Factors causing the structure of urinary tract infections in hivinfected populations in Uzbekistan’s Fergana valley Текст научной статьи по специальности «Клиническая медицина»

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DOI: http://dx.doi.org/10.20534/ESR-17-1.2-150-152

Shadmanov Mirzamahmud Alisherovich, assistant of Andijan State Medical Institute, Uzbekistan

Mamasaliev N.S.,

Professor of Andijan State Medical Institute, Uzbekistan

E-mail: [email protected]

Factors causing the structure of urinary tract infections in hiv-infected populations in Uzbekistan's Fergana valley

Abstract: The results of clinical and population-based analysis of 507 HIV-infected population with an infection of the urinary tract (HIVUTI) . It is proved that the implementation of results of specific epidemiological studies in practice are potentially capable of interrupting the formation of the final "hard points" from HIVUTI: in 80-85% of cases, improving prognosis and determine effective ways to prevent HIVUTI still in preclinical stages.

Keywords: urinary tract infections, HIV-infection, HIV-population.

The problem of urinary tract infections (UTI) in HIV-infected people (HIVUTI) in modern urology remains relevant not only because of the frequency of occurrence, but also due to the need to review the pathogenetic mechanisms of the development and optimization of the treatment strategy against the background of specific therapy.

It should be noted that it is not always possible to identify the causative agent of UTI in HIV-infected patients (HIV-population) and assign causal treatment. In these clinical situations of particular importance, along with the so-called empiric therapy of elimination preventive measures against factors causing morbidity UTI, active and urgent prevention HIVUTI [1; 2; 3; 4].

The fact that the development and/or morbidity HIVUTI exert pathogenic effects on the one hand, structural or functional changes/urinary system violation and other -HIV infection and risk factors. Consequently, for the theory and practice of Urology are of interest not only to basic and clinical work on and epidemiological studies on the development of new prevention technologies HIVUTI [5; 6; 7; 8].

However, it is still not subjected to a focused study of factors that may affect the prevalence of UTI at HIV- patients. Practically not used a preventive approach and methods in this regard.

Materials and methods. Of the population HIV- lists were issued the passport data of persons aged 20-69 years previously drawn up a contract with the National Centre for AIDS and its departments in the field. The date of the start of the study and the date of its completion ■ strictly taken into account the rules of sampling to ensure a thorough and active preparatory work was carried out with high response: On the basis of a random representative sample and work with the HIV population was carried out in strict accordance with the pre-defined protocol in the following sequence has been formed HIV- population and personnel screening group: ■ before the screening test was carried out epidemiological study ofa random sample of50 HIV-positive people ■ people during training (trial) of the primary study population standardized approaches, methods of treatment worked and inviting representatives of the population in a screening center, the order and the procedure for comprehensive health survey. In the case of sampling errors (wrong information about the presence of HIV in a person who is in the sample, patients younger than 20 years; deaths -Face HIV in the sample prior to the study), these persons were excluded from the calculation of the response. In the absence of the respondent (all cases of refusal to participate in a survey of persons included in the sample, who died during the study period, no cases of the possibility of establishing contact with the respon-dent during multiple attempts)

Factors causing the structure of urinary tract infections in hiv-infected populations in Uzbekistan's Fergana valley

its replacement by another person is not allowed. All 507 patients HIV representatives ofthe indigenous population (503 Uzbek — (99.2%), 2 Tajik — (0.4%) and other nationalities — 2 (0.4%).

At the age of 20-29 years were 197 (38.9%) of HIV, 3039 years — 235 (46,4%), 40-49-65 (12.8%), 50-59 years — 8 (1,6%) and 60-69-2 (0.4%). The survey was conducted in the screening center using epidemiological (with an estimate of the conventional large FR, FR moderate to low RF), general clinical laboratory (general analysis of blood, urine and feces, study sediment urine), physical, functional and instrumental methods (ECG, anthropometric measurements. Review and excretory urography at the testimony, four cups of urine test). HIVUTI diagnosis (acute pyelonephritis, urethritis, prostate, kidney stones, cystitis) was based on the standards of survey data (frequent and painful urination, aching, or paroxysmal pain above the vagina and/or in the lumbar region, discharge of turbid or bloody urine, Table 1. - Comparative evaluation of the dec

urgency and withhold urine, temperature reaction with chilling), the results of clinical, biochemical, functional and instrumental studies. Statistical processing of the materials carried out on a PC Pentium IV with a standard package of Microsoft EXCEL-2007 applications. We used the methods of multivariate statistical analysis, rank correlation analysis. The significance of differences of the studied parameters was evaluated by t-test (t): invalid — P>0.05, low confidence — P <0.05, the average — P<0.01 and high — P<0.001.

Results and discussion. The results of the comparative assessment of communications HIVUTI with common factors have shown that the most pronounced prevalence Us HIVUTI body mass reduction (BMR) (r= - 0,54, x2= 62,4, P<0.001), and excessive alcohol consumption (r = - 0,48, x2= 45,2, P<0.001).

Table 2 provides a comparative assessment of the HIV Communication and UTI with behavioral risk factors. 5 of coupling HIVUTI with shared risk factors

General risk factors value r x2 P

Body mass reduction 0,54 62,4 <0,001

Excessive use of alcohol 0,48 45,2 <0,001

Body weight increase 0,29 38,3 <0,01

Impaired glucose tolerance 0,26 34,5 <0,01

Arterial hypertension 0,22 29,8 <0,05

Dislipoproteinemia 0,18 23,5 <0,05

Microelementoses 0,15 17,7 <0,05

Unhealthy Lifestyle 0,13 8,9 <0,05

Physical inactivity 0,10 3,6 <0,05

Table 2. - Comparative evaluation of communication HIVUTI with behavioral risk factors

Behavioural risk factors value r++ x2 P

Consumption of drugs 0,50 49,8 <0,001

Smoking 0,46 44,3 <0,001

Dietary factors 0,28 32,4 <0,05

Infectious agents 0,19 22,5 <0,05

Stress factors 0,12 7,98 <0,05

Table 3. - Comparative assessment of HIVUTI connection with the socio-economic risk factors

Socio-economic risk factors value r++ x2 P

Poor living conditions 0,42 40,6 <0,01

Inadequate intake of fruits and vegetables 0,27 33,7 <0,05

Low educational status 0,16 18,4 <0,05

Factor family problems 0,14 7,1 <0,05

Adverse social status 0,11 3,88 <0,05

The findings in this area suggest that the most pronounced (r= - 0,50, x2= 49,8), and 1.1 times less, smoking (r= - 0,46, x2= HIVUTI connection with the consumption of narcotic means =44,3).

Table 4. - Mathematical model of the cluster of risk factors and progression of UTI in the population, HIV "Socio-epidemiological portrait HIVUTI"

General biological features, socio-economic and epidemiological risk factors associated with the development and progression of IMT in HIV-positive people The significance of differences in groups according to the criterion + Krus Kal -Walts

1 2

Body mass reduction P<0,001

Excessive use of alcohol P<0,001

Consumption of drugs P<0,001

Multiple factors P<0,001

Smoking P<0,001

Impaired glucose tolerance P<0,01

1 2

Body weight increase P<0,01

Poor living conditions P<0,01

Factor family problems P<0,05

Low educational status P<0,05

Inadequate intake of fruits and vegetables P<0,05

Infectious agents P<0,05

Stress factors P<0,05

Dietary factors P<0,05

Microelementoses P<0,05

Unhealthy Lifestyle P<0,05

Physical inactivity P<0,05

Dislipoproteinemia P<0,05

Arterial hypertension P<0,05

Gender (women) P<0,05

Age (20-29 years old) P<0,05

Monofaktory P<0,05

Direct correlation is also observed with dietary factors (less 1.5 times r=-0,28, x2=32,4), infectious factors (reduced by 2.2 times, r=-0,19, x2=22.5) and stress factors (smaller by 6.3 times, r =-0,12, x2=7,9).

The results of the special statistical analysis (by variance-covariance analysis with important models) indicates (Table 3) that high a correlation exists between HIVUTI and poor housing and living conditions (r=-0,45, x2=40,6), inadequate intake of fruit and vegetables (r=-0,27, x2=33,7), low educational status (r =-0,16, x2=18,4), factor family problems (r=-0,14, X2=7,1) and unfavorable social status (r=-0,11, x2=3,8).

In general, it was found that the presence of the general, epidemiological and socio-economic risk factors discussed above notes a progressive increase in the incidence ofUTI among HIV-population. These facts, in our opinion, have a scientific and practical and prognostic significance to improve the diagnostic and treatment process and the development of prevention technologies for the prevention HIVUTI among HIV-positive population. We have studied and investigated the contribution of the study of risk factors in the development HIVUTI. The data obtained are shown in Table 4, which shows that a special analysis helped to create a mathematical model of the cluster of risk factors and progression of UTI matched each population, that is, "Socio-epidemiologic portrait HIVUTI" in modern conditions.

The direct dependence HIVUTI of 22 risk factors. The risk of BMI in the HIV-positive population in unfavorable epidemiological situation is most pronounced in the presence of aggressive consumption of drugs, multiple risk factors and smoking; moderately expressed tendency of BMI cluster disadvantaged epiduslovy and availability Impaired glucose tolerance factor, overweight and poor living conditions of life. Slowly UTI matched each formed in the presence of risk factors such as: NPOIF, infections, stress, diet, microelementoses, unhealthy lifestyle, lack of exercise, dislipoproteinemia, hypertension, age and gender, monofaktory.

Thus, the factors that structure causing morbidity HIVUTI, the presence of which should anticipate the possibility of urologi-cal HIVUTI continuum. Otherwise, any medical diagnostic and preventive technology to a certain extent loses its meaning, that is to our knowledge — 22.7% 100.0% 13.6% — 50% and in 68.2% of cases 25.0%.

Conclusion These data and identified epidemiological patterns suggest the need for a comprehensive and simultaneous "impact" approach to the development of prevention and treatment and rehabilitation, taking into account the mutual influence of risk factors in a population of HIV-population, as well as the relationship with the established HIVUTI epidemiologic situation.

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Factors influencing the choice of hernia repair method in patients with incisional hernias

DOI: http://dx.doi.org/10.20534/ESR-17-1.2-153-155

Shamsiyev Azamat, Samarkand State Medical Institute, doctor degree in medicine, department of pediatric surgery E-mail: [email protected] Davlatov Salim, Samarkand State Medical Institute Master degree in medicine, Department of surgical diseases № 1 E-mail: [email protected]

Factors influencing the choice of hernia repair method in patients with incisional hernias

Abstract: The research work is based on analysis of hernia repair results in 228 patients with incisional, recurrent and primary ventral hernias. All operations were performed in the surgical department of the 1st and 2nd SamMI Clinics in period from 2008 to 2016. Patients were divided into two groups: the control group and the main one. Long-term results of surgical treatment of incisional and recurrent hernias were observed in 196 patients in period from 1 to 10 years. From 196 studied patients with long-term observation of outcomes 112 were in the main group, who were assessed by the mark score, and 84 were in the control group. From 84 examined patients of the control group tension hernia repair using autotissues was performed in 36 patients, hernia repair using polypropylene mesh implants in 41 and tension-free mesh repair in 7 patients. The mark score of assessment the perioperative risk criteria in patients with incisional hernias allows you to choose the best way of hernia repair based on individual characteristics of the organism and improve treatment outcomes.

Keywords: incisional and recurrent hernias, tension free mesh hernia repair, mark score, program.

Relevance. Despite the dynamic development of medical science, the problem of treatment of ventral hernias remains relevant. The increased incidence of ventral hernias is maintained mainly due to incisional hernias, after the laparotomy it is from 10 to 15% according to various data [1; 4; 7]. Results of surgical treatment of incisional hernias are largely dependent on complex issues such as the rational preoperative preparation aimed at the patient's adaptation to increased intraabdominal pressure, the choice of an adequate method of hernia repair and prevention of postoperative complications [3; 6; 7; 9]. In this case the surgeon has a difficult task in determining the indications for use of a particular method of hernia repair taking into account the different risk factors. As a rule, surgeon takes into account the possibility ofpostoperative complications and the risk of post-operative recurrence ofhernia choosing the particular method of hernia repair. To solve the problems every surgeon is guided by its own criteria [2; 5; 8]. Some authors are guided by

Table 1. - Distribution of the main

clinical data, others — by the data of various instrumental methods of research, others use different algorithms to decide how repair the hernia. Analysis of scientific medical and patent documentation shows that in available literature three is no exact indications for use of a particular method of hernia repair taking into account the different risk factors. The decision of the above-mentioned problems is an urgent and priority issue in modern today herniology.

Purpose of the research: To develop a program for quantifying recurrence risk factors in patients with ventral hernias.

Materials and methods. The work is based on an analysis of hernia repair results in 228 patients with incisional, recurrent and primary ventral hernias. All the operations were performed in the surgical department of the 1st and 2nd SamMI Clinics date from 2008 to 2016. The patients were divided into two groups: the control group (96-42.1%) and the main group (132-57.9%). Patients in the main group were divided into 3 subgroups (table 1). group of patients into subgroups

Gender Group Total

1st 2nd 3d

Male 13 15 29 57

Female 22 26 27 75

Total 35 41 56 132

№ Risk factors Quantitative characteristics Marks

1 2 3 4

1 Condition of the abdominal wall by ultrasound, CT. Normal Mild weakness Severe weakness 0 1 2

Up to 5 cm 0

2 Width of the hernial ring 6-15 cm More than 15 cm 1 2

Table 2. - Scoring system of indications to the use of different methods of hernis repair