Background: Adhesive intestinal obstruction is a pressing problem in pediatric surgery. Early diagnosis and treatment options for both early and late forms remain controversial. Objective: To early clarify the proposed diagnosis of adhesive intestinal obstruction in children previously operated on for acute appendicitis. Materials and Methods: From 2020 to 2024, 76 of 382 children at the 2-2 City Children's Surgical Clinical Hospital (2-2DCCH) underwent surgery for acute appendicitis. Adhesive disease was recorded (33 early, 43 late). The patients ranged in age from 2 to 18 years with signs of abdominal adhesive disease. Of these, 44 were boys (57.8%) and 32 were girls (42.2%). Results: The diagnosis was based on the patient's medical history, clinical examination, abdominal ultrasound, laparoscopy, and laparotomy.
Bacterial conjunctivitis occupies a significant place among infectious diseases of the anterior segment of the eye, and within its etiological spectrum, Staphylococcus aureus is recognized as a particularly relevant pathogen, especially in adults, elderly individuals, and patients with compromised ocular surface defense mechanisms. Contemporary literature indicates that the pathogenicity of this microorganism is not limited to superficial colonization but is mediated through a complex, multi-component virulence system. The adhesion of S. aureus to the conjunctival surface is facilitated by fibronectin-binding proteins, extracellular adherence protein, and clumping factors; subsequently, biofilm formation, tissue invasion, toxin secretion, and immune evasion mechanisms contribute to the persistence and recurrence of the disease. In particular, alpha-toxin, gamma-toxin, Panton–Valentine leukocidin, and enterotoxins enhance epithelial cell damage, promote the release of inflammatory mediators, and intensify local tissue destruction. Molecular studies have demonstrated a high prevalence of genes associated with adhesion, invasion, and immune evasion in ocular S. aureus strains; in certain clinical series, the hld and hlg genes were detected significantly more frequently in infectious strains compared to non-infectious isolates. Recent observations indicate that the proportion of staphylococci in bacterial conjunctivitis and the issue of methicillin-resistant strains remain persistent, thereby limiting the effectiveness of empirical therapy. Thus, the pathogenesis of S. aureus-associated bacterial conjunctivitis should be considered as an integrated system involving adhesion, biofilm formation, toxic injury, induction of inflammation, and antibiotic resistance.
The aim of this study is to evaluate the effectiveness of task-based and self-directed learning among students in the Department of Pediatrics, using simulation technologies, in the development of practical skills and clinical reasoning. The study included 120 fourth- and fifth-year students from the Faculty of Pediatrics at Tashkent State Medical University. The participants were divided into a main group (n = 60), which was trained using a task-oriented and self-directed learning model incorporating simulation technologies, and a comparison group (n = 60), which was trained using traditional methods. The results showed that a high level of practical skill development, as assessed by the OSCE, was observed in 86.7% of students in the experimental group, which was significantly higher than the corresponding figure in the control group—61.7% (p < 0.05). The mean total score for performing a pediatric examination was 84.3 ± 6.2 points in the main group and 72.5 ± 7.1 points in the comparison group (p < 0.01). The number of errors in assessing vital signs was significantly lower in the main group (0.9 ± 0.3) compared with the comparison group (1.6 ± 0.4; p < 0.05). In addition, the proportion of students demonstrating confidence and logical consistency in their clinical decisions was 81.7% in the main group versus 58.3% in the comparison group (p < 0.05). The results obtained demonstrate the high effectiveness of task-oriented and independent learning using simulation technologies. This educational model contributes to improving students’ practical training, developing clinical reasoning, and reducing the number of diagnostic errors, thereby enhancing the readiness of future pediatricians for professional practice.
BACKGROUND Hiatal hernia (HH) is a common condition that can present diagnostic challenges when accompanied by complex comorbidities. While HH is associated with obesity and elevated intra-abdominal pressure, its occurrence with eating disorders is not as well documented. We report a rare case of symptomatic HH in a patient with concurrent obesity and bulimia nervosa, a combination not previously reported in the literature. CASE REPORT A 39-year-old woman presented with 2 years of postprandial vomiting, chest pain, dyspnea, and heartburn. Her medical history revealed self-induced vomiting for weight control that progressed to bulimia nervosa, resulting in weight loss of 44 kg. Initial treatments with proton pump inhibitors provided minimal relief. Comprehensive evaluation revealed type III paraesophageal HH (5 cm hernial orifice), grade 2 reflux esophagitis, anemia, and a gallbladder polyp. The patient underwent laparoscopic cruroplasty with Toupet fundoplication and cholecystectomy, combined with psychiatric management including cognitive-behavioral therapy and fluoxetine. At 3-month follow-up, complete symptom resolution was achieved. CONCLUSIONS This case highlights the importance of thorough history-taking in patients with atypical gastrointestinal symptoms and demonstrates that bulimia nervosa can contribute to HH development through repeated increases in intra-abdominal pressure. A multidisciplinary approach integrating surgical and psychiatric interventions is essential for successful management of HH when associated with eating disorders and other complex comorbidities.
This study uses bibliometric analysis to look at global trends in writing differentiation from 2014 to 2024. It does this by looking at how different teaching methods can meet the needs of different learners. It shows how writing differentiation can be used around the world, what new themes are emerging, and what areas need more research in the field of education. The research on writing differentiation from 2014 to 2024 was examined through bibliometric analysis using Web of Science data. Key patterns and clusters were identified by analysing publications by year, journal, authorship, and country using Excel, RIS, VOSviewer, RStudio, and MapChart. A review of 165 writing differentiation papers (2014–2024) shows a publication peak in 2019 followed by a sharp decline in 2023, a growing emphasis on themes like ‘competence’, ‘attitudes’, and ‘differentiation’, and the US as the leading contributor to research. The US leads writing differentiation research output and institutional contributions, highlighting its growing importance. Changing keyword patterns indicate a shift towards adaptive teaching strategies, emphasizing the need for future research to promote international collaboration and broaden the approach’s educational impact.
