{"paper_id":"3b9a240c-70d1-4781-a193-eca90f88f69d","body_text":"51 A journal of the AMERICAN Journal of Pediatric Medicine and Health Sciences www. grnjournal.us  \nAMERICAN Journal of Pediatric Medicine and \nHealth Sciences \nVolume 01, Issue 02, 2023 ISSN (E): ¤¤¤-¤¤¤ \n \n \n \nDIAGNOSTICS OF DISEASES OF THE \nCERVIC IN MODERN GYNECOLOGY \n \nMusurmonova Asal Isroilovna \nNorkhidirova Zilola Bakhtiyorovna \nTermez branch of the Tashkent Medical Academy \n \nAbstract: As a result of complex clinical and endoscopic studies, 78 (32.2%) women turned out \nto be practically healthy. In 164 (67.8%) women, certain diseases were detected, including: a nd \nexocervicitis in 44 (27%), endometriosis of the cervix in 9 (5.5%), pseudo-erosion and erosion of \nthe cervix 35 (21.3%) , cervical polyp in 6 (3.7%), simple and partially overlapped ectopia in 20 \n(12.2%), old ruptures and scars of the cervix in 8 (4.9%), narrowing and infection of the cervix \nin 5 ( 3%), cervical papilloma in 4 (2.4%), cervicitis caused by herpetic and fungal infection in \n29 (17.7%), leukoplakia in 4 (2.4%) women. Given the clinical and echographic prognosis, \nwomen who had significant discrepancies in the diagnosis were assigned to the group of active \nobservation by an oncogynecologist. \nKeywords: colposcopy, human papillomavirus infection. \n \nThe invariably urgent problem of practical gynecology is still the task of effective treatment and \nrehabilitation of patients with pathology of the cervix in order to restore the normal \nmorphofunctional relationships of the tissues of the cervix, its barrier function, prevent ascending \ninfection of the genitals, the occurrence of cancer of this localization, and also due to the severity \nof the caused concomitant pathology of reproductive health disorders in women. \nIn recent years, Uzbekistan has seen a steady increase in infectious and inflammatory diseases of \nthe vagina and cervix, of which 23.2% are endocervicitis, in 30% of cases, cervicitis \nmanifestations are observed against the background of ectopia. In inflammatory diseases, the \nprocesses of maturation and desquamation of the epithelium are disrupted, which creates \nconditions predisposing to the development of cervical dysplasia. According to I.S. Sidirova and \nS.A. Levakov, in every seventh woman, cervical cancer (CC) occurs against the background of \nchronic inflammation, trauma, and a sharp deformation of the cervix. \nIn recent years, the diagnosis and treatment of diseases associated with the human \npapillomavirus (HPV) has attracted special attention due to the sharp increase in the incidence, \nsignificant contagiousness and high oncogenic potential of this pathogen. \nIt is known that the primary factor in the development of cervical cancer is human \npapillomavirus (HPV). After each change of partner, the risk of infection with genital types of \nHPV is 10-15%. HPV types 16, 18, 31 and 45, highly oncogenic viruses, are associated with \nmore than 80% of all cases of invasive cervical cancer that occurs against the background of a \npreviRXV\u0003G\\VSODVWLF\u0003SURFHVV\u0011\u0003&XUUHQWO\\\u000f\u0003LW\u0003LV\u0003NQRZQ\u0003WKDW\u0003+39\u0003LQIHFWLRQ\u0003SUHYDLOV\u0003DPRQJ\u0003³\\RXQJ´\u0003\nwomen from 15 to 25 years old and decreases with age. Along with this, the elimination of HPV \nand the regression of HPV-associated pathology in young women is faster than in women of the \nolder age group. However, according to data, there has been an increase in the incidence of \ncervical cancer among young women, in particular, the incidence in women under the age of 20 \nwas 7% per year. \nCervical leukoplakia (CLC) is a benign disease but may be a predisposing factor for the \n\n\n52 A journal of the AMERICAN Journal of Pediatric Medicine and Health Sciences www. grnjournal.us  \ndevelopment of precancer and cervical cancer. Until now, the issue of its pathogenesis, whether \nit is benign or malignant, remains controversial. In recent years, an assumption has been made \nabout the viral nature of LSM. Although this pathology is not common, malignant transformation \nof stratified squamous epithelium, according to V.N. Prilepskaya, observed in 31.6% of patients \nwith LSM. In this regard, timely diagnosis of leukoplakia is necessary for the prevention and \nreduction of the incidence of precancer and cervical cancer. \nAccording to a number of authors, important factors contributing to the occurrence of LSM are a \nlong-term inflammatory process supported by a violation of the anatomical structure of the \ncervix, as well as a history of various destructive methods of influencing the cervix: \ndiathermocoagulation, cryodestruction, CO2 laser vaporization. \nThe presented data once again confirm that the ctological research method currently remains the \nleading one in the diagnosis of diseases of the cervix. Unfortunately, there is still an erroneous \nopinion among gynecologists about the dangers of an in-depth cytological examination of the \ncervix in pregnant women due to possible pregnancy complications. \nThe relevance of the problem of treating benign diseases of the cervix is due to the widespread \npathology of the cervix, which occurs, according to V.N. Prilepskaya, in 10-15% of women of \nreproductive age. In addition, it is known that benign processes may precede malignant \nneoplasms of the cervix, the incidence of which is currently, according to the studies of V.I. \nKrasnopolsky has no downward trend. \nInflammatory diseases of the cervix, accompanying most background processes, were considered \nby many researchers as etiological factors of possible malignancy. In the works of E.N. \nKaukhova, A.Yu. Lugueva, et al. examined 2119 patients with various non-tumor diseases of the \ncervix (ectopia, simple leukoplakia, hypertrophy, cervical deformity, nabothian cysts, \nendometriosis). The significance for the diagnosis and choice of the method of treatment of \nultrasound of the pelvic organs, the use of PCR, cytological, bacterioscopic, bacteriological \nmethods has been proved. In the studies of I.S. Sidorova, M.N. Zholobova et al. found that 48% \nof women of reproductive age with combined benign diseases of the uterus (uterine fibroids, \nadenomyosis and endometrial hyperplasia) were diagnosed with cervical pathology. Research \nresults S.A. Levakova, A.G. Kedrova et al. made it possible to draw the following conclusions: \nModern colposcopic diagnosis at the primary gynecological appointment is a highly informative \nscreening method for moderate and severe cervical dysplasia, reduces the time from diagnosis to \ntreatment by 2-4 weeks, and also reduces the number of visits by 1-2 to the doctor, with an \naverage increase in the time for the initial examination up to 7 minutes. The sensitivity of the \ncolposcopic method was 73.2%, the specificity was 64.1%, and its accuracy was 69%. In the \npresence of signs of invasion identified during colposcopy, the diagnosis coincided with the data \nof a cytological study in 80% of cases. \nAuthor Vaganova S.E. The advantage of using epigen intim spray for cryodestruction of genital \nwarts has been proven. The effectiveness of galenophyllipt in burn erosion of the cervix was \nstudied by the staff of the Institute of Toxicology under the supervision of Doctor of Medical \nSciences V.K. Sukhankin. On the model of cervical erosion, a comparative evaluation of the \neffectiveness of galenophyllipt and the registered drug Solkovagin, manufactured by Solco Basel \nAG, was carried out. \nEctopia of the cervix - displacement of the boundaries of the cylindrical epithelium on the \nvaginal part of the cervix - is detected in 38.8% of the female population and in 49% of \ngynecological patients. The hormonal factor in the genesis of precancerous diseases of the cervix \nis widely discussed. Experimental data show that the induction of cancer under the influence of \nthe human papillomavirus is potentiated by the action of estrogens when the number of actively \nproliferating cells increases sharply. The frequency of traumatic injuries of the cervix ranges \nfrom 5.6 to 30%. A number of researchers believe that the infectious processes of the genitals \ncaused by the herpes simplex virus type 2 play a role in the development of precancerous and \ncancerous diseases of the cervix. The continuing frequency of pathological conditions of the \n\n53 A journal of the AMERICAN Journal of Pediatric Medicine and Health Sciences www. grnjournal.us  \ncervix, the tendency to a long, recurrent course, the possibility of transformation make it very \nimportant to search for both new effective and safe methods of influencing the pathological \nfocus, and additional factors in order to increase the effectiveness of treatment. \nThe main purpose of the cytological study is to identify the morphological features of cells that \ncharacterize the pathological process. The method makes it possible to assess the structure and \ncellular level of damage to tissues that have fallen into the smear-print, and allows you to \nidentify precancerous changes 3-5 years before the development of cervical cancer. \nIt is known that pregnancy is a risk factor for the development of human papillomavirus \ninfection (PVI) and contributes to the active replication and persistence of HPV. At the same \ntime, the latent form of PVI can turn into subclinical and clinical forms; the clinical features of \nPVI depend on the type of virus (low and high oncogenic). In patients with highly oncogenic \ntypes (16th, 18th), the manifestations of PVI are localized mainly on the cervix in the form of a \nflat condyloma or the development of cervical intraepithelial neoplasia. With low-oncogenic \ntypes (6th, 11th), changes in the cervix are less common, and are determined in the vulva and \nvagina in the form of genital warts. During pregnancy, visible warts often recur, grow \nprogressively and can reach gigantic proportions. The number of cases of transmission of HPV \nfrom mother to fetus, according to different researchers, ranges from 4 to 87%, depending on the \nsensitivity of the diagnostic methods used. HPV has been described as capable of infecting \ntrophoblast cells, leading to spontaneous abortions. \n The term \"dysplasia\" is a morphological and at the same time a clinical concept and includes the \nprocess of proliferation of cells with the appearance of atypia in them, especially nuclear, with a \nsubsequent change in the entire structure of the epithelium, the loss of a normal layered structure. \nDepending on the intensity of cell proliferation, the severity of structural and cellular atypia in \nthe epithelial layer, 3 degrees of dysplasia are distinguished: mild, moderate and severe, \ncharacterized by the appearance of atypical cells, first in the lower third, then in the lower two \nthirds and, finally, in the entire third, then in the lower two-thirds and, finally, the entire \nthickness of the stratified squamous epithelium, including more superficial sections. The \ncondition in which the expansion of atypical cells continues beyond the basement membrane is \ncalled invasive cancer. \nThe problem of diagnosis and treatment of benign diseases of the cervix is due to their steady \ngrowth and significant share in the structure of gynecological morbidity. According to T.A. \nOboscalova, I.N. Kononova and other diseases of the cervix account for 61.2% in the structure of \ngynecological diseases. In 83% of cases, the pathology of the cervix is accompanied by a \nviolation of vaginal dysbiosis and immune dysfunctions, which is consistent with the data of \nother researchers. \nColposcopy is one of the leading methods for examining patients with cervical pathology. \nCurrently, the International Classification of Colposcopic Terms, approved at the 14th World \nCongress of the International Federation of Colposcopy and Cervical Pathology (IFCPC), held in \nJuly 2011 in Rio de Janeiro, is used to interpret colposcopic pictures. This colposcopic study also \nhas a predictive value of 64.6% with a sensitivity of 88.4% and a specificity of 43.2%. The most \nspecific features are acetowhite epithelium (prognostic value - 91.7%), iodine-positive mosaic \nand punctuation (77.8%), atypical transformation zone (77.4%). \nDiagnosis of precancerous processes in the cervix is carried out in several stages. At the first \nstage, an initial examination of women is carried out, which includes a thorough history taking, \nphysical examination, examination with gynecological mirrors, bimanual gynecological \nexamination, colposcopy, cytology of smears, analysis of vaginal smears to determine the flora. \nColposcopy (CS) is a highly informative, widely available and inexpensive method for \ndiagnosing diseases of the cervix (CC), vagina, and vulva, which significantly increases the \nefficiency of examining women with gynecological pathology. Along with other modern \nmethods of examination, the CS allows you to choose the best ways to manage patients and \nmonitor the state of the epithelium of the cervix, vagina and vulva in various physiological \n\n54 A journal of the AMERICAN Journal of Pediatric Medicine and Health Sciences www. grnjournal.us  \nperiods of a woman's life, and can be used repeatedly. The main task of the CS is to identify \nprecancerous conditions of the cervical epithelium, which include dysplasia of the stratified \nsquamous epithelium (SSE) and endocervical glandular epithelium, which is initiated by the \nhuman papillomavirus (HPV). \nExtended CS - the most effective and common technique - examination of the epithelium using \nvarious epithelial and vascular tests, which assess the response of tissues in response to treatment \nwith drug formulations. The technological chain of the CS includes examination of tissues under \ndifferent magnifications, using a filter, after treatment with acetic acid and Lugol solutions. \nEach stage allows you to clarify colposcopic data, since the method is to a certain extent \nsubjective and requires sufficient training and qualifications. \nThe colposcope is an optical system mounted on a tripod (binocular loupe) with a directional \nlighting system. It is recommended to use a binocular colposcope, since monocular devices and \ndigital devices without eyepieces have low research efficiency due to the inability to obtain a \nthree-dimensional three-dimensional picture. \nWith a pathological colposcopic picture (acetowhite epithelium, puncture, mosaic, dyskeratosis, \niodine-negative zone, the presence of atypical vessels), if invasive carcinoma is suspected during \ncolposcopy, as well as when cytological smears of types III, IV and V are obtained, a targeted \nbiopsy is performed followed by a histological examination of the biopsy . \nMany clinicians involved in the problem of diagnosis and treatment of benign diseases of the \ncervix note that against their background, deep naboth cysts are often detected in the thickness of \nthe cervix. According to V.N. Prilepskaya et al. Inadequate choice of treatment method in the \npresence of a large number of treatment methods in the presence of a large number of cysts or \ntheir deep location affects the effectiveness of treatment. Until now, there is no consensus among \nclinicians regarding the tactics of managing patients with another pathology of the cervix - \ncervical canal polyps. Most authors consider it necessary to perform hysteroscopy, polypectomy \nin the endometrium, as well as the possible location of the pedicle of the cervical canal polyp in \nthe uterine cavity. In recent years, a number of works have appeared on the use of ultrasound to \ndetect cysts of the cervix and polyps of the cervical canal. However, ultrasound does not fully \nevaluate from the point of view of choosing a method of treatment for these types of pathology \nof the cervix. \nIn women with a healthy cervix, the material is obtained from three sites: from the exocervix, \nfrom the site on the border of the stratified squamous epithelium and the cylindrical epithelium \nof the cervical canal from the lower third of the endocervix. To do this, use special brushes \n(cervix bronch), spatulas, grooved probes, Volkmann spoons. \nIt is fundamentally important that colposcopic and cytological studies do not allow assessing the \nmorphological changes in the epithelium in its deep layers, its deep layers, therefore, the \nhistological method plays a decisive role in assessing morphological changes. If the histological \nconclusion shows mild, moderate or pronounced dysplasia (CIN I, II, III), in these cases it is \nrecommended to perform a separate diagnostic curettage of the mucous membrane of the \ncervical canal and the body of the uterus with a histological examination of the scrapings. \nThus, diseases of the cervix continue to be an urgent problem of gynecology and the most \ncommon pathology of the female genital area. As studies by gynecologists, hygienists and other \nspecialists have shown, a woman's body reacts to adverse environmental factors with the \nemergence of a number of adaptive reactions, which can later turn into a pathomorphological \nstate. \nConclusions. \nThus, colposcopy is recommended for widespread implementation in the practice of obstetricians \nand gynecologists in order to carry out comprehensive diagnostic measures. Due to the use of \ndigital video systems with software in modern colposcopes, the effectiveness of this diagnostic \n\n55 A journal of the AMERICAN Journal of Pediatric Medicine and Health Sciences www. grnjournal.us  \nmethod is significantly increased, which allows for adequate timely treatment. \nComprehensive diagnostic measures with the inclusion of colposcopy in polyclinics, \ngynecological hospitals, more in-depth studies carried out in specialized oncological institutions \nare promising and expedient, as they improve the accuracy of diagnosing diseases of the cervix, \nprovide adequate timely treatment and provide secondary prevention of cervical cancer. \n \nLiterature \n1. Rakhmatullaeva MM, Navruzova NO The role of colp in the early diagnosis of the cervix// \nAlmanac of Young Science. 2018 No. 4. S. 21-23. \n2. Ashurova, NG, & Navruzova, NO (2017). Preclinical diagnosis of cervical diseases. News of \ndermatovenerology and reproductive health. \n3. Ikhtiyarova GA, Navruzova NO, Karimova GK Modern diagnostic methods for early \ndetection of cervical diseases // Doctor akhborotnomasi. 2019. N. 4. P. 78-80. \n4. Navruzova, NO, & Karimova, GK (2019). Modern diagnostic methods for early detection of \ncervical diseases. Doctor akhborotnomasi, (4), 78-80. SCIENTIFIC PROGRESS VOLUME \n\u0016\u0003Ä\u0003,668(\u0003\u0014\u0003Ä\u0003\u0015\u0013\u0015\u0015\u0003,661\u001d\u0003\u0015\u0014\u001b\u0014-1601 Uzbekistan www.scientificprogress.uz Page 207 \n5. Ikhtiyarova, GA, Navruzova, NO, & Karimova, GK (2019). Modern diagnostic methods for \nearly detection of cervical diseases. Doctor akhborotnomasi, (4), 78-80. SCIENTIFIC \n352*5(66\u0003 92/80(\u0003 \u0016\u0003 Ä\u0003 ,668(\u0003 \u0014\u0003 Ä\u0003 \u0015\u0013\u0015\u0015\u0003 ,661\u001d\u0003 \u0015\u0014\u001b\u0014 -1601 Uzbekistan \nwww.scientificprogress.uz Page 207","source_license":"CC0","license_restricted":false}