Turkish Journal of Physiotherapy and Rehabilitation; 32(2) ISSN 2651-4451 | e-ISSN 2651-446X

EARLY DIAGNOSIS OF THE DISEASES IN PATIENTS WITH COMMUNITY-ACQUIRED

Daulet Azatbekovich Jumanov1, Shakhlo Khamidullaevna Bakieva2, Navruz Noryigitovich Jabbarov3 1PhD, doctoral student, Department of Otolaryngology and Dentistry, Tashkent Medical Academy, Tashkent, Uzbekistan. E-mail:[email protected], ORCID: 0000-0003-3439-6691 2Associate Professor, Doctor of Medical Sciences, Department of Otolaryngology and Dentistry, Tashkent Medical Academy, Tashkent, Uzbekistan. E-mail: [email protected] ORCID: 0000-0002-6093-3449 3Assistant, Department of Otolaryngology and Dentistry, Tashkent Medical Academy, Tashkent, Uzbekistan. E-mail: [email protected] ORCID: 0000-0002-9571-5724

ABSTRACT

This article presents the results of complex otorhinolaryngological and radiological (MSKT) examinationsof nasal cavities of patients with pneumonia outside the hospital.Diseases of this system are inextricably linked due to the similarity of the structure, functions and pathological mechanisms of development of the upper and lower .In the etiopathogenesis of inflammatory diseases of the upper and lower respiratory tract lies a violation of the integrity of the mucous membrane`s epithelial cells under the influence of respiratory viruses.As a result of the general toxic effects of viruses, the process of phagocytosis slows down, and immune protection is disrupted. As a result, some conditions emerge for colonization of conditionally pathogenic microbes in the upper respiratory tract. It allows bacteria to spread from the nasal cavities to the lower respiratory tract.Clinical and radiological examinations revealed a high incidence of acute and chronic diseases of the nasal cavities in patients with community-acquired pneumonia. It allows for the timely treatment of inflammatory diseases of the upper respiratory tract, early and effective treatment of inflammatory diseases of the lower respiratory tract, and preventing their development.

Keywords: upper and lower respiratory tract, rhinosinusitis, community-acquired pneumonia, otorhinolaryngological and radiological examination.

I. INTRODUCTION The results of medical statistics convincingly show an increase in the number of pathologies of the nose, nasal sinuses and broncho-pulmonary [1,2]. Due to the close anatomical and physiological connections between the upper and lower respiratory tract, an increase in the number of rhinosinusitis has led to an increase in the number of lung diseases [3,4] and especially community-acquired pneumonia (CAP).Even despite the joint efforts of leading experts from around the world, this process cannot be disrupted [2,3,4,6]. The mortality rate from community-acquired pneumonia ranks 6th when it comes to mortality rates worldwide, and the number of deaths continues to increase [6,15].

Although there is a lot of data on the interaction between upper respiratory tract pathology and bronchial , coverage of specific aspects of the combination of CAP and rhinosinusitis in the medical literature has begun in relatively recent years. Very few foreign publications have found that 40% -88% of patients with CAP also have nasal complaints [4,13]. Thus, the prevalence of inflammatory pathology of the nasal and nasopharyngeal mucosa in patients with CAP is almost unstudied. The literature does not provide data on radiological screening of the nasal cavity in patients with CAP. Surprisingly, the phenomenon known as the “vicious circle” lies in the basis of the pathogenesis of rhinosinusitis and CAP [3,4,14]. The “vicious circle” is a series of interconnected structural changes that lead to inflammation in the respiratory tract`s mucous membrane, disruption of mucociliary transport, and microflora accumulation in the respiratory tract. www.turkjphysiotherrehabil.org 4082

Turkish Journal of Physiotherapy and Rehabilitation; 32(2) ISSN 2651-4451 | e-ISSN 2651-446X

It is known that one of the factors that greatly contributes to the development and course of CAP is bacterial [7,8,12]. This case emphasizes the need to obtain convincing evidence of a link between bacterial infection of the upper respiratory tract and the severity, nature, and clinical features of CAP.Representatives of the conditionally pathogenic microflora are the most important factors in the development and exacerbation of acute and chronic rhinosinusitis and CAP [9,10,11]. However, there are no published studies on the microflora of the nasal cavity and lower respiratory tract in patients with CAP [3,14].

Thus, the problem of the relationship between the nasal cavity, , and CAP diseases has not been explored in the modern literature. Two pathological conditions that go together are actually the same disease.Certainly, inflammation in the upper respiratory tract supports a similar process in the lower respiratory tract and, conversely, exacerbates the development of both diseases and structural irreversible changes in the broncho-pulmonary system [3,4].It can be seen that one of the reasons for the low efficacy in the treatment of CAP is the lack of data on the specific features of the microbial landscape in the adjacent pathology of the upper respiratory tract and this category of patients [3,4,13,14,15].Therefore, the direct result of the scheme developed for the management of patients with combined pathology of the upper respiratory tract and CAP is the creation of effective and comprehensive treatment methods taking into account all the etiopathogenetic aspects of these diseases. All of the above indicates the relevance of the dissertation topic chosen by the author.

The purposeof the study is the early diagnosis of diseases of the nose and nasal cavities in patients with community-acquired pneumonia.

II. MATERIAL AND METHODS To deal with the identified tasks, 106 patients diagnosed with CAP were selected, who from 2018 to 2021 were treated in the department of therapy - resuscitation and pulmonology of the multidisciplinary clinic of the Tashkent Medical Academy.Patients were admitted on a scheduled and urgent basis according to the instructions of doctors of district polyclinics. All patients were examined clinically, endoscopically and radiologically (multispiral computed tomography -MSCT) in the departments of pulmonology and ENT diseases of the multidisciplinary clinic of the Tashkent Medical Academy.

III. RESULTS Patients ranged by age from 18 to 60 years (mean 37.7 ± 1.2 years). The mean age of men was 34.8 ± 1.5, and that of women was 39.8 ± 1.6 years. Gender distribution: women - 62 people (58.5%), men - 44 people (41.5%). The sex and age of the patients and the severity of CAPare shown in Tables 1 and 2.

Table 1 Distribution of the patients with CAPaccording to their sex and age Age Men Women Overall % 18-30 20 18 38 35,8 31-40 14 15 29 27,3 41-50 7 13 20 18,8 51-60 3 16 19 17,9 Total: 44 62 106 100

Thus, among the patients examined, according to our data, CAPis more common in women than men in a 1.4: 1 ratio.It should be noted that according to the World Health Organization (WHO) age classification, patients between the ages of 18 and 45 are the most numerous group. And the majority, i.e., 75 patients (70.75%), are the most able-bodied patients.The demographic data obtained are consistent with international statistics.

According to the severity of CAP, patients were distributed according to the practical recommendation “Diagnosis, treatment and prevention of community-acquired pneumonia in adult patients” (2015) provided by the Russian Respiratory Society.

Table 2 Distribution of patients according to the severity of CAP The stages of the disease Patients % I - moderate 83 78,3 www.turkjphysiotherrehabil.org 4083

Turkish Journal of Physiotherapy and Rehabilitation; 32(2) ISSN 2651-4451 | e-ISSN 2651-446X

II - severe 23 21,7 Total: 106 100

Patients with mild CTP were not identified because all patients received inpatient treatments and outpatients were not included in the study.Most patients were admitted to the intensive care unit for immediate therapy due to shortness of breath and fever. They were transferred to the pulmonology department when their general condition improved.

A comprehensive otorhinolaryngological examination also identified a number of ENT diseases in patients with CAP. Diseases of the ENT organs were detected in 82 (80.2%) patients (Table 3).

Table 3 Concomitant diseases of the ENT organs in patients with CAP Concomitant diseases The number of patients N % Chronic RSV 47 44,3

Chronic 47 44,3

Nasal septumdeviation 38 35,8 Vasomotorrhinitis 29 27,3 Chronic 21 19,8 Acute RSV 15 14,1 Acute pharyngitis 15 14;1

Paranasalsinuses cyst 9 8,5

Neurosensory deafness 6 5,6 chronic otitis media 6 5,6 Chronic 2 1,8

It should be noted that the concomitant diseases of the ENT organs include acute and chronic rhinosinusitis, pharyngitis (58.5%), deviation (35.8%), vasomotor-allergic (27.3%), chronic tonsillitis (19.8%).This showsthe frequent occurrence of URT and disruption of normal physiology and direct relationof the development and course of LRT diseases. Given the average age of the patients, it is possible to explain the high incidence of chronic diseases of the ENT organs.

In 62 (58.5%) patients, subjective complaints (difficulty through the nose, runny nose and nasal discharge, headache, hyposmia) and objective symptoms (hyperemia and swelling of the nasal mucosa, discharge from the nose and mouth, palpation of the paranasalsinuses projection and to percussion) which are specific to inflammatory diseases of the nasal cavity and paranasal sinus mucosal inflammatory diseases were identified.All 62 patients (58.5%) reported an increase in subjective complaints specific to inflammatory diseases of the nasal cavity and paranasal sinuses inflammatory diseases during or before the course of CAP.

A visual analog scale (VAS) was used to assess the severity of disturbing nasal complaints, and it divided the course of the disease into mild, moderate, and severe.On a conditionally divided line of 10 parts, the patient should independently determine how disturbing the RS symptoms are. 0 to 4 is considered mild and 5 to 10 is considered moderate/ severe.

As a result, of the total number of patients examined using the VAS scale, 27 (25.5%) patients described their nasal complaints as moderate / severe, and 35 (33.0%) as mild.

In all 106 patients, computed tomography of paranasal sinuses and 3D radiography were performed. X-ray changes in paranasal sinuses: mucous membrane thickened by more than 6 mm.X-ray changes were detected in 32 (30.2%) patients. Subtotal and total decrease of all paranasal sinuses pneumatization was detected in 2 patients, right hemisinusitis in 1 patient, left hemicinusitis in 2 patients, right maxilloethmoidal in 4 patients, and left maxilloethmoidal sinusitis in 6 patients. Right and left ethmoidosphenoiditis were observed in 6 www.turkjphysiotherrehabil.org 4084

Turkish Journal of Physiotherapy and Rehabilitation; 32(2) ISSN 2651-4451 | e-ISSN 2651-446X patients, and right, left, and bilateral sphenoiditis in 11 patients. The radiological changes detected in the patients are presented in Table 4.

Table 4 The results of the X-ray examination of the paranasal sinuses Total Subtotal Fluid level Upper jaw Right 1 3 2 Left 2 4 1 Forehead Right 1 2 - Left 2 2 - Circular Right 3 11 - Left 5 9 - Main Right 3 13 - Left 4 15 -

It should be noted that radiological changes in paranasal sinuses were detected in all 27 (25.5%) patients who described their condition as moderate / severe.Among patients who described their condition as mild, radiological changes (thickening of the mucous membrane) were detected in 5 patients, which allowed us to re-evaluate RSV severity and transfer patients to a group with moderate RSV.It was also concluded that patients rated their somatic condition as low on URT, given the predominance of CAP symptoms.

IV. CONCLUSION Diseases of the nose and nasal cavity were detected in approximately 3/4 of patients with community-acquired pneumonia. Among diseases of the ENT organs, acute and chronic inflammatory diseases of the upper respiratory tract accounted for the largest percentage - 58.5%.It is known that in the pathogenesis of the development of CAP, paranasal sinuses are a risk factor for chronic inflammatory diseases. Chronic ethmoiditis and sphenoiditis (59.25% and 70.3%, respectively) were the most common outcomes of MSKT examinations of paranasal sinuses.From this it can be concluded that timely detection and effective treatment of chronic diseases of the nose and paranasal sinuses, especially chronic ethmoiditis and sphenoiditis, reduces the risk of developing community-acquired pneumonia.This, in turn, will lead to a reduction in community-acquired pneumonia, a disease with a high mortality rate among patients worldwide, and a sharp reduction in the health care system’s spending on treating this disease.

CONFLICT OF INTERESTS AND CONTRIBUTION OF AUTHORS The authors declare the absence of obvious and potential conflicts of interest related to the publication of this article and report on the contribution of each author.

SOURCE OF FINANCING No funding was required for this research.

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