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The program of cochlear implantation in children with profound hearing loss in the republic of Uzbekistan («Uzbek model»)
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DOI: http://dx.doi.org/10.20534/ESR-16-9.10-63-65
Amonov Shavkat Ergashevich, Professor, Head of the department of otorhinolaryngology, child otorhinolaryngology and stomatology, Tashkent Pediatric Medical Institute, Tashkent, Uzbekistan Inoyatova Flora Ilyasovna, Professor, Head of the department of hepatology under the Republic specialized scientific research medical center for pediatrics of the Ministry
of Healthcare of the Republic of Uzbekistan, Tashkent, Uzbekistan Akhmedova Diloram Ilkhamovna, Professor, Director of the Republic specialized scientific research medical center for pediatrics of the Ministry of Healthcare of the Republic of Uzbekistan, Tashkent, Uzbekistan E-Mail: lor_amonov@mail.ru
The program of cochlear implantation in children with profound hearing loss in the republic of Uzbekistan («Uzbek model»)
Abstract: The «Uzbek model» of cochlear implantation, developed and implemented at the Republic specialized scientific research medical center for pediatrics of the Ministry of Healthcare of the Republic of Uzbekistan, showed high efficiency of hearing and speech rehabilitation in children with profound hearing loss and deafness, expressed reduction of the indicator of hearing disability in Uzbekistan, increase of the quality of life and integration of the children of the given cohort in the process of studying and society.
Keywords: hearing disorder, cochlear implantation in children, «Uzbek model», efficiency of treatment.
According to the data of the World Health Organization (WHO), hearing loss, in worldwide scale, is one of the six leading factors deteriorating the quality of life. 360 million people suffer from hearing function disorder, which forms 5,3% of the population of the world, out of which, 328 million are adults and 32 million are children (WHO, 2012). Among patients with hearing disorder, the hearing loss in 80% is determined by the damage of sound-perceiving apparatus. Out of every 1000 newborns, one is born with sensorineural hearing loss of 3-4 degree. WHO stated that by 2020, the number of people with hearing disorder would increase by not less than 30% [1-3].
30 years ago, the diagnosis of «Deafness» was nearly a verdict and, today, provided early diagnosis with further cochlear implantation and rehabilitation measures, it is a quite solvable problem.
Cochlear implantation is a highly effective means of rehabilitation of children with profound hearing disorders that allows achieving significant results in the pre-lingual period and in people with profound hearing loss occurred at mature age. There are over 450 thousand users of the systems of cochlear implantation in the world today.
Until 2014, only technical means — hearing devices, were used in Uzbekistan for the rehabilitation of children and adults with light and medium degree of hearing loss. Hearing devices transfer only signals allowing hearing to some degree, and are not efficient in the rehabilitation of the patients with profound hearing loss or deafness. In this respect, patients with this pathology had to go to other countries for the operation of cochlear implantation, which required a lot of expenses. This, in turn, also didn't solve the problem com-
Sectiom 6. Medical science
pletely, because, factually, post-operative rehabilitation of implanted children was not conducted, and, even if it was conducted, it was not done fully and was done on non-system basis.
Due to the care of the state about the health of the children with hearing loss and deafness, it became possible to conduct operations of cochlear operation from 2014 in Uzbekistan.
Within the frame of the state program «Year of a healthy child» (2014), it was planned to perform 300 operations of cochlear implantation in 2014-2016 with the use of the most advanced hearing implants. To conduct these operations, the government allocates annually around 7 billion soms for the children up to 5 years old, and for the children above 5 years old, the mechanisms of soft loan on the acquisition of cochlear implant were defined.
To realize the state program at the Republic specialized scientific research medical center for pediatrics of the Ministry of Healthcare of the Republic of Uzbekistan, «the department for the inborn and acquired ENT diseases», which is an educational-methodical base for prevention and treatment of ENT diseases in children, was established.
The department is equipped with advanced, world standard, highly technologic equipment by the state: diagnostic audiologic complex that includes 3 «neurosoft» devices performing expanded diagnostics of the hearing; 16 screening devices «neurosoft» for early detection of hearing pathology in newborns, two tympanom-eters «interacoustics» (Denmark), operational complex — 2 operational microscopes, 2 inspection microscopes (Germany), operational stand system for the conduct of endoscopic operations, AIDA system for recording and demonstration during master classes, set of micro-surgical tools for minimally invasive interferences in middle ear and inner ear (Germany), mobile endo-video system (Germany), diagnostic inspection equipment — 2 ENT workstations with video-endoscopic devices (Germany and South Korea); computer vestibulometer (Denmark).
For effective realization of the program on cochlear implantation, the Order № 20 as of December 9, 2014 of the Ministry of healthcare was published and the PROVISION about cochlear implantation as ofJanuary 8, 2015 was approved, which is registered under № 2648 (chapter 1, part 12) in the Ministry ofJustice of the Republic of Uzbekistan.
At the RSSRMC for Pediatrics, all stages of the system of cochlear implantation are implemented:
1st stage — selection of children for cochlear implantation. This stage is the most responsible stage, where the degree of hearing disorder based on clinical-audiologic and surdo-pedagogic methods is defined. For this purpose, the department is equipped with modern treatment-diagnostic equipment, which allows performing the 1st stage of cochlear implantation in accordance with world standard.
2nd stage is the main stage, at which, the operation on the installation of cochlear implant is conducted. Operations are performed by local surgeons together with experienced specialists from the leading clinics and centers of the world. A group of Uzbek surgeons performing this operation was prepared at the leading clinics and centers during the training period of two years.
3rd stage — post-operative rehabilitation of implanted children. This is the most difficult stage, where the child is taught sounds and speech skills are developed. Surdo-pedagogical teaching of children at the RSSRMC for Pediatrics and in the regions was associated. Specialists, surdo-pedagogues and parents of the operated children take active part in this process. Significant work is done with the parents in respect of further care and classes with their children, which is one of the most important chains of post-operative reha-
bilitation for proper integration of the children in the future general education process and in the society in the whole.
For the effective implementation of all stages, a big organizational-methodical and scientific research work is done at the Center. According to the program of the rehabilitation of children with hearing loss and deafness in the republic, audio-screening in all regions of the republic is performed under the guidance of the RSSRMC for Pediatrics for the purpose of early detection of hearing disorders. Neuroaudioscreening devices «Neurosoft» were given by the Center for pediatrics to all perinatal centers, branches of RSSRMC for obstetrics and gynecology as well as regional children multi-profile medical centers. In 2015, neuroaudioscreening allowed detecting hearing disorder in 78 children from birth, which was 0,2% of newborns, who underwent screening. 2 children aged 12 months undergone cochlear implantation operation, others are at preparatory stage for cochlear implantation operation.
For the effective rehabilitation, a methodical base with the development of a set of documents for the specialists of all levels and, which is very important, for parents, was created at the Center. There is an opportunity for free technical maintenance of implants during 1 year post operation at the Center. For the effective integration of children in the society, a parent committee was created at the Center and conditions for the communication of parents and implanted children are ensured.
In 2015, the RSSRMC for Pediatrics received an innovative grant within which, researches on the implementation of new highly sensitive tests for hearing study, development of working program and a set of educational material in the form of books, discs for teachers, children and parents in Uzbek language are performed.
For the effective implementation of rehabilitation of children with hearing loss and deafness in the republic, the specialists of the RSSRMC for Pediatrics have performed and perform master-classes on all stages of realization. The training of neonatologists, ENT doctors and general practice doctors on audioscreening and management of patients with profound gearing loss and deafness; surdo-pedagogues on rehabilitation in the system of cochlear implantation was conducted in all regions of the republic. The specialists of the Center are trained and serve internship at the leading clinics and centers of the world: surgeons in France, Slovenia, Austria, Germany, Russia; audiologists — in Russia, Lithuania; surdo-pedagogues — in Austria, Russia, Kazakhstan.
In 2014-2015, cochlear implantation was conducted on 200 children at the RSSRMC for Pediatrics. According to the state budget, the operations were conducted together with the leading surgeons of Russia, Ukraine, Lithuania, Turkey, Italy, Austria and Slovakia. Currently, operations are conducted by Uzbek surgeons on their own.
The monitoring showed that as result of post-operative rehabilitation, all children hear fully and distinguish sounds; over 90% of children started speaking and continue learning oral speech due to the system-based work of surdo-pedagogues.
«Uzbek model» of cochlear implantation developed and implemented by us has own peculiarities and differences from foreign analogues:
1. A unified center for effective realization of all stages of the system of cochlear implantation and rehabilitation (selection and screening, surgical stage, medical and surdo-pedagogical rehabilitation) was created.
2. The conduct of neuroaudioscreening from birth was organized in all regions of the republic for the purpose of early detection of hearing disorders.
Animal models of peritonitis
3. A commission of the Ministry of healthcare on selection of candidates for cochlear implantation was created.
4. A system of individual audiologic and surdo-pedagogical monitoring of implanted children is organized.
5. A set of documents and information materials on rehabilitation of implanted children is developed for parents for further activities in the family.
6. Work with parents and guardians of the patients is performed in order to establish social partnership and consolidate individual responsibility.
7. All-round consultation and methodical help is provided in the regions of the republic through the unified center ofcochlear implantation.
8. Cooperation with all world centers for cochlear implantation is established in order to apply and implement latest world achievements in the sphere of rehabilitation of children with hearing disorders.
The program of cochlear implantation in children with profound hearing loss and deafness and results obtained over a short
period (2 years) received high evaluation and are recognized in terms of their uniqueness and efficiency as «Uzbek model» by the specialists from leading clinics and centers of the world.
Thus, at the RSSRMC for Pediatrics, a program on cochlear implantation in children with profound hearing loss and deafness conforming to the world standards, herewith, beneficially different from the programs in other countries in terms of complex and stage-by-stage approach in rehabilitation, is developed and successfully implemented. The complexity of the program lies in the fact that it includes and monitors all stages of cochlear implantation and rehabilitation of children with profound hearing loss and deafness. All this determined high efficiency of hearing and speech rehabilitation in children with profound hearing loss and deafness, expressed reduction of the indicator of hearing disability in Uzbekistan, increase of the quality of life and integration of the children of the given cohort in the process of studying and society.
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1. Альтман Я. А., Таварткиладзе Г. А. Руководство по аудиологии. - М.: ДМК Пресс, - 2003. - 360 с.
2. Королева И. В. Введение в аудиологию и слухопротезирование. - СПб.: Каро, - 2012. - 400 с.
3. Понамарева Л. П., Ширина Н. С. Аудиологическое тестирование новорожденных детей. «Вопросы современной педиатрии» том 3, - № 3-2004. - С. 20-23.
DOI: http://dx.doi.org/10.20534/ESR-16-9.10-65-70
Aripov Utkur Rashidovich Tursumetov Abdusattar Abdumalikovich Rasul Sadykov, MD, PhD Tashkent Pediatric Medical Institute E-mail: dr_aripovur@list.ru
Animal models of peritonitis
Abstract: Understanding the role of pathogens and endotoxin in peritonitis and its complications may improve accuracy of diagnosis and development of therapeutic options. The etiology of peritonitis is multifactorial and affects cardiovascular, immunological and endocrine systems of the human body. Animal models are the essential contributor in the evaluation of efficacy and safety of potential therapeutic agents. However, their physiological limitations often restrict their usefulness and cause barriers to translate study results into clinical practice. Careful differentiation of models can help study different aspects of the disease. Evidence-based information could potentially contribute to the interpretation of results of animal studies, which can be successfully used in clinical trials.
Keywords: peritonitis, spontaneous bacterial peritonitis (SBP), infections, sepsis, immune system, lipopolysaccharide (LPS), endotoxins, zymosan, inflammation, Toll-like receptor 4 (TLR4), Tumour Necrosis Factor alpha (TNF-a), Interleukin, Polymorphonuclear Leukocytes (PMNs), macrophages, cytokines, cecal ligation and puncture (CLP).
Introduction
Intra-abdominal infections remain a major challenge in clinical practice and represent a leading cause of morbidity and mortality. Intra-abdominal infections represent a wide variety of pathological conditions that involve lesions of all the intra-abdominal organs. The most common cause of peritoneal infections is contamination of the peritoneal cavity by the loss of integrity of endogenous gastrointestinal microflora, which results in secondary peritonitis. Primary peritonitis or spontaneous bacterial peritonitis is less common and generally happens in the occurrence of ascites without an evident source of infection.
Spontaneous bacterial peritonitis (SBP) is an infection of the peritoneal layer of the abdomen caused by bacteria that have no known cause. Spontaneous peritonitis is usually a complication of liver disease, such as cirrhosis. Advanced cirrhosis causes
a large extent of fluid build-up in the abdominal cavity (ascites) [40]. Ascites is predisposed to bacterial infection. SBP diagnosis is based on testing of the ascitic fluid obtained by paracentesis. Polymorphonuclear (PMN) cell count in the ascitic fluid is important for the diagnosis and management of spontaneous bacterial peritonitis (SBP). In more recent Prospective studies reported inpatient non-infection-related mortality rates have still been quite high at 20% to 40%.
The intestinal microflora and bacterial translocation (BT) are considered to be significant factors in the pathogenesis of SBP. The translocation of bacteria from the intestine to mesenteric lymph nodes occurs normally. When this physiological occurrence of BT increases in frequency or severity it leads on to bacteremia and following colonization of ascitic fluid. Additionally, invasive procedures can cause hospital-acquired SBP. Escherichia coli, Klebsiella
