Purpose of the study. To evaluate the cost-effectiveness of using standardized approaches to care and auditing critical cases of mothers with critically severe preeclampsia
Material and research methods. We analyzed reports of cases of critical severe preeclampsia that occurred in the State Institution “Research Institute of AH and P” of the Ministry of Health and SZN of the Republic of Tatarstan. using critical incident audits from 2018 to 2022.When conducting ACС, the methodology and principles of this technology were observed - non-punishment, confidentiality, comparison of practices with standards based on evidence-based medicine, adherence to the principle of searching for the true reasons for missed opportunities and making decisions, the implementation of which helps to eliminate weak practices.
An analysis of the cost of illness was carried out taking into account all the costs of patients with critical severe preeclampsia at a certain time stage and at all stages of medical care. The total cost includes direct expenses - wages of employees, costs of the institution and women for medicines, equipment, food, depreciation of equipment. Indirect (non-medical) costs are those costs that are not directly related to the treatment process, but create conditions for it, i.e. opportunity costs.
Research results and discussion. To calculate costs, the costs of examination, treatment and hospital stay for selected critical severe preeclampsia were calculated. The calculations took into account the order of care, the list of necessary examinations, step-by-step treatment and criteria for the length of hospital stay for women, according to the national guideline “Hypertensive disorders during pregnancy, childbirth and the postpartum period” (2015). After calculating the costs of examination, treatment costs, and hospital service costs, the list price for various nosologies of critical severe preeclampsia was calculated taking into account profitability, which is the sum of cost and profitability. The total costs of care for women with critical severe preeclampsia were calculated by summing the costs for various nosologies of critical severe preeclampsia.
Summary. Severe preeclampsia is an important socio-economic problem in the healthcare system. Critical severe preeclampsia occupies a leading position in the structure of causes of maternal mortality. The financial cost of providing care to women with critically severe preeclampsia amounts to enormous sums of money. This article examines the cost-effectiveness of using standardization of care and auditing of critical cases of severe preeclampsia. A retrospective analysis of the birth histories of women with critical severe preeclampsia for the period from 2018 to 2022 was carried out. During this period, in cases of non-compliance with standards, critical cases were audited, the true causes of missed opportunities were identified, and effective decisions were made, the implementation of which prevented subsequent recurrence of omissions. The cost of the disease, the dynamics of the reduction in critical severe preeclampsia over the studied period of time and a direct method for calculating effectiveness were analyzed. The results of the study showed that the use of standards and audit of critical cases in practices reduces financial costs.
Aim. To study the impact of risk factors on the development of brain damage in the perinatal period.
Material and methods. The work is based on a retrospective analysis of medical documentation of the maternity institution and the “Mother and Child” department of the State Institution MK “Istiklol” in Dushanbe. The analysis included birth histories and developmental charts of newborns for the period from 2019 to 2021. In the process of work, data from statistical accounting form 32 “Report on the provision of medical care to pregnant women, women in labor, postpartum women and newborns” was also used. Approved by order of the Agency for Statistics under the President of the Republic of Tajikistan No. 054 dated October 11, 2013, the analysis covered the period from 2017 to 2021.
Results and discussion. The maximum number of children injured during childbirth in the republic during the five analyzed years was born in 2018 - 2020 cases. The total number of children with birth trauma in 2021 was 1879 children, where over the course of five years, the T/loss rate decreased by - 20.9%, the increase in the proportion of sick children amounted to 393 cases. In Dushanbe, over the course of five years, the maximum number of newborns who suffered intrauterine hypoxia was born in 2019 - 962, which amounted to 7.4% of the total number of newborns born sick or ill. In 2021, there was a decrease in the proportion of children born sick, the T/loss rate was 53.3%.
Conclusions. An unstable downward trend in the number of children born sick or ill has been identified; there is an increase in this indicator in 2021 relative to other years.
The proportion of children who suffered intrauterine hypoxia has a clear trend of decline over the course of five years. The number of children born due to asphyxia in Dushanbe has a pronounced downward trend.
As a result of perinatal neurosonography (NSG), (6.3%) newborns had various forms of hemorrhage in the periventricular region in the form of (PVH and IVH), in 21.5% intraventricular hemorrhage of the 1st degree, IVH of the 2nd degree were determined in 63.4 %, stage 3 IVH in 12.8 % and stage 4 IVH in 2.3 %.
In this article the authors give a brief account of the research work carried out by the staff of the Department and Clinic of Otorhinolaryngology in different years of its activity. Notable scientific achievements in the study of prevalence, peculiarities of clinical course and complex treatment of allergic diseases of the upper respiratory tract and ear in different regions of Tajikistan are noted. The parameters of immune status in persons suffering from allergic diseases of ENT organs living at different altitudes were determined and treatment schemes with the use of immune preparations were developed. On the scientific work on the theme: Modern methods of diagnostics and treatment of combined pathologies of nose and paranasal sinuses (PNS) the basic variants of combined pathologies of nose and PNS are defined, the functional state of nose is defined and algorithms of diagnostic procedures and methods of simultaneous surgery of functional-cosmetic character in patients with the above mentioned combined pathology are developed. Currently, the scientific tasks to solve the issues of diagnosis, treatment, rehabilitation and prevention of various forms of hearing loss, combined with upper respiratory tract pathology with the use of innovative technology have been defined.
Purpose of the study. Studying the influence of pregnancy risk factors on the perinatal outcome of premature infants born at 28-34 weeks of gestation to optimize the medical care provided to them.
Material and research methods. The object of the study were premature babies. The nature of our sample was continuous and included all cases of preterm birth in the gestational age from 22 to 34 weeks from 2018 to 2022. The study was conducted at the clinical base of the Department of Neonatology of the State Educational Institution “IPO in Northwestern RT” of the State Institution “City Maternity Hospital No. 1” in Dushanbe.
An analysis of some factors that have an adverse effect on the condition of the fetus was studied based on the results of a survey of 325 developmental histories of mothers, surviving newborn children and 196 developmental histories of mothers of deceased children. Monitoring of postpartum women included analysis of general somatic and obstetric-gynecological history, the course of pregnancy and childbirth. In newborns, the course of the early neonatal period, morbidity, mortality and causes leading to it were analyzed.
Depending on the duration of pregnancy, the subjects were distributed according to gestational age (up to 28 weeks; 29-31 weeks and 32-34 weeks of gestation) and received a full course of RDS prevention - group 1; those who received an incomplete course of RDS prevention – group 2; those who did not receive RDS prevention – group 3; those who received a full course of RDS prevention followed by labor stimulation/excitation – group 4.
Research results and discussion. Late age of a pregnant woman is an independent risk factor for the development of pathology, both in the mother and in the fetus, and, accordingly, its unfavorable outcome. It was revealed that in mothers who gave birth before 28 weeks of gestation, the average age was critical, and the outcome of the children was fatal, despite the complete prevention of RDS in the group.
Multiparous women predominated in all examined groups, especially in the group who did not receive RDS (62.6%). The least number of them was among postpartum women who received stimulation of labor. At the same time, the vast majority of primigravidas were primigravidas, especially in groups that received a full course of RDS prevention (on average 91.5%). This group also led in reproductive losses and medical abortions. Thus, 14.2% of women who received a full course of RDS prevention and 8.3% of women who received a full course of RDS prevention with stimulation had a history of medical abortion. The rates of spontaneous abortion and stillbirth, indicating the corresponding quality of health, were higher in these groups of patients: 17.9% and 16.6% of women, respectively. It should be noted that spontaneous miscarriages and medical abortions were detected more often (2.4 times) in mothers who gave birth to children weighing less than 1500 g.
Also, in all groups there was a connection between preterm birth in family history and in the woman’s personal history. At the same time, a history of premature birth was most indicated in the group of mothers who received a full course of antenatal corticosteroid therapy (22.4% and 18.7%). Perhaps, based on the experience of previous pregnancies, this contingent tried to be under more careful control of medical institutions, and accordingly receive the necessary amount of medical care.
When distributed by sex depending on the gestational age among the surviving and deceased children, boys predominated mainly, especially among the deceased, to a greater extent in the group that did not receive RDS prophylaxis (regardless of gestational age) and in the group with labor stimulation (up to 28 weeks and 29-31 weeks of gestation).
Conclusions.
- Among the unfavorable factors that have the greatest impact on the timing of gestation and maturation of the fetus are inflammatory diseases of the respiratory and urinary systems, as well as anemia.
- The role of the threat of miscarriage has been established as a factor influencing the perinatal outcome of all studied groups.
- The connection between preterm birth in the family history and in the woman’s own history with miscarriage of her current pregnancy, noted in all groups, dictates the need to identify the risk group and ensure appropriate monitoring and treatment.
- The importance of prenatal prevention of RDS has been established, determined by its influence on increasing the survival rate of premature infants.
The purpose of the study. To study influence of pregravid preparation on birth outcomes in pregnant women with type 1 diabetes mellitus.
Research materials and methods. For a comparative assessment of the effectiveness of the influence of pregravid preparation on perinatal outcomes, 2 groups were formed, the main group the control group (n-45) was formed from among pregnant women without pregravid preparation.
Research results and discussion. The analysis showed that neonatal morbidity is more often observed among pregnant women in the comparative group who did not undergo pregravid preparation, since diabetic fetopathy was more often observed among the comparative group 19 (42,2%), where the Chi-test with Yates’ correction was - 3.777 (P<0.01). FGRS (28,5±6.9%) and respiratory distress syndrome (21.4±6.3%) were also frequently observed among the comparison group (P<0.05).
Summary. The analysis showed that pregravid preparation has a beneficial effect on the outcome of pregnancy, as there is a significant decrease in the incidence of diseases among newborns such as FGR, diabetic fetopathy, and intrauterine infection. The data obtained indicate that the somatic condition of the mother directly affects the outcome of pregnancy.
Aim. Study of the composition and medicinal properties of water from natural mineral springs of the Republic of Tajikistan.
Material and methods. Study of the climatic-geographical region, study of the water quality and chemical composition of Khoja-Obi-Garm, Obi-Garm, Garm-Chashma, Shoambary. The influence and effectiveness of mineral waters in the treatment of skin diseases.
Results and its discussion. The Republic of Tajikistan has a large number of mineral springs that are used to treat diseases of the skin and other organs. There are 5 classes of medicinal mineral waters based on their composition: hydrocarbonate, chloride, sulfate, nitrate, and waters of complex composition. In addition, a distinction is made between waters with active ions and gaseous waters (hydrogen sulfide, radon, nitrogen, methane, etc.). Based on temperature, they are divided into: cold, warm and hot or thermal waters. The mineral water sources in Khoja-Obi-Garm, Obi-Garm, Garm-Chashma, Shoambary are hot water and belong to hydrocarbonate-chloride-sulfate-sodium thermal baths. In addition to the main salt and gas components, water contains biologically active microelements: aluminum, titanium, manganese, copper, silicon, molybdenum, strontium, barium, boron, fluorine, etc.
Conclusion. Tajikistan occupies a leading position in Central Asia in terms of the number of mineral springs and it can be considered that the mineral waters of Tajikistan meet all the requirements for healing springs. They contain a variety of chemical elements that are very active in their effects on the body and, when used correctly, can treat many diseases.
The purpose of the study. Determining the environmental impact of climate change in Central Asian countries.
Research materials and methods. In the article, various literatures of the field and materials of world conferences on climate are used, and the issue is discussed with the method of comparison in the science of geography.
Research results and their discussion. The results of the research were discussed at the meetings of the department and national conferences.
Conclusion. It was found that incorrect use of water resources causes climate damage in Central Asian countries.
The purpose of the training. Analysis of the research and therapeutic features of the availability of fruits and vegetables in the issue of the composition of the body and the normative annual ratio of its consumption in% to the total demand among vegetable and fruit crops.
Materials and teaching methods. Quality determination methods distinguish all food products and divide them into groups according to the quality of identification; organoleptic and laboratory methods are used.
The result of their study and consideration. The results of the conducted studies allowed us to determine the amount of soluble and insoluble solids in the composition of fruits and vegetables.
Dry soluble substances include nitrogenous compounds, carbohydrates, acids, pectins, dry insoluble substances – fiber, half-cell, protopectin, as well as some nitrogenous substances, pigments and fat-soluble vitamins, iron.
100 g of vegetables contains 25-40 kcal, and 100 g of fruits contains 50-70 kcal (1 kcal = 4.19 kcal).
Conclusion.
- Fruits and vegetables are an important food source for the human body and play an important role as an energy source for his body.
- Fruits and vegetables are an indispensable and necessary part of the diet, and in our republic, a person is recommended to eat fruits and berries throughout the year, depending on age and type of activity.
Research purpose. Determining the origin, development and functions of language.
Research materials and methods: literary, scientific and Internet sources, as well as general scientific research methods such as value-normative, historical and comparative methods were used in the research.
The results of research and their discussion. The scientific results of the research reveal the essence of the state language “is to observe the law of the state language”. That is, the Tajik language today is related to the analysis of the relations of the state language. This relationship is, first of all, the relationship between people regarding their real status in society, mainly regarding respecting the state language and recognizing it and observing its norms both in the spoken language and in the standard language.
Conclusion. Tajik people looked at us from the crook of their necks, they saw a proud nation that was mastered to preserve its language. It was the analysis and strength of our Bonang and Ori people that the Tajik language has survived.
REVIEW OF LITERATURE
Diabetes is a common comorbidity in patients hospitalized for acute coronary syndrome, and its prevalence is increasing. Among patients hospitalized with acute myocardial infarction, diabetes may be an independent predictor of mortality and new cardiovascular events; Both short- and long-term outcomes are worse for patients with diabetes compared to those without, and undiagnosed diabetes is associated with greater mortality. Cardiovascular disease and insulin resistance are closely related. Triglyceride-glucose index and glychemoglobin are often used as indicators of insulin resistance. However, there is scant information on the triglyceride-glucose index in the prediabetic population, and the prognostic value of the index in patients with diabetes and acute coronary syndrome is unknown.
