a violation of the integrity of the mucous membranes and skin. The source of infection can be contaminated blood products, medical equipment and instruments, transplanted organs and tissues; transfusion of blood or blood products containing HBV can also cause infection (post-transfusion hepatitis) [8; 11].
In addition to medical procedures, non-medical parenteral injections are of paramount importance in the transmission of IIBV infections. This is especially true of intravenous administration of drugs, which has become widespread in recent years. According to a number of authors [2], it has been shown that in recent years there has been a rapid increase in the number of patients with acute viral hepatitis "B", which is associated with the use of intravenous drugs, and a quantitative increase in the incidence is observed among young men aged 15 to 30 years. . Below is a list of the most common causes of acute viral hepatitis B.
The purpose of this study is to substantiate the functional features of periodontal tissues in chronic hepatitis B, C and mixed infection B + C.
The aim of the research work is to improve the results of surgical treatment of chronic anterior-medial dislocations of the radial head in children based on the improvement of the method of surgical treatment.
The object of the study was 83 patients with chronic antero-medial dislocations of the head of the radius, treated in the department of the consequences of childhood injuries of the Samarkand branch of the RSSPMC of Traumatology and Orthopedics for the period 2017-2020. The scientific novelty of the research work is the following: it is proved by histological examination that, in case of injuries from up to 1 month ago, the anterior wall of the joint capsule is thin and elastic, which is easily stretched, and from 3 months ago, it thickens, scars and forms fibrous tissue; the possibility of using a fibrous-modified joint capsule for annular ligament plasty in the surgical treatment of chronic antero-medial dislocations of the radial head from 3 months ago was proved; the tactics of surgical treatment of chronic antero-medial dislocations of the head of the radius depending on the deformity of the bones of the forearm were determined; a direct relationship between the results of surgical treatment of chronic antero-medial dislocations of the head of the radius, depending on the duration of the injury, has been proven.
The introduction of research results. Based on the obtained scientific results on the optimization of surgical treatment of chronic antero-medial dislocations of the radial head in children:
based on the results of the development of a method for annular ligament plasty, a patent for an invention was obtained from the Intellectual Property Agency of the Russian Federation “A method for the surgical treatment of chronic anterior medial dislocation of the radial head in children by capsuloplasty according” (patent № 2749870 dated 06/17/2021). The results obtained made it possible to improve the results of surgical treatment, to reduce the period of penetration in the hospital and after the surgical rehabilitation period; based on the results of scientific research on the surgical treatment of chronic anterior medial dislocations of the radial head, the guidelines “Surgical treatment of chronic dislocations of the radial head in children” were approved (Conclusion of the Ministry of Health of the Republic of Uzbekistan 8 n-z / 81 dated February 21, 2022). The results obtained have improved the quality of early diagnosis and treatment of patients with chronic anterior medial dislocations of the radial head in children; based on the results of scientific research on the surgical treatment of chronic antero-medial dislocations of the head of the radius, the methodological recommendations “Conclusion of the Ministry of Health of the Republic of Uzbekistan 8 n-z / 289 of August 31, 2021” were approved. The results obtained have improved the quality of early diagnosis and treatment of patients with chronic anterior medial dislocations of the radial head in children;
Scientific results have been introduced into the practice of healthcare (Conclusion of the Ministry of Health 08-32955 of October 24, 2022), in particular, the Samarkand branch of the Republican Specialized Scientific and Practical Medical Center for Traumatology and Orthopedics, the Bukhara branch of the Republican Scientific Center for Emergency Medical Care, and the Samarkand Regional Children's Multidisciplinary Medical Center. The proposed method for the treatment of chronic anterior-medial dislocations of the radial head in children allowed to reduce the frequency of relapses, increase excellent and good results from 75.6% to 92.9%.
The structure and scope of the dissertation. The dissertation consists of an introduction, 5 chapters, conclusion, conclusions, practical recommendations, a list of references and applications. The volume of the dissertation is 109 pages.
Topicality and demand of the subject of dissertation. Bronchial asthma (BA) is one of the most common and serious diseases, which in the world suffer from 3 to 12% of the child population of the globe. Proportion of adolescents with asthma, is one third of all children with this disease. High prevalence of asthma in the numbers of teenagers, characteristics of the disease, age-related aspects of the functioning of the endocrine and immune systems of teenagers that cause difficulties which arise in the course of the diagnostic process, highlight the need to find innovative approaches to diagnosis and treatment of this disease.
It is known that the key immune mechanisms in the pathogenesis of the vast majority of AD cases is real and indisputable fact. Currently, considerable interest to researchers involved in the pathogenesis of positions of allergic diseases, especially asthma, along with IL-4 and IL-13 causes a number of other (IL-6, IL-8, IL-10, IL-5, INF-a and INF-y) immunoregulatory cytokines.
Genetic predisposition plays an important role in the development of allergic diseases. Currently available data on the relationship with asthma and associated with disease symptoms polymorphism approximately 150 genes. Important role as the main contender for the predisposition to asthma gene is a gene encoding flchain of high affinity receptor IgE. Interaction elevated levels of antigen-specific IgE with FceRip plays a central role in the pathogenesis of allergic asthma. Particularly attractive candidate gene asthma is also one of the enzyme genes biotransformation - GSTirl, encoding glutathione S-transferase and л1 express almost exclusively in the pulmonary tissue. This gene is located at the locus 11 ql 3, for which repeatedly shown clutch with atopic symptoms. Accumulated in the literature say about the relationship of gene polymorphism FceRI, GSTnl with different allergic diseases.
From this perspective, the study of immunological and genetic mechanisms of the pathogenesis of this disease for the construction of rational treatment and prevention emphasizes the relevance of this thesis research.
From the earliest days of independence, the country has successfully implemented state programs aimed at reforming the health care system. As a result, the targeted implementation of organizational health and research activities aimed at effective diagnosis, prevention and treatment of asthma among adolescents, with some success in the treatment of this disease in the country. However, now the problem of early diagnosis and the development of effective programs for treatment and prevention among adolescents with asthma remain one of the most important issues of modern health care. This research work was carried out in the framework of the tasks set by the Resolution of the Cabinet of Ministers of the Republic of Uzbekistan "On additional measures to improve the health of women and the younger generation," dated 25.01.2002 for the №32. In this regard, the need to deepen the information received about the state of cellular and humoral immunity among adolescents, asking pathogenetic informative immunogcnctic studies in asthma arc one of the important criteria demand the dissertation topic.
Purpose of research is study the immunological and genetic mechanisms of the pathogenesis of asthma in adolescents and form the basis of this plan rational diagnostic and therapeutic measures in this pathology.
In To achieve this goal the following tasks of research is solved:
to establish the clinical course of asthma in the population of adolescents living in the Samarkand region, in the early stages of the pathological process in the bronchopulmonary system.
explore the features of the state of cellular and humoral immunity, as well as activation markers in asthma in adolescence by determining the immunophenotype of lymphocytes in the peripheral blood.
to examine the level of production of immunorcgulatory cytokine interleukin-6 and interfcron-y and install them pathogenetic informative in asthma among adolescents.
to determine the features of distribution of allele and genotype frequencies of polymorphic variants of genes and FceRip GSTnl population Uzbek people with asthma, compared with the healthy part of the population.
examine the clinical and immunological aspects effectiveness of therapies using drugs and polioksidony tsikloferon in patients with asthma in adolescence.
on the basis of studies to develop a multivariate model of formation of bronchial asthma and develop an optimal algorithm for the diagnosis, treatment, prevention in adolescents with this pathological condition.
Scientific novelty of dissertational research consists in the following:
proposed introduction to the work of doctors teen clinics layered approach testing can significantly improve the detection rate of asthma in adolescence and optimize treatment and preventive measures in high-risk groups;
first defined the peculiar characteristics of the quantitative parameters of the immune status of patients with asthma in the cohort of adolescence and the corresponding proposed regulations and guidance documents for the healthy part of the adolescent population;
for the first time presents a comprehensive assessment of the cytokine profile of blood serum in bronchial asthma in adolescents. Specific features of products immunorcgulatory cytokines IL-6 and INF-y and their pathogenetic and regulatory information content in asthma among adolescents;
first analyzed the distribution of alleles and genotypes of polymorphic gene variants and gene FceRip GSTirl among patients with different phenotypic variants of AD and healthy individuals of Uzbek nationality, which resulted in the identified markers of increased risk or, conversely, resistance to the development of asthma in adolescents Uzbek ethnicity;
algorithms for phase diagnosis, treatment and prevention of asthma in adolescence in terms of disclosure of important moments of the pathogenesis of the disease, allowing to build a rational sequence of diagnostic search, aimed at verifying the diagnosis and expedient construction of preventive measures.
Conclusion
1. Set the frequency of occurrence of the disease and the structure of "asthma" in the arid zone among teens. Said pathology is recorded in 9,6% of the population surveyed adolescents, while the disease is more common among females. In the structure of the disease prevails periodical exposure and mild persistent form.
2. Identified by clinical features of asthma among adolescents living in the arid zone, indicate a high frequency of lesions of the bronchial tree association with allergic processes in other organs and tissues: in 73,9% of the AR, 53,7% with AK. 16,6% with BA and 14% with urticaria/angiocdcma.
3. Found that in the study population of patients with asthma adolescence occur expressed disturbances of the immune status, manifested deficit indicators as cell (CD3‘, CD4+, CD8 , CD16+), and humoral immunity (CD19 , IgA, IgG, IgM) and activation markers (CD23+, CD95). The immune status of patients with asthma in young people, adolescence has distinctive features, the depth of detected violations immunoreactivity was most pronounced in the younger age group.
4. In patients with bronchial asthma in adolescence revealed distinct changes in cell-cell interactions in the immune system: a significant increase in the content of Th2-cclls secreted IL-6 is a regulator of maturation of antibodies and immunoglobulin production itself, and vice versa reducing regulator activity of Th 1-cell cytokine INF-y.
5. It was found that the contents of cytokines IL-6, INF-y and in the peripheral blood is in communication with one pathogenic disease. It is shown that the lowest level of INF-y production in the scrum is characteristic of allergic clinical pathogenic variant asthma in adolescence. Adolescents suffering from predominantly infectious form of asthma, there is a sharp trend towards increased production of IL-6 in peripheral blood.
6. Revealed that markers of increased risk of allergic forms of asthma in adolescents Uzbek ethnicity arc genotype FceRip-109T/T allele FceRip-109T, low-risk markers - FcsRip-109C/C and allele Fc£Rip-109C. A high degree of cohesion genotype FcsRip-109T/T allele and FcsRip-109T with hereditary burden of asthma in the Uzbek population.
7. Among females ethnic Uzbek Association revealed lie-105 allele and genotype Ilc-105/Ilc-105 polymorphic gene locus GSTkI at high risk for asthma. Revealed that the genotype associated with the development Ilc-105/Ilc-105 allergic form of asthma in adolescents Uzbek population.
8. Complex therapy with adolescents’ patients with asthma ciklofcron and polyoxidonium, providing immunocorrective effect, enhances the clinical efficacy of basic therapy. In the study of prophylactic efficacy of immunomodulators positive indicators prevailed in the group of patients receiving polioksidony, necessitating its inclusion in the priority scheme of integrated treatment and prevention of asthma in adolescents.
Diabetes is a major cause of chronic kidney disease (CKD). Poor blood sugar control accelerates the progression of CKD to terminal renal failure. Chronic kidney disease is also an important co-morbidity of diabetes. Impaired renal function further increases the risk of cardiovascular events in diabetic patients and ultimately carries a severe social and economic burden. Altered fibroblast growth factor 23 (FGF-23) and Klotho levels are considered the earliest biochemical abnormality of chronic kidney disease, the mineral and bone disease syndrome.