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11cholesterol level, increases the complex concentration of gall acids and also increases the phospholipids inside the gall. Of the results identified, it is assumed that the juice of the Kokanica ferrula of prevents the appearance of stone in the gallbladder and is one of the most valuable reparatives of therapeutic effects.
Kawords: Kokanica, ferula, composition, juice, kokanica, chemical, elements, sour, flaminum, gall, cholesterol, bilirubin, medicinal, experimental.
Сведение об авторах:
Хафизов Давлатёр Шомуддинович - ассистент кафедры анатомии и физиологии Таджикского государственного педагогического университета имени Садриддина Айни. Телефон: (+992) 918818298. E-mail: Davlatyor_2015@mail.ru
Шамсудинов Шаъбон Нацмудинович - кандидат биологических наук, доцент кафедры анатомии и физиологии Таджикского государственного педагогического университета имени Садриддина Айни. Телефон: (+992) 935085614. E-mail: Samsudinov.@mail.ru
Каримов Акобир Изатуллоевич — доктор биологических наук, професор декан биологического факултета Таджикский национальный университет г. Душанбе, Республика Таджикистан тел. 8(10 992) 919416472. E-mail: karimov. akobir@inbox.ru
Information about authors:
Khafizov Davlatyor Shomuddinovich - assistant of the Department of Anatomy and Physiology of the Tajik State Pedagogical University named after Sadriddin Ayni. Phone: (+992) 918818298. E-mail: Davlatyor_2015@mail.ru
Shamsudinov Shabon Najmudinovich - candidate of biological sciences, associate professor of the Department of Anatomy and Physiology of the Tajik State Pedagogical University named after Sadriddin Ayni. Phone: (+992)935085614. E-mail: Samsudinov.@mail.ru
Karimov Akobir Izatulloevich-doctor of biological Sciences, Professor Dean of biological faculty Tajik national University Dushanbe, Republic of Tajikistan tel. 8(10 992) 919416472. E-mailKarimov. akobir@inbox.ru
OTOLARYNGOLOGIC MANIFESTATIONS OF GASTROESOPHAGEAL
REFLUX DISEASE (GERD)
Dr.Abdullah Darman Rahimzada
Medical Faculty of Balkh University
Pohandowi Dr. Mohammad Younis
Medical faculty of Balkh University
Summary
Reflux Disease (GERD) is a widespread disease in digestion system and the disease break out has been increased in recent years. One fourth population has been affected in the developed countries in the world. The both male and female affected equivalently though out years.
GERD disease affects daily 10% and weekly 30% population in the world. Some newly-made information provided about dark sides of this diseases and which considered to be widespread than expectations. Because it's specified that some 25% ill people infected to GERD diseases.
It has been declared that Reflux Disease widespread causes of laryngitis diseases in human.
Some complications have seen including inflammation and damages of tissue of Barratts Esophagus for men, increasing age is considered to be important factor in the onset of the complications. White skin people infects more than other people with different races but the disease seen among all races in the world.
Key Words: Reflux and symptoms of Otolaryngologic for children and old age people.
Explanation the topic: Gastric acid reverse are considered to be common people and series disorders will accrue during process. It's essential that it must be emphasized on introduction, ways of diagnosis, treatment and outbreak of the disease, so which will decrease outbreak of the disease as possible.
Preface
Reflux disease is to be considered as important, lack of edification and lack of awareness paves the way for infection. This has threats, series complications and uncontrolled risks aftermath.
We are experiencing some incidents during practice days. Reflux takes great cost due to treatment and pursuit session held for the patients. Therefore, this issue must be taken serious and specifically studied or inspected with all aspects.
Over large number of people affected with the diseases which compel us to consider more and prepare treatment and prevent outbreak through researches.
Therefore, fatalities, complications and disorders are considerable for relevant people which needs more specific probe.
We knew that economic, social problems, lack of awareness, neglect of government institutions and lack of diagnoses are factors to increase the diseases outbreak. These factors made people to face series problem.
. Population growth and migration are among the contributing factors today
But it's important to identify cause of threat which cooperates with health of community and support to defuse as well as prevent widespread of the diseases.
If ongoing incidents or situation are on progress including neglect for outbreak and treatment, so this diseases causes great costs in the community and takes time for recovery process.
I propose from academic research centers in order to work further because of widespread of the diseases around the world.
Its estimated that 25% patients have only upper and lower extremities. This extremity or worry including one or more as follows: high saliva, harsh sound, post-nasal drip, changes in voice, cough, sticking food to throat, feeling blocking food to throat, earache, clearing throat, neck ache, sore throat, feeling burning to throat and feeling choking. Carcinoma and respiratory system can be included to chronic reflux diseases.
Importance of research
• Evaluation of GERD Reflux diseases and phsiupitology.
• Reflux diseases introduction and not to mistaken with other diseases based on specific consideration.
• Resisting on treatment and lack of following up of treatment by infected people.
• Earlier checkups or diagnoses which prevent further complications and guidelines for treatment of the diseases.
• Introduction of appropriate descriptions for the patients in order to be healthy and prevent return of the disease.
Goals
• Receiving diseases incidents at research area and matching it with different areas.
• Receiving counterpart or different pathology tools at incident areas..
• Evaluation of symptoms based on situation of the patient.
• Receiving disorders and complications from the diseases during evaluation process.
Research Queries
• What causes to affect people Reflux diseases?
• Does acid play important role for having Reflux diseases?
• What are the most cases which create Reflux acid diseases?
Research hypothesis
1: It is thought that not paying attention to the causative factors and the steps of diagnosis and non-treatment have a meaningful relationship with the disease.
2: Lack of awareness of the disease and a number of maladaptive eating habits are thought to play a significant role in the development and progression of the disease
3: Poverty and social and cultural disruption seem to have a major impact on the disease.
Background
Gastro esophageal reflux Disease (GERD) presents itself at epigastria burning and regurgitation. The disease is very common and symptoms such as hoarseness, laryngitis, posterior
paraphrase, hoarseness, chronic perforation, globes pharyngiosus, earache, sore throat, neck pain and many other symptoms may be reflux manifestation.
(Johnson DA, 2014, 126)
The disease sometimes manifests as extra pulmonary or atypical illnesses, such as chest pain such as heart disease, pulmonary symptoms such as chronic stoma and perforation, laryngeal symptoms such as aphonic and hoarseness, or sleep disturbances.
Although the underlying causes of reflux disease remain unknown, the structure and function of the esophageal gastric junction are important in the pathogenesis of the disease. In people with mild to moderate reflux, the passage of the lower esophageal sphincter is no greater than in healthy individuals, but compared to these patients, those with severe reflux often have hiatal hernia. (Hom C, 2013, 71-91)
The prevalence of the disease is estimated to be around 25% in western countries based on clinical symptoms such as chest pain and acid regurgitation at least once a week.
It is one of the most common digestive diseases that have been increasing in recent years. The decrease in H. pylori infection rate in recent years has led to an increase in gastric acid production and is one of the possible reasons for this upward trend. Helicobacter pylori infection can cause gastric acid depletion by the simultaneous involvement of the enteric and gastric body (which contains acid secreting cells). Another possible cause of the increase is the obesity epidemic at the present time. The prevalence of familial disease and its complications has suggested the genetic role of this disease. Here are some of the causes of the disease:
Inferior esophageal sphincter loosening during swallowing is in 5-10% of patients with reflux.
Low-pressure esophageal sphincter in a number of patients with reflux may be a contributing factor, and non-steroidal fatty foods, alcohol, tobacco, and non-steroidal anti-inflammatory drugs are also cited.
Hypothelial hernia is isofagite-induced reflux in 94-54% of patients. This hernia can impair the function of the lower esophageal sphincter as well as impair the esophageal acid clearance. (M Nilsson, 2004, 53)
Two important factors in causing reflux otolaryngologic manifestations are:
1: Reflux changes caused by vagus nerve stimulation
2: Direct contact of gastric juice with acid, pepsin, bile and secretory gland secretions in the upper esophageal mucosa, larynx and trachia.
Eating, Fast Eating, Whole Foods, Eating Highly Anxiety, Eating Spicy, Fatty, and Sour Foods, Consuming Spicy and Fried Shrimp, Eating Variety of Fatty and Pure Sauces, especially Red Sauces, Eating Bread It is not cooked properly, wearing tight clothes, eating heavy foods that put extra pressure on the lower esophageal sphincter, lying down immediately after meals, lifting heavy objects or bending too much because it puts pressure on the sphincter, causing pregnancy. The stomach can cause or aggravate reflux. Overweight, obesity due to increased intra-abdominal and gastric pressure are also considered to be factors that make gastro esophageal reflux. (Richter JE, 1998, 93)
Entering the gastric acid into the distal oesophagus through stimulation of the vagus nerve or other refluxes causes the throat to become chronically flat and coughing, followed by signs and symptoms of Larynx disease. Oesophageal motility disorders can cause esophagitis. It is unclear whether esophagitis leads to oesophageal motility disorders or a dysfunctional motor dysfunction that makes a person susceptible to reflux disease.
Loss of saliva at bedtime is the cause of the nocturnal reflux periods, which prolongs the time the acid is cleansed from the oesophagus and causes inflammation in the oesophagus. Cigarette smoking also prolonged oesophageal clearance time due to decreased salivation and in addition nicotine cigarette reduces inferior esophageal sphincter pressure causing reflux.(Orenstein R, 2002, 34)
Delay in gastric emptying is one of the important causes of disease especially in diabetic patients with neuropathy. In these patients, the discharge of solids is slow.
Acid and pepsin are important factors in causing mucosal damage due to gastric contents returning to esophagus. Animal studies have shown that acid alone causes mild injury, whereas low-dose pepsin acid destroys the gastric mucosal barrier and permits greater permeability and mucosal changes. Bile seems to exacerbate the damage caused by reflux acid in the esophagus. (Katle EJ, 2013, 238
In various studies, mental disorders in people with reflux disease, especially a group of patients who do not have clear mucosal lesions at endoscopy, are more commonly seen. In other studies, increased acid secretion during stress, slowing gastric emptying with psychological stress, and increased esophageal sensitivity have been suggested as mechanisms involved in the occurrence of the disease.
Chest burning is one of the main symptoms of the disease that begins in the stomach or lower chest and spreads to the neck and bladder and sometimes back and worsens after consuming bulky foods.
Other common symptoms are the exhaustion of hot gas or the sensation of bitter and salty fluid entering the bladder, which usually occurs without pressure and after food intake and worsens in sleep (Sherman PM, 2009, 104
Swallowing is reported in 30% of cases. Usually, after a long period of back burns and swallowing, swelling progresses toward solids. Weight loss is an uncommon symptom.
Excessive salivation, painful swallowing, belching, nausea and vomiting are symptoms of the disease, and may be less common. Some elderly patients have no symptoms.
Most recent studies have shown that chest pain caused by reflux disease is the most common cause of non-cardiac chest pain.
Reflux disease should be considered in patients with a coma that appears in adolescence, without allergic causes and which does not respond well to routine treatment of coma. These patients do not have the main symptoms of reflux disease but are relieved by treatment with reflux disease. Samuels TL, 2010, 203)
Laryngitis caused by reflux is common. These patients present with hoarseness, a feeling of something in their throat, and frequent sore throats. Reflux Disease is the third leading cause of chronic perforation after sinus and stoma diseases. Twenty percent of people with chronic serous dementia have reflux. (Katle EJ, 2013, 23)
Severe bleeding, esophageal rupture, and esophageal lumen stenosis account for 23-7% of reflux esophagitis complications.
Diagnosis is based on clinical evidence and symptoms and response to treatment. But sometimes diagnostic measures are needed to confirm the disease or to track the complications of the disease. Perform specific examinations if necessary.
Examination of staples is prescribed for Helicobacter pylori.
Endoscopy is one of the methods of diagnosis, if necessary.
Confirmation of the diagnosis should inform the patient of the following points and outline treatment modalities, with a view to the contributing factors and the exacerbating factors.
Antacids neutralize gastric acid and also increase inferior esophageal sphincter pressure. It should be used every one to three hours after meals and repeatedly to relieve symptoms.
Treatment with acid suppressants is the simplest and most definitive way to diagnose the disease and evaluate its association with symptoms. Treatment with a proton pump suppressor (the most potent acid suppressor) usually lasts 2 to 6 weeks.
Proton pump inhibitors inhibit the secretion of food-stimulated acid and nocturnal acid to a greater degree than the H2 receptor. Consumption of H2 type II receptors (cimetidine, ranitidine, famotidine and also isatidine), like antacids, cannot completely restore esophagitis, especially in cases of severe esophagitis.
Medications that help lower esophageal sphincter help to clear the stomach more quickly, including domperidone and metoclopramide.
Drugs that control muscle spasms, such as disicyclamine and hyoscine
Antidepressants such as, nortriptyline, desipramine, low dose sertraline antibiotics are used in the stomach if Helicobacter pylorus is present in the stomach.
Improve your lifestyle and proper diet.
The patient receives less meals and more often.
Avoid pain-inducing foods, such as spicy and fatty foods
Chew slowly and thoroughly
Avoid getting too much air through the mouth in situations such as smoking, eating fast, chewing, drinking through the straw, consuming carbonated beverages.
Maintaining a post-meal vertical status means that you should not lie down or sleeps for at least two hours after a meal.
Lift pillows during sleep, especially in cases where there is nocturnal reflux.
1: Avoid tight clothing.
2: weight loss if reflux is associated with obesity.
3: No alcohol or smoking
Identifying stressors in daily life and actions such as exercise, listening to relaxing music, praying, etc. can counteract daily stresses (Hom C, 2013, 71-91).
Learning and practicing exercise techniques such as breathing relaxation, meditation, yoga, relaxation muscle therapy, etc.
You should not exercise immediately after eating; you should always give your stomach and digestive an opportunity to digest food.
Finally, esophageal motor dysfunction, impaired cleansing mechanisms, and low acidity and pain caused by acid in the esophagus have no effect on the occurrence of atherogenic manifestations (Dent J, 2005, 710).
Otolaryngologic manifestations of esophagea reflux head and neck
Common manifestations of reflux otolaryngology Uncommon manifestations of reflux
Hoarseness Feeling foreign body in the throat
Chronic cough Neck pain, mouth and throat
Straighten the throat Oropharyngeal dysphagia
Chronic laryngitis Bad smell, and bad taste
Globes Farrangius Dental Injuries
Acoustic and granulomas of the vocal cord Otalgia
Laryngeal stenosis and Trachia Chronic sinusitis
throat cancer Croup and Strider
Laryngospasm Yi attack Dysphonia
Epigastric burning and regurgitation Uncommon manifestations of reflux
In various studies, about 50-80% of patients with chronic hoarseness have a reflux pH meter study. Ness and her colleagues studied 18 patients who had hoarseness, including about 50% with hiatal hernia and esophagitis.
Patients who have more than three weeks of chronic serpentia cause posterior parenchyma, chronic bronchitis, and stoma, with about 20% of these patients suffering from reflux. These patients usually do not smoke; have normal chest radiographs (Orenstein R, 2002, 34
Research Methodology
In this study, a mixed research method was used, ie direct observation and accurate patient history and complementary examinations as well as library resources.
This prospective study was conducted on 149 patients, including 83 females and 66 males. Patients referred to the clinic were closely monitored and supplemented by examinations, taking into account all the characteristics of the patient and the registration of the discharge and its associated factors. Results
Table 1- Percentage of events by gender
Sex Number Per cent
Male 66 44.3
Female 83 55.7
Total 149 100
Table 2 - Percentage of events by sex and age
Sex Male Total Female Total
Age in years 3 41 11 21 3 41 5
0 0 0 0 0 0 0 0
Number 21 39 6 66 6 38 27 8 4 83
Per cent 31.8 59 9 100 9 45.8 32.5 9.6 4.8 100
Table 3- The number and percentage of reflux otolaryngologic manifestations
Otolaryngologic manifestations Hoarseness cough Globus throat clearing heartburn or acid regurgitation stenosis reflux laryngitis Dysphagia chronic cough miscellaneous
Number 37 40 36 62 64 3 55 34 49 19
Per cent 25% 27% 24% 41% 43% 2% 37% 23% 33% 13%
Taking into account Table 1, it is observed that reflux constituted 55.7% more females, while males were 44.3%. Taking into account the social and cultural conditions of our people, it is thought that stress is more prevalent in women and that stress is likely to play the most important role in reflux production in women. Inadequate nutrition, inadequate nutrition, condemnation at home, lack of self-reliance, and lack of economic income and the high number of births and home-based births can be factors in the production of disease in women.
The second table shows that Reflux accounted for 59-40% of men in the age group of 40-40, while women accounted for the most (45.8%) in the same age group. In contrast, the lowest percentage of incidents was reported in the age group of 51-60 years (4.8%), while there was no incidence in men in this age group, but the lowest incidence was recorded in men in the age group of 41-50 years.
Most of the cases were heartburn or acid regurgitation, with 64 patients.
Discussion
Approximately 7.8% of the population daily experienced gastric irritation due to frequent gastric reflux. If reflux symptoms occur more than twice a week, the person is affected.
Acid reflux is one of the most common health problems and can have many symptoms.
Increasing saliva after each meal can be a sign of reflux. When the salivary glands feel a stimulating agent in the esophagus, they increase their activity and prepare to wash, erase, and move everything in the esophagus.
People often confuse heartburn and sourness with heart attack.
It often happens that people with severe chest pain go to the emergency department, while their main problem is reflux. The story can also be true. People with heart attacks do not go to the emergency department because they think they have reflux. If in doubt, see your doctor.
It is far more common than previously thought, as new diagnostic tests have helped patients identify. In the United States, for example, more than 2 million people experience heartburn at least once a month, and some studies estimate that about 2 million people in the country suffer from it every day and 6 million children These patients are struggling.
Conclusion
According to research, the risk of developing esophageal cancer in a person with a 4-year history of severe reflux is more than 5 times that of a person without reflux.
When the stomach acid gets out of the stomach, it is not only irritates the throat but can also make its way to the lungs. If this happens, you will get a headache. If you have chest pain repeatedly and for no apparent reason, reflux can be one of the causes.
In children, besides problems such as esophageal inflammation, reflux can cause gastric contents into the esophagus, which can lead to inflammation and lung infection, and sometimes even apnea, which sometimes have life-threatening effects on the baby.
Stress most likely plays the most roles in reflux production. Inadequate nutrition, inadequate nutrition, condemnation at home, lack of self-reliance and lack of economic income and the high number of births and home affairs can be factors contributing to the production of disease in women.
Suggestion
1: Introduce and publicize more about its agents and toys so that people in the community can become more aware of it.
2: Since exercise is one of the best programs to get rid of a number of important factors, work needs to be done to encourage more exercise.
3: Establishing strong centers for the treatment of patients with psychiatric problems and programs through the media to alleviate stress are among the most valuable initiatives.
4: Good food culture is one of the most important issues that need to be addressed by the community, especially through specialized nutrition programs.
REFERENCES
1. Dent J, El-Serag HB; Wallander AM; Johansson S, ( 2005) "Epidemiology of gastro-oesophageal refluxe disease: a systematic review, p. 710 -70.
2. Gilger MA. (2003), Pediatric otolaryngologic manifestations of gastroesophageal reflux disease. Curr Gastroenterol Rep, p.247-52.
3. Goh KL, Chang CS, Fock KM, (2000), et al: Gastroesophageal reflux disease in Asia. J Gastroenterol Hepatol 15:230
4. Hom C, Vaezi MF. (2013), Extraesophageal manifestations of gastroesophageal reflux disease. Gastroenterol Clin North Am. p.71-91.
5. Johnson DA, Fennerty MB: (2004), Heartburn severity underestimates erosive esophagitis severity in elderly patients with gastroesophageal reflux disease. Gastroenterology 126:660
6. Katle EJ, Hatlebakk JG, Steinsvag S. (2013), Gastroesophageal reflux and rhinosinusitis. Curr Allergy Asthma Rep. p.218-23.
7. M Nilsson, R Johnsen, W Ye, K Hveem and Leagergren. (2004) "Lifestyle related risk factors in the aetiology of gastro- oesophageal reflux". Gut; 53; 1730 -1735.
8. Orenstein R, Shalaby TM, Barmada M, Whitcomb DC, (2002), Genetics of gastroesophageal reflux disease: A review. J Pediatr Gastroenterol Nutr 34:506,.
9. Richter JE, Falk GW, Vaezi MF, (1998), Helicobacter pylori and gastroesophageal reflux disease: The bug may not be all bad. Am J Gastroenterol 93:1800
10. Samuels TL, Johnston N, (2010), Pepsin as a marker of extraesophageal reflux. Ann Otol Rhinol Laryngol .;119(3):203-8
11. Sherman PM, Hassall E, Fagundes-Neto U, (2009), et al. A global, evidence-based consensus on the definition of gastroesophageal reflux disease in the pediatric population. Am J Gastroenterol.;104(5):1278-95.
12. Tasker A, Dettmar PW, Panetti M, Koufman JA, Birchall JP, (2002), Pearson JP. Reflux of gastric juice and glue ear in children. Lancet. 359(9305):493
13. Yawn RJ, Acra S, Goudy SL, Flores R, Wootten CT. (2015), Eosinophilic laryngitis in children with aerodigestive dysfunction. Otolaryngol Head Neck Surg.153(1):124-9.
Сведения об авторе: доктор Абдулла Дарман Рахимзада, доцент медицинского факультета Балхского университета.
Сотрудник: похандуи Доктор Мохаммад Юнис Лектор на медицинском факультете Балхского университета.
About the author: Researcher: Dr.Abdullah Darman Rahimzada Assistant Professor at Medical Faculty of Balkh University.
Co-worker: Pohandowi Dr. Mohammad Younis Lecturer at Medical faculty of Balkh University.
ХУСУСИЯТ^ОИ МОРФОЛОГИЮ ЭКОЛОГИИ НАВЪ^ОИ (ШАКЩОИ) РУСТАНИИ АНГАТ (HIPPOPHAE RHAMNOIDE S l) ДАР ХДВЗАИ ДАРЁИ ИСКАНДАР
Садиков Х.Х.
Донишгоуи миллии Тоцикистон
Дар асоси талаботи конуни Чумхурии Точикистон "Дар бораи мухофизат ва истифодаи олами наботот" № 31 аз 17 майи соли 2004 принсипхои сиёсати имрузаи давлат дар сохаи мухофизат ва истифодаи окилонаи олами наботот тахким бахшидан, асосхои хукукй, иктисодй ва ичимоии ин сохаро муайян намудан, ба хифз ва баркарор кардани захирахои олам и наботот нигаронидан мебошад.
Аз ин лихоз, мухофизати табиат ва дуруст истифодабарии боигарихои табии Чумхурии Точикистон хамеша мавзуи асосии давлат ва хукумат ба хисоб меравад. Х,ануз аз даврахои кадим мардуми точик истифодаи сарватхои табииро, аз чумла рустанихои дорувориро бо таври сахех асоси зиндагонй ва муоличаи касалихои гуногун мехисобиданд. Хусусан дар солхои охир, бо ташаббуси Асосгузори сулху вахдат, Пешвои миллат, Президенти Чумхурии Точикистон, Ч,аноби олй, мухтарам Э. Рахмон ахамияти мухим доштани масъалахои мухофизати табиат, муносибати боэхтиёт ба боигарихои кишвари махбуби мо, кабудизоркунии мухити атроф, аз он чумла окилона истифодабарии рустанихои доруворй, ки ба тараккиёти рузафзуни куввахои истехсолкунандаи чамъият ва таъсири фаъолияти инсон ба мухити зист маънидод карда мешавад. Аз ин гуфтахо бар меояд, ки дуруст истифодабарй, нигохдорй ва аз нав баркароркунии сарватхои табий хусусан наботот муносибати эхтиёткорона ва истифодаи онхоро аз руи талаботхои меъёрию хукукй аз мо талаб менамояд [8, 9, 10].
Чй тавре, ки дар маколахои илмии пештара кайд карда будем, хавзаи дарёи Искандар байни каторкуххои Зарафшон ва Х,исор чойгир буда, ба зернохияи марказии нохияи ботаникию географии Зарафшон тобеъ мебошад. Масохати умумии хавза 950 км2 - ро дар бар гирифта, аз баландии 1750 м аз сатхи бахр то баландии 5633 м аз сатхи бахр (к. Чимтарга) чойгир аст [5,9].
