Optimising Hygienic And Surgical Aspects Of Prevention, Early Diagnosis And Treatment Of Echinococcal Disease

In this scientific report, the authors analyze the results of epidemiological examination cards, as well as the medical history of operated patients for echinococcal disease. The studies were carried out by the authors according to the generally accepted methodology for a retrospective epidemiological analysis of the incidence rate and at the same time an application form was created for examining patients suffering from hydatid disease. According to the authors, the developed “Model of the program of complex medical and diagnostic measures” is intended for early detection and for drawing up a plan for hygienic and surgical complex measures for echinococcal disease. The authors used highly informative research methods (ultrasound, CT, MSCT), as well as biochemical and morphological studies of patients with echinococcal disease in the pre- and postoperative period.


INTRODUCTION
Echinococcosis as a severe parasitic disease remains a very urgent medical and social problem in many countries of the world, Echinococcal disease (ED) is the most common parasitic disease endemic to Central Asian countries, including Uzbekistan. The disease has been registered in all regions of the republic. According to the Republican Centre for State Sanitary and Epidemiological Surveillance, in 2017 the number of people suffering from echinococcosis in Uzbekistan was 2.1%, and the incidence among children under 14 was 1.2 per 100,000 population.This trend is due to a number of factors, including, first and foremost, the deteriorating sanitary and epidemiological situation, especially in regions endemic for echinococcosis and problems with prevention and medical examinations, including in risk groups .
Despite improvements in the general standard of living, there has been a steady increase in the incidence of echinococcosis with the geographical expansion of the disease. Preventive measures currently used against echinococcosis are effective to some extent, but insufficient; there is no downward trend in the incidence of the disease among the country's population, which often leads to chronic diseases, unpleasant complications and disability. The main reason for this is the lack of public awareness of this infestation and its transmission factors, as well as poor dietary hygiene. Humans become infected by ingestion of the parasite eggs from contaminated food, water or soil, or by direct contact with animals.

THE AIM OF THE STUDY
To develop therapeutic, preventive and hygienic measures to reduce morbidity and optimize the results of surgical treatment of patients with echinococcosis.

MATERIALS AND METHODS
To achieve the aim of the study the following methods were used; general clinical, laboratory, radiological, ultrasound, CT and multispiral tomography and hygienic research methods.
The work is based on: archival and reporting materials for the period from 2010 to 2019 of the State Sanitary and Epidemiological Surveillance Administration of Fergana province, epidemiological examination charts, as well as case histories of operated on the basis of surgical clinics of Andijan State Medical Institute. The age of the patients ranged from 16 to 76 years. The vast majority of the patients were in the working age category from 17 to 50 years -91.7%, which emphasises the socioeconomic importance of the problem. Men accounted for 48.2% and women for 56.8%. Urban dwellers accounted for 43.6% and rural dwellers for 56.4%. The research was carried out according to the generally accepted methodology of retrospective epidemiological analysis of morbidity and a "Cardquestionnaire" (questionnaires) for the examination of patients suffering from echinococcal disease. which aims at early detection and for hygienic and surgical measures in the population suffering from echinococcosis.
The questionnaire includes the following questionnaires:  Information about the patient suffering from echinococcal disease;  Circumstances and conditions in which the infection is important in terms of occurrence;  Sanitary and hygienic living conditions of patients suffering from echinococcal disease;  Questionnaires to identify hygienic factors of nutrition and the main causes contributing to the development of echinococcal disease.  Questionnaires for patients operated on for echinococcal disease.
"The questionnaire is to be filled in by patients suffering from echinococcal disease and operated on for this disease, answering these questions by underlining "yes" or "no" and the desired word in the text.
The developed "card -questionnaire" (questionnaire) is intended for;  Persons whose professional activity is closely connected with animal husbandry;  Persons at risk;  Persons working in the agricultural sector;  People who have close contact with animals  People living in rural areas with a high incidence of disease;  Persons who have undergone surgery for echinococcal disease.
The main causes and conditions of the disease were thoroughly analysed on the basis of the results of "questionnaire cards" of patients suffering and operated for echinococcal disease; the condition of operated patients was also assessed. We conducted educational activities to prevent the development of echinococcosis and its spread. Transmission routes, such as food, water, and contact, were also explained. The main factors of transmission were, in particular, lack of personal hygiene, consumption of unwashed and thermally untreated products of plant and animal origin, and use of water from natural reservoirs contaminated with excreta of infected animals.

RESULTS OF THE STUDY
Having outlined the main objectives aimed at improving the quality of diagnosis, dynamic monitoring and treatment, as well as with the aim of providing comprehensive therapeuticdiagnostic and preventive measures in the Fergana Valley, we structured our study in the following directions; to outline the range of socio-hygienic aspects, implementation of therapeutic and preventive measures and assess the quality of care for patients with EDto consider the results of surgical treatment, develop an algorithm for diagnosis and treatment of patients with EDand develop a comprehensive therapeutic and preventive measures at all stages of diagnosis and treatment of ED . In this connection, we have developed a model programme for providing therapeutic and preventive measures to patients suffering from ED in the Ferghana Valley population, which is presented in Figure 1.  the vast majority of patients were in the working age category from 17 to 50 years -85.7%, of whom 46.3% were men and 53.7% were women. All the patients were in a severe to moderate degree of severity during the period of observation. The clinical assessment was based on the identification of complaints, clinical examination data, and the results of additional methods of investigation including, clinical and laboratory, radiological, ultrasonography (USG), magnetic resonance imaging (MRI) and multispiral tomography (MSCT). X-ray revealed a rounded shadow with clear contours at the opening of the echinococcal cyst, a rounded shadow with a fluid level, a double-contour wall, chitinous membrane detachment with calcification as "lime spray", a high diaphragm condition -a symptom of "dead diaphragm". On ultrasound, echinococcal masses with clear contours had an irregularly shaped focus and defined topographic size, presence of septa, structures often with the presence of daughter blisters and cavities. It should be noted that in large and giant echinococcal cysts a significant volume of parenchyma were affected by the pathological process, which was accompanied by hepatocyte deficiency and impaired liver function. In this regard, biochemical studies included determination of liver functional indices. The choice of the optimal tactics of the patient management should be individual and based on the analysis of risks and advantages of this or that method, taking into account contraindications. All admitted patients underwent various surgical interventions comparable in severity, volume, and duration. Intensive therapy in the postoperative period included: antibiotic therapy, immunocorrection, correction of malnutrition, infusion and transfusion therapy to correct anaemia, hypoproteinaemia, electrolyte imbalance and maintenance of functions of vital organs and systems, correction of coagulation and anti-coagulation system, detoxification using forced diuresis. The feasibility of prescribing anthelmintic drugs before surgical intervention remains controversial. There is evidence of the effectiveness of preoperative drug therapy, but there is a lack of reliable data in the literature on the appropriateness of this tactic. The undoubted advantage of radical surgical intervention is the cure of the patient, but no mention can be made of complications, which are reported in 2-10% of interventions, and lethal outcomes range from 0.5 to 4%, according to various data. Postoperative antihelminthic therapy significantly improves the efficacy of treatment. Timely administration of anthelminthic drugs practically minimises (less than 1%) the risk of recurrence of the disease, provided that the rules of surgical intervention are followed and all identified cysts are removed.
A comparative analysis of the efficacy of these drugs suggests that albendazole is the drug of choice for contraciliation therapy of echinococcosis. At least 3 courses of treatment were administered to the patients for the purpose of contra-convulsive therapy after surgical intervention. Albendazole was administered in a dose of 10 mg per 1 kg of body weight per day in 1 dose -morning/evening with an interval of 12 hours for 28 days, with the obligatory combination of hepatoprotector. The drug is recommended to be taken with a fatty meal, which increases its bioavailability. The interval between courses was 15 days. Liver function and blood cell counts were monitored before treatment and every 15 days of the first course. If there were no marked changes in blood parameters during the following courses blood tests were carried out at least once a month. Treatment with albendazole was carried out against the background of basic therapy (dietary regime, diet). cases is due to the lack of preventive measures and the failure to observe the rules of personal hygiene, as well as in the care of animals and agricultural activities. Nutrition is not rational and the daily norms of nutrition are not met. Due to the low level of awareness of the population, it is necessary to conduct sanitary and educational work on disease prevention. The card-questionnaire makes it possible to qualitatively assess the actual nutrition and to make a targeted plan of preventive and hygienic measures at all stages of diagnosis and treatment of patients suffering from this pathology.The nutrition of patients both before and after the operation must be balanced and of good quality, containing sufficient proteins, lipids, minerals and vitamins, which can prevent postoperative complications. Research in this direction is ongoing and the results will be reported in our future scientific publications.
Due to the low level of public awareness, active public health education on effective measures to prevent the spread of echinococcosis is necessary. Operative intervention in EB should be performed after a comprehensive, pathogenetically based preoperative preparation, instrumental diagnosis and include removal of the parasite, resolution of the residual cavity. As evidenced by our experience, the combined use of highly informative instrumental and laboratory studies ultrasound, CT and MRI allows to determine the localization and size of echinococcal cysts in the liver and abdominal organs, to assess the condition of the fibrous capsule, the presence and nature of complications Chemotherapy for echinococcal disease in the pre-and post-operative period is one of the important aspects, and sometimes the only method, of preventing recurrence. The developed "card -questionnaire" (questionnaire) is likely to contribute to the early detection of the main causes and clinical signs of the disease, as well as a qualitative assessment of the state of the operated patients, gives the possibility to make a timely and targeted plan for preventive, hygienic and surgical measures in regions with high levels of echinococcal disease.The developed programme model is likely to facilitate the early detection of echinococcal disease in the Fergana Valley population and to provide a comprehensive treatment and diagnostic plan.