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THE MECHANISM OF DEVELOPMENT AND IMPROVEMENT OF TREATMENT OF ACUTE SINUSITIS OCCURRING WITH A BLOCK OF NATURAL FISTULAS Ulmasov B.B.1, Arifov S.S.2 Email: Ulmasov17164@scientifictext.ru
1Ulmasov Biser Bakhodir ugli - Assistant, DEPARTMENT OF OTORHINOLARYNGOLOGY, ANDIJAN STATE MEDICAL INSTITUTE, ANDIJAN;
2Arifov Sayfutdin Saidazimovich - Doctor of Medical Sciences, Professor, Head of the Department, DEPARTMENT OF OTORHINOLARYNGOLOGY, CENTER FOR THE DEVELOPMENT OF MEDICAL PERSONNEL, TASHKENT, REPUBLIC OF UZBEKISTAN
Abstract: acute sinusitis - the most common causes are acute respiratory diseases, viral infections (such as influenza), hypothermia, colds, general bacterial infections, trauma. The course of the disease can aggravate the curvature of the nasal septum, hypertrophy of the lower or middle turbinates, impaired immunity, an allergic process, an increase in the nasopharyngeal tonsil (adenoid vegetation in children). The fistulas of the nasal sinuses can be blocked with various deformations of the intranasal structures (hypertrophic rhinitis, curvature of the nasal septum, anomalies in the structure of the ethmoid labyrinth and turbinates). As a result of inflammation, the mucous membrane of the paranasal sinuses and nasal cavity swells. The mucous glands begin to secrete a large amount of secretion. The fistulas of the paranasal sinuses narrow even more due to edema of the mucous membrane and are clogged with a thick pathological secretion. Keywords: acute sinusitis, treatment, viral infection, course of the disease.
МЕХАНИЗМ РАЗВИТИЯ И СОВЕРШЕНСТВОВАНИЯ ЛЕЧЕНИЯ ОСТРЫХ СИНУСИТОВ, ПРОТЕКАЮЩИХ БЛОКОМ
ЕСТЕСТВЕННОГО СОУСТЬЯ 12 Улмасов Б.Б. , Арифов С.С.
1Улмасов Бисёр Баходир угли - ассистент, кафедра оториноларингологии, Андижанский государственный медицинский институт, г. Андижан;
2Арифов Сайфутдин Саидазимович - доктор медицинских наук, профессор, заведующий
кафедрой, кафедра оториноларингологии, Центр развития медицинского персонала, г. Ташкент, Республика Узбекистан
Аннотация: острый синусит - причинами чаще всего бывают острые респираторные заболевания, вирусные инфекции (например, грипп), переохлаждение, простуда, общие бактериальные инфекции, травмы. Течение заболевания может усугубить искривление перегородки носа, гипертрофия нижних или средних носовых раковин, нарушение иммунитета, аллергический процесс, увеличение носоглоточной миндалины (аденоидные вегетации у детей). Соустья носовых пазух могут блокироваться при различных деформациях внутриносовых структур (гипертрофические риниты, искривление носовой перегородки, аномалии строения решетчатого лабиринта и носовых раковин). В результате воспаления слизистая оболочка придаточных пазух и носовой полости отекает. Слизистые железы начинают вырабатывать большое количество секрета. Соустья параназальных
пазух еще больше сужаются из-за отека слизистой и забиваются густым патологическим секретом.
Ключевые слова: острый синусит, лечения, вирусная инфекция, течения заболевания.
UDC 616.216-07-085
Introduction. Sinusitis is an inflammatory disease of the paranasal sinuses associated with infection or allergic reactions. The incidence of sinusitis among the population of our country is 40%. With sinusitis, the cells of the ethmoid bone, maxillary, frontal and, finally, the sphenoid sinuses are damaged [3].
Nowadays, it is customary to say sinusitis, since most often there is a combined inflammation of the mucous membrane of the paranasal sinuses and the mucous membrane of the nasal cavity [1].
The most common types of pathology of the upper respiratory tract are inflammatory diseases of the nose and paranasal sinuses, they occupy the second place in the structure of diseases of the ENT organs. Patients with inflammation of the paranasal sinuses account for 29-30% of all patients in otorhinolaryngological hospitals and 15-16% of outpatients [7].
Acute maxillary sinusitis is a widespread disease and represents one of the important problems of otorhinolaryngology. Acute rhinosinusitis is a disease that is most often encountered not only by otorhinolaryngologists, but also internists, pediatricians and general practitioners [4].
The prognosis for acute sinusitis is favorable, subject to timely treatment and prevention of complications. In chronic sinusitis, the prognosis can be favorable if the allergen is eliminated (identified) and good drainage is provided using a sinus puncture or yamik procedure [2].
In European countries, sinusitis occurs annually in every seventh person. In the United States, 31 million cases of rhinosinusitis are registered per year, and in Russia -over 10 million cases per year.
Acute sinusitis is one of the most common human diseases, and this problem becomes more and more urgent every year. This is evidenced by an increasing number of various consensus documents that appear regularly in Europe and the United States and are based on the results of new evidence-based studies and meta-analysis data.
At the same time, in different countries, the criteria for accounting for the incidence and the algorithms for the diagnosis and treatment of rhinosinusitis themselves differ significantly, and for chronic rhinosinusitis (CRS) these differences are more pronounced than for acute.
Among adults, this figure is 2-3 episodes per patient per year. Secondary bacterial infection of the paranasal sinuses after a viral URTI develops in 0.5-2% of adults and in 5% of children. Acute rhinosinusitis in 2-10% of cases has a bacterial etiology, and in 90-98% of cases is caused by viruses.
Purpose of the study. To establish the presence of additional fistulas in patients with various diseases of acute sinusitis.
Materials and research methods. A total of 350 patients were examined, of which the middle nasal passage was examined in 250. The examination was performed using a rigid endoscope with a diameter of 4 mm with an angle of 30 °. Previously, application anesthesia and anemization of the nasal mucosa were performed with solutions of S. Lidocaini 10% and S. Adrenalini hydrochloridum 0.1% using a sterile cotton swab.
Research results. According to the severity of the process, sinusitis is divided into mild, moderate and severe.
The data obtained are presented in the table. Among patients of the 1st group with acute HE, DS was detected in 61.1% of cases, of which on the background of PPI - in 45.5%. In group 2 (patients with chronic HE), DS was visualized in 63.8% of cases, of which, against the background of PPI, in 53.3%.
In patients with short-course odontogenic HP (group 3), DS was found in 35.7% of cases, of which 60% were found against the background of PPI. In the 4th group (long-term odontogenic HE), DS was observed in 55.6% of studies, of which, against the background of PPI, in 20% of patients. In the 5th group (patients with PPI without concomitant sinus pathology), DS was found in 30% of cases, in the 6th group (with PPI against the background of sinus diseases, except for VSP) - in 38.9%.
Among patients without pathology of SNP and nasal cavity (7th, control group), DS was detected most rarely (13.2% of cases).
The main goal of the treatment of acute bacterial sinusitis is to eradicate the pathogen. In this regard, preference in prescribing an antibacterial drug should be given to drugs with rapid bactericidal effects.
In this case, the criteria for the effectiveness of treatment are, first of all, the dynamics of the main symptoms of sinusitis (local pain or discomfort in the projection of the affected sinus, nasal discharge, body temperature) and the general condition of the patient.
In the absence of a noticeable clinical effect within three days, without waiting for the end of the course of therapy, the drug should be changed.
The prerequisites for the formation of FJ are, apparently, aerodynamic disturbances arising from PPI, which lead to a deflection of the air stream into the fountain area, as a result of which, possibly, a portion of the mucous membrane dries out, focal atrophic processes and FJ occur.
In the presence of DS, hyperventilation of the VSP occurs, which reduces the concentration of NO, one of the important factors of local immunity and a regulator of mucociliary clearance.
The presence of DS contributes to the violation of the evacuation of the contents of the VSP through the EU due to stagnation in the VSP or reverse casting.
It can be argued that FJ is an important link in the pathology of HPP, especially in patients with PPI. At the same time, DS can also form without deformation of the nasal septum due to acute inflammatory processes in the HPP, creating the preconditions for the development of a chronic process.
Output. Thus, the state of the sinus anastomosis, opening in narrow spaces bounded by the middle and superior turbinates, largely depends on the features of the ethmoid labyrinth development.
However, the literature does not illuminate the question of what role the size and location of the sinus anastomosis play in the development of pathological processes in their mucous membrane; what is the relationship between the location and size of the sinus anastomoses with other anomalies of endonasal structures.
References / Список литературы
1. Alekseevskaya O.A., Nazarov I.I., Piskunov G.3., Kosyakov S.Ya. Features of the ciliary activity of the nasal mucosa // Russian rhinology, 2007. № 2. S. 14.
2. Bogolyubov V.M. Physiotherapy and balneology. M.: BINOM, 2008. Volume 1. 408 p.
3. Vavin V. V. The use of local antioxidant therapy in the complex treatment of patients with acute purulent rhinosinusitis: author. dis. ... Cand. honey. Sciences: 14.00.04. Novokuznetsk, 2008. 18 p.
4. Karpova E.P. The role of hypertonic solution in the treatment of pathology of the nasal cavity in children // Consilium Medicum. Pediatrics., 2009. № 4. S. 22-25.
5. TurovskyA.B. Treatment and prevention of recurrent bacterial sinusitis: author. dis. ... dr. honey. Sciences: 14.00.04. M., 2009. 47 p.
6. Alkan A., Celebi N., Ba B. Clinical Acute maxillary sinusitis associated with internal sinus lifting: report of a case. // Eur J Dent., 2008. Vol. 2 (1). P. 69-72.
7. Urlea-Sch MI. Effectiveness and tolerability of Euphorbium comp SN for the symptomatic treatment of rhinitis in children aged 2-6 years. Eur JIntMed., 2018. 1: 236.
EFFICACY OF MOXONIDINE IN THERAPY OF ARTERIAL HYPERTENSION IN TYPE 2 DIABETES MELLITUS Yusupova Sh.K.1, Nishonova M.S.2, Shоkirova G.K.3, Urinboeva I.R.4 Email: Yusupova17164@scientifictext.ru
1Yusupova Shakhnoza Kodirzhonovna - Candidate of Medical Sciences, Docent, Head of the
Department; 2Nishonova Malika Sanzharovna - Assistant; 3Shokirova Gulnoza Kodirzhonovna - Assistant; 4Urinboeva Iroda Ravshanbek kizi - Assistant, DEPARTMENT OF HOSPITAL THERAPY AND ENDOCRINOLOGY, ANDIJAN STATE MEDICAL INSTITUTE, ANDIJAN, REPUBLIC OF UZBEKISTAN
Abstract: in patients with type 2 diabetes mellitus and arterial hypertension, the use of moxonidine and enalapril showed a more pronounced hypotensive effect compared to monotherapy with enalapril, which was associated with a decrease in sympathetic-adrenal activity in this category ofpatients; metabolic blood parameters also improved. Large clinical trials have shown that tight blood pressure control reduces the incidence of cardiovascular disease and mortality in people with type 2 diabetes. Keywords: moxonidine, enalaprile, arterial hypertension, type 2 diabetes.
МОКСОНИДИН В ТЕРАПИИ АРТЕРИАЛЬНОЙ ГИПЕРТОНИИ
ПРИ САХАРНОМ ДИАБЕТЕ 2 ТИПА Юсупова Ш.К.1, Нишонова М.С.2, Шокирова Г.К.3, Уринбоева И.Р.4
1Юсупова Шахноза Кодиржоновна - кандидат медицинских наук, доцент, заведующий
кафедрой;
2Нишонова Малика Санжаровна - ассистент; 3Шокирова Гулноза Кодиржоновна - ассистент; 4Уринбоева Ирода Равшанбек кизи - ассистент, кафедра госпитальной терапии и эндокринологии, Андижанский государственный медицинский институт, г. Андижан, Республика Узбекистан
Аннотация: у больных сахарным диабетом 2 типа и артериальной гипертонией применение моксонидина и эналаприла показало более выраженный гипотензивный эффект по сравнению с монотерапией эналаприлом, которое было связано со снижением симпатико-адреналовой активности у данной категории больных, также улучшились метаболические показатели крови.
В крупных клинических исследованиях было показано, что жесткий контроль артериального давления снижает частоту сердечно-сосудистых заболеваний и смертность лиц с сахарным диабетом 2 типа.
Ключевые слова: моксонидин, эналаприл, артериальная гипертония, сахарный диабет 2 типа.
UDC 616.12-008.331.1+616.37
