CC BY
3
УДК 375.894
Kirgizova H.
Toshtemirova I.
Vakhobov B.
Kamolova N. Andijan state medical Institute Uzbekistan, the city of Andijan PULMONARY PNEUMONIA IN PATIENTS WITH CHRONIC HEART FAILURE: DIFFICULTY DIFFICULTIES
Abstract: The scientific review examines the effect of chronic heart failure (CHF) on the course of community-acquired pneumonia (IP). Difficulties in interpreting the radiographs in patients with CHF, the possibility of using the results of determining biomarkers for differential diagnosis and optimizing the treatment of EP in patients with CHF are discussed in detail.
Keywords: Community-acquired pneumonia, chronic heart failure, difficulties in diagnosis.
Киргизова Х.
Тоштемирова И.
Вахобов Б.
Камолова Н.
Андижанский государственный медицинский институт
Узбекистан, г. Андижан
Аннотация: В научном обзоре рассматривается влияние хронической сердечной недостаточности (ХСН) на течение внебольничной пневмонии (ВП). Подробно рассмотрены трудности интерпретации рентгенограмм у больных ХСН, возможности использования результатов определения биомаркеров для дифференциальной диагностики и оптимизации лечения ВП у пациентов с ХСН.
Ключевые слова: Внебольничная пневмония, хроническая сердечная недостаточность, трудности диагностики.
A distinctive feature of the modern clinic of internal diseases is the presence of one or more patients with two or more internal diseases. Of particular relevance is the comorbid pathology in cases of a combination of diseases that have important medical and social significance. They are understood as widespread diseases, accompanied by high morbidity, disability and mortality, treatment and prevention of which entails high economic costs. To these diseases with full justification can be attributed to community-acquired pneumonia (VP) and chronic heart failure (CHF). The spread and danger of these diseases dictate the need for further study of etiopathogenesis, the clinic, treatment and prophylaxis of both of them individually, and the combination of the same patient.
The incidence of EP is 3-11 cases per 1000 adults per year and the largest among patients of the older age group. Men are sick more often than women. The presence of such diseases as chronic obstructive pulmonary disease (COPD),
chronic heart failure (CHF), chronic renal failure (CRF), liver disease, immunodeficiency states, predisposes to the emergence of EP. Outcomes of the disease are worse in elderly patients and in the presence of concomitant diseases. The mortality from EP remains unchanged, despite the introduction of new classes of antibiotics into clinical practice in recent decades. Pneumonia with influenza is the eighth leading cause of death in the US.
Among patients with GP who received treatment in a hospital, mortality varies between 5-20%, and in hospitalized in intensive care units (ICU) can reach 50%. The mortality rate in cases of IP is not related to the resistance of pathogens to antibiotics. In the United States, mortality in the population of patients enrolled in the Medicare program is more than 40% after 1 year after the ERP. This means that pneumonia can be a surrogate marker of a severe underlying disease or that it initiates some undesirable consequences for the patient that can eventually lead to his death.
The economic damage from the EaP in the US alone exceeds $ 17 billion annually, and in Europe - 10 billion euros. The bulk of the funds are spent on the treatment of hospitalized patients. The potential benefit from reducing the length of stay of patients with EI in the hospital for at least 1 day may be $ 2,000.
The prevalence of CHF increased over the past 40 years. Data on the incidence of CHF are contradictory and depend on the criteria for diagnosing this syndrome, the studied patient population and many other factors. So, according to one of the recent population-based studies, the incidence of CHF in the population of men over the age of 18 is 4.24 (95% confidence interval (CI) 4.05-4.43) per 1000 person-observation, in the female population - 3, 68 (95% CI 3.52-3.84) per 1000 person-observation. The incidence significantly increases with age (in the age categories of 65-74 and> 75 years it is ten times greater than that at the age of 18-54). Despite the fact that the incidence of CHF remains quite stable for many years, the prevalence of CHF increases and in men it exceeds 2.1%, and in women it approaches 1.8%.
In patients with CHF with a reduced systolic function of the left ventricle (LV), the risk of hospitalization and death is increased. Despite the improvement of medical care for patients with CHF, the frequency of hospitalizations for this disease continues to increase, largely due to the "aging" of the population in developed countries and the improvement of survival in many diseases due to effective interventions and treatment [15-17]. In the United States in the last decade, CHF has become the leading cause of admission to the adult population. The frequency of hospitalizations for CHF is greatest among patients with low socioeconomic status, especially if there are concomitant diseases.
The economic damage from CHF in the US annually exceeds 37 billion dollars. Approximately 70% of all costs for CHF are the costs associated with hospitalization of patients. Mortality of patients with CHF for 1 year is> 20%, 5-year mortality rate exceeds 50%, and mortality over 10 years is more than 80%.
30-35% of patients with CHF have at least 1 concomitant disease, 30-33% have 2, and 14-18% have 3 or more concomitant diseases. The most frequent
among them are arterial hypertension, diabetes mellitus (DM) and ischemic heart disease (CHD). Lung diseases (infectious and non-infectious) are the leading cause of noncardial mortality in patients with CHF-both immediate and associated comorbidities
The presence of CHF increases the risk of adverse outcome in patients with EI. The negative effect of CHF on the prognosis in patients with EI is reflected in many prognostic scales. For example, CHF is one of the components of the PSI prognostic chart (Pneumonia Severity Index), which is used both to address the place of treatment of the patient with EP and to assess the risk of adverse outcome. In this scale, 20 parameters are used, among them - demographic factors, concomitant diseases, objective and laboratory characteristics of the disease. In the list of concomitant diseases, malignant neoplasms, liver diseases, CHF, cerebrovascular diseases and kidney diseases are mentioned.
The destabilization of CHF may be one of the first manifestations of EP, which makes it difficult to clinically diagnose both diseases. Thus, acute destabilization of CHF and inflammatory lung diseases (pneumonia, as well as COPD, acute bronchitis, exacerbation of bronchial asthma, etc.) are the most frequent causes of acute shortness of breath in patients entering hospital reception rooms, with about one third patients, dyspnea is due to two or more concomitant disease.
Known difficulties arise in the determination of the functional class of CHF in patients with EP. One of the simple, reproducible and affordable methods for assessing the functional capacity of the heart is a 6-minute walking test . In accordance with the recommendations of the American Society for the Study of Heart Failure the New York Heart Association (NYHA) criteria or a 6-minute walking test should be used to assess the severity of the disease and the functional state of the heart. This point of view is supported by experts from the American College of Cardiology and the American Heart Association, who confirmed the significance of the 6-minute walking test to assess the prognosis and severity of functional impairment in patients with CHF, although they noted that the results of repeated measurements of the traversed path may not correlate with changes in the clinical state of the patient. However, this test is unsuitable for use in patients with CHF and EP.
Patients with CHF are mainly elderly and senile. On the other hand, more than 80% of all cases of EP occur in the age category of persons older than 60 years. Age is the most important prognostic factor in predicting mortality within 30 days after admission in patients with EI. Persons of the older age group are more prone to pneumonia due to anatomical and physiological changes that occur in the lungs over time. Aging is associated with a progressive decrease in lung function, including a decrease in the elastic response of the lungs, the compliance of the chest wall and the strength of the respiratory muscles. In addition, with age, the alveoli gradually increase, which leads to an increase in the residual volume and a further increase in the load on the respiratory muscles. All these changes contribute to the reduction of cough reflex in elderly and senile people. Reduction
of the emetic reflex, together with a change in the cough reflex, leads to an ineffective mucociliary clearance of secretions (secretions) of the respiratory tract.
Bibliography:
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2. Capelastegui A., Espana P.P., Bilbao A., Gamazo J., Medel F., Salgado J. et al., on behalf of Poblational Study of Pneumonia (PSoP) Group. Study of community-acquired pneumonia: incidence, patterns of care, and outcomes in primary and hospital care // J. Infect. — 2010. — 61. — 364371.
УДК 811.247
Nurdinova F.X.
Head teacher of the Department of « Foreign languages» Namangan Engineering Construction Institute
MODERN METHODS OF TEACHING FOREIGN LANGUAGES
Abstract: This article discusses the actual problems of studying a foreign language. New approaches to the study of foreign languages were analyzed
Keywords: teaching, method, science, crisis, language
Аннотация: В этой статье рассматриваются актуальные проблемы изучения иностранного языка. Были проанализированы новые подходы к изучению иностранных языков
Ключевые слова: обучение, метод, наука, кризис, язык
In the methods of teaching the English language, the most applied were communicative-oriented concepts. Among them the most popular are communicative, project, intensive and activity-based methods.
A few words about the history of their appearance, development and basic provisions.
The nomination of a foreign culture as a learning goal raised the issue of the need to create a new methodological system that could achieve this goal in the most effective and rational way. Then the staff of the Department of Foreign Languages Training of the Lipetsk State Pedagogical Institute for a number of years developed the principles of communicative methodology.
The logic of the development of a communicative methodology led to the final nomination of a foreign culture as the goal of teaching foreign languages in school. A similar system can be built only on a communicative basis.
In addition, as the practice of using the communicative method has shown, it provides not only the assimilation of a foreign language as a means of communication, but also the development of the comprehensive qualities of the personality of the students.
Communicative method was the basis for creating textbooks on English in
