1-2022

 

THEORY AND PRACTICE OF MEDICINE

 

Abdullaeva N.A.

STUDY OF SKIN MICROBIOSIS IN CHILDREN WITH ATOPIC DERMATITIS

Aim.The research of the species composition of the skin in sick children with atopic dermatitis.

Material and methods. We analyzed the medical histories of 35 sick children with atopic dermatitis at the age from 1 to 5 years.

Results. In case of the addition of a secondary infection in the condition atopic dermatitis, a comorbid approach to treatment is required. Secondary infection changes the clinic of the main process and aggravates immunological disorders in sick children with the skin condition of atopic dermatitis.

Conclusion. Atopic dermatitis changes the skin barrier and contributes to the addition of a secondary infection of a bacterial, viral, and mycotic nature. The process itself causes immunological disorders, which are aggravated by secondary infection.

Key words: atopic dermatitis, skin microflora, bacterial, viral, fungal skin infections

 

Abdusamatzoda Z., Yunusova D.Z., Mukhamadieva S.M., Alieva R.J., Mirzabekova B.T.

ANALYSIS OF MATERNAL MORTALITY STRUCTURE DURING COVID-19 PANDEMIC

Aim.To study the structure of maternal mortality (MM) during the COVID-19 pandemic and propose measures to improve the quality of medical services and reduce maternal losses in the country.

Materialandmethods.Official statistics for 2020 – 2021, a retrospective study of primary medical records of 113 deaths in women who died during pregnancy, childbirth, and the postpartum period from April 2020 to November 2021.

Results.A comparative analysis of official sources showed that during the coronavirus pandemic (2020), compared to the same period of the previous year (2019), the MM in the country increased from 21,9 to 26,7 per 100,000 live births. At the same time, indirect (indirect, uncontrollable) causes of MS increased by 1,4 times (from 27,5% to 39,7%), while (controllable) decreased from 72,5% to 60,3%.

It was established that mortality from bronchopulmonary diseases increased by 5,6 times, the proportion of cardiovascular diseases decreased by 1,5 times, tuberculosis by 3,5 times, and hepatitis by 1,7 times. Among the direct obstetric causes of MS, hypertensive disorders do not tend to decrease: the proportion of preeclampsia was 26/27%, eclampsia – 10,8/10,5%; septic complications decreased by 4,1 times (from 10,8% to 2,6%), by 9,3 times – HELLP syndrome (from 24,4% to 2,6%); the proportion of amniotic fluid embolisms was 21,6% and 23,7%, respectively.

Conclusion.In the context of the COVID-19 pandemic, high rates of MS are due to both an infectious agent and obstetric reasons associated with the organization of medical services and low public awareness. Monitoring the implementation of national standards / clinical protocols for the management of pregnancy, childbirth and the postpartum period, as well as auditing critical cases of obstetric complications, will reduce the maternal mortality rate and improve women’s reproductive health.

Key words: coronavirus infection, COVID-19, maternal mortality, structure, obstetric causes, indirect causes, reproductive health

 

Вobokhodzhaeva M.O.

INDICATORS OF YOUTH QUALITY OF LIFE WITH SAFE AND RISKY BEHAVIOR

Aim. Assess the health-related quality of life of young people with socially safe behavior and high-risk groups.

Materials and methods. A study was conducted on the quality of life of 1000 young people, including 550 people with safe behavior (organized youth), 200 labor migrants, 120 sex workers (SW), 30 men who have sex with men (MSM) and 100 – injecting drug users (IDU), residents of cities and villages of the Republic of Tajikistan using the questionnaire recommended by WHO (WHOQOL-100) for assessing the quality of life. In order to assess the state of reproductive health, a general objective and gynecological examination was carried out according to generally accepted methods, hematological, bacteriological and ultrasound examinations.

Research results. Among the respondents, men accounted for 32.7%, women – 67.3%. The age range of the respondents was from 14 to 30 years. The educational level of the respondents was studied, which showed that, basically, the respondents had secondary education – 566 (56.6%), higher – 279 (27.9%) and primary education had 64 (6.40%) young people. The economic situation of the family was assessed by the respondents as “good” – 619 (61.9%) of the respondents, satisfactory – by 299 (29.9%) of the respondents, and only 82 (8.20%) of the respondents consider the economic status of the family to be difficult. Material and living conditions were assessed as “good” in 61.5% of cases, as “satisfactory” in 28.3%, as “difficult” in 10.2%.

Engaged in sexual relations before the age of 19 – 416 (41.6%) respondents, including those aged 10-14 years – 14 (1.4%) respondents, 15-17 years old – 68 (6.8%), 18 –19 years – 334 (33.4%) respondents. Have entered into sexual relations at the age of 20-24 – 398 (39.8%), 25-29 years – 174 (17.4%) and at the age of 30 -12 (1.2%). The bulk of young people get married at the age of 20-24 554 (55.4%), the share of early marriages (under 19) was 187 (18.7%), at the age of 25-29 – 246 (24.6 %) and there is a small group of those who got married at the age of over 30 – 13 (1.3%). If we compare the rates of sexual contacts between persons who first had sexual contacts under the age of 19 (37.5%) with the age of marriage under 19 (17.4%), it is obvious that they entered into premarital sexual contacts 20.1 % young people. The quality of life for different groups of young people differs: the highest average score was obtained among organized youth (on average 4.2 points), the lowest – among SWs (3.3 points), MSM (3.3 points) and IDUs (3.2 points) , average values ​​- for labor migrants (3.4 points).

Conclusions

1. The quality of life for different groups of young people differs: the highest average score was obtained by organized youth, the lowest – by SWs, MSM and IDUs, average values ​​- by labor migrants.
2. It has been established that young people in the high-risk group have a high epidemiological significance in the spread of socially significant diseases.
3. The effective functioning of the Youth Medical Advisory Departments, the integration of medical advisory services for young people with other services at the PHC level, the introduction of reproductive and sexual health programs in the curricula of schools, colleges and universities in the country can serve as a significant reserve for improving the health-related quality of life of young people.

Keywords. Youth, Safe and Risk Behavior, Quality of Life, Youth Health Advisory Departments.

 

Yorov Y.B., Rabiev H.S.

DIFFERENTIATED SURGICAL MANAGEMENT IN ACUTE CHOLECYSTOPANKREATITIS

Aim.Improving the results of surgical treatment of patients with acute cholecystopancreatitis.

Material and methods. The results of complex diagnostics and surgical treatment of 130 patients with acute cholecystopancreatitis were analyzed. All patients were divided into 2 groups. The control group (group I) consisted of 70 (53,8%) patients who underwent traditional, open surgical interventions. The remaining 60 (46,2%) patients who made up the main group (Group II) underwent minimally invasive surgical interventions.

Results. The use of minimally invasive surgical interventions in patients with acute cholecystopancreatitis in combination with developed and improved methods of surgical treatment of acute cholecystopancreatitis, as well as with local administration of drugs through the round ligament of the liver, helps to reduce the intensity of inflammatory changes in the pancreatobiliary zone after cholecystectomy, and increases preventive measures progression of acute pancreatitis. In addition, such patients have a smoother course of the postoperative period, there is a suppression of systemic membrane-destabilizing processes and a decrease in the intensity of endotoxemia and lipid peroxidation processes, which are among the most significant factors in the development and progression of acute inflammatory lesions of the pancreas and other purulent-inflammatory processes. in the hepatopancreatobiliary zone.

Conclusion. Laparoscopic cholecystectomy, the use of puncture-drainage interventions under visual ultrasound monitoring on the gallbladder in patients with aggravated somatic status, i.e. minimally invasive interventions showed better results in the immediate postoperative period than with open traditional cholecystectomy.

Key words: acute cholecystopancreatitis, surgical tactics, minimally invasive interventions, cholecystectomy

 

Izzatov Kh.N., Abdurahmonova R. F., Faizulloev A.Kh., Saidamirov U.H., Turakulov D.A.

NEUROMIDIN IN COMPLEX THERAPY CHRONIC BACK PAIN

Aim.To study the effectiveness of the drug Neuromidin in the complex treatment of chronic back pain.

Material and methods.The results of treatment of 566 patients with chronic back pain aged 20 years and older were studied. For all patients, in addition to the examination of the neurological status, CT and MRI examination of the spine, we determined the intensity and dynamics of the pain syndrome using a visual analogue scale (VAS).

Results. Our studies have shown that the use of adjuvant analgesics, in particular the drug Neuromidin, in the complex therapy of chronic back pain actually affects the intensity and dynamics of the pain syndrome: by 48,6% it contributes to a pronounced regression of the pain syndrome and by 60% contributes to the expansion volume of active and passive movements in the lower back.

Conclusion. Thus, the use of adjuvant analgesics, in particular Neuromidin, in the complex therapy of chronic back pain increases the effectiveness of the treatment of patients and helps to reduce the duration of treatment.

Key words: Neuromidin, chronic back pain, treatment

 

Karimov S.M., Zaripov A.R., Nazarov Z.A.

STANDARD QUALITY TREATMENTS OF ENDO-PERIO COMPLICATIONS OF THE FRONTAL FUNCTION-ORIENTED GROUPS TEETH AND ITS EFFICIENCY IN NEAREST AND REMOTE PERIODS OF THE OBSERVATION

Aim.To evaluate compliance with the standard of endodontic care and the effectiveness of treatment of endoperiapical lesions in an aesthetically significant occlusal zone.

Material and methods.To study the frequency of endoperiapical complications of dental caries located in an aesthetically significant occlusal zone, a comprehensive examination of the oral cavity was performed in 513 patients aged 20 to 45 years. To identify endoperiapical complications, intraoral radiographic and orthopantomographic studies were used.

Results.Presence of endodontic complications in the manner of acute and chronic form pulpitis was discovering accordingly in the field of 16 and 76 teeth located in aesthetic significant occlusion zone of upper (63) and lower (29) jaws. From the gross amount of the examined persons presence of chronic periapical destruction revealed in the field of 108 teeth upper (81) and lower (27) of the jaws.

Conclusion.Evaluation of the effectiveness of treatment of endoperiapical complication of one- and two-rooted teeth 2 years after the implementation of a set of measures in a group of middle-aged patients showed that the presence of clinical and radiological symptoms of this lesion was absent in 63.6% and 48.5% of cases.

Key words:endo-periapical complication, aesthetic zone, endodontic treatment, one radix teeth, two radix teeth

 

Mukharamshoeva M.Sh.

REPRODUCTIVE HEALTH OF WOMEN WITH THE INFERTILITY AFTER SURGICAL INTERVENTIONS ON THE ABDOMINAL CAVITY AND PELVIS

Aim.Study the state of reproductive health of women after surgical interventions on the abdominal cavity and pelvis with the use of miniinvasive organ-saving techniques suffering from infertility.

Material and methods: Analysis of reproductive health indicators of 69 women who applied to Nasl Medical Center in connection with infertility. The main group (MG) was 29 patients who, in terms of pre-gravidic preparation for the IVF program, underwent mini-invasive surgical interventions with in the center with a therapeutic and diagnostic purpose. In the postoperative period, all MG patients underwent anti-solder resorption therapy in combination with physiotherapeutic procedures on the pelvic area. The control group (CG) included 40 patients who had previously undergone various surgeries on abdominal and pelvic organs in other institutions.

Results. The male infertility factor was found only in MG in 8 (28%), and the pipe-peritoneal factor prevailed in KG – 30 (75%). 29/58 surgical interventions in KG were performed by laparotomy access, while in MG this figure was only 2/37 cases. A significantly significant increase in testosterone levels and a low AMH score were in KG (r≤0,05). Pelvic ultrasound revealed that the number of antral follicles of both ovaries in the MG exceeded that in the KG, and statistically significantly the M-echo thickness was also greater in the MG.

Conclusions. The findings indicate a decrease in the fertility of women who underwent hollow surgery in other institutions without respecting conservation principles and anti-solder measures.

Key words: operations on abdominal organs, endoscopic interventions, women, reproductive health, infertility

 

Mullodzhanov G.E., Olimov A.M.,  Ashurov G.G.

ASSOTIATIVE ESTIMATION OF THE INNATE CLEFT OF MAXILLA AND NATURE DISEMBRYOGENESIS OF DENTISTRY AND COMMONSOMATIC STATUS  BESIDE CHILDREN

Aim.To study the relationship between congenital cleft maxilla and clinical signs of connective tissue dysplasia of stomatogenic and general somatic location.

Material and methods.There were explored 76 children at the age from 6 to 16 years with different forms of innate maxillary cleft and clinical manifestations of the breach embryogenesis for the reason studies of interconnection between abovementioned vice of the development and 42 children of the similar age without like vice.

The state of the connective tissue structures of the body was taken as an acceptable norm in the presence of no more than 3 dysembryogenesis stigmas, from 4 to 6 stigmas for a moderate form of connective tissue dysplasia, from 7 to 9 stigmas for a pronounced form of connective tissue pathology, an extremely pronounced connective tissue dysplasia was stated when visualizing 10 stigmas and more.

Results.Significant phenotypic manifestations of connective tissue dysplasia among patients with an isolated form of nonunion of the palate were observed in 39,7% of children, among patients with a penetrating form of nonunion they were observed in 41,1% of children, among patients with an isolated form of nonunion of the upper lip they were observed in 18,9% cases.

Conclusion.In patients with congenital nonunions of the upper jaw, almost all phenotypic forms of connective tissue dysplasia of the dentition were detected significantly more often than in the control group.

Key words:innate cleft, upper jaw, palate, connective tissue, embryogenesis, эмбриогенез, dysplasia

 

Radzhabova G.K.

COMPARATIVE ANALYSIS OF THE RESULTS OF THE MINIMALLY INVASIVE TREATMENT OF WOMEN WITH URGENT COMBINED ABDOLOGIES OF THE ABDOMINAL CAVITY AND SMALL PELVIC ORGANS

Aim.To study a comparative analysis of the results of treatment of women with urgent combined pathologies of the abdominal cavity and small pelvis with the use of traditional and minimally invasive interventions.

Material and methods.A comparative analysis of the results of surgical treatment of 240 women operated on for urgent combined pathologies of the abdominal cavity and small pelvis was carried out. The main group consisted of 120 women operated laparoscopically, the control group – 120 women with traditional methods of treatment. Comparison criteria were considered such indicators as the timing of removal of the drainage tube, postoperative hospital stay and complications.

Results.The duration of the operation in women of the main group averaged 59,4±11,7 minutes, and in women of the comparison group – 73,8±13,4 minutes. Postoperative bed-day in women operated laparoscopically was 4,8±1,7, on the contrary 11,2±3,8 after open surgery. Postoperative complications in women of the main and comparison groups were 7,5% and 13,3%, respectively. A short-term discharge of sanious discharge along the control drainage was noted in 4 (3,3%) women who underwent laparoscopic adhesiolysis with III and IV degrees of adhesions of the small pelvis. In 3 (2,5%) observations, suppuration of trocar wounds was noted, and in 1 (0,8%) – bile leakage, which was eliminated conservatively.

Conclusion.The advantages of laparoscopy in case of urgent combined pathologies of the abdominal cavity and small pelvis are in a wide overview access, for diagnosing combined pathologies, ensuring minimally invasive operations, simultaneous treatment of several combined surgical and gynecological diseases at once within the framework of one anesthetic benefit.

Key words: urgent combined pathologies of the abdominal cavity and genital organs, laparoscopic interventions, laparoscopic simultaneous operations

 

Salimov B.M., Munieva S.Kh., Umarova Z.K., Mustafakulova N.I.

THE EFFICIENCY OF COMPLEX TREATMENT OF PATIENTS WITH FEET AND NAIL MYCOSIS USING THYMOCIN

Aim.Study of the effectiveness of thymocin in the complex therapy of patients with mycosis of the feet and nails

Material and methods.The study involved 56 patients with foot mycoses with onychomycosis (m – 34, f – 22), mean age 45,7±1,6 years. The average duration of the disease was 13,2±1,3 years. The first group (26 patients) received systemic therapy with terbinafine, vitamins A and E, and trental. The second group (30 patients) received combined treatment (terbinafine + vitamins A and E + trental + thymocin).

Research methods: microscopic, bacteriological, immunological.

Results.The etiology of mycoses in 63,3% of patients was Trichophyton rubrum, in 31,7% – Trichophyton mentagrophytesvar. interdigitale, in 5% – Candida albicans. A complex method of treatment using thymocin after 3 months of therapy showed clinical and mycological recovery in 86,1% of patients, systemic therapy without thymocin – only in 50%. The complex method of treatment had a positive effect on immunological disorders in patients, increased the rate of nail growth.

Conclusion.Immunostimulatory therapy in patients with foot and nail mycoses using thymocin increases the effectiveness of treatment, normalizing all impaired immunological parameters.

Key words:foot mycosis, onychomycosis, etiology, immunological disorders, treatment

 

Saraev A.R.

EVALUATION OF THE SEVERITY OF THE CONDITION IN PREDICTING THE OUTCOME OF GENERALIZED PERITONITIS

Aim.To study the effectiveness of patient severity rating scales in predicting the outcome of treatment for generalized peritonitis.

Material and methods. 188 patients with generalized peritonitis were examined, and a comprehensive assessment of the severity of generalized peritonitis was carried out based on the calculation of clinical study indicators by groups of severity of the condition according to the SAPS scales and the Mannheim peritonitis index.

Results. The group of patients with the severity of the condition from 0 to 4 according to the SAPS scalecorresponded to an absolutely favorableprognosis of the disease. The likelihood of a poor prognosis increases with the severity of the condition. With an assessment of more than 10 points on the SAPS scale, the prognosis of the disease is unfavorable. In the study group of patients with an MPI index of less than 16, the lethality was 2,6%. In the second group (MPI scores from 16 to 25 points) 16,7% of patients died, in the third group (MPI index – more than 29%) 69,7% of patients died.

Conclusion. The general correspondence of the assessment of the severity of the condition and the outcome of generalized peritonitis according to the MPI and SAPS scales is obvious. The scales have shown their suitability for the tasks of assessing the severity of the patient’s condition. The solution of these tasks will allow choosing the optimal tactics for the treatment of generalized peritonitis.

Key words:generalized peritonitis, evaluation of the severity of the condition, prediction of the outcome

 

Sobirov S.S.

LUMBAR SYMPATHECTOMY EFFICACY IN PATIENTS WITH CHRONIC LOWER LIMB ISCHEMIA

Aim. Study the effectiveness of lumbar sympathectomy and long-term epidural anesthesia in the complex treatment of inoperable patients with critical lower limb ischemia.

Material and methods. The results of treatment of 100 patients with critical ischemia of the lower extremity (CENR) were analyzed. The age of patients ranged from 29 to 86 years. The majority of patients were men (77 (77%)). Depending on the methods of treatment, patients were divided into two groups: the first group (control) – 50 patients who received standard treatment using the preparation pentoxyphilin. The second (main) group was also 50 patients who were treated with lumbar sympathectomy (PSE) and epidural blockade (EB) against the background of conservative therapy. In terms of disease etiology, sex and limb ischemia, both groups were comparable.

Results. The results for all patients were evaluated after 12 weeks of therapy. Consequently, 96% of patients in the second group managed to preserve the limb and only two patients underwent a large amputation of the limb. In the control group, 6 patients had a large amputation. Results for all patients in both groups were assessed by treadmill walking prior to the development of intermittent limp. The distance without pain walking in the first group is 36 ± 56m, in the second – 86 ± 220 m (p≤0,001).

Conclusions. Modern complex conservative treatment in inoperable patients with critical ischemia of the lower extremities in combination with lumbar sympathectomy, epidural blockade and intravenous laser irradiation of the blood, is manifested by a decrease in pain syndrome, an increase in the distance of pain-free walking, regression of trophic phenomena, as well as the preservation of the limb.

Key words: critical ischemia of the lower extremities, atherosclerosis, endarteritis, treatment, intravenous laser blood irradiation

 

Umarova M.N.

RESULTS OF TREATMENT OF MALIGNANTOVARIAN TUMORS IN CHILDREN IN THE REPUBLIC OF TAJIKISTAN

Aim. Study the results of malignant ovarian tumors (MOT) treatment in children according to the State institution “Republican Oncological Scientific Center” of the Ministry of Health and Social Protection of the Population of the Republic of Tajikistan.

Material and methods. The results of treatment of 49 cases of MOT in children in the conditions of the Department of Pediatric Oncology of the “Republican Oncological Scientific Center” of the Ministry of Health and Social Protection of the Population of the Republic of Tajikistan for 2005-2020, at the age of 1-17 years, are presented. Children from the 1st group (n = 31) at the first stage received surgical treatment followed by adjuvant chemotherapy (ACT), patients of the 2nd group (n = 18) at the preoperative stage underwent non-adjuvant chemotherapy (NACT) according to the “EP” and “CAP” regimens.

Results. Most patients had stage II and III diseases – 33 (68%) and 7 (14%), respectively, only 57% of children were hospitalized in a profile institution within 1 month of the onset of symptoms of the disease, and 88% had a moderate severity of the general condition associated with complications of the main process. There were also errors in surgical treatment tactics in non-core institutions in 12% of cases (organ interventions), and a third of patients (35%) violated the regime or refused drug therapy. At the end of the study, 84% of children from group 1 and 94% from group 2 were alive and in remission. Rates of 3-year dynamic survival by treatment protocol did not have a significant difference, and a 5-year overall survival rate of 12% was yours in the group receiving NACT. 6 dead patients initially had stage III-IV disease, did not receive NACT, and 4 of them against the background of ACT had continued tumor growth. The fate of 5 children is not known.

Conclusion.Unsatisfactory survival rates of patients require measures to increase the oncology of primary care doctors, pediatricians, general surgeons to increase the proportion of patients with early stages of the disease, which will improve treatment outcomes, improve survival and quality of life of this category of patients.

Key words: germ cell tumors, teratoblastoma, children, treatment, survival

 

Fayzulloev Kh.T.

DISTURBANCES OF STRUCTURAL AND FUNCTIONAL PARAMETERS OF THE HEART, METABOLIC FUNCTIONS OF THE LUNGS AND OXYGEN-TRANSPORT BLOOD FUNCTION IN PATIENTSWITH MYOCARDIAL INFARCTION, ISCHEMIC STROKE AND THEIRCOMBINATION

Aim.Determination of the relationship of violations of structural and functional disorders of the heart, metabolic functions of the lungs and oxygen-transport function of the blood in patients with myocardial infarction, ischemic stroke, and their combination.

Material and methods.Studies were conducted in 100 patients with myocardial infarction (MI), 60 with ischemic stroke (IS), 35 with combined MI and IS, as well as in 30 healthy donors. Among them, there were 122 men (62,5%), women – 73 (37,4%). The mean age of patients with MI was 54,4±1,4 years, IS – 56,4±1,4 years, MI+IS – 55,4±1,4 years.

Assessment of hemostasis systems, metabolic functions of the lungs, acid-base state, oxygen transport function of the blood was carried out according to the main parameters in the pools of venous cubital blood (VKK), mixed venous blood (VK), outflowing arterial blood (OAK). We also studied the structural and functional parameters of the left (LV) and right (RV) ventricles of the heart.

Results.In patients with myocardial infarction, IS, and their combination, processes of impaired delivery, consumption, and utilization of oxygen are noted, and peripheral blood shunting occurs. These processes directly depend on the staging of impaired metabolic functions of the lungs, the parameters of general and pulmonary hemodynamics, the severity of systolic and diastolic LV dysfunction, and other factors associated with the severity of the underlying pathology.

Conclusion.The detected changes in the processes of delivery, consumption, utilization of oxygen, peripheral blood shunting and hypoxia are the links of the “vicious circle of critical condition” in this category of patients.

Key words:myocardial infarction, ischemic stroke, acid-base state of the blood, structural and functional state of the heart, metabolic functions of the lungs, oxygen transport function of the blood

 

Yusupov A.Sh., Makhmudnazarov M.I., Makhamadiev A.A., Nazarov Z.Kh.

RESULTS OF SURGICAL TREATMENT OF DEFORMATION OF THE NASAL SEPTUM, COMBINED WITH HYPERPLASIA OF THE NASOPHARYNGEAL TONSIL IN CHILDREN

Aim.Evaluation of the results of surgical treatment of deformity of the nasal septum, combined with hypertrophy of the pharyngeal tonsil in children.

Materials and methods. The results of surgical treatment of 86 children aged 7 to 14 years (girls – 28, boys – 58) with deformity of the nasal septum, combined with hypertrophy of the pharyngeal tonsil and varying degrees of conductive hearing loss were studied.

Research methods: endoscopy of the nose and nasopharynx, otomicroscopy, audiometry, radiography, also examined the functional state of the nasal mucosa and performed tone-threshold audiometry.

Results. In the immediate postoperative period, a good anatomical result was obtained in 36 (83,7%) patients in the main group and in 18 (41,9%) patients in the comparative group. group and in 28 (65,1%) patients of the second group, and a satisfactory anatomical result was observed in 5 (11,6%) patients in the main group and in 13 (30.2%) patients in the comparison group. Long-term follow-up after surgery revealed a relapse of the deformity of the nasal septum in 2 (2,3%) patients, the cause of which was a repeated nasal trauma. All of them were successfully re-operated.

Conclusion.  The use of simultaneous operations in children aged 7 to 14 years with deformity of the nasal septum, combined with hypertrophy of the pharyngeal tonsil, is an effective method of surgical treatment of these categories of patients and in 88,4% of cases they give good anatomical and functional results, thereby preventing the development of exudative otitis media and hearing loss.

Key words: curvature of the nasal septum, hypertrophy of the nasopharyngeal tonsil, dysfunction of the auditory tubes, conductive hearing loss

 

Yusypov Z.Ya., Ashurov G.G., Narusheva D.O.

INFLUENCES OF TECHNOGENIC FACTORS OF ALUMINUM PRODUCTION ON CONDITION OF PARODONT AND MUCOUS OF ORAL CAVITY

Aim.To assess the impact of technogenic factors of aluminum production on the state of the parodontal and oral mucosa.

Material and methods. Conducted complex dentistry examination with deepened study of parodontal and mycology status between 250 workman’s aluminum production of the Tajik aluminum plant at age from 30 before 50 years and checking group from 230 persons not having professional’s bad factors by similar on age-sexual sign. In depending on duration of the contact with bad factors of aluminum production chosen four groups: 1^st group – 65 workman with length of service from 1 to 5 years; 2^nd group – 70 persons with length of service from 5 to 10 years; third group – 55 persons with length of service of the work from 10 to 15 years; fourth group – 60 persons with length of service of the work more than 15 years.

Results. Analysis the result of clinic-epidemiological examination worker of aluminum plant allowed to reveal high prevalence of parodontal and mycology diseases of oral cavity. In the main group these factors have formed 100% and 93,6±2,12% accordingly, under corresponding of importance 89,7±3,76% and 35.6±0,15% – in checking.

Conclusion. In the main group established high level importance of the index hygiene of oral cavity that is indicative of bad hygiene and insufficient level motivations of its realization.

Key words: parodontal, mucous of oral cavity, aluminum production, professional factor

 

REVIEV

 

Shukurova S.M, Kholov S.S.

MODERN TREATMENT STRATEGY FOR BEHCHET’S DISEASE

The presented review is devoted to the issues of modern treatment strategy for one of the rare forms of systemic vasculitis – Behcet’s disease (BD). The strategy for treating BD is determined by the degree of involvement of organ lesions in the process, including lesions of the eyes, blood vessels and the central nervous system. The diagrams of mucocutaneous, ocular, musculoskeletal, vessels and neurological lesions are presented in detail. The article presents new groups of drugs, including monoclonal inhibitors of tumor necrosis factor (TNF) and genetically engineered biological drugs.

Key words:Behcet’s disease, uveitis, stomatitis, interferon alpha, GCS, azathioprine

 

 

2-2022

THEORY AND PRACTICE OF MEDICINE

AbdullozodaJ.A., RuziboyzodaK.R., AbdulloevS.Kh., Bilolov M.K.

PREVENTION OF SUITATION FAILURE OF THE DUODENAL STUNT AFTER GASTRIC RESECTION

Aim. Improving the results of complex treatment of patients with “difficult” duodenal ulcers by preventing duodenal stump suture failure after gastric resection.

               Material and methods. The results of complex diagnostics and treatment of 51 patients with “difficult” duodenal ulcers were analyzed. In 35 (68,6%) cases, the ulcer was localized in the duodenal bulb, and in 16 (31,4%) cases, in the postbulbar duodenum.

               Results. In the early postoperative period after various options for resection of the stomach according to Billroth 2, in 26 (50,9%) cases of 51 patients, functional duodenostasis developed, where in 6 (11.7%) cases there was a development of duodenal stump suture failure. Thus, in 7 (13,7%) patients, duodenostasis was in the stage of compensation, duodenostasis in the stage of subcompensation – in 11 (21,5%) cases, and in 8 (15,6%) patients duodenostasis developed in the stage of decompensation.

The level of serotonin in 7 patients with duodenostasis in the stage of compensation was 0,7±0,11 µmol/l. As the serotonin levels decrease to 0,5±0,09 µmol/l, duodenal motility is even more disturbed, where it corresponded to duodenostasis in the subcompensation stage (n=11). A deeper decrease in the level of blood serotonin was observed in 8 patients with duodenostasis in the stage of decompensation, which amounted to 0,3±0,12 µmol/l.

To prevent the risk of developing functional duodenostasis, preventing the progression of serotonin deficiency and the development of failure of the sutures of the duodenal stump in 26 patients in the complex therapy, the drug serotonin adipinate was included in the dose of 1,0 ml 3 times a day, intramuscularly administered for 5-7 days, where regardless from the severity of changes in serotonin in the blood, an increase in intraduodenal pressure and the presence of duodenostasis in the stage of sub- and decompensation, the development of insolvency of the duodenal stump sutures was not observed.

               Conclusion. Thus, in the pathogenesis of duodenal stump suture failure, the leading place is given to transient serotonin deficiency in the early postoperative period, for the prevention of which it is advisable to include serotonin adipinate.

               Key words: resection of the stomach, duodenal stump suture failure, serotonin deficiency, prevention

 

Ashurov G.G., Mullodzhanov G.E., Ismoilov A.A.  

ESTIMATION RESULTS OF DISSATISFACTIONS PATIENT WHEN RENDERING DENTISTRY ORTHOPEDIC HELP WITH USING OF DENTAL IMPLANTS

Aim. Analyzed the reasons of dissatisfactions among patient with prosthesis on dental implants.

Material and methods. From 850 patients with implant’s prosthetic device, received to us from 2017 to 2020 years in dentistry clinic «Smile» (accordingly 246, 240, 201 and 163 persons), beside 82 patients (48 woman and 34 men) were revealed different complaints prosthetic and implants nature. This patient patients addressed with complaint after prosthesis on dental implants, in different dentistry institutions of Dushanbe was set 382 of the screw dental implants from which 218 in the upper jaw and 164 – on lower.

Results. For specified period patients whole have presented 169 complaints. Of them the most frequent of which (25.4%) were on loose at the closing of dentition complaints,  labored chewing of foods complaints (18.3%) and aesthetic disorders (8.3%). The patients presented more than one complaints (on average 2 complaints per case).

Conclusion. Long use wrong made orthopedic design becomes the traumatic factor, bring about elimination of the dental implants.

Key words: prosthetic device, dental implant, orthopedic design, hygiene of oral cavity

 

Badalov SH.A.

TREATMEN OF COMPLICATED NEPHROLITIASIS IN CHILDREN

Aim. Optimization of surgical treatment methods of children with complicated nephrolithiasis.

Materials and methods.  The results of treatment of 115 patients with complicated types of nephrolithiasis were analyzed, divided into 2 groups: the main group – 84 (73,04%) and comparison – 31 (26,9%). The age of the children ranged from 1 to 17 years.

For an objective assessment of the severity of nephrolithiasis in children, the data of X-ray diagnostics (ultrasound, plain radiography, excretory urography, CT and MRI) were taken into account. Studies of renal circulation (Doppler sonography), glomerular filtration rate (Rehberg-Tareev test), (CFL) were carried out according to the Kunahan-Barratt formula.

Results.   Surgical methods for the treatment of complicated nephrolithiasis are divided into three parts: the method of minor surgery, or palliative, radical and the method of reconstructive plastic surgery. The method of minor surgery was performed in 20 (17,3%) of 115 children as a preparation for radical and reconstructive plastic surgery. Radical methods of surgery included pyelolithotomy – 32 (27,8%), nephrolithostomy – 22 (19,1%), percutaneous nephrolithotripsy – 25 (21.7%). Reconstructive plastic surgery mainly consisted of intrarenal plastic of the neck of the large calyx – 16 (13,9%).

Conclusions. There is no single approach to both surgical and conservative treatment for complicated nephrolithiasis. Double drainage of the PCS and stend-by after surgery showed good results. In treating children with complicated nephrolithiasis, there should be an individual approach depending on the type of complications, the degree of renal dysfunction, the degree of hydronephrosis, and the activity of the inflammatory process.

Key words: kidneys, nephrolithiasis, double drainage, complications, children

 

Gaibov A.G., Shodikhon Jamshed, Goziev J.G., Iskandarova M.Kh.

SOME ASPECTS OF LEGAL REGULATION IN THE SPHERE OF SOCIAL PROTECTION OF THE DISABLED IN TAJIKISTAN

Aim. Assessment of the existing regulatory and legal regulation in the field of social protection of persons with disabilities in Tajikistan.

Material and methods. Materials of international organizations, documents of the Commissioner for Human Rights in Tajikistan, results of sociological research, publications of non-governmental organizations involved in protecting the rights of people with disabilities.

The analysis and generalization of official documents, comparative, formal-legal, as well as other methods of cognition were used in the research.

Results.  The UN Convention on the Rights of Persons with Disabilities, signed by Tajikistan, recognizes the importance of the accessibility of persons with disabilities to all the benefits and rights provided by society to its free citizens, incl. health, education, employment, information, and communication services. It is necessary to develop and improve the social legislation of the country in accordance with a certain standard of regulation of social relations in the social sphere, the active participation of the state in solving global medical and social problems and the observance of the rights of vulnerable sections of society is required. Empowerment of people with disabilities allows them to receive appropriate education, better manage their health, reduce the cost of providing health care, incl. rehabilitation.

Conclusion. Over the past years, the government of the country has been systematically working to improve legislation aimed at improving the situation and quality of life of people with disabilities. In the coming years, it is necessary to gradually amend a number of laws and regulations.

Key words: disability, regulations, social protection, Convention on the Rights of Persons with Disabilities, Tajikistan

 

Gulomova M.O., Davlyatova D.D., Kabirov K.M., Nazhmidinova K.I., Salimova M.D.

PREVENTIVE EXAMINATIONS OF ADOLESCENTS IN THE PRACTICE OF A FAMILY DOCTOR

Aim.  Evaluation of the effectiveness of preventive work among adolescents of the City Health Center No. 1 (HC No. 1) in Dushanbe.

Material and methods. Analysis of the reporting and accounting documentation of work with adolescents for 2019 State Central Park No. 1 in Dushanbe.

Results. The incidence among boys is 3,9% higher than among adolescent girls. The greatest number of detected pathologies among adolescents is accounted for by diseases of the organs of vision, endocrine pathology, and pathology of the musculoskeletal system. However, there is no detailed description of social and living conditions, no data on school performance, no attention is paid to an allergic history, past diseases and bad habits are not considered, there is no information about sexual life, there is no conclusion on the neuropsychic development of a teenager, the conversations held are not noted. and counseling.

Conclusion. Conducted preventive medical examinations among adolescents at the PHC level are not effective enough. Among the identified pathologies among adolescents, there are no data on chronic diseases, data on the mental state of adolescents, on the sexual and reproductive health of adolescents, and laboratory examination does not cover 100% of adolescents.

Key words: adolescent, preventive examination, morbidity

 

Imomova F.Z., Karimov S.M., Ashurov G.G.  

ESTIMATION THE RESULTS STUDIES OF THE DISEASES OF PULPE-PERIODONTAL COMPLEX  BESIDE PATIENTS WITH DIFFERENTDIRACTION  OF BETWEENSYSTEMS DISORDERS

Aim. Study the diseases of pulp-periodontal complex hftients, associated with betweensystems disorders.

Material and methods. For achievement specified purposes we organized retrospective test of 568 dispensaries of the cards by way of the casual sample dentistry patient with differentdirection betweensystems disorders (main group), and 570 dispensaries of the cards patient without of somatic pathology (group of the comparison) primary addressed employee of therapeutic dentistry department. Choice patient with betweensystems disorders is conditioned recommendation of WHO, defining given group as contingent of the high risk for estimation of dentistry level health of somatic patients.

Results. Amongst examined contingent prevalence of pulp’s inflammation formed 209 (36.8%) events on 568 addresses. Prevalence of chronic periodontitis formed 183 (32.2%) event on 586 addresses.

Conclusion. At analysis of the interconnection pulp-periodontal’s diseases complex discovered reliable correlation between pulpitis and periodontitis between compared groups.

Key words: pulpitis, periodontitis, pulp-periodontal complex, teeth, jaw

 

Makhmadov F.I., Najmudinov F.N.

THE CHOICE OF MINIMALLY INVASIVE TACTICS FOR THE TREATMENT OF CHOLEDOCHOLITHIASIS IN PATIENTS WITH OBESITY

Aim. Improving the results of treatment of choledocholithiasis in obese patients through the combined use of minimally invasive interventions.

Material and methods. A comparative analysis of the results of surgical treatment of 116 patients with choledocholithiasis on the background of obesity was carried out. Patients of the main group (n=60) underwent combined minimally invasive, control group (n=56) – urgent traditional interventions. Obstructive jaundice on admission to the clinic was present in 101 (87,1%) patients and in 15 (12,9%) it was noted in history, after attacks of pain in the right hypochondrium. Accompanying obstructive jaundice with cholangitis was diagnosed in 39 (33,6%) cases and biliary pancreatitis in 67 (57,8%) cases.

Results. In 56 (93.3%) cases, preliminary minimally invasive biliary decompression was performed in patients of the main group, in 55 (47,4%) cases one-stage surgical interventions were performed using open traditional techniques (n=51) and using minimally invasive methods (n=4). During primary minimally invasive interventions in patients of the main group (n=60), in 34 (56,7) cases, endoscopic papillosphincterotomy with lithoextraction and nasobiliary drainage (n=9) was performed, in 7 (11,7%) percutaneous-transhepatic cholangiostomy under ultrasound -control. Percutaneous transhepatic cholangiostomy under laparoscopic navigation was performed in 2 (3,3%) patients. Traditional open decompression interventions in the form of choledocholithotomy with drainage according to Robson (n=3) and choledocholithotomy with drainage according to Kare (n=2) were performed in 5 (8,9%) patients of the control group. Postoperative complications in the main group occurred in 3 (5,0%) patients, in the control group – in 7 (12,5%) with a mortality rate of 1,8%.

Conclusion. In obese patients, two-stage minimally invasive treatment methods are the method of choice, as they significantly reduce the number of postoperative complications and deaths.

Key words: choledocholithiasis in obese patients, minimally invasive two-stage interventions, biliary pancreatitis, obstructive jaundice

 

Rasulov S.R., Ganiev D.F.

DYNAMICS OF MORBIDITY AND MORTALITY FROM BREAST CANCER IN THE REPUBLIC OF TAJIKISTAN FOR 2016-2020

Aim. To study the dynamics of morbidity and mortality from breast cancer in the Republic of Tajikistan for the period from 2016 to 2020.

Material and methods. The clinical data of 2357 women registered for breast cancer (BC) in the period from 2016 to 2020 were studied according to the organizational and methodological department of the RSC and the Republican Center for Medical Statistics and Information of the Ministry of Health and Social Protection of the Population of the Republic of Tajikistan.

Results. In 2016, 462 patients were registered, and in 2019, 506 were identified, which is 1.1 times more. The annual increase in the incidence of breast cancer from 2016 to 2019 was 1.0-1.1 times. The lowest incidence rates were established in 2020, which is probably not true and is associated with a decrease in the incidence of women and the detection of breast cancer on known problems of the COVID-19 pandemic. When applying, 71,9% of patients had stages I-II, 14,5% of patients applied in stage III and 13.4% – in stage IV of the process. Mortality rates in 2016 and 2020 they were 312 and 260, respectively, which indicates a 1,2-fold decrease in mortality.

Conclusion. The annual increase in the incidence of breast cancer in the Republic of Tajikistan was 1.0-1.1 times. Mortality from breast cancer in the republic decreases by 1.1 times from year to year. The annual mortality reduction rate is 1.5%.

Key words: breast cancer, morbidity, mortality

 

Sаdullоzоdа Т.S.

THE STRUCTURE OF COMPLICATIONS AND THE MAIN CAUSES OF MORTALITY FROM DIABETES MELLITUS IN THE REPUBLIC OF TAJIKISTAN

Aim. To study the structure of complications and the main causes of mortality from diabetes mellitus.

Material and methods. The work was based on the results of the analysis of case histories from various regions and endocrinological centers of the republic, and the absolute value and percentage of the number of complications were calculated, as well as data on all officially registered deaths for the period 2016 to 2020. in all regions of the republic. Also, data from statistical reports on regions and regions of the republic, which were included in a common database, were used.

Results. In terms of the level of complications of diabetes in the regional aspect, it can be said that the leading place in the total number of major complications is occupied by the Sughd region, accounting for 48664 (35,6%) cases of complications from diabetes mellitus. It has been established that the bulk of the deaths occur in the elderly, while patients with insulin dependence do not live to be 65 years old. The most common causes of death in patients with diabetes mellitus were acute cardiovascular insufficiency, chronic cardiovascular insufficiency, acute cerebrovascular accident, totaling 65,6%.

Conclusion. An analysis of the situation by complications showed a wide variety of early and late complications, which we divided into macroangiopathies and microangiopathies. Of the complications by the type of macroangiopathies, most of them were presented in the form of cardiovascular pathology (31,7%). From microangiopathies, complications were recorded in the form of diabetic lesions of the organs of vision and kidneys in the form of diabetic nephropathy, retinopathy, amounting to 5,8% and 13,7%, respectively. The leading causes of death from diabetes mellitus were cardiovascular complications with a priority towards myocardial infarction (39,4%) with the formation of cardiogenic shock and other complications.

Key words: diabetes mellitus, complications, mortality

 

Fayzulloev KH.T.

FRACTAL ANALYSIS OF CARDIOINTERVAL VARIATIONS IN PATIENTS WITH MYOCARDIAL INFARCTION, ISCHEMIC STROKE AND THEIR COMBINATION

Aim. To study the fractal analysis of cardiointerval variations in patients with myocardial infarction, ischemic stroke, and their combination.

Material and methods. The studies were conducted in 225 people: group 1 – 100 patients with myocardial infarction (MI), group 2 – 60 with ischemic stroke (IS), group 3 – 35 with combined MI and IS; control group – 30 healthy people. There were 122 men (62,5%), 73 women (37,4%). The average age of patients with MI was 54,4±1,4 years, with IS – 56,4±1,4 years, MI+AI – 55,4±1,4 years.

Fractal analysis of cardiointerval variation in patients was carried out according to the method of N.I. Muzalevskaya and V.M. Uritsky. The parameters were determined: RR (mc) – the duration of the cardiointerval; s_RR – standard deviation of R-R interval variations from the mean value (R-Rav), b – characterizing the degree of integration of systemic connections that form extracardiac regulation from the central parts of the nervous system.

Results. The imbalance of ss_RR, β indicators indicates a wide change in the dynamic range of R-Rav, i.e., adaptive load in patients with MI, IS, MI + IS in moderately severe course of the disease and the actual loss of stability of heart rate regulation in severe and extremely severe condition of these patients.

Conclusion. The conducted studies of fractal analysis have shown the effectiveness, availability, and high information content of this non-invasive technique for assessing the functional state of the autonomic nervous system by autonomic regulation and heart rate variability, which is a reliable and independent prognostic indicator for cardiovascular diseases.

Key words: myocardial infarction, ischemic stroke, fractal analysis of cardiointerval variations

 

Khushvakhtov D.I., Bayrikov I.M., Mirzoev M.Sh., Khushvakhtov D.D., Narzuloev V.A.

OPTIMIZATION OF SURGICAL TREATMENTS CYSTIC FORMATIONS OF THE JAW BONES

Aim.  Determination of the effectiveness of titanium nickelide barrier membranes in the replacement of bone defects in the jaws.

Material and methods. The study was conducted based on the results of treatment of 50 patients with odontogenic cysts of the jaws, who were treated at the City Dental Clinic in Dushanbe, in the period from 2016 to 2021. Among them, there were 22 men (44,0%), women – 28 (56,0%). The average age for men was 30,0 years, for women – 35,5 years.

All patients with a diagnosis of “root cyst” of the upper and lower jaws, according to indications, underwent a tooth-preserving operation – “cystectomy” with resection of the apex of the root of the causative tooth. The patients were divided into 2 groups. In the comparison group of 22 people, the bone defect was filled with osteoplastic materials and a resorbable membrane of a standard type. The main group – 28 people, fine-granulated and tissue membranes from titanium nickelide with thromboplastic mass were used to replace the bone defect.

Results. Surgical treatment in 50 patients according to the proposed method: fixing a titanium nickelide membrane with a platelet mass on the area of the bone defect provides stabilization of the blood clot in the wound, optimizes the formation of new bone by creating space for vascularization and protects the wound from the external environment. With a combination of materials, the membrane plays the role of a barrier, keeps the bone material in the defect space and isolates it from surrounding tissues without disturbing the blood clot.

Conclusion. The proposed method of fixing membranes made of tissue titanium nickelide in the treatment of patients with cystic formations of the jaws is effective due to the reliable protection of the blood clot, limiting the proliferation of epithelial elements in the area of the formed bone defect.

Key words: root cysts of the jaws, membranes, fine granular titanium nickelide, platelet mass, guided bone regeneration

 

Shukurova S. M., Fayzulloev A.I., Kabirzoda R.H.

CLINICAL AND HEMODYNAMIC PARALLELS OF CHRONIC HEART FAILURE DEPENDING ON THE LEFT VENTRICULAR EFUCTION FRACTION

 

Aim. Determine the structural and functional state of the left ventricle (LV) and clinical and hemodynamic features of the course of chronic heart failure (CHF) depending on the ejection fraction (EF) and assess the state of coronary blood flow based on the results of KAG.

Material and methods. We studied 170 patients with CHF divided into: subgroup I (n=80) – CHF I-III functional class (FC) according to NYHA to study variants of LV EF and the nature of LV remodeling depending on the type of EF; Subgroup II (n=45) – CHF III-IV FC according to NYHA, to assess the state of coronary blood flow based on the results of percutaneous coronary interventions (PCI).

All patients (n=170) underwent a standard examination: a survey, a general examination, anthropometric data, blood pressure (BP), instrumental and biochemical studies, including coronary angiography (CAG; n=45).

Results. Among 80 patients (subgroup I), 30 patients had preserved EF (37,5%), 25 – intermediate (31,25%) and 25 – low (31,25%). In the group of CHF patients with preserved EF, women over 60 years of age predominated in association with BP and overweight. In the second group (CHF with low EF), men aged 60 and < and without obesity are more common. It should be noted that in patients with CHF with low EF, postinfarction cardiosclerosis (PICS) is often (40%) observed, and BP as a causative factor is rare (16%). The morphofunctional parameters of the myocardium according to EchoCG data in patients with CHF, depending on the LV EF, had their own characteristics. The results of CAG in 45 patients indicate the most pronounced violations of vascularization in patients with CHF with reduced and intermediate LVEF.

Conclusions. The study of CHF depending on EF revealed fundamental differences between CHF-pEF and CHF-nEF in terms of etiology and gender: in women with hypertension and obesity in the age group >60 years, CHF-pEF is more common. In patients with CHF-pEF, a type of myocardial remodeling is often observed according to the type of concentric hypertrophy, while the state of LV EF does not affect the severity of the course.

Key words: chronic heart failure (CHF), arterial hypertension (AH), coronary heart disease (CHD), echocardiography (EchoCG), left ventricular ejection fraction (LVEF), coronary angiography (CAG)

 

REVIEWS

Artykova N.K.

VIRAL DISEASES OF THE ORAL MUCOSA

The article presents an analysis of modern native and foreign publications on topical issues of viral infection of the oral mucosa (OM). Information is provided on the prevalence of herpesvirus and papillomavirus infections, on the routes of penetration of these agents into the oral mucosa, and on the clinical manifestations of OM diseases caused by them.  Based on generalized literature data, the authors focus on the influence of herpes simplex virus and human papillomavirus on the severity and progression of OM diseases. Based on the analysis of literature data, the author considers that viral infections localized in the oral cavity can be the initiators of pathological conditions of oral mucosa and affect the quality of dental care. It is indicated that the identification of pathological conditions of the mucous membranes should alert the doctor to viral infections and take measures to detect them early, which will help reduce the incidence of OM diseases and their undesirable consequences.

Key words: mucous membranes of the oral cavity, pathological conditions, types of human papillomavirus, herpesvirus infectionral cavity, pathological conditions, types of human papillomavirus, herpesvirus infection

 

CASE FROM PRACTICE

Kasymova S.D., Mirakhmedova M.A.

CLINICAL CASE OF 14 YEARS OLD GIRL WITH SECKEL SYNDROME

Presented a clinical observation of a rare genetic disorder “Seckel syndrome” 14 years old girl. Feature of the clinical case is the late diagnosis of the disease in a child, with typical manifestations of mentioned syndrome, who treated by pediatricians with anemia for a long time.

In literature, we did not find cases with “Seckel syndrome” and timely puberty development.

Key words: bird-headed dwarf, genetic disorder

 

Saidova M.I.

MANAGEMENT OF PREGNANCY IN HEREDITARY THROMBOPHILIA COMBINED WITH FOLATE DEFICIENCY

The article presents cases of successful outcomes of pregnancies and childbirth in patients with habitual pregnancy losses on the background of hereditary thrombophilia in combination with folate deficiency. Timely pathogenetic therapy, high-quality antenatal follow-up, inpatient treatment for complications, prenatal hospitalization, allowed preserving pregnancy and carrying out delivery in full-term pregnancy with a viable fetus.

Key words: pregnancy outcomes, hereditary thrombophilia, folate deficiency, anticoagulant therapy

 

3-2022

THEORY AND PRACTICE OF MEDICINE

Abdulaev B.A., Ismoilov A.A.,   Amindzhanova Z.R., Zaripov A.R.

TO QUESTION ABOUT ENDODONTIC STATUES OF SUPPORTING TEETH IN DEPENDING OF GROUP ACCESORIES AND EXTENT SUPRACONSTUCTION’S ELEMENT

Aim. Study the endodontic statues of supporting teeth in depending of group accessories and extent of occlusion defects.

Material and methods. For the reason estimations of endodontic statues of supporting teeth were studied 280 x-rays beside 186 patients at age 20-50 years. In examined group entered dentistry patients both sex with defect of the teeth rows which divided into 3 groups: 1-st group formed the patients with small intermediate supraconstruction unit; in the 2-nd group entered the examined patients with average extent of the orthopedic prosthetic device; 3-rd group formed the patients with greater intermediate unit of orthopedic design.

Intraoral radiography was performed using a Heliodent DS dental device from Sirona Dental System GmbH, orthopantomography was performed using an Orthophos XG5 DS Ceph device from Sirona Dental System GmbH. Cone beam computed tomography (Morita) was also used.

Results. Most often endodontic change of the teeth, serving supraconstruction support, diagnosed at presence of orthopedic prosthetic device with average and big extent. In most cases inadequate obturation of root channel was noted in depulped teeth, residing under fixed orthopedic design.

Conclusion. Traditional x-ray methods which using in dentistry practical give limited information on topographies and quality obturation of root channel teeth, serving hereinafter supporting of orthopedic design. Using of cone-beam computer tomography vastly raises informative of physician-dentistry about difficulty, with which he can be met when performing endodontic manipulate before prosthesis.

Key words: endodont, supporting teeth, group attribute, root channel, оobturation, extent of fixed prosthetic device

 

Artykova N.K.

PAPILLOMAVIRUS INFECTION OF THE ORAL MUCOSA AND ITS SKIN MANIFESTATIONS IN PERSONS USING DENTURES

Aim. To identify papillomavirus infection of the oral mucosa and its skin manifestations in persons using dentures.

Material and methods. We have examined 110 patients with removable dentures (age 50-70 years) and 100 patients with fixed dentures (age 20-40 years). Detection of papillomavirus infection was carried out using PCR method (Kvant-21) and assessment of viral load.

Results. Pathological conditions of the oral mucosa were detected in 91 (82,7%; 110)) cases with removable dentures and in 75 (75,0%; 100) cases with non-removable ones. In patients with fixed dentures, HPV was detected 1,4 times more often than in patients with removable dentures, that is, in 36 (48,0%) versus 31 (3,1%), and their viral load was 1.8 times higher than in patients with fixed dentures. In patients with removable prostheses, HPV types 5,6,11 and 34 and 37 were detected, and with non-removable prostheses, HPV types 4,6, 11, 16, 34 and 41 were detected. Skin warts were detected in 27 (87,1%) cases in persons with removable dentures and in 34 (94,4%) cases in those with fixed dentures.

Conclusion. At the time of managing patients using dentures, it should be taken into account that human papillomavirus infection plays an important role in the development of pathological conditions of the oral mucosa, and skin manifestations of this infection in the form of warts of various localization can be an indicator diagnostic sign in the absence of the possibility of using the method of laboratory diagnostics.

Key words: mucous membranes of the oral cavity, pathological conditions, types of human papillomavirus, removable dentures, fixed dentures, warts

 

Akhmedov F.S.

FEATURES OF LUNG MICROFLORA IN POST-COVID PATIENTS

Aim. Investigation of the microbial and mycological landscape of sputum in patients who have had COVID-19.

Material and methods. 102 sputum samples were studied, which made it possible to grow bacterial and fungal flora in pathogenic titers CFU>103. The bacterial landscape of patients’ sputum in the post-COVID period made it possible to grow 194 cultures of bacterial flora and 94 cultures of fungal flora.

Results. The most frequent representatives of the bacterial flora were the microorganism’s staphylococcus and streptococcus – 37,1% and 13,4%, respectively, of the total number of microorganisms. The result of the study of the biological properties of the presented strains of staphylococcus and streptococcus showed that most of the strains (48 strains of staphylococcus and 18 strains of streptococcus) were able to ferment mannitol and plasma. This circumstance can serve as a basis for judging the high pathogenicity of the identified strains.

94 cultures of fungal flora were isolated, most of which is represented by yeast type (89 cultures) and mold species (5 cultures). More than 8 species of fungi were grown, among which there were pathogenic and opportunistic types.

Conclusion. A viral attack with COVID-19 does not exclude the possibility of exacerbation or accession of bacterial and fungal microflora, the symptoms of which can persist for a long time.

Key words: post-COVID period, COVID-19, polysegmental pneumonia, sputum microflora

 

Boyboboev A.A.

THE FEATURES OF CLINICAL MANIFESTATIONS OF MENTAL DISORDERS IN THE POST-COVID PERIOD

Aim. To study the features of clinical manifestations of mental disorders in the post-COVID period. Elaboration of prevention and treatment measures.

Material and methods. A clinical and dynamic study of 102 patients with neurotic and somatoform disorders was carried out.

Results. Panic attacks of all examined patients were manifested  suddenly  and rapidly, within a few minutes, increasing symptom complex of autonomic disorders (palpitations, chest tightness, a feeling of suffocation, lack of air, sweating, dizziness), combined with a feeling of impending death and fear. Among the psychopathological manifestations of anxiety-phobic disorders, the greatest comorbid connections were found in the presence of panic attacks, agoraphobia, and hypochondriacal phobia. It has been established that if moderate anxiety has a mobilizing effect on a person, then excessive anxiety significantly impairs cognitive functioning and problem-solving behavior.

Conclusion. The COVID-19 pandemic caused the pathomorphism of neurotic and somatoform disorders in the form of worsening symptoms, the appearance and occurrence of panic attacks, the prevalence of somatic anxiety with the dominance of symptoms from the respiratory system with vital fear, the transformation of patient behavior in the form of measures to identify suspicious fear, the detection of fear for the health of relatives and friends, frequent visits to medical institutions.

Key words: phobic anxiety disorder, comorbidity, agoraphobia, social phobia, coronaphobia

 

Boynazarova M.Kh., Odinaev N.S.

EPIDEMIOLOGICAL CHARACTERISTICS OF THE SHRED OF COVID-19 AMONG STUDENTS DURING THE 2020 PANDEMIC

Aim. To study the prevalence of COVID-19 among students of the State Educational Establishment of the Avicenna Tajik State Medical University

Materials and methods. Retrospective analysis of data from outpatient cards and questionnaires, laboratory data. The survey was conducted among 174 (100%) students of TSMU, of which 117 (67,2%) were men, 57 (32,8%) were women. Among those examined, only 89 (51,1%) students were infected with COVID-19, of which 66 (74,2%) were men and 23 (25,8%) were women.

Result. When studying the place of residence of 174 (100%) surveyed students, it turned out that while studying in Dushanbe, 64 (36,7%) lived in multi-story buildings, 68 (39,1%) – in private houses and 42 (24,1%) in a student dormitory. Of the 64 (100%) students living in high-rise buildings, 34 (53,1%) had COVID-19. Of the 68 (100%) students living in their own homes, only 27 (39,7%) had COVID-19. Of the 42 (100%) students living in student residences, 28 (66,7%) had COVID-19.

Of the 89 (100%) students who contracted COVID-19, the majority – 72 (80,4%) – lived in 5 people, the remaining 17 (19,5%) – 4 people in the room.

Conclusions. The data obtained indicates a high degree of infection with COVID-19 with closer contact, which is observed in student dormitories, multi-story buildings, and people get sick less in their own homes. The more contact between family members, the higher the risk of contracting COVID-19. Of the total number of cases of COVID-19, the majority – 73,6% – were men, less – 26,4% – women, which indicates a lower susceptibility of young women to infection with COVID-19.

Key words: pandemic covid-19, students, place of residence, virus

 

Gulov F.M.

FUNCTIONAL STATE OF THE OBTURATOR APPARATUS OF THE RECTUM WITH EXTRASPHINCTERAL FISTULAS

Aim. Research of the functional state of the obturator apparatus of the rectum in patients with extrasphincteric fistulas.

Material and methods. The study included 25 patients aged 17 to 75 years with extra sphincteric pararectal fistulas, 15 men (60,0%), 10 women (40,0%).

All patients underwent a survey, examination of the perineum, digital examination, determination of anal, rectoanal reflexes. Instrumental research methods included sphincterometry and monometry.

Results. In 3 (12,0%) patients, perianal dermatitis was noted, in 7 (28,0%) cases – the presence of multiple fistula openings of the rectum (more than 2 and up to 6 openings), in 5 (20%) cases, pararectal fistulas had 2 openings. In finger examination of the rectum with extrasphincteric fistulas of the rectum, in 9 (36,0%) cases, there was a decrease in the tone of the anal sphincter, in 8 (32.0%) cases, the presence of pectinosis of the anal sphincter was found, and in 4 (16,0%) cases, there was infiltration pararectal tissue. In 8 (32,0%) patients there was an increase, in 7 (28,0%) – a decrease, in 10 (40,0%) – the absence of the anal reflex. In 8 (32,0%) patients there was a threshold of rectal sensitivity, in 6 (24,0%) there was a minimum volume for relaxation of the internal anal sphincter. In 4 (16,0%) patients, the threshold for a constant urge to defecate was determined. Sphincterometry in 5 (20,0%) cases of anal sphincter insufficiency (ASI) was not detected, in 5 (20,0%) cases I degree was noted, in 10 (40,0%) – II degree, in 5 (20,0%) %) – III degree of ASI.

Conclusion.    45.0% of patients with extrasphincteric fistulas of the rectum have functional disorders of the obturator apparatus of the rectum in the form of varying degrees of insufficiency of the anal sphincter. When preparing a patient for surgery, it is necessary to take into account the existing functional disorders of the obturator apparatus of the rectum.

Key words: extrasphincteric fistula of the rectum, sphincterometry of the anal sphincter, anal sphincter insufficiency

 

Gulomov M.Sh., Kholov K., Saidaliev Sh.Sh., Khalimov J.S., Ashurov D.M.

LAPAROSCOPIC ECHINOCOCCECTOMY AS AN ALTERNATIVE TREATMENT FOR LIVER AND ABDOMINAL ECHINOCOCCOSIS

Aim. Evaluation of the effectiveness of laparoscopic echinococcectomy in patients with echinococcosis of the liver and abdominal organs.

Material and methods. The results of surgical treatment of 224 patients with echinococcosis of the liver and abdominal organs were analyzed. Patients of the most able-bodied age accounted for 81,3%. Ultrasound measurements of echinococcal cysts ranged from 3,0 to 27,0 cm. Localization of cysts in the right lobe occurred in 63,0%, in the left lobe – in 37,0%. In 30,3% of patients, echinococcal cysts were found in hard-to-reach segments of the liver (I and VII). Simultaneous lesions of the right and left lobes of the liver were observed in 9,4% of patients. The frequency of complicated forms of liver echinococcosis was 4,0%. Combined lesions of the liver and abdominal organs accounted for 8,0% of patients. In terms of diagnostics, the information content of ultrasound reached 97,1%. In 14,3% of cases, MRI and CT were used for the purpose of differential diagnosis.

Results. Traditional surgical methods of treatment were performed in 67,8% of patients. Open echinococcectomy was performed in 31,7% and closed in 12,5% ​​of patients. Pericistectomy was performed in 8,0% of patients. Ideal echinococcectomy was performed in 8,6% of cases. Atypical liver resections were performed in 4,6% of patients, and right sided hemihepatectomy in 3,2% of cases. Simultaneous removal of cysts of the liver and other organs was performed in 6,6% of patients. Postoperative mortality was 0,6%. The average length of stay of patients in the clinic was 13±3 days. Laparoscopic echinococcectomy was performed in 32,1% of patients. Open laparoscopic echinococcectomy was performed in 54,2% of patients. Closed echinococcectomy in 20,8% and various options for pericystectomy in 6,9% of patients. Ideal echinococcectomy without opening the wall of the fibrous capsule was performed in 4,2% of cases. Complications and lethal outcomes were absent. The average length of stay in the hospital after minimally invasive interventions was 7±2 days.

Conclusion. Laparoscopic echinococcectomy can be used as an alternative to the traditional surgical method. The main advantages of the method are minimal trauma and the frequency of postoperative specific complications, high economic efficiency and fast terms of social and labor rehabilitation.

Key words: echinococcosis, laparoscopy, treatment

 

Gulomova M.O., Davlyatova D.D., Nazirova N.K., Fatikhov B.Kh.

ADDITIONS IN THE NATIONAL IMMUNIZATION CALENDAR

Aim. Estimated vaccination coverage of children under 4 months of age.

Material and methods. Monitoring of 103 outpatient cards for the development of children F-024 was carried out.

Results. Vaccination coverage for children aged 12 months was 100%.

Conclusion. Family physicians and family nurses should be more careful in preparing medical records in order to avoid distortion of vaccination coverage rates, and correctly document the reasons due to which the child was not vaccinated. Health care workers need to talk more with parents about the need for vaccination and its benefits.

Key words: vaccine, inoculation, national calendar, immunization

 

Ismoilov A.A.,  Mullodzhanov G.E., Sultanov M.Sh.

ESTIMATION OF THE CONDITION OF SURROUNDING IMPLANTS AND ORTHOPEDIC DESIGN’S SOFT TISSUES IN DEPENDING OF EXTENT FIXED IMPLANT PROSTHESIS WITH USING OF HYGENIC INDEX

Aim. Estimate the condition of orthopedic prosthetic device with supporting on dental implants and surrounding their soft tissues in depending of extent fixed supraconstruction by hygienic indexes’.

Material and methods. In study have taken part 88 patients, which by method of randomization were conditionally divided into four groups: the first group has formed the patients with fixed implant’s prosthetic device of small extent; in the second group entered the examined patients with fixed implant’s prosthetic device of average extent; the third and fourth groups formed the patients with fixed implant’s prosthetic device big and very big extent. Estimation of the condition of fixed implant’s prosthetic device and surrounding their soft tissues in depending of extent supraconstruction elements has valued by index MPI, GI, CS, PD and CAL.

Results. In the field of all supporting elements of functioning implants prosthetic device between importance’s used indexes, got for week period of the using and in 9 months of their usages, is not revealed statistical significant difference in 1^st and 2-nd groups. However breakup with rest group was significant.

Conclusion. Amongst examined patient with fixed supraconstruction elements big and very big extent necessary more active realization of the hygienic care with regular connection background principle of professional hygiene of oral cavity.

Key words: prosthetic device, dental implant, orthopedic design, hygiene of oral cavity, supraconstruction, extent of fixed prosthetic device

 

Kasymov O., Kasymov A., Karimov Kh.

MODERN TREATMENT PERSPECTIVES OF ALOPECIA AREATA

Aim. To study the efficiency of topical Minoxidil in the complex treatment of alopecia areata.

Material and methods. 36 patients at the age of 13-35. Methods: clinical, microscopical, statistical.

Results. Higher efficiency of the complex treatment of alopecia areata with the use of Minoxidil and Chlormethine hydrochloride established in comparison with non – Chlormethine hydrochloride therapy (68.2% against only 57.2%). Long-term results (after one year) proved the substantial benefit of the combined therapy. Of 15 patients with the direct positive results relapses occurred only in 5 (33.3%), in the control group – in 4 (50%) out of 8.

Conclusion. Higher efficiency of the complex treatment of alopecia areata with the use of Minoxidil and Chlormethine hydrochloride in comparison with non- Chlormethine hydrochloride therapy.

Key words: alopecia areata, therapy, Minoxidil, Chlormethine hydrochloride

 

Kakharova R.A., Ibrohimov Yu.H., Cirojev D.N.

COMPARATIVE EVAIUATION OF SURGICAL TREATMENT OF HEMOROIDS

Aim. Comparative analysis of the results of various methods of surgical treatment of chronic hemorrhoids in the near and long term.

Materials and methods. The work is based on the results of surgical treatment of 1871 patients with hemorrhoids. Pathology is equally common in both men and women. Among operated men there were 975 (52,2%), women – 896 (47,8%). Most patients (80,5%) are of working age from 25 to 59 years.

Results and conclusion: The study showed that the use of various methods of surgical treatment of hemorrhoids in the immediate postoperative period has a different course, but long-term results practically do not depend on the method of its implementation.

Key words: hemorrhoids, surgical treatment, choice of operation method

 

Rabiev Kh.Kh., Sirodzhev K.Kh., Gafarzoda S.S., Makhmadaliev B.G., Sirodzhoda M.S.

OPTIMIZATION OF PREVENTION OF THROMBOEMBOLIC COMPLICATIONS IN HIP ARTHROPLASTY IN PATIENTS WITH FRACTURES OF THE PROXIMAL FEMALE ON THE BACKGROUND OF DIABETES

Aim. Optimization of early diagnosis and prevention of thromboembolic complications in hip arthroplasty in patients with fractures of the proximal end of the femur on the background of diabetes mellitus.

Material and methods. The work is based on the results of hip arthroplasty in 80 patients with fractures of the proximal femur due to diabetes mellitus. There were 46 men (57,5%), women – 34 (42.5%). All patients underwent arthroplasty against the background of an individual complex of infusion therapy developed by us. In the first group (n=49), the composition of infusion therapy was as follows: tivortin solution 4,2%, latren solution 0,05%, and sodium hypochlorite solution 0,06 and 0,03%. In the second group (n=31), solutions of Reamberin 1,5% and Latrena 0,05% were used.

Results. A rheological study of venous blood upon admission of patients with fractures of the proximal end of the femur due to diabetes mellitus revealed severe hypercoagulability. After arthroplasty against the background of optimized infusion therapy, starting from the third day, there is a tendency to normocoagulation, while in the main group all indicators had significant significance and approached the border of normal values, on the seventh day after arthroplasty, normocoagulation is also observed with a significant predominance of indicators towards hypocoagulation in patients of the main group.

Conclusion. The use of optimized infusion therapy in the complex treatment of patients with fractures of the proximal end of the femur on the background of diabetes mellitus after hip arthroplasty improves the rheological properties of blood, reduces the risk of venous thromboembolic complications, and minimizes the duration of inpatient treatment, accelerates rehabilitation and the patient’s integration into normal life.

Key words: arthroplasty, rheology, fracture, injuries, diabetes, complications, trauma

 

Rasulov S.R., Obidov D.S., Rasulov K.S.

EXTENDED RADICAL MASTECTOMY WITH CLOSURE OF SOFT TISSUES DEFECT OF THE THORACIC WALL WITH A MUSCULOSKELETAL THORACODORSAL FLAP IN PATIENTS WITH STAGE IIIB, IIIC AND IV BREAST CANCER

Aim. Demonstration of the possibilities of performing an extended radical mastectomy with simultaneous plasty of an anterior chest wall defect with a musculocutaneous thoracodorsal flap in patients with stage IIIB, IIIC, IV breast cancer and evaluation of its immediate results.

Material and methods. Extended radical mastectomy with simultaneous plasty of an anterior chest wall defect with a displaced thoracodorsal flap has been used by us since 2015 in 15 patients. Patients had stages T4N1M0 – 3 (20%), T4N2M0 – 5 (33,3%) and T4N0-3M1 – 7 (46,7%).

Results. After extended radical mastectomy with simultaneous plasty of an anterior chest wall defect with a TD flap, marginal necrosis of the flap was observed in one case (13,3%), and partial skin necrosis along the medial edge of the flap was observed in the other. In the postoperative period, adjuvant chemotherapy was continued in 5 (33,3%) patients; 13 (86.7%) patients without distant metastases underwent adjuvant radiation therapy.

Conclusion. The use of displaced flaps to close an anterior chest wall defect after extended mastectomies in MR breast cancer allows performing the surgical stage of treatment in the “incurable” group of patients in a radical volume. The obtained results allow to achieve a satisfactory cosmetic result, increase the duration, and improve the quality of life of patients.

Key words: breast cancer, extended radical mastectomy, anterior chest wall defect plasty, musculocutaneous thoracodorsal flap

 

Sаdullozoda Т.S., Ruziev M.M., Muzaffarov F.B.

THE STATE OF THE INCIDENCE OF DIABETES IN THE REPUBLIC OF TAJIKISTAN

Aim. Assessment of the incidence of diabetes in the Republic of Tajikistan in the Republic of Tajikistan.

Material and methods. Retrospective analysis of statistical materials presented in the annual statistical collections of the Republican Center for Statistics and Medical Information of the Ministry of Health and Social Protection of the Population of the Republic of Tajikistan from 2016 to 2020.

Results. A comparative assessment of the incidence rates of type 1 diabetes and type 2 diabetes shows that type 1 diabetes in quantitative terms is significantly inferior to type 2 D. Note that type 2 D has a steady upward trend compared to type 1 D. In 2016, type 1 D had a total incidence rate in the republic of 3659 people, and by the end of 2020 – 3321 people. In 2016, the total number of patients on dispensary records was 38,203 people, the rate per 100,000 people was 462,6, in 2020 this figure increased to 48,337 and 529,6. In 2012, the rate of dispensary registration of children under 18 was 402 people, while in subsequent years it increased, amounting to 933 children in 2020.

Conclusion. The incidence of diabetes mellitus is growing and the population of the republic is at risk, which requires the adoption of urgent measures for further research to find out the causes of this situation.

Key words: diabetes mellitus, complications, mortality

 

Usmonov I.M., Djuraev M.N., Ismoilzoda S.S.,  Dostiev U.A., Zokirov R.А.

RISK FACTORS OF SENSITIZATION AND ANALYSIS OF THE PIRCHE II, HLA MATCHMAKER SCORE CORRELATION FOR ANTIGEN

Aim. Improving kidney allograft outcomes by evaluating antigen mismatches in kidney allograft recipients.

Material and methods. Our retrospective study included 75 highly sensitized women at risk of acute kidney rejection to analyze the correlation of scores on the PIRCHE II, HLA MATCHMAKER donor matching scores. All patients underwent solid-phase immunoassay using a Luminex 200 multiplex analyzer on the Xmap platform. The lymphocytotoxicity test (CDS) was performed by the serological method. The analysis for matching a donor to a sensitized recipient was carried out with HLA-ABC Eplet Matching Version 3.1 Match maker and HLA-DR, DQ, DP Eplet Matching Version 3.1 Match maker. Analysis for the prediction of the appearance of DSA according to the PIRCHE-II algorithm.

Results. Preeclampsia (nephropathy of pregnancy) was noted in women’s history – 44,0% (33), hypotonic bleeding – 34,6% (26), which were corrected by transfusions of blood and its components’, repeated transplantations were in history in 14,5% (11) patients. In the analysis of mismatch of HLA antigens in kidney recipients with a donor according to the HLA Matchmaker program, they ranged from 0 to 75,5 for the entire group with an average value of 27,2 (15.8) points. 68% (51) women had scores ranging from 1 to 52.1. The HLA mismatch resulted in a mean PIRCHE-II score of 70,0 (49,9). The PIRCHE-II score varied for the whole group from 0 to 323,9, but in 60% (45) of patients the range was from 1,2 to 162,7, indicating that there is a huge individual range of PIRCHE-II scores for each nonconformity for HLA antigens. The kidney allograft survival analysis in the group was 76,0% (95% confidence interval [CI]: 75,0–81,0) 10 years after transplantation. Graft loss (i.e., return to dialysis) was reported in 18 (24,0%) patients. 24 (32,0%) patients developed donor-specific antibodies (dnDSA)

Conclusions. The PIRCHE-II score is an independent predictor of denovo DSA. Stratification according to the PIRCHE-II scale allows to identify patients with a low risk of developing denovo DSA.

Key words: kidney transplantation; analysis for DSA; PIRCHE-II algorithm; Hla Matchmaker

 

Khafizov A.A.

POSSIBILITIES OF USING ELECTROMYOGRAPHY OF MASTICATORY MUSCLES WHEN CREATING FIXED ORTHOPEDIC STRUCTURES ON DENTAL IMPLANTS WITH COMPLETE EDENTULOUS JAWS MISMATCH IN KIDNEY RECIPIENTS

Aim. Improving the results of complex treatment of patients with complete edentulism in orthopedic treatment with fixed structures on dental implants by using an electromyographic (EMG) study.

Material and methods. The results of an EMG study of 45 people were analyzed, divided into 3 equal subgroups according to skeletal and facial types using the Hummingbird electromyograph for 90 days. The data obtained during the compression of the dentoalveolar system in each subgroup separately were evaluated for comparison with data from other studies. The skeletal ratios were determined for each subgroup and the norms of load distribution on the masticatory muscles were determined.

Results. In subgroup 1, the load on the masticatory muscles was distributed evenly by 25% on the temporal (M. temporalis) and masticatory muscles (M. masseter) on both sides with an allowable deviation rate of ±4,0%. In subgroup 2, the temporal muscles dominate, which account for 30% of the masticatory load, and the masticatory muscles – 20% on each side. This is due to the peculiarities of the structure of the facial skeleton of the subjects. The permissible deviation rate in this subgroup is ± 5,5-6,0%. In subgroup 3, the temporal muscles account for 20% of the load, in this group, the masticatory muscles dominate, which account for 30% of the masticatory load on each side. The allowable deviation rate in this subgroup is ±4,0%.

Conclusion. It is advisable to use electromyography for the treatment and prevention of possible further complications in prosthetics with fixed orthopedic structures on dental implants with complete edentulous jaws.

Key words: electromyography, complete edentulism, prosthetics on dental implants

 

Khushvakhtov D.I., Mirzoev M.Sh., Gafarov Kh.O., Khushvakhtov D.D., Khodzhaev M.U.

STATE OF THE MUCOSA OF THE MOUTH IN PATIENTS WHO HAD COVID-19

Aim. The study of the state of the oral mucosa in patients who have undergone COVID-19 with concomitant and chronic dental diseases.

Material and methods. The work is based on the results of a survey of 36 patients (22 women and 14 men) who underwent COVID-19, aged 30 to 65 years, with pathology of the oral mucosa.

Dental examination of patients was carried out according to the generally accepted scheme, according to the results of the examination, patients were prescribed complex pathogenetic and etiotropic treatment, considering the principles of an individual approach. Patients are recommended sanitation of the oral cavity with professional hygiene.

Results. Most patients (95%) first of all noted bad breath, probably due to impaired taste and smell sensitivity. All patients noted the restoration of taste at various times after recovery, while 20% of patients reported a decrease in smell after recovery; 12% reported dry atrophic mucous membrane of the tongue, the presence of a white viscous coating. Men at the same time less often noted halitosis relative to females. Almost every second patient (50%) noted the appearance of putrefactive-necrotic ulcers on the cheeks and hard palate.

Conclusion. The results obtained substantiate the necessity and expediency of including a dental examination of this category of patients after their clinical recovery. The task of a dentist is to timely diagnose dental manifestations in patients who have had a coronavirus infection and to select the most adapted algorithm for their treatment, depending on the clinical manifestations in the oral cavity.

Key words: Covid-19, coronavirus, mucous membrane, oral cavity, putrefactive necrotic ulcer, plaque

 

CASE FROM PRACTICE

Abdieva D.H., Dyrda N.I., Valieva М.S.

ACUTE SMALLPOINT LICHENOID PARAPSORIASIS (MUCHA-HABERMANN DISEASE)

Parapsoriasis is a heterogeneous group of chronic inflammatory dermatoses e characterized by the presence of spots and/or papules and plaques covered with hemorrhagic crusts. Interest in this pathology is partly due to the unclear etiopathogenetic mechanisms of the development of the disease, the lack of a generally accepted classification, and the possibility of transforming parapsoriasis into T-cell lymphoma.

The article describes a case of varioliform (smallpox-like) Mucha-Gaberman’s parapsoriasis in a newborn. Due to the rarity of this disease, we present our own observation.

Key words:  acute smallpox-like lichenoidparapsoriasis, Mucha-Habermann disease, papulovesicular with central necrosis, atrophic scars

 

Кosimova Z.N., Рulotov O.N., Dadabаeva D.R, Rakhimboeva N.U., Rustamova R.I.

ВIRTH OUTCOME IN PLACENTAPREGNANT WOMEN WITH THE РLACENTAACCRETAIN

Describes the outcomes of child birth in pregnant women with a scar on the uterus and with placenta  accrete by Maternal hospital of Sugd region. Рlanned  preparation of  a pregnant women, interdisciplinary involvement of doctors in the operating room and modern infusion and transfusion care were key to a successful outcome of childbirth.

Key words: ingrowth of the placenta, obstetric bleeding, infusion-transfusion therapy, obligation of the iliac artery

 

4-2022

THEORY AND PRACTICE OF MEDICINE

Zarqua N.E., Pavlov A.V., Akimov V.P., Mukhiddinov N. D., Savin A.S., Shpis P.V.

TREATMENT OF COMPLICATIONS OF CROHN’S DISEASE

Aim.Development of a treatment and diagnostic algorithm for complications of Crohn’s disease, based on the use of innovative diagnostic methods and differentiated surgical tactics.

Material and methods.The results of treatment of 132 patients with Crohn’s disease were analyzed. 61 (46,2%) patients were diagnosed with stricture and penetrating forms of the disease, which required surgical treatment.

Results.Resection of various sections of the small and large intestine was performed in 53 patients, strictureplasty in 4 patients, dilatation of the stricture in 1, and opening of abscesses in 3 patients. Various postoperative complications developed in 17 (27,9%) patients. Mortality was 6,6%.

Conclusion.Complications requiring surgical treatment in Crohn’s disease are observed in almost half of patients. Indications for surgical treatment are stricture and penetrating forms of the disease, which develop in 27,8% and 20,4% of cases, respectively.

Key words:Crohn’s disease, surgical complications, stricture and penetrating forms, diagnosis, surgical treatment

Imomova F.Z., Karimov S.M., Yorakov F.M.

EVALUATION OF THE EFFICIENCY AND SATISFACTION OF DENTISTRY PATIENT WITH DEFEAT OF PULP-PERODONTAL COMPLEX IN DEPENDING ON GENERAL CONDITION OF THE ORGANISM

Aim.Evaluation of the efficiency and satisfaction of somatic patients with pulp-periodontal defeat with provision for particularities of the emotional directivity and compliance.

Material and methods.In 107 patients with lesions of the pulp-periodontal complex aged 20 to 50 years, depending on the presence of an intrasystemic disorder, the effectiveness of treatment of combined pulp and periodontal lesions was evaluated. Considering their temperament, 1 group (sanguine) included 34 people, 2 (choleric) – 27 people, 3 (phlegmatic) – 24 people, 4 (melancholic) – 22 people.

Results. Patients 1 and 3 groups basically were a satisfied result of the treatment of combined pulp-periodontal defeat that corresponded to the data, got at estimation of efficiency called on medical-preventive action dentistry nature (accordingly, 40,9% and 64,1%). Dentistry patients 2 and 4 groups with intersystem disorders, in spite of high clinical efficiency of the treatment of pulp-periodontal defeat (accordingly 32,2% and 19,7%), to a lesser extent were a satisfied result of the treatment of combined defeat.

Conclusion. Such difference in complacency of patients was conditioned particularity individually-typological directivities their high nervous activity, which play not last role in provision of compliance these patient.

Key words: pulpitis, periodontitis, pulp-periodontal defeat, larval reaction on disease, between system disorder, somatic pathology, compliance at dentistry treatment, satisfaction dentistry treatment, efficiency of the treatment, temperament

 

Kamolova J.K., Juraev M.N., Tavakalov M.M.

STRUCTURE, CLINICAL FORMS AND FEATURES OF THE COURSE OF BRONCHIAL ASTHMA IN CHILDREN IN TAJIKISTAN

Aim.To study the structure, clinical forms and features of the course of bronchial asthma in children in Tajikistan.

Material and methods.A retrospective analysis of case histories describing the clinical picture of bronchial asthma in 123 children aged 6 months and older.up to 14 years old.

Results.In most children, the disease developed before the age of 3 years. The non-infectious-allergic (atopic) form of the disease predominates in the structure of bronchial asthma. In the etiological structure, hypersensitivity to food allergens, house dust and plane tree pollen was determined. In the infectious-allergic form, the development of the disease is due to the formation of hypersensitivity to the fungal and combination of bacterial flora.

Conclusion.Polyvalent sensitization leads in the development of severe forms of non-infectious-allergic (atopic), infectious-allergic and mixed forms.

Key words:bronchial asthma, structure, course features in children

 

Kurbonova R.K., Ashurov G.G.

IMPORTANCE OF THE HOMEOSTATIC ACTIVITY OF MIXED SALIVA IN DEPENDING OF CARIES INTENSITY

Aim.Estimation importance of the mineral homeostasis of mixed saliva in depending of intensity of the carious defeat.

Material and methods.Importance of homeostatic activities of the saliva valued with using the methods of the clinical estimation of velocities enamel remineralization  beside 138 patients with sound teeth, as well as with compensate, sub- and decompensate level of caries intensity. For the reason studies of homeostatic abilities of the mixed saliva amongst dentistry patients used test reconstruction of damaged surfaces of enamel, offered by academician V.K. Leontiev.

Results.At coloration of the area damaged enamel by intensity of 1-3 ballets examined follows to refer to group with high homeostatic activity of the mixed saliva, 4-5 – to group of moderate homeostatic activity, 6-7 – lowered mineralization activities of oral liquid and intensity of the coloration of enamel above 8 ballets allows to speak of very low level homeostatic activity of the mixed saliva.

Conclusion.Got material are indicative of the most low homeostatic activity of the mixed saliva beside patient with decompensate of caries intensity.

Key words:caries, intensity, saliva, homeostasis, enamel, mineralization, microdamages

 

Makhmadov F.I., Juraev M.F., Mirov L., Ashurov A.S., Murodov A.I.

POSTOPERATIVE INTRA-ABDOMINAL ABSCESSES IN HEPATOBILIARY SURGERY: QUESTIONS OF CHOOSING THE ADEQUATE METHOD OF SURGICAL TREATMENT

Aim.Improving the immediate results of surgical treatment of postoperative intra-abdominal abscesses using minimally invasive technology.

Material and methods. A comparative analysis of 104 patients with postoperative intra-abdominal abscesses, operated on for the pathology of the hepatobiliary zone, was carried out. 60 patients (main group) were operated on using minimally invasive technology (video laparoscopy, interventions under ultrasound guidance and Mini laparotomy), 44 patients were operated on using traditional relaparotomy and extraperitoneal opening of abscess. Intra-abdominal abscesses in 41 (39,4%) cases were noted after liver operations in 63(60,6%) – on the biliary tract.

Results. Patients of the main group in 44 (73,3%) cases underwent ultrasound-guided interventions, in 4 (6,7%) – relaparoscopy, in 5 (8,3%) – relaparoscopy in combination with mini laparotomy and in 7 (11,6%) observations – minilaparotomy. In the control group, relaparotomy was used in 41 (93,2%) cases, and traditional extraperitoneal opening of the abscess was used in 3 (6,8%) cases. A comparative analysis of the immediate results showed that in the main group, postoperative complications were noted in 6 (10,0%) cases, with 2 (3,3%) deaths. The cause of death was acute myocardial infarction (n=2). In the control group, after performing traditional repetitions, complications occurred in 14 (31,8%) with 10 (22,7%) deaths.

Conclusion. The justified choice of a minimally invasive method for the treatment of postoperative intra-abdominal abscesses in hepatobiliary surgery significantly improves the immediate results of surgical treatment of this severe group of patients.

Key words: postoperative intra-abdominal abscesses, relaparoscopy, ultrasound-guided interventions, mini laparotomy, relaparotomy

 

Makhmudova P.U., Mahmudova R.U., Zakirova K.A., Nurov R.M., Ismatova M. A.

EPIDEMIOLOGICAL SITUATION ON MULTIDRUG-RESISTANT FORMS OF TUBERCULOSIS ON THE BACKGROUND OF HIV INFECTION

Aim.To study the epidemiological situation in terms of the prevalence of multidrug-resistant forms of tuberculosis (MDR-TB) against the background of an increase in HIV infection in the Republic of Tajikistan.

Material and methods.The spread of MDR-TB was studied; it was carried out according to the official annual reporting statistics of forms No. 30; No. 33 “Information on patients with tuberculosis”, as well as data on drug-resistant forms of tuberculosis TB-07A / y; 08A / y, for the period 2019-2021 of the Republican Center for the Protection of the Population from Tuberculosis as part of the implementation of the “National Program for the Protection of the Population from Tuberculosis in the Republic of Tajikistan for 2021-2025”

Results.In 2019, the overall incidence of tuberculosis in the republic was 56,0 cases per 100 thousand population, in 2020 – 40,5-40,2 cases per 100 thousand population. In 2019, out of the total number of registered patients (5976), 713 patients with MDR were identified, of which 467 (65,4%) were new cases, 246 (34,6%) were repeated cases, and extensive drug resistance was 71 (9,95%); in 2020 – 4316, 545, 372 (68,2%) and 173 (31,8%), 52 (9,5%) – respectively. Compared to 2019, the indicator decreased by 0,45%. In 2021, 4299 patients were registered, the overall incidence tends to decrease by 0,4% compared to 2020. Overall, the number of cases with MDR decreased by 25,4%. For the period 2019-2021 the analysis of the epidemiological situation in terms of the detection rate of HIV infection among TB patients remains stable at the same level – within 2,9%, although it tends to decrease in absolute numbers in 2019 – 175 (2,9%) patients with co-infection TB/HIV in 2021 – 125 (2,9%).

Conclusion.An analysis of the epidemiological situation indicates the need to improve the integration of the TB service with the HIV Prevention Center to provide care to patients in the same medical facility, which will allow timely diagnosis of TB and MDR-TB in people living with HIV/AIDS, which will help reduce the incidence of tuberculosis and improve the epidemiological situation of TB in the country.

Key words:tuberculosis, HIV, multidrug and extensive drug resistance of mycobacteria

 

Naimov A.M., Razzokov A.A., Parpiev F.M.

DYNAMICS OF HOSPITAL MORTALITY IN SEVERE CONCOMITANT INJURY

Aim.Decreased mortality in severe concomitant trauma.

Material and methods. The data of 3186 patients with severe concomitant injury (injury severity over 13 points on the Nazarenko scale) aged 18 to 74 were analyzed, including 2432 (76,3%) men and 757 (23,7%) women. In the main group (n = 1517) an optimized treatment tactic was carried out, in the control group (n = 1669) a generally accepted tactic.

Results. The key links of the realized complex tactics of diagnostics and treatment of concomitant injury were their construction on the data of objective methods for assessing the severity of injuries and the condition of patients with an emphasis on the use of modern technologies. The implementation of this approach made it possible to reduce the consequences of the “mutual burden” syndrome and create favorable conditions in terms of preventing complications and early activation of patients. As a result, lethal outcomes were noted in 514 (16,1%) patients, in the main group (n= 1517) in 205 (13,5%), in the control group (n= 1669) – 309(18,5%), P< 0.05.

Conclusion. The implementation of the proposed comprehensive measures in the main group allowed decreasing the proportion of deaths due to an increase in the portion of preventable deaths by optimizing the tactics of diagnosing the treatment of the acute period of concomitant injury.

Key words: Concomitant injury, hospital mortality, the scale for assessing the severity of the condition of patients and injuries, the optimized tactics for the diagnosis and treatment of concomitant injury

 

Rabiev Kh.Kh., Sirodzhov K.Kh., Makhmadaliev B.G., Sirojzoda M.S., KhukumatovM.I.

IMMEDIATE COMPARATIVE RESULTS OF HIP JOINT ARTHROPLASTY IN PATIENTS WITH FRACTURES OF THE PROXIMAL FEMINAL END WITH COMORBIDITY INCLUDED

Aim. Improving the immediate results of surgical treatment of a fracture of the proximal end of the femur in patients, considering comorbidity.

Material and methods. The work is based on the results of hip arthroplasty in 80 patients with fractures of the proximal femur against the background of comorbidity, 46 (57,5%) men and 34 (42,5%) women. The patients were divided into 2 groups: the main group – 49 observations and the control group – 31. Joint arthroplasty in patients of the 51main group was performed after correction of homeostasis system disorders, in particular, in diabetes mellitus with an acceptable gradation of the level of glycated hemoglobin HbA1c 8–9% (68–75 mmol /mol), cardiovascular pathology, pathology of the kidneys and peripheral nerves, as well as indicators of the cortical index, which is necessary to select the type of endoprosthesis and the method of fixing the components of the endoprosthesis.

Results. Evaluation by indicators and the final result according to the modified Harris scale showed that the patients of the main group in relation to the control group had the best results – statistically significant differences were revealed in the final total scores in favor of the main group, as well as in the “Functional capabilities” indicator. According to the obtained data, the result of treatment according to the modified Harris scale was significantly better in the main group.

Conclusion. An optimized approach to assessing the comorbidity of the patient’s condition, timely correction of homeostasis system disorders, treatment of existing complications against the background of the underlying disease contributed to minimizing complications in the immediate postoperative period and improving functional results in the long-term period.

Key words: arthroplasty, rheology, fracture, injuries, diabetes, complications, trauma

 

RuzievM.М.,VohidovS.D., SharipovA.A., GulomovaM.O.

ABOUT ACTIVITY OF THE HOT LINE ON COVID-19 IN THE REPUBLIC OF TAJIKISTAN

Aim. To study the activities of the anti-crisis information center for the prevention and control of COVID-19 infection (hot line – 511).

Material and methods.An analysis was made of reporting and accounting documentation, call logs to the Anti-Crisis Information Center on the prevention and control of COVID-19 infection. Collected data through call analysis to optimize the public health response to COVID-19 infection prevention and control.

Results.Phone calls came from all over the country. During the period of the center’s activity, 6203 clients applied, including 3104 (50,0%) – from Dushanbe, 1026 (16,5%) – from districts of republican subordination, 787 (12,7%) – from cities and districts of the Sughd region, 1140 (18,4%) – from cities and districts of Khatlon region, 146 (2,4%) – from cities and districts of GBAO, i.e. The largest number of calls came from residents of the city of Dushanbe.

In total, 6203 calls were received by hotline 511, most of which – 2367 (38,2%) – were related to vaccination, including about symptoms, contraindications, types of vaccines and the third stage of vaccination. 1170 (18,9%) – “On the prevention of coronavirus infection COVID-19”, 520 (8,4%) – “On the treatment of COVID-19”, 429 (6,9%) – “On taking blood tests for antibodies to COVID-19”, 70 (1,1%) – “On nutrition during COVID-19”, 534 (8,6%) – “On laboratories and research on COVID-19”. At the same time, 232 (3,7%) of the total number of incoming calls were in no way related to COVID-19 infection, of which 71 (1,1%) – “On the symptoms, diagnosis and treatment of other diseases”, 143 (2,3 %) – “On organizational issues” and 18 (0,3%) – “Issues not related to the health sector”.

Conclusion.   The work of the “Anti-Crisis Information Center for the Prevention and Control of COVID-19” from the 511 hotline showed that this initiative is needed not only during pandemics, but also on other issues related to emergencies and non-standard situations that require urgent intervention.

Key words: COVID-19 coronavirus infection, vaccine, vaccination, hotline, population

 

SamadzodaU.S.

IMMUNOLOGICAL DISORDERS IN MEN,PATIENTS WITH ANOGENITAL WARTS

Aim.The aim of the study was to study immunological changes in men with papillomavirus infection (genital warts).

Material and research methods. Under observation were 47 men with OK, whose age ranged from 18 to 42 years.

Results. Thus, studies have shown that among men in the Republic of Tajikistan, the most common STIs of viral origin (AB – OK) have a certain distribution, they occur, in most cases, in the form of mixed infection with other, more often bacterial STIs.

Conclusion. In the pathogenesis of AD, immunity disorders are important, which must be taken into account in the treatment of patients.

Key words: anogenital warts, genital warts, immunity

 

Samadova G.A., Dadabaeva B.S., Dzhabarova K.A., Khusainova A.O.

NEW STRUCTURE OF THE PRIMARY CARE – PRE-MEDICAL EXAMINATION ROOM AT THE FAMILY MEDICINE DEPARTMENT

Aim. To study and analyze the results of the work of the pre-medical examination room.

Material and methods. Reports of the City Health Center No. 1 (ГЦЗ№1), 8 departments of family medicine, three pre-medical examination rooms for year 2021.Studied indicators – the actual annual load of family nurses in the pre-medical examination room, the load on patient care – the average hourly load at the reception, the daily load. Attendance of rooms by patients from risk groups – pregnant women (PW), children aged 0 to 1 year, disabled people.

Results. The indicators of the work of family nurses in the pre-medical examination room are different because the patient chooses which of the three rooms to go to and number of patients go directly to the doctor. The actual annual workload of three nurses differs from each other, one office is overloaded (128,2), others are not (91,2% and 48,4%). A similar picture is observed when comparing the average hourly, daily workload of nurses (3,6; 5,2; 1,9 patients per hour and 21.6; 31,2; 11,4 patients per day). Only 6058 pregnant women underwent an anthropometric study in the offices, of which 1805 (72,4%) visited the offices 4-5 times. According to the reports of three offices, 5651 visits were recorded to parents with children from 0 to a 1 years old, and 1207 patients with disabilities, this amounted to 78,6% of the total number of disabled people taken for dispensary registration by the center.

Conclusion. Despite the fact that the performance of family nurses in the pre-medical examination room is satisfactory, many patients who apply bypass it due to the lack of control of the registry staff over the movement of the patient in the center, on the other hand, a number of patients want to be examined only by a doctor.

Key words: pre-medical examination room  , workload, family nurse

 

Umarova S.G., Sanginov J.R.

LOCAL CANCERIN THE STRUCTURE OF BREAST CANCER INCIDENCE

Aim. To study the proportion of locally advanced cancer in the structure of breast cancer incidence in the Republic of Tajikistan.

Material and methods. The clinical data of 213 patients with breast cancer who received treatment in the conditions of the State Institution “Republican Cancer Research Center” of the Ministry of Health and Social Protection of the Republic of Tajikistan in the period from 2019 to 2021 were studied. The proportion of patients with locally advanced forms in the structure of breast cancer incidence was determined.

Results. Primarily operable forms of breast cancer (TisN0M0-T3N1M0 stages) account for 37,1%. Locally advanced (primarily inoperable/unresectable) breast cancer (T3N2M0-T,4N3M0) is 54,4%. Patients with metastatic form of breast cancer accounted for 8,5%.

Conclusion. In the structure of breast cancer incidence in the Republic of Tajikistan, the share of patients with locally advanced form is 54.4%.

Key words:malignant tumors, breast cancer, locally advanced form

 

Khairova G.Kh.

IMMEDIATE RESULTS OF SURGICAL TREATMENT OF RECURRENT EPITHELIAL CODDLE TRAVEL

Aim. To study the character and frequency of postoperative complications in patients with recurrent epithelial coccygeal passage (RECP).

Material and methods. An analysis of the treatment of 80 patients with RECH, 56 (70%) men, 24 (30%) women aged 16 to 34 years, divided into the main – 38 (47,5%) and control – 42 (52,5%) groups.

Conducted laboratory and instrumental research methods, morphological study of excised coccygeal passages and skin-subcutaneous flap, scar tissue. The choice of surgical intervention depended on the degree of ECX complexity.

Results. In the early postoperative period among patients in the control group, complications were observed in 14 (17,5%) people. The most severe complication in patients with recurrent ECC was suppuration on days 3-5 after surgery. When diagnosing suppuration of a wound in the sacrococcygeal region, sutures were removed, the wound was revised, followed by debridement with antiseptic solutions and further management by secondary intention. Also, a frequent (n=5) complication in patients of the control group was the failure of the sutures applied to the wound, where the postoperative period proceeded without visible complications.

Conclusion. The study showed that the incidence of early postoperative complications during surgical treatment of ECP and its recurrence depended on: insufficient length and size of the flap, which cannot prevent tissue tension; insufficient vascularization of cutaneous-dermal flaps creating ischemia and favorable conditions for infection development, formation of residual cavities when suturing the sacrococcygeal region wounds after ECP excision.

Key words: epithelial coccygeal passage,  postoperative complications, recurrent epithelial coccygeal passage

 

¹Shukurova S.M, ²Kholov S.S.

 

CLINICAL AND DEMOGRAPHIC CHARACTERISTICS

 

OF PATIENTS WITH BEHCETS DISEASE

Aim. To present demographic, ethnic characteristics and clinical phenotypes in the onset of BD.

Materials and research methods.  The medical records of 62 inpatients with BD (38 men and 24 women) were analyzed, the mean age was 35,2±10,2 years, the median duration of BD was 134,3 [60,0; 192.0] months (about 11 years). All patients met the classification criteria of the International Group for the Study of BD (ISGBD) (1990) and the International Criteria for BD (ICBD) (2014). Exclusion criteria – cases of simple aphthous stomatitis; viral hepatitis B, C and HIV infection; history of pulmonary tuberculosis; pregnancy; viral or bacterial infection.

Research results. Among patients with BD, 38 (61,3%) men predominated, mean age 35,2±10,2. The most common ethnicity among patients was mixed marriages (Uzbeks + Tajiks) – 24 (38,7%). Overall, 24% of patients with BD had a family history of autoimmune diseases. The most frequent clinical manifestations of BD in the debut were recurrent aphthous stomatitis – 87,1%; skin lesions – 51,6%; genital ulcers – 14,5%; eye damage 16,1%. Analysis of information about the factors preceding the disease revealed in 18 (29%) patients.

Conclusion. Thus, the most common ethnicity is mixed marriages (Tajiks + Uzbeks). Although the etiology of the disease remains unclear, patients with BD have a high family history of autoimmune disease. Clinical manifestations in the debut of the disease are diverse and their phenotype, frequency is directly dependent on the region, age and gender.

Key words:Behçet’s disease (BD), phenotypes, aphthous stomatitis, uveitis

 

REVIEWS

Obidov Dzh.S.

TREATMENT OF DIFFUSE BREAST CANCER

The article presents the results of the analysis of the data of modern world literature on the possibility of treating diffuse forms of breast cancer. It has been proven that diffuse breast cancer is initially systemic. The main method of treatment is drug and radiation therapy. The surgical method is palliative in nature, it is performed mainly with the aim of ridding the patient of a bleeding ulcer and improving the quality of life. Radical mastectomy in the absence of distant metastases or isolated skeletal metastases prolongs life and improves its quality. There are separate reports of an extended modified mastectomy with the closure of a soft tissue defect of the chest wall with displaced musculocutaneous flaps.

Key words: malignant tumors, diffuse breast cancer, treatment, extended modified mastectomy

 

Fayzulloev KH.T.

MYOCARDIAL INFRACTION AND ISCHEMIC STROKE: PREVALENCE, RISK FACTORS AND OUTCOMES OF COMBINED ELABORATION

In this review we analyzed prevalence, tendencies, predictors, common risk factors                                                                                                              and causal relationships between myocardial infraction and ischemic stroke.

Their association is accompanied by high mortality of patients, requires timely diagnosis, prophylactics of cardiac and cerebral complications, also dictates choice of optimal urgent medical and resuscitation measures

Key-words: myocardial infraction, ischemic stroke, prevalence, risk factors, outcome

______________________________________________________________________

 

CASE FROM PRACTICE

 

Kobilov S.S., Kholmatov I.A., Kasymova Z.N., Dzhabborov Sh.U., Tadzhibaev A.A.

SYNDROME OF POSTERIOR REVERSIBLE ENCEPHALOPATHY IN A PREGNANT WOMAN WITH SEVERE PREECLAMPSIA

A clinical case of diagnosis and treatment of posterior reversible encephalopathy syndrome in a pregnant woman with severe preeclampsia, with a favorable outcome of childbirth and the disappearance of symptoms of brain damage in the early postpartum period is presented.

Key words: pregnancy, severe preeclampsia, posterior reversible encephalopathy syndrome

 

Sanginov J.R., Huseynzoda Z.Kh., Zoirov R. A., Naibov M.X.

COLORECTAL CANCER: A RARE CLINICAL CASE OF METASTASIS TO SKELETAL MUSCLE

A significant number of rare metastases of colorectal cancer (CRP) (lungs, kidneys, muscles, bone marrow and brain) are diagnosed in patients with T3-4 stages of the disease. The presented clinical observation is a rare casuistic case of metastatic lesions of the skeletal muscle, although the latter make up 50% of the human body weight. Another, less important factor contributing to CRC implantation metastasis in the muscles is the untimely diagnosis of the process and tactical surgical errors associated with the level of care in the general surgical hospital, which took place in our observation. Metastatic lesion of skeletal muscles clinically manifests itself in the form of pain syndrome, which increases with movement of the corresponding zone due to formations from 2 to 12 cm. The ways of spreading metastasis to skeletal muscles can be lymphogenous and hematogenous.

Key words:colorectal cancer, skeletal muscle, metastasis

 

 

 

 

 

1-2023

THEORY AND PRACTICE OF MEDICINE

 

Ashurov G.G., Ismoilov A.A.,   Karimov S.M., Ismoilov A.A.  

RANGE OF ABSORBANCES OF THE JAW BONES BESIDE PATIENTS WITH IMPLANTATION’S PROSTHETIC DEVICE DIFFERING EXTENT

Aim. Define the range of absorbance bone tissue beside dentistry patients with implant prosthetic device with differing extent.

Material and methods. Beside patient with occlusion defects of small extent after undertaking dental implantations realistically increased importance of investigation factor in nearest (6 months) and remote periods (12 months) of the observation under corresponding of importance 1038 HU and 1138 HU. The track record of absorbance bone tissues beside patient with occlusion defects of average extent is indicative increase the under-investigation value on 6- and 12-months x-ray’s observations (to corresponding importance of 827 HU and 982 HU).

Results. For specified period patients whole have presented 169 complaints. Of them the most frequent of which (25.4%) were on loose at the closing of dentition complaints, labored chewing of foods complaints (18.3%) and aesthetic disorders (8.3%). The patients presented more than one complaint (on average 2 complaints per case). At remote periods of the observation beside all patient with occlusional defects of big extent x-ray density bone tissues, surrounding implants, at the average increased to importance of 518 HU in contrast with source importance before implastuction (145 HU).

Conclusion. After operation of the installation of dental implants minimum importance x-ray density bone tissue, surrounding implants, on CT-picture was situated within the range of from 55 HU to 2150 HU (source importance of the under-investigation factors has formed accordingly 35 HU and 550 HU). Fluctuations maximum x-ray density after dental implastuction was at the average found within the range from 500 HU to 2600 HU under source importance 250 HU and 1650 HU.

Key words: jaw, absorbance, prosthetic device, dental implant, orthopedic design, occlusion defect

 

Gaibov A.Dzh., Abdullozoda Dzh.A., Safarzoda A.M., Samadov A.Kh.

THE STUDY OF THE FEATURES OF CYTOMEGALOVIRUS AND BACTERIAL INFECTIONS IN PATIENTS WITH CHRONIC KIDNEY DISEASE IN NEED OF TRANSPLANTATION

Aim. To study the characteristic features and structure of the cytomegalovirus (CMV) and other bacterial infections in patients prior and after kidney transplantation with an analysis of their serological status.

Materials and methods. From 2016 to 2022 was retrospective analysis of frequency and founding of CMV and bacterial infection in recipients in Republic clinical hospital of Dangara and 100 (80,6%) and city medical center named by K. Ahmedov – 24 (19,4%). There were 101(81.4%) men and 23(18,6%) women.

Results. In recipients, seronegative results were found in 56 (45%) cases and seropositive in 68 (55%). The seropositive group consisted of 2/3 of the examined recipients, 27 (21,7%) of them presented a group with an average risk of developing post-transplant complications caused by the dominant CMVI pathogen, but mortality was higher in the group with a high risk of developing complications (n ​​= 2; 1,21%). The majority (n=101; 81,4%) of recipients were males. Infectious contamination of urine was detected in 42 (33,8%) of urine cultures.

Conclusion. The serological marker of CMVI is the IgG titer. Due to the high mortality of recipients, the strategy for preventing viral complications includes in case of D-R- low-risk group, administration of antiviral agents during the first month after transplantation, D+R+ and D-R+ group of medium risk, treatment in for 3 months, and in case of D+R – taking drugs a week before surgery and for 6. Isolated pathogens are sensitive to broad-spectrum antibiotics – 2-3 generation cephalosporins and macrolides.

Key words: chronic kidney disease, bacterial and cytomegalovirus infection (CMVI)

 

Kamalova S., Azizov Z.A., Kuzieva L.S.

ANALYSIS OF SOME ASPECTS OF THE LIFE OF ELDERLY PEOPLE ACCORDING TO THE SRI OF MEDICAL SOCIAL EXPERTISE AND REHABILLITATION OF THE DISABLED

Aim.To analyze the quality of life of older people who are being treated at the Research Institute of Medical and Social Expertise and Rehabilitation of the Disabled by analyzing some aspects of life, developing recommendations.

Material and methods. Interviews were conducted with 50 older people using questionnaires developed by us, which made it possible to obtain information about family and family relationships, children, education level, health characteristics, disability group, access to work, pensions, and manifestations of ageism. There were 37 men, 13 women, the duration of the disease was from 4 to 26 years. The largest number of surveyed suffered from various chronic diseases for 5-15 years. 33 had disability, including group 1 – 6, the second – 24, the third group – 3 people. 17 beneficiaries did not have a disability.

Results.Beneficiaries living in families have favorable living conditions, there is no feeling of loneliness and neglect on the part of children (ageism), which is evidence of still preserved national traditions. Some manifestations of ageism exist in society, which is the cause of social exclusion.

For most beneficiaries, the main income is a pension, although 56% of them had a strong desire to work, however, they were not hired because of their age, which is a violation of the rights of older people (age discrimination).

All patients were satisfied with the services provided at the Institute. The disadvantage of the services received at the research institutes is the lack of narrow specialists, such as an endocrinologist, a neurologist, a psychologist.

Conclusion.  The main problems of disabled people in obtaining specialized assistance in research institutes are the difficulties in obtaining advice from narrow specialists. There are also problems with employment after retirement. This attitude of employers violates the rights of pensioners and disabled people of groups 2 and 3, which is a manifestation of ageism.

Key words: elderly person, family and family relations, access to work, medical and social assistance, ageism

 

MezhevikinaV.M.,  LazarevV.V., ZhirkovaY.V.

CHARACTERISTICS OF THE HEMOSTASIS SYSTEM AND ANALYSIS OF FACTORS AFFECTING IT DURING PERIOPERATIVE USE OF FRESH FROZEN PLASMA IN CHILDREN DURING THE FIRST MONTHS OF LIFE

Aim.To evaluate the effect of fresh frozen plasma transfusion on the hemostasis system in children in the first months of life who undergo surgical interventions.

Material and methods.156 patients (median age 49 (32.5; 74) days) who underwent elective surgical interventions were divided into 2 groups: group 1 (comparison) – 85 children who did not receive FFP transfusion; group 2 (main) – 71 children who received FFP transfusion.

We compared the percentage of blood loss, the length of stay in the neonatal intensive care unit (NICU), the frequency of pulmonary or gastric bleeding in the perioperative period, as well as the frequency of mechanical ventilation before and after the operation. We studied the dynamics of the parameters of the general blood test, the parameters of the hemostasis system and thromboelastographic (TEG).

Results.It has been established that in the postoperative period during planned surgical interventions, the hemostasis system of patients in comparison with the preoperative period changes in most cases towards an increase in coagulation properties, which is explained by the effect of surgical trauma, blood loss and anesthesia on the child’s body, as well as the use of hemostatic drugs and FFP infusion. At the same time, there were no statistically significant differences in TEG parameters between groups depending on FFP transfusion.

Conclusion.The data obtained confirm the justification for the use of FFP in children in the first months of life with surgical pathology. The decision to perform this procedure should be made using an individual approach.

Key words: newborns, bleeding, fresh frozen plasma, operations, hemostasis

 

Roitman E.I., Larina N.G., Miroshnichenko O.M., Pogrebnyak L.N., Secheneva L.V.

POSSIBILITIES OF CHANGING THE LIFESTYLE OF ADOLESCENTS WITH CONSTITUTIONALLY EXOGENOUS OBESITY IN THE DYNAMICS OF SANATORIUM TREATMENT

Aim.Study the possibilities and effectiveness of rehabilitation of adolescents with constitutionally exogenous obesity according to the rehabilitation educational program “School of an overweight child” in the dynamics of sanatorium treatment.

Materials and methods. According to the program “School of an overweight child”, 153 adolescents with I-III degree obesity, aged 10 to 17 years were examined: group I – 83 adolescents with obesity, who underwent rehabilitation; group II – 70 adolescents with obesity,  who did not participate in the rehabilitation program; control group – 52 healthy adolescents. Anthropometry was assessed (height, body weight, body fat percentage, body mass index (BMI), waist circumference, hip circumference; as well as laboratory and instrumental examinations, psychological and nutritional status, motor activity before and 21 days after rehabilitation in a sanatorium.

Results. The possibilities and effectiveness of the program in terms of weight loss and BMI, improvement of psychological status, diastolic and endothelial function, normalization of lipid and carbohydrate metabolism in adolescents with constitutionally exogenous obesity are shown.

Conclusion. The implementation of the rehabilitation educational program “School of an overweight child” in a sanatorium allows you to teach a child and his parents the right healthy lifestyle, which will undoubtedly have a significant positive prognostic effect on the possible development of cardio-metabolic changes and prevent cardiovascular disasters in the future and generally improve the quality of life.

Key words: adolescents, obesity, metabolic syndrome, rehabilitation, sanatorium, heart remodeling, endothelial dysfunction

 

Pirov U.M., Razzokov A.A.

LONG-TERM RESULTS OF SURGICAL TREATMENT OF UNSTABLE UNCOMPLICATED VERTEBRAL FRACTURES

Aim.Improving the results of surgical treatment of unstable uncomplicated vertebral fractures.

Material and methods.The results of treatment were analyzed in 237 patients with unstable uncomplicated spinal fractures aged 18 to 74 years, treated using the method of posterior transpedicular spondylodesis. Among them, 72,6% were males, and 27,4% were women. Patients were divided into two groups: the main group (treated with the proposed approaches) -51,9% and the control group-treated with traditional approaches) – 48,1%. The results of treatment were assessed using the developed scale.

Results. Long-term results from 1 to 8 years according to the proposed method were evaluated in 187 (78,6%) patients. The arithmetic mean sum of points in the main group was 95,5±0,4 points, in the control group – 88,7±0,7 points (p<0,05), i.e., in the main group, the results of treatment were statistically significantly better compared to the control group.

Conclusion. The results of the study revealed a pronounced correlation of the outcomes of the discussed damage from the implemented tactics of posterior transpedicular fixation. The implementation of the operation on the proposed approaches in the main group contributed to a statistically significant increase in the proportion of good results and quality of life of patients.

Key words: unstable uncomplicated spinal fractures, posterior transpedicular spondylodesis, long-term results of treatment of unstable uncomplicated spinal fractures

 

Rakhmatulloev Kh.

NATURE OF ANTIARRHYTHMIC AND ANTIAGREGGANT THERAPY FOR ATRIAL FIBRILLATION IN OUTPATIENT CONDITIONS

Aim.To study the nature of antiarrhythmic and antiplatelet therapy, considering undesirable risks in real clinical practice in patients with atrial fibrillation.

Material and methods. The material for the study was 85 patients with AF mean age 66 years (62,0-74,0), women – 32 (37,6%), men – 53 (62,4%), who were on outpatient treatment at the doctor- cardiologist NMC “Shifobakhsh”, who were previously treated in the cardiology and therapeutic departments. For patients observed in the clinic, the risk of thromboembolic complications was calculated according to the CHA2DS2-Vasc scale, the risk of hemorrhagic complications, assessed by the HAS-BLED scale.

Results. Most of the 56 (65,9%) observed patients had a permanent form of AF, and 10 (11,8%) had a new onset and 12 (14,1%) a persistent variant. Arterial hypertension (AH) and coronary heart disease (CHD) accompanied AF with a frequency of 72 (84,7%), and 13 (15,3%) had other cardiac and non-cardiac causes. Patients with AF with AH 72 (84,7%), who were in the age group of 65-75 years 44 (51,8%) and had cardiovascular diseases (CVD) in association with the female sex 38 (44,8%). The most common risk factors for hemorrhagic complications according to the HAS-BLED scale are arterial hypertension above 165 mm. rt. article 72 (84,7%) and age 65 and over 60 (70,6%).

Conclusion.An analysis of the nature of therapy in patients with AF showed that the use of DOACs in patients with AF in real clinical practice wants to be better. The underperforming use of anticoagulants is due to several factors, among which doctors’ low knowledge and high fear of side effects. At the same time, the pharmacological control of heart rate is mainly represented by beta-blockers and digoxin.

Key words: atrial fibrillation (AF), direct oral anticoagulants (DOACs), thromboembolic and hemorrhagic risks, antiarrhythmic therapy, INRR

 

Safarova Z.R.

MEDICAL AND SOCIAL ASPECTS OF THE HEALTH OF PREGNANT WOMEN AFTER IVF

Aim. To study the medical and social aspects of the health of women whose pregnancy occurred because of IVF, and to identify factors affecting them.

Material and methods.A retrospective study of 64 birth histories of women who underwent IVF.

Results.Pregnant women after IVF are represented mainly by urban residents of active reproductive age, multi-pregnant women, suffering from a burdened gynecological history, a long period of primary infertility, and having a complicated pregnancy. An analysis of medical records indicated inadequate antenatal care: 27 (45%) pregnant women after IVF were not registered and were not observed by an obstetrician-gynecologist at the Reproductive Health Centers, 33 (55%) visited primary health care workers no more than 4 5 times.

Conclusions. All pregnant women who have undergone IVF treatment for infertility should be at high perinatal risk and need an individual approach to pregnancy and childbirth, which will contribute to a favorable perinatal outcome.

 Key words: IVF, medical and social aspects,pregnancy

 

Sochaev O.A.

CUSTOM ABUTMENT WITH ANTIROTATION PLUG

Aim.To evaluate the effectiveness of using an individual abutment with an anti-rotation plug in preventing loosening of the abutment fixing screw.

Material and methods.This study included 130 patients who applied to the Chair of Prosthetic Dentistry of the State Educational Establishment «Avicenna Tajik State Medical University» and «Eurodent» dental clinic for dental implantation. Patients were divided into two groups: main and control. The main group – 60 patients (33 Females, 27 males) and the control group – 70 patients (39 females, 31 males) aged 19 to 61 years with a diagnosis of secondary partial edentulous. During prosthetics in patients of the main group, individual abutments with an anti-rotation plug were used. For patients in the control group, standard abutments were used for prosthetics.

Results. By the end of the study, in the main group, in the projection of artificial crowns on dental implants, there were no clinical and radiological signs of loosening of the fixing screw of the abutment. In the control group, the loosening of the abutment screw was detected in the projection of 6 artificial crowns on dental implants, which accounted for 7,3% of the total.

Conclusion.Based on the data obtained, the effectiveness of a custom abutment with anti-rotation plug, in preventing loosening of the abutment fixing screw is reasonable.

Key words: abutment screw loosening, custom abutment, dental implants

 

Sultanov M.Sh., Zaripov A.R., Khafizov A.A., Sultanov Sh.R.

USING AXIOGRAPHY IN PROSTHETIC PATIENTS WITH COMPLETE JAW DENTITY WITH NON-REMOVABLE ORTHOPEDIC STRUCTURES ON DENTAL IMPLANTS

Aim.Possibilities of axiography in patients with edentulous jaws, prosthetic orthopedic structures on dental implants.

Material and methods.As part of a clinical study, 90 patients with complete edentulous jaws aged 47-64 years were examined, which were divided into 2 groups: I-st – 30 people, prosthetics were performed according to the generally accepted method (without axiography and KAVO Protar7 articulator); II-nd – 60 people, orthopedic prosthetics was carried out on dental implants according to an optimized technique using axiography and a KAVO Protar7 articulator with the possibility of its individual adjustment according to the analysis of articulation data obtained using axiography. The studies were carried out for 36 months.

Results.During the examination, 12 (40%) people of group I revealed the following combined complications: chips and mechanical damage – 9 (30,0% of the total), muscle-pain dysfunctions (MBD) – 7 (23,3%), temporomandibular joint dysfunction (TMJ) – 6 (20,0%), overbite – 6 (20,0%), underbite – 2 (6,7%). Axiography data for group II show the presence of combined complications in 7 (11,6%) people: chips and mechanical damage – 2 (3,6% of their total number), MBD – 2 (3,6%), TMJ dysfunction – 3 (5,4%), overbite – 3 (5,4%), underbite – 1 (1,8%).

A comparative analysis of the results of groups I and II obtained during the study showed: the number of chips and mechanical damage decreased by 8.3 times, MBD – by 3,3 times, TMDJ – by 3,7 times, the number of overestimations and underestimations of the bite height also decreased by 3,7 and 1,9 times – respectively.

Conclusion.The conducted study shows the effectiveness of adapting axiography as an additional diagnostic method in the process of prosthetics with fixed structures on dental implants for patients with completely edentulous jaws.

Key words:axiography, jaw adentia, prosthetics on dental implants

 

KhafizovaG.A., RasulovN.A., KakharovM.A., NazarovH.Sh.,SultonovB.J.

THE CHOICE OF SURGICAL TREATMENT TACTICS IN PATIENTS WITH PERFORATIVE GASTRODUODENAL ULCERS

Aim.To improve the results of surgical treatment of patients with perforated gastroduodenal ulcers (PGDU).

Material and methods. The results of diagnosis and treatment of 190 patients with PGDU for the period 2017-2022 are presented.

The age of the patients ranged from 18 to 69 years. There were 70 women (36,8%), 120 men (63,2%). Patients with late (more than 6 hours from the onset of the disease) seeking medical help prevailed, which amounted to 120 (63,2%) cases. In 169 (88,9%) cases, the perforating hole (PH) was localized on the anterior wall of the duodenal bulb.

Results. In the presence of an adhesive process in the upper floor of the abdominal cavity, in which laparoscopic manipulations cannot be performed, the presence of purulent peritonitis, localization of PH along the posterior wall of the stomach and duodenum, the operation of choice was the traditional open suturing of perforated ulcers (n=46). Excision of the ulcer with pyloroplasty (n=24) was performed in the presence of a large PH (10 mm) with pronounced periulcerogenic inflammation. Gastric resection (n=12) was performed in patients with a combination of PGDU with penetration or pyloroduodenostenosis, suspected malignancy of gastric ulcers, as well as in the case of perforation of a giant ulcer with the impossibility of suturing the perforating hole. Laparoscopic suturing (n=100) was performed in patients with a small PH (no more than 10 mm) and a minimally infiltrated edge. Laparoscopically assisted suturing was performed with a large size (more than 10 mm) (n=3) and difficulty in suturing due to the presence of more pronounced infiltrated edges (n=5).

Postoperative complications occurred in 15 (7,9%) patients, which, according to the literature, is up to 19% of cases, and in severe cases this figure reaches 40%.

Fatal outcome occurred in 3 (1,6%) cases, the cause of which was pulmonary embolism (PE) (n=1) and widespread purulent peritonitis, causing multiple organ failure (n=2).

Conclusion. An individual approach to choosing the method of surgery in patients with PGDU makes it possible to reduce the frequency of postoperative purulent-inflammatory complications and, thereby, improve the results of surgical treatment of this contingent of patients. The use of minimally invasive technology (in the absence of contraindications to their use) is the method of choice in the treatment of PGDU, which promotes early recovery of patients’ ability to work and reduces their hospital stay.

Key words: perforation, gastroduodenal ulcer, laparoscopic suturing, periulceral inflammation

 

Shukurova S.M., Radzhabova G.M.

GENDER-AGE DIMORPHISM OF COMORBID PATHOLOGY IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

Aim.To study the character and frequency of comorbid pathology in patients with acute myocardial infarction depending on gender and age at the hospital stage.

Material and methods. The material for the study was 160 patients diagnosed with AMI who were admitted to the cardiac intensive care unit for the period 2018-2019. Of these, 58 (36,3%) women and 102 (64,7%) men. All patients underwent a complete clinical, laboratory and instrumental examination. In all patients, the level of the Charlson comorbidity index was calculated.

Results. When comparing the studied groups, it was noted that men were younger than women with a low BMI of 27,1 versus 29,9 kg/m2, respectively. The top three among the concomitant conditions of MI (n=160) include AH – 86,9%, type 2 diabetes – 33,8% and CKD – ​​but there are differences depending on age and gender. The calculation of comorbidity in the group established a high frequency of the average level of comorbidity – 63,8% among women and 69,6% in men.

Conclusions.Thus, the number of concomitant conditions is directly proportional to age, and has sexual dimorphism. In our studies, older females were more likely to have multiple comorbidities compared to middle-aged males.

Key words: acute myocardial infarction (AMI), comorbidity, gender, age, Charlson comorbidity index

 

Yunusova D.Z.

ASSESSMENT OF THE QUALITY OF MEDICAL SERVICES AT THE STAGE OF IMPLEMENTATION OF AN INNOVATIVE MODEL OF THE SYSTEM OF PERINATAL REFERRALS (ON THE EXAMPLE OF PILOT REGIONS)

Aim.To evaluate the existing mechanism of perinatal referrals between medical institutions of different levels and develop proposals for improving the quality of medical services in the region.

Material and methods. Mapping of 10 rural maternity hospitals of the 1st and 2nd levels was carried out in the pilot districts of Faizabad, Rasht and Shamsiddin Shokhin, 120 mothers and 194 medical workers were interviewed.

Results. The problems of routing pregnant women, women in childbirth and mothers to a higher level of medical services provision have been identified. Most of the residents arrived at the hospital for childbirth accompanied by relatives, more than 1/3 spent more than one hour on the road to the maternity hospital, almost every second patient did not receive an explanation from the health worker on a reason for the referral to the hospital; every second health worker uses a telephone messaging for emergency referrals and provides postpartum women with a return referral form to primary care for postpartum care; Practically in all institutions, defects in the execution of medical documentation were revealed, and cases of referrals of patients are rarely discussed.

Conclusion. The development and implementation of an electronic perinatal registry will allow monitoring the system of referrals/referrals and interaction between institutions. Conduct training for specialists from pilot districts and train a team of specialists from the National Reproductive Health Center on the use of the electronic perinatal register and mobile application.

Key words: quality of medical services, system, innovation, direction, mapping, interviewing, regionalization

 

REVIEWS

 

¹Zarqua N.E., ¹Pavlov A.V., ¹Akimov V.P., ²Mukhiddinov N.D., ¹Savin A.S., ¹Shpis P.V.

INSTRUMENTAL DIAGNOSIS OF CROHN’S DISEASE

The review analyzes the possibilities of modern research methods in the diagnosis of Crohn’s disease.

Key words: Crohn’s disease, instrumental diagnostics

 

Komilov T.T.,Radzhabzoda M.E., Rizoev M.M.

ACUTE AND CHRONIC KIDNEY INJURY IN PATIENTS AFTER MYOCARDIAL INFRACTION

This article views the issues of occurrence and development of acute and chronic kidney injury in patients after myocardial infraction, their connection, propagation frequency, common risk factors and sequels.

Key words: acute kidney injury, myocardial infraction, cardiorenal syndrome,   pathogenesis, risk factors

 

Usmonov I.M., Dostiev U.A.

 This review focuses on the epidemiology of acute renal transplant rejection and the risk factors influencing its development. As the analysis of the literature showed, the detection of humoral sensitization before kidney transplantation is important for choosing the most suitable donor and identifying patients at high risk of rejection, as well as for achieving the goal of treatment, which reduces the production of donor-specific antibodies (DSA), which are important for the survival of the allograft.

Key words:acute rejection of a kidney transplant, risk factors, donor specific antibodies, sensitization

 

 

2-2023

THEORY AND PRACTICE OF MEDICINE

Abdullozoda S.M., Usmanova G.M., Kobilov K.K., Umarova Z.A.

FEATURES OF THYROID HORMONE METABOLISM IN OBESITY

Aim. To study the metabolism of thyroid hormones in obesity (OB).

Material and methods. The content of thyroid hormones in 550 people aged 18-84 years with different body mass index (BMI) was studied. There were 221 men (40,2%), women – 329 (59,8%). The average age of the surveyed was 42,2±0,6 years. Normal BMI had б252 people, overweight – 135, OB 1, 2 and 3 degrees – 89, 60 and 14 people, respectively.

The content of thyroid-stimulating hormone (TSH), triiodothyronine (T3) and thyroxine (T4) in venous blood serum was determined by enzyme immunoassay.

Results. Persons with elevated levels of TSH (81,3±18,6 kg) and T4 (92,2±18,1 kg) had a higher body weight compared to those examined with normal levels of these hormones (72,4±15,3 kg and 76,4±13,3 kg, respectively) (p<0,001). Persons with excess T3 content (68,6±13,5 kg) had less body weight compared to respondents with its normal content (73,9±16,2 kg) (p<0,001). With an increase in body weight, there was a proportional increase in the concentration of TSH and T4 and a decrease in the content of T3 in the blood serum. In addition, in men, as BMI increased to 40,0 kg/m2, there was a significant decrease in the level of T3 (up to 1,3 ± 0,3 nmol/l), and with OB grade 3 (2,08 ± 0,2 nmol/l k) the level of this hormone had no significant difference compared to men with normal BMI (3,0±0,2 nmol/l) (p>0,05). Also characteristic of the examined cohort was only a significant difference in the level of T3 in men (3,0±0,2 nmol/l) and women (2,7±0,1 nmol/l) without overweight (p<0,05). In other cases, there were no significant differences in the content of thyroid hormones in both sexes depending on BMI.

Body mass index, waist circumference, hips and waist / hip index had a direct correlation with hormonal imbalance towards an increase in TSH, T4 and a decrease in T3.

Conclusion. An increase in body weight is associated with thyroid dysfunction in the form of an increase in the level of thy­roid-stimulating hormone and thyroxine against the background of a decrease in triiodothyronine. Among the examined cohort of patients, a direct correlation was found between the level of thyroid hormones and body mass index, waist circumference, hip circumference, and waist/hip index. The data obtained confirm the need to introduce mandatory correction of hypothyroidism into a comprehensive program for the treatment of obesity.

Key words: obesity, overweight, thyroid hormone, triiodothyronine, thyroxine

Bokiev F.B.

PLACING THE MESH PROSTHESIS BY THE INLAY METHOD IN CORRECTION OF GIANT VENTAL HERNIAS

Aim. Improving the results of surgical treatment of giant ventral hernias by placing a mesh prosthesis according to the inlay method.

Material and methods. We studied 17 patients with giant ventral hernias who underwent hernia repair using a synthetic mesh placed in the inlay position. The average age of patients is 45±5,6 years. The duration of hernia carrying is 13±2,4 years. Contributing factors for the formation of hernias were widespread peritonitis (10), total suppuration of the postoperative wound with intestinal eventration and open wound management (3), recurrent hernias with extended defects (4). In 17,6% of patients, concomitant pathology was established, requiring simultaneous performance of simultaneous operations.

All patients underwent general clinical, biochemical blood tests, a study of the parameters of the function of external respiration, radiography of the chest and abdominal cavities, ultrasound, and computed tomography.

Results. In the immediate postoperative period, wound suppuration occurred in 5,8% of cases. No relapses were noted within 36 months.

Conclusion. Placement of a mesh polymer prosthesis by the inlay method for extended defects of the hernia ring is considered the best reconstruction option, which ensures the strength of the abdominal wall and warns patients against the occurrence of compartment syndrome.

Key words: chronic kidney disease, bacterial and cytomegalovirus infection (CMVI)

 

Gulshanova S.F., Ismoilov S.S.

EARLY DIAGNOSTICS OF ISCHEMIC REPERFUSION INJURY TO THE LIVER TRANSAim. Early local diagnostics of ischemia-reperfusion damage of the liver graft for timely prevention of early dys­function.

Material and methods. The study is based on the examination and treatment of 120 (100%) recipients before and after living donor liver transplantation aged 15 to 67 years, 86 men (72%) and 34 women (28,3%).

Based on the study of venous blood (the recipient’s own hepatic vein), the state of energy metabolism, early metab­olism in the transplanted liver fragment was monitored immediately after perfusion of the organ intraoperatively and in the early post-transplantation period.

Results. Early graft dysfunction in the first week after transplantation of the right lobe of the liver was observed in 31,6% of cases, the studied laboratory parameters reflected dysfunction of the graft.

A pH deviation above 7,45 occurred in 4 (3,3%) recipients. An increase in the level of transaminases, compared with baseline, was noted on the 7th day, by the second week it was restored to its original values. In the early post-trans­plantation period, the rise of ALT and AST by 3-4 times is the result of massive damage to hepatocytes due to isch­emia-reperfusion injury. Over time, the international normalized ratio decreased in groups with early graft dysfunction. With a reversible form of early graft dysfunction, the variability of the results of the range limit of glutamate up to 22–25 mmol/l, lactate up to 20–25 mmol/l, pyruvate up to 1220 μmol/l was noted, these indicators approached the norm by the end of 2 days after liver transplantation.

Conclusion. The use of a catheter installed in the recipient’s own hepatic vein allows early local laboratory diag­nostics and continuous monitoring of the functional state of the liver graft intraoperatively and early after surgery. The technique allows to accelerate the diagnosis of ischemia-reperfusion damage of the graft, prophylaxis, as well as timely intensive therapy of recipients depending on the results of the analysis. RDT in the first week after trans­plantation of the right lobe of the liver was observed in 31,6% of cases, in accordance with the laboratory indices reflecting graft dysfunction.

Key words: diagnosis, ischemia-reperfusion injury, liver transplant, dysfunction

Davlyatov S.B., Sulaimonov S.Ch., Rofiev R.R.

RESULTS OF CORRECTION OF CONGENITAL PUNCH DEFORMATION IN CHILDREN

Aim. Improving the results of surgical correction of congenital pectus excavatum in children.

Material and methods. The results of treatment of 44 children with congenital pectus excavatum at the age of 4-9 years old – 3 (6,8%), 10-14 years old – 16 (36,3%), 14-18 years old – 25 (56,8%) %) of patients. There were 26 (59%) boys and 18 (40,9%) girls. 2nd degree of deformity according to Gizhitskaya was present in 12 (27%) patients, 3rd degree – in 32 (72%) patients.

Standard laboratory (clinical and biochemical) and dynamic instrumental studies (plain radiography, CT scan of the chest, Diplography with the determination of central and pulmonary hemodynamics, spirography, ECG, ultrasound of the heart, liver, and kidneys) were carried out. Depending on the method of thoracoplasty performed, the patients were divided into two groups: group I – 20 (45,5%) children who received nickel-titanium wire-type fixators during thoracoplasty, group II – 24 (54,5%) children who used Nickel-titanium lamellar retainers. In both groups, we used the improved technique for holding the fixator, which we proposed.

Results. When using a wire fixator, complications were noted in the form of wound suppuration in 4 (9,1%) children, plate displacement – in one (2,3%) patient, pneumonia with pleurisy – in 2 (4,5%) children. After the expiration of the period, the tissue grew between the wires and the removal of the fixative was a certain difficulty. Two (4,5%) children who underwent thoracoplasty at the age of 8 years underwent repeated correction of chest deformity with shape mem­ory titanium nickelide plates.

Complications in the immediate postoperative period in the second group were noted in one (2,3%) patient in the form of pneumothorax, which was eliminated by puncture of the pleural cavity. In the long-term period, one patient after 1 year showed a slight displacement of the plate, associated with a violation of the regime of physical activity, additional treatment was not required. In all cases, a good cosmetic result was obtained in the main group.

Conclusion. Thus, the method of thoracoplasty using a titanium nickelide plate with shape memory is a simple, safe method for correcting pectus excavatum in children.

Key words: congenital pectus excavatum, chest, childhood, titanium nickelide, surgical treatment

Karimov S.M., Imomova F.Z., Amindzhanova Z.R.

RESULTS STUDIES OF COMBINED DEFEAT OF THE PULP-PERIODONTAL COMPLEX IN PATIENTS WITH INNERSISTEM’S DISORDERS UNDER THEIR ADRESS

Aim. Study the conditions of the combined defeat of pulp-periodontal complex beside patient with different direction disorders when referencing to specialist.

Material and methods. We are organized analysis of the condition of root channel and nearradicular change in 366 teeth beside 265 somatic patients at the age from 20 to 50 years and senior with combined defeats of pulp-periodontal complex. On group accessories the teeth were distributed as follows: incisors of upper jaw – 56; incisors of mandible – 30; premolars of upper jaw – 55; premolars of mandible – 43; molars of upper jaw – 103; molars of mandible – 79. To study the endoperiapical state of the teeth, various methods of X-ray examination were used.

Results. Combined pulpal-periapical lesions in patients with multidirectional intersystem disorders are a common endoperiapical pathology and account for at least 50-55% in the structure of dental diseases aged 20 to 50 years and older.

Conclusion. Among the examined persons out of 366 teeth, only in 123 (33,6%) the canals were not filled up to the top, in 243 (66,4%) they were filled up to the top. From this it follows that out of 3 teeth, one with poorly sealed canals accounts for 2 with fully sealed ones.

Key words: pulp-periodontal complex, intersystem disturbance, endoperiapial state

Kakharov M.A., Solidzhonova Kh.T., Toshmatov R.A.

EFFECTIVENESS OF AREFLEXUAL ROUX-EN-Y BILIODIGESTIVE ANASTOMOSIS IN SURGICAL TREATMENT OF BENIGN DISEASES AND EXTRAHEPATIC BILE DUCTS INJURIES

Aim. To show the effectiveness of reconstruction of the biliary tract by applying Roux-en-Y hepaticojejunostomy (RYHJ) in surgical treatment of patients with benign diseases and extrahepatic bile ducts injuries.

Material and methods. We analyzed the results of reconstructive operation of 99 patients with choledocholithiasis (n=70), rupture of echinococcal cyst into the bile ducts (n=3), Mirizzi syndrome (n=5), iatrogenic injury (n=3), bile duct stricture (n=13), biliary fistula (n=5). Among the examined were 62 (62,6%) women and 37 (37,3%) men. The mean age of the patients was 42,5+3,5 years (M+m).

Results. All patients were operated. In 13 patients because of adhesive process in mesocolon area was applied the antecolic RYHJ, in 86 patients – retrocolon. The complications in postoperative period were noted in 19 patients. Including intra-abdominal bleeding in 2 (2,02%), bile leakage from the anastomosis area in 13 (13,13%), wound complications in 4 (4,04%) patients. Relaparotomy was performed in 2 patients. All patients were discharged under satisfactory condition. In the late postoperative period, high stricture recurrence of HJA (Bismut I) was observed in 2 (2,02%) cases.

Conclusion. . RYHJ is a pathogenetically substantiated operation in benign diseases and extrahepatic bile ducts injuries. The main advantage of this reconstructive operation is a reduction of the intestinal contents reflux into extrahepatic bile ducts, which is the prevention of cholangiogenic infection development and complications which associated with it.

The isoperistaltic nature of superimposed anastomosis helps to reduce the suture failure. The foregoing allows us to recommend the widespread use of RYHJ in the surgical treatment of benign diseases and extrahepatic bile ducts injuries.

Key words: biliodigestive anastomosis, Roux-en-Y hepaticojejunostomy, choledochoduodenoanastomosis, choledocholithiasis, reflux cholangitis

Kosimov M.M., 2Vokhidov A., 3Pulatova B.J., 4Yusupova Z.Kh.

PREVALENCE OF CONGENITAL CLEFT LIP AND PALATE AMONG CHILDREN OF THE REPUBLIC OF TAJIKISTAN

Aim. To study the population frequency of congenital cleft lip and palate among newborns in the Republic of Tajikistan.

Material and methods. The data of the National Register of Congenital Malformations DAHIS 2, as well as the data of the statistical reporting form 12 “Report of medical care for pregnant women, women in childbirth, puerperal women and newborns” F-32 and “Report on diseases of the service area of health centers” F-12 for the period from 2016 to 2021.

Results. . Between 2016 and 2021 in the Republic of Tajikistan, 500 newborns were born with malformations of the orofacial region – congenital cleft lip and palate. The population frequency of CCHD was 3.4 per 10,000 newborns. Conducted clinical and genealogical studies of families with children suffering from CVD and N indicate that no more than 40% of cases are classified as “family”, while the remaining 2/3 (60%) have a “sporadic” nature of occurrence.

Conclusion. The population frequency of CCHD in 2016 was 4.0, in 2021 it decreased to 2.4 per 10,000 newborns. Over the past 6 years, the absolute number of sick children suffering from CRHD has almost halved. With a decrease in the overall incidence of congenital malformations, there is an increase in the dynamics of the birth of children with CCHD.

Key words: orofacial anomalies, prevalence, incidence, COVID-19, fetus, newborn

Mullodzhanov G.E., Makhmudov D.T., Ismoilov A.A., Ashurov G.G.

CLICAL RESULTS OF QUANTITATIVE-TOPOGRAPHICAL ESTIMATION INSTALLED DENTAL IMPLANTS BESIDE PATIENTS WITH IMPLANTATION’S PROSTHETIC DEVICE OF DIFFERING EXTENT

Aim. Conduct quantitative-topographical estimation installed dental implants beside explored patient with occlu­sional defects of differing extent.

Material and methods. Installation of dental implants held at standard methods beside 136 patients with occlusional defects small (66 pers.), average (56 pers.) and big (14 pers.) extent. Majority patient, which is organized operation of dental implastruction, have formed the men (76.5%), rest – a woman (23.5%). Amongst all patient implantation is organized with use of innerbone’s implants of the company DIO implant dentsply group «Implant system» (the Korea) in amount 226 units. Most percent installed of dental implants had a diameter 3.75х10,0 and period of the observation has formed 3 years.

Results. Amongst examined persons in corresponding segments of upper and mandible (1, 2, 3 and 4) in pro­jections of premolars installed 11.1%, 3.1%, 9,7% and 7.9% dental implants. Importance factor data in the field ofmolars formed accordingly 7.9%, 11.5%, 11.5% and 12.8% under their total importance 19.0% and 5.3% in the field of incisor and canines.

Conclusion. Most often installation of dental implants was conducted in the field of molars of the mandible (in 3 and 4 segments) under their total importance 24.3%.

Key words: implantation prosthetic device, dental implant, orthopedic design, occlusional defect

Mukhamadieva S.M., Narzullaeva A.R., Nasridinova Kh. S, Pulatova A.P.

OUTCOMES OF PREGNANCY AND BIRTH IN WOMEN WITH HEART DEFECTS

Aim. To study the features of the course of pregnancy with the assessment of perinatal outcomes in women with heart defects.

Material and methods. A retrospective study of 140 birth histories of women with heart defects and newborn records according to the data of the third-level hospital of the “Research Institute of Obstetrics, Gynecology and Perinatology of Tajikistan” for 2015-2022.

Results. The average age of pregnant women with heart defects averaged 27,7 ± 5,8 years. In the structure of heart defects, 59,2% were congenital heart defects, 23,6% – mitral valve prolapse, operated heart – 12,1%, acquired defects -5 %. 52,8% of pregnant women had a burdened obstetric history, 56,4% suffered from anemia of varying degrees, 20% suffered from iodine deficiencyIn 16,3% of cases, childbirth occurred prematurely, in 83,7% a caesarean section was performed, of which in 79,3% of cases at full-term gestation, in 20,7% of cases at a gestational age of 35-36 weeks due to uterine dysfunction. -placental circulation. 85,8% of babies were born full-term, 14,2% premature.

Conclusion. The peculiarities of the course of pregnancy in women with heart defects are the high frequency of extragenital pathology and preterm birth, leading to adverse perinatal outcomes and the risk of operative delivery. To reduce maternal and perinatal morbidity and mortality, it is necessary to develop proposals for preconception prepa­ration and a risk-straining algorithm for managing this category of patients.

Key words: heart defects, pregnancy, childbirth, caesarean section, perinatal outcomes

Naimov S., Khushvakhtov Sh.D., Abdullaeva M., Otambekova M.G., Burkhanova N.A.

NEW TECHNOLOGIES AND MEDICAL AND SOCIAL CHALLENGES FOR PEOPLE AFFECTED TB IN TAJIKISTAN (based on the results of using the ONEIMPACT mobile application)

Aim. Studying priority medical and social problems of people affected by TB using the OneImpact mobile ap­plication.

Material and methods. Quantitative research methods were used for all applications of people affected by TB and registered on the OneImpact platform (1051 people) within one year. The observation unit of the study is each personwho applied to the OneImpact platform for the period from March 2022 to March 2023. The representativeness of the data obtained was achieved by analyzing all requests (general population). The analysis of the results of the collected information is carried out by the OneImpact program itself in real time.

Results. The analysis of cumulative data made it possible to determine the prompt response to 699 requests from people affected by TB, which made it possible to solve problems in 79%; The main barriers to increasing the availability of diagnostics and treatment of TB patients is stigma – 38% of all these problems, every fourth appeal is associated with difficulties in obtaining medical services from the TB service, and problems of social support.

Conclusion. The OneImpact platform is an innovative technology that expands access to health and social services for people with TB, regardless of where they live. Efficiency in resolving the issues received (89%) demonstrates the effectiveness of the use of modern technologies. the identified priority problems have pronounced differences in gender, age and socio-economic aspects and require the development of preventive and medical and social measures, taking into account the above features.

Key words: community monitoring, new technologies, TB, access to TB treatment, social barriers, stigma

Obidov S.A., Karimov S.M., Mullodzhanov G.E.

CONDITION OF THE SOURCE INTENSIVE FACTORS OF MAIN DENTISTRY DISEASES BESIDE CHILDREN WITH INNATE UNJOINING UPPER LIP AND PALATE

Aim. Study of the source intensive factors of the caries and parodontal diseases beside children with innate unjoining of lip and palate.

Material and methods. Organized clinical examination 108 children of the key age groups (3, 6, 9, 12, 15 years) with innate unjoining upper lip and palate. Absolute importance of the intensive factors of the caries deciduous and permanent teeth valued with using the index cft for deciduous bite and CFEt for permanent bite. Structuration intensive factor of caries conducted with using structured component cft for deciduous teeth (component «c», component «t», component «m» and component «f») and CFEt for permanent teeth (component «C», component «T», component «M», component «F» and component «E»). Amongst examined children importance intensive factors of the parodontal diseases valued with using of index CPITN, designed WHO specialist.

Results. Called on study allows to draw a conclusion about that in key age group children with unjoining lip and palate source intensive factors of cariesology status in deciduous and permanent bite, as well as parodontal status, are found on high level. However quite a number of the pathological processes accounts for children with unjoining lip and palate on background of the maximum disorders of ecosystem’s oral cavity at presence of the abovementioned vice of the development.

Conclusion. Got materials under complex analysis of dentistry status are indicative that beside children with in­nate unjoining upper lip and palate intensive factors cariesology status at age before 12 years is defined by defeat first permanent molars, after 12 years growing caries intensities defined by defeat other function-oriented groups teeth. Consequently, number of children with sound permanent teeth decreased in inverse proportion to amount children, having struck by caries first permanent molars.

Key words: lip, palate, tooth caries, parodontal disease, child, unjoining lip and palate

Rakhmatova N.A., Rakhmatova R.A., Kodirov A.R.

ASSESSMENT OF INCIDENCE AND PREVALENCE OF DIABETES MELLITUS IN REPUBLIC OF TAJIKISTAN FOR 2017-2021

Aim. Study of the source intensive factors of the caries and parodontal diseases beside children with innate unjoining of lip and palate.

Material and methods. Organized clinical examination 108 children of the key age groups (3, 6, 9, 12, 15 years) with innate unjoining upper lip and palate. Absolute importance of the intensive factors of the caries deciduous and permanent teeth valued with using the index CFt for deciduous bite and CFEt for permanent bite. Structuration intensive factor of caries conducted with using structured component CFt for deciduous teeth (component «c», component «t», component «m» and component «f») and CFEt for permanent teeth (component «C», component «T», component «M», component «F» and component «E»). Amongst examined children importance intensive factors of the parodontal diseases valued with using of index CPITN, designed WHO specialist.

Results. Called on study allows to draw a conclusion about that in key age group children with unjoining lip and palate source intensive factors of cariesology status in deciduous and permanent bite, as well as parodontal status, arefound on high level. However quite a number of the pathological processes’ accounts for children with unjoining lip and palate on background of the maximum disorders of ecosystem’s oral cavity at presence of the abovementioned vice of the development.

Conclusion. Got materials under complex analysis of dentistry status are indicative that beside children with innate unjoining upper lip and palate intensive factors cariesology status at age before 12 years is defined by defeat first permanent molars, after 12 years growing caries intensities defined by defeat other function-oriented groups teeth. Consequently, number of children with sound permanent teeth decreased in inverse proportion to amount children, having struck by caries first permanent molars.

Key words: lip, palate, tooth caries, parodontal disease, child, unjoining lip and palate

Muradov A.M., Dustov SH.B., Nozirov Dzh.Kh.

CHRONIC HEART FAILURE AND SOME ASPECTS OF ITS TREATMENT

This article is a review of modern aspects of chronic heart failure such as definition, prevalence, social significance, comorbid conditions affecting this pathology, and also main problems of its treatment.

Key words: chronic heart failure, acute heart failure, comorbidity, hemod ynamics, treatment

Shumilina O.V., Ikromov T.Sh., Safarzoda A.M., Rakhmatova R.A., Odinazoda A.A.

IMPACT OF STEM CELLS ON THE IMMUNOLOGICAL REACTIVITY OF THE ORGANISM

This article provides a review of foreign literature sources, describes the effect of stem cells on the immunologi­cal reactivity of the body, which is an active area of research in the field of stem cells and immunology. Studies are presented that show that stem cells can not only have an effect at the cellular level, but also affect immune processes. They can modulate the activity of immune cells such as lymphocytes and monocytes and regulate the production of cytokines and other signaling molecules that influence immune responses. Works are shown that reflect the role of stem cells in interacting with the immune system through their ability to differentiate into cells of the immune line. Their directions for differentiation into those cells that are necessary to suppress the immune response or increase its activity. However, the mechanisms of action of stem cells on the immunological reactivity of the body are still poorly understood. Further research is needed to explore these mechanisms in more detail and identify potentialclinical applications of this knowledge. Thus, the study of the effect of stem cells on the immunological reactivity of the organism is of great interest and may open up new prospects in the field of immunotherapy and the treatment of various immunopathological conditions.

Key words: immunological reactivity, stem cells, inflammation, CD14+, T-cells, mesenchymal stem cells, transplanta­tion, leukemia

CASE FROM PRACTICE

 

Rogov A.V., Barabash R.Z.

A COMPLEX OF THERAPEUTIC GYMNASTICS FOR THE REHABILITATION OF A PATIENT WITH A MALIGNANT NEOPLASM OF THE RETROPERITONEAL SPACE

Rehabilitation of cancer patients is complex and requires an individual approach. The article outlines a complex case of rehabilitation of a patient with neuroblastoma. The role of non-drug correction in reducing the restrictions on the life of the child is shown.

Key words: neuroblastoma, rehabilitation, reduction of vital activity res trictions medical

 

3-2023

THEORY AND PRACTICE OF MEDICINE

Abdullozoda S.M., Usmanova G.M., Gulbe­kova Z.A.

MARQUERS OF OXIDATIVE STRESS AND ANTIOXIDANT PROTECTION FOR OBESITY

Aim. To study the features of oxidative stress and antioxidant protection in a domestic cohort of the obese population.

Material and methods. The levels of malondialdehyde (MDA), catalase and superoxide dismutase (SOD) were studied in 1304 people (718 women and 586 men) with different body weights, average age 41,1±13,6 years. Insufficient body weight (body mass index (BMI) <1,5 kg/m2) was present in 74 (5.68%) people, normal indicators (BMI=18.5-24.99 kg/m2) – in 637 (48,85%), overweight (BMI=25,0-29,99 kg/m2) – in 330 (25,3%), class I obesity (OB) – in 189 (14,49%), class II – in 60 (4,6%) and III degree – in 14 (1,07%) respondents.

Results. The levels of MDA, SOD and catalase in all respondents were within the reference values, however, there was a significant increase in the level of SOD and catalase in men compared to women.

Depending on age, there were significant differences in the level of SOD between young (18-44 years old) and elderly (60-74 years old) respondents (p<0,001), as well as catalase levels in young (18-44 years old) and middle-aged (45-40 years old) respondents (p<0,001). 59 years old) and elderly (60-74 years old) ages (p<0.001).

In persons with grade 1 OB, compared with those examined with normal weight, the level of MDA was 14,3% higher, and in the group with grade 2 OB it was 24,3% higher (p<0,001). Also, with OB of degrees 1 and 2, compared with normal body weight, the level of SOD was reduced by 122,2% and 131,9%, respectively (p <0,001). In cases of OB of 1 and 2 de­grees, compared with persons with normal BMI, catalase activity was reduced by 21,9% and 28,2%, respectively (p <0.001). A direct correlation was found between an increase in BMI and an increase in the level of MDA (r=0,25, p<0,001) and its inverse correlation with the activity of catalase (r=-0,36; p<0,001) and SOD (r=-0,41; p <0,001).

Conclusion. Against the background of an increase in body weight, the imbalance between the pro-oxidant and antioxidant systems is disrupted with the development of oxidative stress. In the cohort we examined, the severity of oxidative stress directly depended on the degree of increase in body mass index and had no association with gender and age. The results obtained confirm the role of obesity in the development of oxidative stress, and therefore it is necessary to add antioxidants to a comprehensive treatment program for this category of patients.

Key words: obesity, oxidative stress, antioxidant system, malondialdehyde, catalase, superoxide dismutase

 

Gulshanova S.F., Ismoilov S.S.

PREVENTION AND TREATMENT OF REPERFUSION INJURY OF THE LIVER TRANSPLANT FROM LIVING RELATED DONOR

Aim. To study the effect of antioxidant therapy on the indices of lipid peroxidation products, when administered locally for the prevention and therapy of ischemia-reperfusion injury of liver transplant.

Material and methods. The scientific study was based on the examination and treatment of 120 (100%) recipients before and after liver transplantation from a living donor, who were in the department of portal hypertension and dispensary observation of the National Scientific Center for Transplantation of Human Organs and Tissues of the Ministry of Health and SZN of the Republic of Tajikistan from 2012-2022. The age range of the patients varied from 15 to 67. The gender ratio among the study recipients was 86 men (71.7%) and 34 women (28.3%). The following parameters of the CBS were measured using an indirect calorimeter model “CCM Express” (Medgraphics, USA), the lactate content in venous blood was deter­mined using a portable clinical analyzer “i-STAT 300” (Abbott, USA). Using Dimension EXL 200 equipment, an integrated biochemical and immunochemical analyzer, the level of AlAT E/l and AST E/l, and the cytokine profile were determined.

All patients underwent general clinical, biochemical blood tests, a study of the parameters of the function of external respiration, radiography of the chest and abdominal cavities, ultrasound, and computed tomography.

Results. In our study, reperfusion injury was detected in 38 (31.6%) recipients. In patients with RDT, compared with recipients without dysfunction, changes in the content of various lipid peroxidation products were observed: towards a decrease in primary and secondary lipid peroxidation products. The damaging effect of IRP was also evidenced by a significant increase in the content of lactate dehydrogenase by the end of the first day of observation in the control group by 23.9%, while in the main group it increased only by 7.1%. The analysis revealed a slight increase in ALT in both groups one day after liver transplantation with its subsequent decrease, and an increase in AST in both groups, more pronounced in the control group -by 14.7%, while in patients who received Reamberin these changes amounted to only 3.9%.

Conclusion. To increase the prognostic significance of changes in the gas composition of venous blood, it is necessary to take into account the correlation between lipid peroxidation and blood interleukins. Determination of interleukins in venous blood after transplantation of the right lobe of the liver is necessary for the prevention and early detection of manifestations of ischemia-reperfusion injury, as well as the use of antioxidant therapy to prevent early dysfunction of the liver graft.

Key words: living-donor liver transplantation, antioxidant therapy, ischemia-reperfusion injury

 

Dzhaborova M.C.

PSYCHOPHYSIOLOGICAL ASPECTS OF PREDIABETES

Aim. Study of psychophysiological aspects of prediabetes.

Material and methods. 65 women of fertile age were studied. We studied the psycho-emotional state in prediabetes.

Results. Statistical analysis revealed significant differences in well-being (p = 0.000069), activity (p = 0.0013), and mood (p = 0.0402) between women with prediabetes and controls, indicating lower levels of these parameters in women with prediabetes. Significant differences were also found in anxiety levels, with higher scores in women with prediabetes (p<0.001 at all levels), highlighting the impact of prediabetes on psychological well-being and the need for support to manage anxiety.

Conclusion. Research highlights the critical need for attention and support to improve psycho-emotional well-being and manage anxiety in women with prediabetes. Understanding the causes of psychological changes is important for developing strategies to reduce anxiety, improve quality of life, and prevent the development of diabetes. The study makes an important contribution to understanding the relationship between psychological aspects and diabetes risk and the development of prevention programs.

Key words: prediabetes, anxiety, psychophysiological aspects

 

Irgasheva J.Z., Abdullosoda S.M., Khali­mova F.T., Shukurov F.A.

FEATURES OF QUALITY OF LIFE IN PATIENTS WITH CORONARY HEART DISEASE AND LIVER CIRRHOSIS BEFORE CELL THERAPY

Aim. To study quality of life indicators in patients with coronary heart disease and liver cirrhosis before cell therapy.

Material and methods. The study involved 52 patients aged 40 to 65 years, of which 45 with coronary artery dis­ease and 7 with liver cirrhosis. Diagnoses were confirmed by clinical data, quality of life was assessed using the SF-36 questionnaire. Statistically significant differences in the quality of life between the groups were revealed, the analysis was carried out at a significance level of p < 0.05.

Results. Patients with liver cirrhosis demonstrate a statistically significant decrease in quality of life scores compared to patients suffering from coronary heart disease on almost all SF-36 scales. This decline is particularly pronounced in areas such as physical functioning, role-physical functioning, general health, vitality, social functioning and mental health. These results may be due to the complex impact of cirrhosis, which affects not only patients’ physical well-being, but also their emotional well-being, social interactions, and ability to function normally.

Conclusion. Determining the quality of life in patients before starting cell therapy is of great clinical importance, as it allows us to assess the general condition and needs of the patient, as well as predict possible risks and treatment outcomes. This helps doctors adapt therapeutic strategies, taking into account not only physical, but also psycho­logical and social aspects of health. In addition, baseline quality of life can serve as a starting point for subsequent monitoring of the effectiveness and safety of treatments, including cell therapies.

Key words: : coronary heart disease, liver cirrhosis, quality of life, SF-36

 

Iskandari F.

RESULTS OF AN ELECTROMYOGRAPHIC STUDY IN CHRONIC INFLAMMATORY DEMYELINATING POLYNEUROPATHY DEPENDING ON AGE

Aim. To evaluate the results of electromyographic studies in chronic inflammatory demyelinating polyneuropathy depending on age.

Material and methods. 60 patients with a clinical diagnosis of CIDP were examined. The patients were divided into group A, which included 13 (21.7%) children, and group B, which included 47 adult patients (78.3%).

EMG was used for the study using standard methods.

Results. When examining motor nerves, along with diffuse demyelination, signs of local demyelination in the form of GSV were revealed. in children in 72.3% of cases, in adults in 61.5% of cases; Children also showed statistically sig­nificantly lower M-response amplitudes compared to adult patients.

Conclusion. The nature of the demyelinating process differed in the subgroups. Statistically lower rates were found in children, indicating greater damage to the myelin sheath.

Key words: chronic inflammatory demyelinating polyneuropathy, electromyography, age

 

Ismoilov A.A., Аshurov G.G., Sultanov M.Sh.

RESULTS OF THE QUALITATIVE ESTIMATION OF PO­SITIONING DENTAL IMPLANTS AND OPERATIOIN OF IMPLANTATION PROSTHETIC DEVICE IN DE­PENDING OF EXTENT SUPRACONSTRUCTION

Aim. Estimation the value of the results of positioning dental implants and operation of implantation prosthetic device in depending of extent unfixed designs.

Material and methods. Conducted the situational estimation of the positioning of dental implants in depending of extent unfixed orthopedic design. In depending of extent supraconstruction elements examined contingent was divided into 3 groups: 1st -an implantation prosthetic devices with small intermediate unit (from 1 to 3 units); 2nd -unfixed implantation prosthetic devices with average extent (from 4 to 6 units supraconstruction); 3rd -an implantation pros­thetic devices with greater intermediate unit (6 and more units supraconstruction).

Results. Most goodness of the positioning is determined when using of implantation prosthetic device with small intermediate unit and, accordingly, risk low degree on biomechanical criterion and functional forecast.

Conclusion. Amongst examined patient with implantation prosthetic device by big extent after 2 and more years vastly increased the number a patient amongst which have revealed expressed signs inflammations, mobility and presence of deep bone pocket.

Key words: dental implant, implantation prosthetic device, unfixed supraconstruction, extent of the prosthetic device

 

Kurbonova R.K., Ashurov G.G.

ASSOCIATED CHANGE OF THE SOURCE IMPORTANCE OF CLINICAL PARAMETERS CARIESOLOGY STATUS IN DEPENDING OF GOMEOSTATIC’S ACTIVITIES OF THE MIXED SALIVA

Aim. Analyses of associated change of source importance clinical parameter of cariesology status in depending of homeostatic activities of the mixed saliva.

Material and methods. Examined 206 patients with the main dentistry diseases at age from 20 to 60 years and senior. Amongst examined persons valued the cariesology parameters of homeostatic factors of oral cavity with determination of the intensities of caries and its structured element in depending of the age factor.

Results. Importance of the intensity of caries amongst examined patient with very low of homeostatic activities of the mixed saliva turned out to be realistically more, than beside persons with low level of homeostatic potential of the mixed saliva. This possible explain that in depending of gravity homeostatic activities of the mixed saliva suffers the complex nearteeth’s tissues which leaves their own «imprint» on condition component of cariesology intensities defeats.

Conclusion. . Beside persons with low level of homeostatic activities of the mixed saliva amount removed teeth very high that are indicative of need of the active decision of the organizing questions for improvement medical-pre­ventive help cariesology nature.

Key words: caries, intensity of the caries, mixed saliva, homeostas, enamel, mineralization, structure of caries intensity

 

Mukhamadieva S.M., Nabiev Z.N, Yunusova D.Z., Gadoeva H.C.

ANALYSIS OF THE EFFECTIVENESS OF THE ACTIVITIES OF THE REGIONAL PERINATAL CENTER IN THE CITY OF KULYAB IN ENSURING THE QUALITY OF MEDI­CAL CARE FOR PREGNANT WOMEN AND WOMEN IN CHILDBIRTH IN RURAL AREAS

Aim. Assess the role of the regional perinatal center in the city of Kulyab in providing the availability and quality of perinatal care in the region.

Material and methods. Pregnant and parturient women of the Khatlon region who received medical services in the regional maternity hospital No. 2 of the Khatlon region in 2017-2018 and the Perinatal Center of Kulob in 2019-2022 were examined.

The annual reports of the regional maternity hospital No. 2 of the Khatlon region and the perinatal center of the city of Kulob were analyzed.

Results. Compared to the regional maternity hospital No. 2 of the Khatlon region, the Perinatal Center has intensi­fied medical care for high-risk pregnant women and nursing low-birth-weight infants. The number of pregnant women and women in labor with complicated gestational processes increased by 1,5 times, the number of births increased by 1,6 times, while the proportion of premature births decreased by 1,4 times. The high frequency of cesarean sections remains (23,7%). The proportion of severe preeclampsia increased by 1,4 times, and obstetric hemorrhage by 1,7 times; the number of massive bleedings decreased by 2 times, hemorrhagic shock -by 3 times, and early neonatal mortality among premature newborns increased by 2,3 times.

Conclusion. The regional perinatal center of Kulob is an effectively operating third-level institution in the Khatlon region, which improves the availability of high-quality, highly qualified and specialized medical care for pregnant women, women in labor, postpartum women and newborns in the region. Regular audits of critical cases are key indicators of the effectiveness of the perinatal center. The introduction of a digital mechanism for perinatal referrals will increase the medical activity of the perinatal center and reduce reproductive losses.

Key words: perinatal center, risk group, preterm birth, bleeding, preeclampsia, caesarean section, perinatal mortality

 

Mukhiddinov N.D., Kurbonov Sh.M., Ruzi­boyzoda K.R.

THE CHOICE OF SURGICAL TACTICS FOR POSTOPER­ATIVE OBSTETRICAL AND GYNECOLOGICAL PERITO­NITIS

Aim. To evaluate the results of patient-oriented surgical tactics in postoperative obstetric-gynecological peritonitis

Material and methods. The results of surgical treatment of 110 (100%) patients with postoperative obstetric-gyne­cological peritonitis are presented. All patients were divided into two groups: the control group consisted of 45 (41%) patients, the main group -65 (59%).

Widespread postoperative obstetric-gynecological peritonitis in patients of the main (n=28) and control groups (n=19) occurred in 47 patients. Local unrestricted postoperative obstetric-gynecological peritonitis was observed in 27 (24.5%) patients of the main (n=15) and control (n=12) groups, and limited peritonitis was found in 36 (32.7%) patients of the main (n= 22) and control (n=14) groups.

Results. Traditional open re-interventions -relaparotomies were performed in 41 patients with generalized peri­tonitis. At the same time, in 19 (42%) observations in patients of the control group and in 22 (34%) of the main group. Traditional open interventions for local postoperative obstetric-gynecological peritonitis were performed in 63 patients of the main (n=37) and control groups (n=26).

In general, minimally invasive operations in the main group of patients were performed in 33 cases. Videolaparoscopic interventions were performed in 10 (30.3%) cases in patients with widespread postoperative obstetric-gynecological peritonitis (n=6) and with local unrestricted (n=10). Minimally invasive echo-guided interventions were performed in 17 patients.

As a result of complex surgical treatment of patients of the main group (n=65), in 15 (23.0%) cases, various post­operative complications developed, while in patients of the control group (n=45), complications were observed in 21 (46.6%) observation.

Conclusion. Thus, surgical tactics in postoperative obstetric-gynecological peritonitis is strictly personalized and the choice of relaparotomy or minimally invasive interventions should be strictly based on the data of the proposed objective criteria.

Key words: postoperative obstetric-gynecological peritonitis, personalized surgical tactics, relaparotomy, minimally invasive interventions

 

Nazarov Kh.N., Kurbanov S.Kh., Karimov K.K., Abduloev M.S., Akramov S.

FEATURES OF REHABILITATION OF PATIENTS IN EN­DOPROSTHETICS OF THE HIP JOINT

Aim. Improving the results of hip replacement in degenerative diseases through the development of rehabilitation measures aimed at optimal restoration of limb function.

Material and methods. Clinical material included a study of 285 patients after hip replacement. The results of endopros­thesis according to the Harris scale were assessed immediately after completion of the rehabilitation course and after a year.

Results. In the main group, where rehabilitation was carried out according to the proposed improved scheme, the average Harris scale score before surgery was 28,4±7,4 points, after – 95,8±2,6 points. In the control group, this indicator was up to 27,5±6,8 and 80,5±2,8 points after surgery, with a discrepancy in the result of 15,3±1,7 points (p<0,01).

Conclusion. Positive results of hip replacement, in addition to highly qualified surgery, largely depend on com­prehensive rehabilitation treatment, part of which is physical therapy aimed at restoring limb function. Rehabilitation treatment begins in the preoperative period and continues until complete restoration of limb function with the obligatory performance of regular exercises throughout life.

Key words: endoprosthesis, hip joint, stages of rehabilitation, physical therapy, quality of life

 

Narzullaeva A.R., Tabarov A.I., Salimzo­da J.M.

GENDER FEATURES OF STRUCTURE AND FLOW ACUTE FORMS OF CORONARY HEART DISEASE

Aim. To study the features of the course of acute forms of coronary heart disease in women in comparison with men.

Material and methods. We examined 127 patients with acute forms of coronary artery disease, comparing 57 women and 70 men. All patients underwent anthropometry, clinical examination, electrocardiography and echocardiography, coronary angiorrhaphy with calculation adverse events with the TIMI score.

Results. Among the complications in women, pulmonary hypertension, ventricular fibrillation, intraventricular conduction disturbances and sinoatrial blockade are more often observed, and the likelihood of developing primary asystole is high. Significant risk factors that women need to pay attention to are stress and obesity, while for men it is tobacco use and age. Clinical data from both the anamnesis and complaints, and physical methods in women are not clear. The ECG picture in women is more often represented by ischemic changes, while in men there are signs of necrosis and ischemic damage, while markers of necrosis are higher in women. Aggravating factors in women are also the common left ventricular hypertrophy, anemia, and leukocytosis.

Conclusion. In women, it is necessary to carry out timely prevention of risk factors such as obesity, HPEN, hyper­tension and dyslipidemia, timely measures aimed at left ventricular remodeling, and early detection of coronary artery disease, including coronary angiography, exercise testing and stress echocardiography.

Key words: coronary heart disease, women, gender

 

Odinaev P.H., Shukurova S.M., Rakhmat­ulloev Kh.F.

HEART FAILURE AND ATRIAL FIBRILLATION: DIFFER­ENCES IN DIASTOLIC HEART DYSFUNCTION DE­PENDING ON LEFT VENTRICULAR EFUCTION FRAC­TION

Aim. To analyze the severity of diastolic dysfunction in patients with heart failure and atrial fibrillation depending on the ejection fraction of the left ventricle.

Material and methods. Material for the study were 68 patients with chronic heart failure and atrial fibrillation. All patients underwent transthoracic echocardiography either at enrollment in the study, or the data were extracted from the patient’s medical records (only if the data complied with the study protocol and patients had AF at the time of echocardiography).

Results. More than half of patients 57.4% had heart failure with low ejection fraction (HF-nEF), 16.2% had heart failure with intermediate ejection fraction (HF-prEF) and 26.5% had heart failure with preserved ejection fraction (HF -sFV). Patients with HF-nEF and AF had higher E/e’ ratio and left atrial volume index (LALI) compared with patients with HF-rEF or HF-prEF and AF.

Conclusion. Diastolic dysfunction is common in patients with HF and AF. Moreover, diastolic dysfunction is one of the causes of HF-rEF. The E/e’ ratio is a reliable parameter for non-invasive assessment of left ventricular (LV) filling pressure and can be used in patients with AF.

Key words: chronic heart failure (CHF), atrial fibrillation (AF), diastolic dysfunction, left ventricular ejection fraction (LVEF)

 

Sanginov Dzh.R., Nazhmiddinov A.H., Dz­humaev T.J., Niyazov I.K.

EXENTERATION OF PELVICORGANSINLOCALLY-AD­VANCED MALIGNANT TUMORS

Aim. To evaluate the results of total pelvic exenteration (TPE) in patients with locally advanced rectal and cervical cancer.

Material and methods. The results of EMT surgery were studied in 13 patients: cervical-rectal cancer -4 and vaginal -1. There were 8 primary patients, 5 recurrent cases, average age – 51,6±3,6 years. In all cases, morphological verifica­tion of the diagnosis took place. Initial hydronephrosis was established in 4 patients, rectovaginal fistulas – in 3 and parametrium invasion – in 4, 2 patients had ureters stented.

Results. All patients underwent EMT, with total exenteration in 6, anterior in 4, and posterior in 3. The average du­ration of the operation was 321±46,2 minutes, the average volume of blood loss was 761 ml. In 9 patients it was possible to perform R0 resection. Squamous cell carcinoma was confirmed in 9 patients, adenocarcinoma with G2 predominance was confirmed in 4 (n = 10). The operations were performed by joint teams of urological oncologist, abdominal oncologist and gynecological oncologist. All patients underwent bilateral aortoiliac and pelvic-obturator lymph node dissection. Urine diversion was restored by Bricker’s operation in 9 cases, uretercutaneostomy in 1 case.

A comparative assessment with literature data shows that the immediate and immediate results of EMT on our material correspond to the data of other studies.

Conclusion. Various options for TPE with R0 resection increase the survival rate of patients with locally advanced pelvic tumors. A careful, differentiated approach to patient selection at the consultation is the most important condition for the effectiveness of TPE.

Key words: exenteration, locally advanced pelvic malignancies tumors

 

Usmonov I.M.

RESULTS OF SELECTION OF THE OPTIMAL DONOR AND DEVELOPED METHOD FOR STRATIFICATION OF THE RISK OF HUMORAL REJECTION IN HIGHLY SEN­SITIZED WOMEN WITH STAGE 5 CKD

Aim. To improve the results of kidney allotransplantation by developing a protocol for selecting the optimal donor and introducing a method for risk stratification for highly sensitized women with stage 5 CKD before kidney transplantation.

Material and methods. The study is based on a prospective and retrospective analysis of 120 sensitized women with stage 5 CKD, who were divided into 3 groups.

All patients underwent solid-phase immunological analysis using the Luminex 200 multiplex analyzer on the Xmap platform. Lymphocytosis test (CDS) was performed serologically. The analysis for matching a donor to a sensitized re­cipient was carried out with HLA-ABC Eplet Matching Version 3.1 Match maker and HLA-DR, DQ, DP Eplet Matching Version 3.1 Match maker. Analysis for predicting the appearance of DSA using the PIRCHE-II algorithm.

Results. When comparing the groups according to the frequency of rejection, in patients of the retrospective group it was 35,6%, in patients of the prospective group – 14,5% (p <0,05).

The probability of developing rejection in both groups was maximum in the first week after ATP; by the end of the first year, it reached 32% and 7%, and by 5 years 41% and 6%, respectively (p<0,01).

Conclusions. The results obtained reflect a significant improvement in graft survival in a prospective group of patients who were treated with an algorithm for selecting the optimal donor and a developed method for stratifying the risk of humoral rejection. This in turn indicates the effectiveness of the new approach in preventing rejection and increasing long-term graft survival in sensitized patients.

Key words: kidney transplantation; analysis for DSA; PIRCHE-II algorithm; Hla Matchmaker

 

Khafizova G.A., Rasulov N.A., Kakharov M.A., Nazarov H.SH.

THE CHOICE OF SURGICAL TREATMENT TACTICS IN PATIENTS WITH PERFORATIVE GASTRODUODENAL ULCERS

Aim. To improve the results of surgical treatment of patients with perforated gastroduodenal ulcers (PGDU).

Material and methods. The results of diagnosis and treatment of 190 patients with PGDU for the period 2017- 2022 are presented.

The age of the patients ranged from 18 to 69 years. There were 70 women (36,8%), 120 men (63,2%). Patients with late (more than 6 hours from the onset of the disease) seeking medical help prevailed, which amounted to 120 (63,2%) cases. In 169 (88,9%) cases, the perforating hole (PH) was localized on the anterior wall of the duodenal bulb.

Results. In the presence of an adhesive process in the upper floor of the abdominal cavity, in which laparoscopic manipulations cannot be performed, the presence of purulent peritonitis, localization of PH along the posterior wall of the stomach and duodenum, the operation of choice was the traditional open suturing of perforated ulcers (n=46). Excision of the ulcer with pyloroplasty (n=24) was performed in the presence of a large PH (10 mm) with pronounced periulcerogenic inflammation. Gastric resection (n=12) was performed in patients with a combination of PGDU with penetration or pyloroduodenostenosis, suspected malignancy of gastric ulcers, as well as in the case of perforation of a giant ulcer with the impossibility of suturing the perforating hole. Laparoscopic suturing (n=100) was performed in patients with a small PH (no more than 10 mm) and a minimally infiltrated edge. Laparoscopically assisted suturing was performed with a large size (more than 10 mm) (n=3) and difficulty in suturing due to the presence of more pro­nounced infiltrated edges (n=5).

Postoperative complications occurred in 15 (7,9%) patients, which, according to the literature, is up to 19% of cases, and in severe cases this figure reaches 40%.

Fatal outcome occurred in 3 (1,6%) cases, the cause of which was pulmonary embolism (PE) (n=1) and widespread purulent peritonitis, causing multiple organ failure (n=2).

Conclusion. An individual approach to choosing the method of surgery in patients with PGDU makes it possible to reduce the frequency of postoperative purulent-inflammatory complications and, thereby, improve the results of surgical treatment of this contingent of patients. The use of minimally invasive technology (in the absence of contraindications to their use) is the method of choice in the treatment of PGDU, which promotes early recovery of patients’ ability to work and reduces their hospital stay.

Key words: perforation, gastroduodenal ulcer, laparoscopic suturing, periulceral inflammation

 

Khudoyorov S.A., Makhmudov D.T., Ashu­rov G.G.

RESULTS OF THE STUDY OF FUNCTION INDEPEN­DENT DEFOGGING OF ORAL CAVITY, VELOCITY OF THE FORMATION TEETH PLAQUE AND EFFICIENCY OF THE HYGIENE OF ORAL CAVITY IN DEPENDING ON OCCLUSION-ARTICULATION RELATION BESIDE CHILDREN WITH ANOMALY OF TEETH-MAXILLARY SYSTEM

Aim. Research the function of independent defogging oral cavity, velocity of the formation teeth plaque and effi­ciency of the hygiene of oral cavity in depending on occlusion-articulation relations beside children with anomaly of teeth-maxillary system.

Material and methods. Examined 250 children and teenager 12-18-year-old, having narrowing the teeth rows in the field of function-oriented frontal group’s teeth. Study of functions independent defogging of oral cavity (the value retention of food detritus and velocity of its disappearance with surfaces of teeth) held at method designed by V.K. Leontev et al. Velocity of the formation of teeth plaque (index PFRI) on surfaces of the teeth defined by method offered P. Axelsson. Efficiency hygiene of oral cavity valued by means of index PHP.

Results. Factor promoting of the development of carious process are a concourse food plaque, deceleration ve­locities of its removal from area of the longed for position teeth and unsatisfactory efficiency hygiene of oral cavity. Formation sub-and supragingival teeth plaque, deceleration velocities of its removal from area of the longed for position teeth and unsatisfactory efficiency hygiene of oral cavity. Formation sub-and supragingival teeth plaque, containing parodontopathogenic stamp of microorganism brings about development of caries and inflammation diseases of marginal parodont.

Conclusion. In the field of overcrowding teeth in consequence of the breach of occlusion-articulation relations formed favorable «microclimate» for development such main dentistry diseases, as caries and parodontal diseases.

Key words: overcrowding teeth, carious, parodontal diseases, retention of food plaque, velocity formation of teeth plaque

REVIEWS

Kobilbekov B.I.

SOME ASPECTS OF EPIDEMIOLOGY, PATHOGENE­SIS AND DIAGNOSIS OF NON-SPECIFIC AORTOARTE­RITIS

A review of domestic and foreign literature devoted to some of the most important aspects of the prevalence, pathogenesis, risk factors and diagnosis of nonspecific aortoarteritis (NAA) was conducted. The prevalence of NAA in different regions of the world ranges from 0,3 to 16,9 cases per 100,000 population. More often, the pathology is detected in young women and occurs with frequent exacerbations of the autoimmune inflammatory process. In the diagnosis of pathology, research methods that visualize the vascular system play a significant role, and laboratory research methods play a significant role in assessing the activity of the inflammatory process. However, in the literature there are only reports of diagnosed forms of pathology; its early detection through active screening is practically not carried out. Certain aspects of the pathogenesis of the disease and the role of oxidative stress, endothelial dysfunc­tion and immunological changes in exacerbating the inflammatory process in the walls of large arteries also require further study. The frequent occurrence of the disease in the conditions of the Republic of Tajikistan, the severe course of the pathology, the complexity of preparing patients and choosing a treatment method dictate the need for further scientific research in this direction among the domestic cohort of patients.

Key words: nonspecific aortoarteritis, Takayasu arteritis, prevalence, pathogenesis, inflammatory markers, diagnosi

 

Reshetnyak T.M., Cheldieva F.A., Shukuro­va S.M.

CATASTROPHIC ANTIPHOSPHOLIPIID SYNDROME

A literature review on catastrophic antiphospholipid syndrome (CAPS) is presented. Criteria for the diagnosis of CAPS, possible mechanism of CAPS development, differential diagnosis, and association with infection are pre­sented. The treatment of CAPS is still difficult due to the necessity of intensive therapies. The existing algorithm of management of patients with CAPS is presented.

Key words: catastrophic antiphospholipid syndrome, systemic inflammation syndrome, thrombosis, obstetric pathology, ferritin

 

4-2023

THEORY AND PRACTICE OF MEDICINE

 

KakharovaR.A., MardonovaS.M., BakhrievaZ.S., KhairiddinovaJ.A., MurodovaSh.M.

RESULTS OF SURGICAL TREATMENT OF PELVIC ORGAN PROLAPSE IN THE ELDERLY WOMEN Aim. To improve the approach to choosing a method of surgical treatment of pelvic organ prolapse in elderly and senile patients

Material and methods. The results of surgical treatment of 284 women suffering from pelvic organ prolapse were analyzed. Patients from 60 to 74 years old accounted for 47%, from 75 to 80 years old – 53%. Among the operated patients, prolapse of the uterus of varying degrees was most often noted – 94,7%, and in 5,3% of patients there was a combined prolapse of the uterus and rectum. All patients before surgery were examined by a gynecologist and a colposcope examination of the cervix was performed.

Results. Laparotomy with hysteropexy was performed in 72 (25,5%) patients, hysteropexy in combination with levatoroplasty – in 86 (30,1%), Lefort-Neugebauer operation – in 111 (39,1%) women and in 15 (5,3%) performed laparotomy, hystero and rectopexy.

Conclusion. The research showed that individually selected methods of surgical treatment of pelvic organ prolapse are methods that reduce the risk of recurrence of the disease. The Lefort-Neugebauer operation can be used as an alternative to other surgical methods. The main advantages are low trauma, the minimum number of complications, cost-effectiveness and rapid rehabilitation of patients.

Key words: Le Fort – Neugebauer operation, surgical treatment, choice of operation method

 

KlimovA.E., MirzoevS.I., AbdulI.A.M.N.

DETERMINATION OF THE RISK OF STRANGULATION OF INCISIONAL VENTRAL HERNIAS

Aim. To develop a simplified prognostic scale for assessing the risk of strangulation of incisional ventral hernia.

Materials and methods. Retrospective analysis included data from 66 patients with strangulated IVH for the period 2019—2023. The criteria for inclusion in the study were a strangulated IVH. We evaluated various independent factors as possible predictors of the risk of strangulation of IVH.

Results. Each variable described in the article after statistical analysis was compared depending on the frequency of occurrence and divided into two groups: main and additional. Based on a detailed analysis, risk levels for developing IVH were identified (low, medium, high) for each factor.

Conclusion. The developed prognostic scale allows to identify patients with high, moderate and low risk of strangulation. The planned elimination of IVH helps to reduce the negative consequences of emergency operations and reduces healthcare costs.

Key words: incisional ventral hernia, laparotomy, risk factors, strangulation, incarcerated, complication

 

Mirzoaliev Y.Y.

RESULTS OF VACCINATION AGAINST COVID-19 AMONG THE POPULATION OF THE REPUBLIC OF TAJIKISTAN ACCORDING TO THE STEPS SURVEY

Aim. Study of COVID-19 vaccination coverage among the population using the WHO STEPS wise methodology.

Material and methods. A survey was conducted among 2,551 respondents aged 18-69 years about receipt of vaccination against COVID-19 and symptoms of long-term coronavirus infection COVID-19.

Results. Vaccination against COVID-19 is paramount in reducing deaths due to the pandemic. For both sexes combined, the vaccination rate is 87,6%, with a trend towards higher vaccination coverage among older age groups (92,0%) than among younger age groups (85.6%). For women, this is reflected in the large difference in coverage between older ages (93.1%) and younger ages (83,7%).

Conclusion. The results obtained indicate a high level of collective immunity from coronavirus infection COVID-19, especially among the elderly.

Key words: COVID-19, vaccination, immunity, population

 

Obidov S.A., Ashurov G.G., Karimov S.M. 

ATRAUMATIC TREATMENT OF THE OF CARIES PERMANENT TEETH IN DEPENDING OF RESISTANCE ENAMEL SUPERFICIALIS BESIDE CHILDREN WITH INNATE UNJOINING LIP AND PALATE

Aim. To select the optimal method for caries treatment of permanent teeth with different degree of enamel cariesresistance in children with innate unjoining lip and palate.

Material and methods. Beside 40 children was examined the condition of hard tissue of teeth. In dependent of enamel resistance was using atraumatic restorative treatment with using of new technology of prepared teeth by minimum invasive method with following filling by glassionomer cement. Among examined children, using enamel resistance test, revealed four level of resistance. Depending on the enamel resistance level, corresponding treatment was provided: a child with high and moderate enamel resistance was organized traditional treatment of caries. Children with low and very low enamel resistance had a complex of treatment-preventive approach in 3 directions: atraumatic restorative treatment of caries by method of minimal invasive prepared; local pathogenetic remotherapy by deep fluoridation combined with professional oral hygiene lessons, followed by filling of glassionomer’s cement; general pathogenetic therapy (in conjunction with the internist  oral administration  of calcium preparations, vitamin complexes and rational nutrition).

Results. Complex of integration approach treatment of caries in children with innate unjoining lip and palate was highly reliable (р<0.001) effective in depending of source level enamel resistance. This approach helped prevent the development of secondary caries around early assessed filling material.

Conclusion. Beside children with innate unjoining lip and palate in the course of active realization of the complex method of the treatment tooth decay was noted reliable reduction of cariesology complications after filling of carious cavity under low and very low enamel resistance on all under study parameters.

Key words:caries, permanent teeth, innate unjoining lip and palate., enamel resistance, atraumatic restorative treatment, glassionomer cement

 

Odinaev B.A.

POSSIBILITIES OF RESOURCES OF LOCAL TISSUES IN TREATING THE CONSEQUENCES OF ELECTRICAL INJURY OF THE HAND

Aim. Improving the results of surgical treatment of patients with consequences of electrical trauma of the hand and fingers using the resources of local integumentary tissues.

Material and methods: During the period from 2010 to 2023, in the Department of Reconstructive and Plastic Microsurgery of the Russian Research Center for Cardiovascular Surgery, 16 patients used local integumentary tissue resources to eliminate various deformities and contractures of the hand and fingers.

Results. Among the given number of patients, the most difficult was the correction of contracture of fingers I to V, which in most cases required an operation in 2or more stages. Contractures of fingers II to V were also complex, which were accompanied by fusion of the proximal phalanges and a defect in the palm of the hand below the skin fold. Determining the stage of the operation depended on the severity of the contracture, the combination of contracture with defects of the integumentary tissues and severe deformities of some fingers, the degree of compression, or obliteration of the digital vessels.

With contracture of fingers I–V (Fig. 1), when there was relatively favorable blood circulation of local tissues without the presence of gross scar changes, no severe changes in the finger joints (Fig. 2) and satisfactory blood flow in the vessels of the hand and fingers, the choice of a one-stage operation was considered optimal treatment option.

Conclusion. The good condition of the local tissues of the hand and fingers contributes to the widespread use of local plastic surgery to eliminate deformation and contracture of the fingers.

Key words: consequences of electrical injury, neurovascular bundles, contracture of the hand and fingers, upper limb, injuries and their consequences, soft tissue defect

 

Razakova Sh.K., Zaripov A.R., Ismoilov A.A.

ABOUT SOME ASPECT OF THE PROPHYLACTIC OF ORTHODONTIC COMPLICATIONS BETWEEN CHILDREN WITH ANOMALY OF TEETH-MAXILLARY SYSTEMS

Aim. To study of remineralizing-hygienic prophylactic’s aspect of the orthodontics complications under using of unfixed orthodontic designs beside children with anomaly of teeth-maxillary system.

Material and methods. Examined 150 children and teenager 12-18-year-old with unfixed orthodontic designs. Proceeding to orthodontic treatment of the anomalies of teeth-maxillary systems beside children, came from medical-preventive methods of the education such patient must consist of two parts:  1-st part – general i.e. in it necessary to explain and hereon train, what follows to conduct the individual hygienic procedure in oral cavity; 2-nd part – specialized, she must concern the particularities of the care for oral cavity and orthodontics device in given concrete condition, in accordance with new dentistry situation of oral cavity.

Results. The necessary condition of the successful preventive maintenance of orthodontics’ complications is remineralizing therapy, right choice of the methods and facilities individual hygiene of oral cavity.

Conclusion. Beside children with unfixed orthodontic design undertaking remineralizing therapy is recommended conduct for 1 month before fixation of corresponding device. Rational hygiene of oral cavity with using of toothbrush and pastes are an integral part general hygiene organism.

Key words: anomaly of teeth-maxillary system, unfixed orthodontic design, orthodontic complication, hygiene of oral cavity,  remineralizing therapy

 

Rasulov S.R., Obidov D.S.

LOCAL RECURRENCE AND FREQUENCY OF DISTANT METASTASES

IN PATIENTS WITH DIFFUSE BREAST CANCER DEPENDING

ON THE VOLUME OF SURGERY

Aim.To study the timing of the appearance of local relapses and the realization of distant metastases in patients with diffuse breast cancer, depending on the volume of surgery.

Material and methods.The study groups included 50 patients with diffuse breast cancer. Patients, depending on the volume of surgical intervention, were divided into two groups: 24 (main group) patients underwent an extended modified mastectomy with closure of the soft tissue defect of the chest wall with TDL and TRAM flaps and 26 (control group) patients underwent radical mastectomy with closure of the anterior defect chest wall with local tissues. The timing of the appearance of local relapses and the occurrence of distant metastases was studied from the moment the patients were discharged from the department after surgery.

Results. Within 36 months, local relapses after surgery appeared in 8,4% of patients in the main group, and in the control group up to 24 months, local relapses were noted in 34,6%, i.e. the frequency of local relapses in patients of the control group was 4 times higher than in patients of the main group. Distant metastases appeared during the follow-up period in 9 (37,5%) patients of the main group and 8 (30,8%) of the control group.

Conclusion. The frequency of local relapses in patients with diffuse breast cancer is directly related to the volume of mastectomy performed, and is 4 times less in patients after extended modified mastectomy with closure of the soft tissue defect of the chest wall with TDL and TRAM flaps, compared with traditional mastectomy and closure of the defect with local tissues. The volume of surgical intervention does not affect the frequency and timing of distant metastases in patients with diffuse breast cancer.

Key words: diffuse breast cancer, surgical treatment, local recurrence, distant metastases

 

Rakhmatova R.A., Nabiev Z.N., Shamsov B.A.,Rakhmatova N.A., Kosimova F.S.

DINAMICS AND PREVALENCE OF CONGENITAL DAMAGES IN THE REPUBLIC OF TAJIKISTAN

Aim. Tostudy the frequency and prevalence of congenital malformations, and the factors influencing them in the Republic of Tajikistan

Material and methods. This study was conducted on the basis of statistical data from the State Institution “Republican Center for Statistics and Medical Information” of the Ministry of Health and Social Protection of Population of the Republic of Tajikistan (SI “RCSMI” MoHSPP RT), the State Institution “National Center for Reproductive Health” of the Ministry of Health and Social Protection of Population of the Republic of Tajikistan (SI “NCRH” MoHSPP RT) and the State Institution “Republican Scientific and Clinical Center of Pediatrics and Pediatric Surgery” of the Ministry of Health and Social Protection of Population of the Republic of Tajikistan (SI “RSCCPPS” MoHSPP RT).

Results. According to the RCSMI Ministry of Health and Social Protection of the Republic of Tajikistan, every year from 2,400 to 3,300 children with congenital malformations are born in the country. All cases of congenital malformations are registered, with more than 2,0% of births completed at home, and they are also recorded by health care institutions according to national health indicators

Conclusion.The main reasons for the growth of congenital malformations in newborns are: complicated obstetric history, heredity, bad habits, occupational hazards, previous viral and bacterial infections, late prenatal diagnosis.

Key words: congenital malformation, pediatrics, children, prevalence

 

Sanginov J.R., Nazhmiddinov A.H., Dzhumaev T.J., Niyazov I.K.

EXENTERATION OF PELVIC ORGANS IN LOCALLY-ADVANCED MALIGNANT TUMORS

Aim.  To evaluate the results of total pelvic exenteration (TPE) in patients with locally advanced rectal and cervical cancer.

Material and methods.  The results of ТРЕ surgery were studied in 13 patients treated at the Russian Cancer Research Center for the period 2022 (cervical-rectal cancer – 4 and vaginal – 1).  There were 8 primary patients, 5 recurrent cases, average age – 51,6 ± 3,6 years.  In all cases, morphological verification of the diagnosis took place.  Initial hydronephrosis was established in 4 patients, rectovaginal fistulas – 3 and parametrium invasion – 4, 2 patients had ureters stented.

Results.  All patients underwent TPE, with total exenteration in 6, anterior in 4, and posterior in 3. The average duration of the operation was 321 ± 46.2 minutes, the average volume of blood loss was 761 ml.  In 9 patients it was possible to perform R0 resection. Squamous cell carcinoma was confirmed in 9 patients, adenocarcinoma with G2 predominance was confirmed in 4 (n = 10).  The operations were performed by joint teams of urological oncologist, abdominal oncologist and gynecological oncologist. All patients underwent bilateral aortoiliac and pelvic-obturator lymph node dissection. Urine diversion was restored by Bricker’s operation in 9 cases, uretherocutaneostomy in 1 case. A comparative assessment with literature data shows that the immediate and immediate results of TPE on our material correspond to the data of other studies.

Conclusions.  Various options for TPE with R0 resection increase the survival rate of patients with locally advanced pelvic tumors.  A careful, differentiated approach to patient selection at the consultation is the most important condition for the effectiveness of TPE.

Key words: exenteration, locally-advanced tumors, pelvic malignancies

 

Sirodzhov K.Kh., Rabiev Kh.Kh., Dustov Kh.S., Makhmadaliev B.G.,Khamidov J.B.

ANALYSIS OF THE LONG-TERM RESULTS OF PRIMARY HIP ARTHROPLASTY IN DEGENERATIVE-DYSTROPHIC PROCESSES

Aim. To give a comparative assessment of long-term results of treatment of patients using arthroplasty technologies in degenerative-dystrophic processes of the hip joint.

Material and methods. During the period 2013-2022, 86 patients with degenerative-dystrophic processes of the hip joint, who underwent 111 hip arthroplasty, were treated at the City Medical Center No. 3 in Dushanbe. Of these, 15 patients underwent surgery from 2 sides. Of these, 15 patients underwent surgery from 2 sides. Additional research methods included pelvic radiography in 2 standard positions, CT and MRI individually in the metal artifact suppression mode (MARS). A questionnaire was conducted, each examined patient filled out a questionnaire (Harris, Oxford), radiologically assessed the angle of frontal incline of the endoprosthesis cup.

Results. “Excellent” functional results of surgery according to the Oxford scale, 54.7% of patients were noted, “good” – 24,4%, “average” – 18,6% and “below average” – 2,3%. The functional results on the Harris scale were: “excellent” – 56,9%, “good” – 17,4%, “average” – 20,9% and “below average” – 3,5%.

The angle of frontal incline of the endoprosthesis cup in 73.3% of cases is less than 45 °, which is the optimal option for the normal functioning of the artificial joint. The angle of the frontal tilt of the cup 45° – 49° is 13.9%, the angle exceeding 50° is 12.8%.

Conclusion. If a pain syndrome appears in the short and long term after hip arthroplasty, it is necessary to examine the patient to assess the stability of the components of the endoprosthesis, if the problem is not related to the instability of the components, then exclude the presence of soft tissue pseudotumor.

Key words: arthroplasty, dystrophic process, injuries, osteoporosis, instability

 

Khudoyorov S.A., Makhmudov D.T., Ashurov G.G., Tagaeva Sh.O.

RESULTS OF THE STUDY OF FUNCTION INDEPENDENT DEFOGGING OF ORAL CAVITY, VELOCITY OF THE FORMATION TEETH PLAQUE AND EFFICIENCY OF THE HYGIENE OF ORAL CAVITY IN DEPENDING ON OCCLUSION-ARTICULATION RELATION BESIDE CHILDREN WITH ANOMALY OF TEETH-MAXILLARY SYSTEM

Aim.Research the function of independent defogging oral cavity, velocity of the formation teeth plaque and efficiency of the hygiene of oral cavity in depending on occlusion-articulation relations beside children with anomaly of teeth-maxillary system.

Material and methods. Examined 250 children and teenager 12-18-year-old, having narrowing the teeth rows in the field of function-oriented frontal group’s teeth. Study of functions independent defogging of oral cavity (the value retention of food detritus and velocity of its disappearance with surfaces of teeth) held at method designed by V.K. Leontev et al. Velocity of the formation of teeth plaque (index PFRI) on surfaces of the teeth defined by method offered P. Axelsson. Efficiency hygiene of oral cavity valued by means of index PHP.

Results. Factor promoting of the development of carious process are a concourse food plaque, deceleration velocities of its removal from area of the longed for position teeth and unsatisfactory efficiency hygiene of oral cavity. Formation sub- and supragingival teeth plaque, deceleration velocities of its removal from area of the longed for position teeth and unsatisfactory efficiency hygiene of oral cavity. Formation sub- and supragingival teeth plaque, containing parodontopathogenic stamp of microorganism brings about development of caries and inflammation diseases of marginal parodont.

Conclusion. In the field of overcrowding teeth in consequence of the breach of occlusion-articulation relations formed favorable «microclimate» for development such main dentistry diseases, as caries and parodontal diseases.

Key words: overcrowding teeth, carious, parodontal diseases, retention of food plaque, velocity formation of teeth plaque. 

 

Sharipov A.A., Ghulomova M.O., Khudoynazarova Sh.S., Narzuloeva M.F., Nazirai A., Mirzoaliev Y.Y.

EPIDEMIOLOGICAL AND CLINICAL FEATURES OF POST-COVID SYNDROME

Aim. Study of epidemiological and clinical characteristics of posttraumatic stress disorder (PTSD).

Material and methods. Questionnaires A retrospective analysis of medical records and questionnaires completed among 207 people who had COVID-19 and applied with signs of post-Covid syndrome was carried out.

Results. Of the 207 people with COVID-19, 58 showed symptoms of post-Covid syndrome (PCS). Of these, 41 were men (70,6%) and 17 women (29,4%). In general, after varying amounts of time after the infection, 20 types of complaints and symptoms associated with PCS appeared; these symptoms totaled 396 cases and persisted for a certain period of time. In 43 (48,3%) cases there were symptoms of damage to the nervous system, in 11 (12,4%) – to the musculoskeletal system, in 8 (8,9%) – to the cardiovascular system, in 8 (8,9%) ) – the respiratory system, in 4 (4,5%) cases – the mental state, in 3 (3,4%) cases – the gastrointestinal tract and in 1 (1,1%) case – the urinary system.

Conclusion. More than 5 to 12 types of signs can be found in one person, which indicates the disease of 2 or more of these systems and organs of the body. In order to reduce the consequences of a serious disease, after recovery, it is necessary to undergo a comprehensive period of treatment and rehabilitation of patients with PTSD. When making a diagnosis of “Condition after COVID-19 (U09.9)”, the history of the disease and the recommendations of specialists should be taken into account.

Key words: posttraumatic stress disorder, COVID-19 infection, International classification of disease

 

Shokirov M.K., Karimov S.M.

TO QUESTION ABOUT EFFICIENCY OF COMPLEX THERAPY OF INFLAMMATORY PARODONTAL DISEASES AMONGST AIRCRAFT WORKMAN IN DEPENDING OF THE LEVEL OF THEIR ADHERENCE TO PARODONTIUM TREATMENT

Aim. To estimate the efficiency of the therapy of chronic parodontitis amongst flying composition of the civil aviation in depending of the level of their adherence to treatment of the inflammatory-destructive parodontal diseases.

Material and methods. For the reason estimations of the influence level to adherences of the flying composition to parodontium treatment was examined 98 aircraft workman of civil aviation with miscellaneous level of the adherences to treatment of the parodontal diseases. Amongst examined patient used on evidences standard actions, including applique antinflammation unguents. Course of parodontium therapy conducted for 15 days. For revealing the level of adherence to parodontium treatment amongst aircraft workman conducted sociological interview.

Results. Beside flying composition with low level of the adherence to parodontal therapy  after 7 and 14 days importance of PI-index differs from source factors in 3.2 and 5.3 times accordingly, with average level of the adherence – in 2.5 and 2.7 times accordingly, with high level of the adherence – in 3.8 and 3.9 times accordingly.

Conclusion. Beside flying composition of the civil aviation with chronic parodontitis it is necessary to take into account the degree of the gravity of parodontal pathology and level of their adherence to the long treatment.

Key words: level of the adherence, chronic parodontitis, standard treatment of parodontitis, outcome of parodontitis treatment

 

UsupovaZ.Kh., MulloevK. Kh., AkramiSh., UsupovaM.B

FEATURES OF PROVIDING ORTHOPEDIC DENTAL CARE TO PATIENTS WITH POSTOPERATIVE DEFECTS AND DEFORMATIONS OF THE MAXILLOFACIAL AREA

Aim.To study the features of orthopedic dental care for patients with postoperative defects and deformities of the maxillofacial area.

Material and methods.This work is based on the results of orthopedic treatment of 182 patients with postoperative defects and deformities of the maxillofacial region (MFA). Patients were distributed by age and gender. Two types of prosthetics were used – direct and remote. Particular attention was paid to the study of a diagnostic model for better fixation of mediate prostheses in the postoperative wound. To determine the effectiveness of the resection prosthesis, tests were carried out (speech and water). A questionnaire card was used to assess the patient’s subjective feelings.

Results.Men predominate among the subjects. Most often, maxillofacial tumors occur in people aged 40 – 65 years. According to the location of the tumor, the maxillofacial area is predominantly localized in the upper jaw.

For direct prosthetics, 3 stages of intervention were used, for remote prosthetics – 2. The results of the tests and the questionnaire were the best for direct prosthetics.

Conclusion.From the moment of treatment to rehabilitation, difficulties arise in complex prosthetics for patients with acquired defects and deformities of the maxillofacial area. The coordinated work of surgeons, dentists, psychologists and other specialists contributes to the successful comprehensive rehabilitation of patients. The choice of a complex jaw prosthesis at the first stage of orthopedic treatment, using planning on diagnostic models, improves the restoration of anatomical, functional and aesthetic disorders.

Key words:dental orthopedic care, postoperative defects, deformations, dentofacial system

 

REVIEVS

 

Zokirova K.A., Muminzoda B.G., Gulbekova Z.A.

OBESITY: SOME ASPECTS OF EPIDEMIOLOGY, ETIOPATHOGENESIS AND RISK FACTORS

This review article addresses current aspects of the epidemiology, risk factors and etiopathogenesis of obesity. It focuses on the role of the gut microbiome and the importance of maternal and child diet in utero in the development of obesity. Attention is also focused on the physiology and pathophysiology of adipose tissue, as well as the problem of fatty liver hepatosis.

Key words: obesity, epidemiology, etiology, pathogenesis, risk factors, fatty liver hepatosis

 

Mukhiddinov N.D., Abdullozoda F.A., Boltuev K.H., Ruziboyzoda K.R.

HIATAL HERNIA: SOME ASPECTS OF CLASSIFICATION, DIAGNOSIS AND TREATMENT TACTICS

The article provides an overview of some aspects associated with hiatal hernia. The concept of this disease, its classification, principles of clinical and instrumental diagnosis and choice of treatment tactics are considered. In particular, the question of the possibility of conservative therapy and surgical correction using modern technologies is being considered.

Key words: hiatal hernia, classification, diagnosis, treatment tactics

 

CASE FROM PRACTICE

 

Shukurov Al.S., Mavlyanova Z.R., Shukurov As.S., Khudoimerganov A.N., Khakimov Kh.A.

VENOUS STROKE: SOME ASPECTS OF ETIOLOGY, RISK FACTORS, DIAGNOSIS AND TREATMENT

The article provides a clinical observation of the diagnosis, identification of causes, condition and successful treatment of venous stroke in a relatively young patient. Recommendations for further therapy are given.

Key words: stroke, thrombosis, drug therapy

 

 

 

 

 

 

 

 

 

 

1-2024

THEORY AND PRACTICE OF MEDICINE

 

Gairatova I.B.

CLINICAL-HAEMODYNAMIC AND BIOCHEMICAL PARALLELS OF ISCHEMIC HEART DISEASE WITH THE LEVEL OF GLYCED HEMOGLOBIN

Aim. Present the clinical, hemodynamic and biochemical relationship of coronary heart disease in association with the level of glycated hemoglobin.

Material and methods. The material 67 patients with coronary heart disease (CHD) and type 2 diabetes mellitus (DM) were studied.

The level of glycated hemoglobin (HbA1c) in the blood serum was determined for all patients; depending on its level, the patients were divided into 3 groups.

Results. There was a significant difference in fasting blood glucose and HbA1c levels between the three groups (p<0,05). Statistically significant differences were found in plasma levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) and uric acid, left ventricular end-diastolic dimension (LVED), left ventricular end-systolic volume (LVESV), left ventricular ejection fraction (LVEF), and NYHA grades of heart failure among the three groups (p<0,05). Statistical analysis showed that HbA1c level was positively correlated with blood glucose, NT-proBNP, uric acid, LV EDV, LV ESV and NYHA HF functional classes, but negatively correlated with LVEF (p < 0,05).

Conclusion. The level of HbA1c in patients with diabetes mellitus in combination with coronary artery disease is closely related to the degree of cardiac dysfunction. Levels of glycated hemoglobin are associated with the development of heart failure in patients with coronary artery disease. Glycated hemoglobin is also an independent predictor of serious adverse cardiovascular events. Reasonable and effective control of blood glucose levels is of great importance for the prognosis of patients.

Key words: coronary heart disease (CHD), diabetes mellitus (DM), glucose, glycated hemoglobin (HbA1c), echocardiography (EchoCG)

 

Ziyozoda Z.K., Olimboev Sh.M., Fatoev F.C., Abdulloev B.M.

DIFFERENTIAL DIAGNOSIS OF PATIENTS WITH TUBERCULOUS MENINGITIS, MENINGOENCEPHALITIS AND BRAIN TUBERCULOMA

Aim. Increasing the efficiency of diagnosis and differential diagnosis of tuberculous brain lesions using CT, MRI and MRI with intravenous contrast.

Materials and methods. Based 74 patients with tuberculosis of various localizations in whom specific brain damage was suspected were examined.

Along with general clinical and laboratory examination (XpertULTRA), patients underwent CT, MRI, and MRI with intravenous contrast. Cerebrospinal fluid and cytological studies (autopsy materials) were conducted. The diagnosis of tuberculous brain damage against the background of a tuberculous process of various localization was confirmed bacteriologically..

Results. In 56 patients, the changes identified were most consistent with tuberculous brain damage. Of these, 9 patients (16,1%) were diagnosed with tuberculous meningitis, 27 patients (48,2%) were diagnosed with tuberculous meningoencephalitis, 18 patients (32,1%) were diagnosed with tuberculomas, tuberculous brain abscess was diagnosed in 2 patients (3,58%). A combination of these processes occurred in 9% of cases.

Conclusion. Differential diagnosis of tuberculous brain damage is complex and, first of all, this pathology should be differentiated from toxoplasmosis, acute disseminated encephalomyelitis, herpetic encephalitis, and leptomeningeal metastases.

Key words. Tuberculosis, meningitis, meningoencephalitis, tuberculoma, differential diagnosis

 

Ikromov M.K.

DIAGNOSTIC VALUE OF COMPUTED AND MAGNETIC RESONANCE TOMOGRAPHY IN DETERMINING THE FORMS AND STAGES OF JUVENILE ANGIOFIBROMA OF THE SKULL BASE

Aim. To study the diagnostic capabilities of computed and magnetic resonance tomography in determining the various forms and stages in juvenile angiofibroma of the skull base.

Material and methods. The An analysis of the diagnostic results of 70 patients diagnosed with “Juvenile angiofibroma of the skull base” aged from 10 to 25 years was carried out.General clinical examinations, radiological research methods and magnetic resonance imaging were carried out.Results. Depending on the results obtained, an objective assessment of the diagnostic value of computed tomography and magnetic resonance imaging in determining the volume and direction of spread of the tumor process in juvenile angiofibroma of the base of the skull is given. Analysis of data from computed tomography and magnetic resonance imaging of patients showed that of the total number of patients, the sphenoethmoidal form of tumor growth was identified in half of the cases, the basilar form was less common (25,7%), the pterygomaxillary form of tumor growth occurred in 21,4% of cases, tubar form was identified in 1 case.A significant number of patients (61,4%) had stage II angiofibroma, stage I was present in 10,0% of patients, stage IIIA occurred in 20,0% of patients, stages IIIB and IV occurred in 4,3% of the total number of patients.Conclusions. Computed and magnetic resonance imaging can be considered the gold standard in the study of patients with suspected juvenile angiofibroma of the skull base. Key words: juvenile angiofibroma, skull base, computed tomography

 

Karimov M.B., Makhmadzoda Sh.K., Mirakhmedova P.K., Khaidarov Z.B., Ziyozoda M.R.

THICKNESS OF THE RETINAL NERVE FIBER LAYER AT DIFFERENT STAGES OF PRIMARY OPEN-ANGLE GLAUCOMA

Aim. To conduct a comparative assessment of the diagnostic value of the determining the thickness of the retinal fiber layer (RNFL) at different stages of primary open-angle glaucoma (POAG) in residents of the Republic of Tajikistan.

Materials and methods.  The To determine the thickness of the nerve fiber layer (RNFL), patients suffering from glaucoma and healthy individuals were included. A total of 129 people (187 eyes) were examined. Of these, the control group (healthy individuals) consisted of 51 people (97 eyes), the group of patients with POAG included 78 people (90 eyes) with stages I, II and III of glaucoma. Optical coherence tomography (OCT) was performed using RTVue-100 coherence tomographs (USA).

Results. The authors observed a progressive decrease in the average RNFL thickness starting from stage I (early glaucoma), and the greatest decrease was observed in stages II and III (moderate and severe POAG).  Analysis of RNFL thickness in the superior, inferior and nasal quadrants confirmed the revealed pattern in the corresponding areas. It was revealed that for each stage of primary open-angle glaucoma there is a corresponding decrease in the RNFL thickness.

Conclusion. The study results show that as glaucoma progresses. There is a corresponding decrease in RNFL thickness, indicating the ganglion cells death and a decrease in the number of their axons and existing correlation between the stage of the glaucomatous process and the RNFL thickness, which can contribute to earlier detection of the glaucoma progress and preserve the patient’s vision.

Key words: optical coherence tomography, primary open-angle glaucoma, RNFL

 

Mamadaminova H.Kh., Khodzhamurodov G.M., Rakhimov H.S. 

MICROSURGICAL REPAIR OF FINGER AND HAND FLEXOR TENDONS BY IMPROVED SUTURE TECHNIQUE

Aim. To improve the results of treatment of patients with traumatic injuries of finger and hand flexor tendons by applying the improved suture technique.

Material and methods.  We analyzed 54 patients admitted on an emergency basis with injuries to the flexor tendons of the fingers and hand.

When restoring the flexor tendons of the fingers and hand, a new microsurgical suture method was used, which differs from previous analogues in a more accurate comparison of the damaged ends of the tendons.

All patients underwent complete clinical, laboratory and instrumental examination.

Results. The functional results of the hand were assessed after 3 and 6 months using to the method of V.I. Rozov and the upper limb disability questionnaire (DASH). Analysis of the functional results after 3 months   was carried out using Rozov’s method, which showed that in patients the level of hand movement increased by 5 and 4 points – in 51 (96%) and   3-2(4%).

Thе results on the standardized dash questionnaire varied on average from 30 to 1 point. All eхamined patients after 6 months recovery of the fleхor tendons after the fingers and hand was not eхperienced problems with self-care.

Conclusions. Application of the developed suture method and microsurgical technique gives an opportunity for early active immobilization which in turn prevents the formation of adhesions in the bone-fibrous canal improving the results both in the early and distant period.

Key words: tendon suture, flexor tendon injury

 

Mirzoaliev Y.Y.

ACTIVITIES OF «DIRECT TELEPHONE LINE (HOTLINE) – 511» ON COVID-19 PANDEMIC IN THE REPUBLIC OF TAJIKISTAN

Aim. Study the activities of the «Anti-Crisis Center for the Prevention and Combating of COVID-19».

Material and methods. Retrospective analysis of reporting and accounting documentation, logs of telephone calls received at the Anti-Crisis Center for the Prevention and Combating of COVID-19 for the period July – November 2023.

Results. A comparative analysis of telephone calls shows that a total of 1,552 residents of the country contacted the center’s activities for the period July – November 2023, including 878 or 56,5% men and 674 or 43,5% women. Of these: 448 or 28,8% from Dushanbe, 361 or 23,2% from districts of republican subordination, 386 or 24.8% from cities and districts of the Sughd region, 357 or 23,0% from cities and districts of Khatlon region. The analysis of calls showed that the most calls were made by residents of the city of Dushanbe.

Conclusion. In total, the direct telephone line – 511 received 1,552 calls from across the region, to which responses were given in the form of appropriate recommendations and consultations.

Key words: COVID-19 coronavirus infection, vaccine, vaccination, direct telephone line, population

 

Narzuloeva M.F.

EPIDEMIOLOGICAL SITUATION OF BRUCELLOSIS IN THE REPUBLIC OF TAJIKISTAN

Aim. To provide a comparative epidemiological assessment of the spread of brucellosis among the population of various regions of the Republic of Tajikistan.

Materials and methods. An analysis of the reporting data of the Agency for Statistics under the President of the Republic of Tajikistan and the State Sanitary and Epidemiological Control Service of the Ministry of Health and Social Protection of the Population of the Republic of Tajikistan for the period 2010 – 2022 was carried out. Subsequently, the arithmetic mean values ​​of all obtained results are calculated, and their comparative assessment is also given.

Results. The incidence of brucellosis in areas of republican subordination (RRS) is higher than the rate for the republic as a whole. If in 2010 the figure for the republic was 12,7, then in the RRP for the same period it was 14,9. When analyzing indicators for the RRP and for the republic as a whole, a sharp decrease in the incidence of brucellosis was revealed, starting from 2020 to 2022 (8,3 and 3,9; 7,23 and 5,03, respectively), which is associated with the COVID-19 pandemic, and redistribution of medical workloads. The incidence rates of brucellosis in the Gorno-Badakhshan Autonomous Region (GBAO) are also several times higher than the republican average. High indicators in this region occurred in 2014 and 2017 – 15,0 and 17,6 times, respectively, higher than the indicators for the Republic of Tatarstan as a whole. The incidence of brucellosis in the Khatlon region for 2010 – 2022 generally tends to decrease: from 2010 to 2020 there is a steady decrease in the rate from 13,0 to 1,0, respectively.

Conclusion.  For the period 2010-2022. The incidence of brucellosis in the Republic of Tajikistan averaged 9.6 per 100 thousand population. During the analyzed period, high indicators occurred in 2010 and 2011. (12,7 and 13,2 respectively). A significant decrease in these figures is observed in 2020, 2021 and 2022, amounting to 3,9, 5,2 and 5,0 per 100 thousand population, respectively. The incidence among the population of the RRS and, especially, GBAO differs significantly from the average for the republic (17,1 and 103,3), tending to increase from 2015 to 2017, which is associated with the organization of the work of medical institutions to identify patients. Across the republic, there has been a sharp decrease in the registration of patients in 2020 and 2021, which is associated with the COVID-19 pandemic and the repurposing of medical institutions.

Key words: brucellose, brucellosis epidemiology, brucellosis incidence

 

Razakova Sh.K., Ashurov G.G., Karimov S.M. 

CLINICAL FACTORS OF PREDORTHODONTIC CONDITIONS OF ORAL CAVITY BESIDE TEENAGER, RESIDING ON TREATMENT ANOMALY BITE WITH USING OF FIXED CONSTRUCTION

Aim. Analyzed the source factors of cariesology and parodontology status beside teenager with system teeth-maxillary anomaly, residing on orthodontic treatment with using of fixed designs.

Material and methods. The study involved 98 patients undergoing orthodontic treatment with bracket systems. Examined patients were divided into 2 age groups: 12-14 and 15-18 years. We conducted preorthodontic checkup organs and tissues of oral cavity with using of clinical and indicative indexes.

Results. In existing of teeth-maxillary anomalies increases both frequency of the prevalence and intensities of main dentistry diseases in contrast with patient without disorders of occlusion-articulation relations.

Conclusion. Beside teenager, passing orthodontic treatment, on high level of dentistry pathology in the first place affects the unsatisfactory hygienic condition of oral cavity.

Key words: teenager, oral cavity, preorthodontic status, teeth-maxillary anomalies, bracket system, intensity of caries and parodontal disease

 

Rasulova G.T., Alimov Z.D., Kurbanova P.Z., Madinai K.

USING THE SCORING TABLE TO IMPROVE THE EFFECTIVENESS OF «МATERNITY NEAR-MISS» CASE ANALYSIS

Aim.  Assessing the implementation of the critical case analysis (CCA) methodology in a level III obstetrics facility through an internal audit using an assessment tool and further developing proposals in the hospital to improve the quality of medical services.

Material and methods.  A retrospective analysis of the ССА methodology was carried out using a scorecard consisting of 4 blocks and including 33 questions characterizing appropriate technologies: 1) organizational aspects; 2) the activities of the working group and the responsibilities of everyone on the team; 3) methodology for conducting meetings; 4) interaction of the work team with the administration, staff, and other institutions.

The analysis was carried out based on the minutes of meetings of the working group on ССА, annual reports of the State Institution “Tajik Research Institute of Obstetrics, Gynecology and Perinatology” of the Ministry of Health and Social Protection of the Republic of Tajikistan (2021-2023), interviews with women, draft orders and minutes of classes on recommended topics among employees for 2021 -2023.

An ССА monitoring scorecard has been developed, based on a point system: 0 – technology has not been implemented and/or is not used; 1 – technology has been introduced, but is not implemented properly and requires significant effort to achieve it; 2 – technology has been implemented, but requires minor improvements; 3 – implemented and can be used as best practice for other institutions.

Results. The number of critical cases analyzed in 2021-2022 – 2023 was 15, 9, 11 respectively. At the same time, an important point in making organizational and tactical decisions to improve existing practices is the ratio of cases, the analysis of which was carried out, to the total number of all critical cases in the institution. Thus, in 2021, all cases that, according to the selection criteria, should have been analyzed were analyzed. In 2022 and 2023, ССА meetings were held in 71% and 86% of cases requiring an audit.

Monitoring using scoring allowed us to identify strengths and areas where the team’s performance could be improved. Systematic self-monitoring, adherence to methodology, continuity of the process and control over the implementation of solutions allows us to achieve sustainability and makes it possible to prevent and/or reduce cases of critical conditions in obstetrics.

Conclusion.  The developed and tested ССА score card using a point system is an effective tool for objective analysis of the quality of medical services in a maternity institution and self-assessment of the team itself in determining the strengths and weaknesses of activities. This tool can be recommended for use in maternity institutions of the 2nd and 3rd levels of the country by trained specialists in the ССА methodology to improve quality and ensure sustainability of implementation.

Key words: Monitoring, critical care audit, assessment tool, critical illness, maternal morbidity and mortality

 

Saidmuradova R.Kh., Olimova F.K., Zurbekova Sh.R., Akhatova S.R.

FEATURES OF EARLY ADAPTATION OF PREMATURE NEWBORNS BORN FROM MOTHERS WITH FETOPLACENTAL INSUFFICIENCY

Aim. To study the clinical features of early adaptation of premature infants born from mothers with feto-placental insufficiency, and to assess their level of survival.

Material and methods.  The subjects of the study were 68 premature babies who were born at a gestational age of 28 to 36 weeks and their mothers.

Results. Important clinical features of early adaptation of premature infants who suffered intrauterine hypoxia as a result of feto-placental insufficiency, which was a high perinatal risk for the premature infant, were identified. All children in the study group required varying degrees of resuscitation after birth. A fifth of premature babies were intubated at birth (19%). In 76% of newborns, there was a deterioration in their condition in the first day after birth in the form of respiratory distress syndrome. In CPAP, i.e. creation of constant positive pressure in the lungs was required by 29% of children. ALV (artificial pulmonary ventilation) was required by a third of the studied premature newborns (38%).   Violation of early adaptation was noted in all 100% of children.

Conclusion. Features of the period of early adaptation of premature newborns from mothers with feto-placental insufficiency is the high frequency of asphyxia at birth, where more than 50% of children received an Apgar score below 6 points, and the survival rate among them was 51%.

Key words: newborn, premature, gestational age, uteroplacental insufficiency, adaptation, survival

 

Turdiboev Sh.A., Berdiev R.N., Rahmonov H.D.

CONSERVATIVE TREATMENT OF HEMORRHAGIC STROKE

Aim. To study the influence of Nimotop on the course of hemorrhagic stroke.

Material and methods. We studied the results of treatment of 188 patients with acute hemorrhagic stroke. The patients were divided into two groups. The first group (main group) included 96 patients who took the drug nimodipine 2 ml in isotonic sodium chloride solution for 120 minutes with mandatory blood pressure monitoring and no later than 3 days from the moment of the disease. The second group (control group) included 92 patients and did not use nimodipine.

All hospitalized patients received complaints, medical history, general clinical examination, assessment of neurological disorders, neuroimaging research methods (CT and MRI), ophthalmological examinations, examination by a neurologist and an intensive care specialist, as well as photographic documentation.

Results. In patients of the main group the level of consciousness cleared from stupor and deep stunning to moderate stunning and clear consciousness in 28 (29.2%) cases, and in patients in the control group, this figure was 24 (26.1%). In the main group, in 74 patients, severe hemiparesis turned moderate on the 14th day in 56 (58.4%) cases, and in patients in the control group, it lasted up to 1 month in 64 (69.6%) patients. Also, speech impairment in 12 (12.5%) patients in the main group regressed up to 2 weeks, and in patients of the control group, speech impairment recovered up to 2 weeks in 4 (4.3%) patients. Cerebral symptoms in the main group on day 14 out of patients remained only in 5 patients, and in the control group of 67 patients they were recorded in 25 examined.

Conclusion.Тherapy using nimotop has a significant effectiveness in the acute period of hemorrhagic stroke, received in complex therapy and leads to an acceleration of the recovery of brain functions, compared with the control group. Taking into account the general condition, neurological status, age, as well as tomodensitometric data of sorting patients with hemorrhagic stroke, it is possible to achieve positive results in the treatment of these categories of patients.

Key words: hemorrhagic stroke, conservative treatment, arterial hypertension, computed tomography

 

Khuseinzoda Z.Kh., Mirzoeva D.S., Gairatova N.K., Sufiev L.A.

OBESITY AS A RISK FACTOR IN THE DEVELOPMENT OF BREAST CANCER

Material and methods. A retrospective analysis of outpatient records of patients diagnosed with breast cancer was carried out.

For the purpose of adequate treatment, weight and height were determined for all patients, body mass index (BMI) and degree of obesity were calculated.

Results.  In 2022, 142 (30,5%) patients and in 2023, 98 (27,5%) patients were obese. At the same time, the majority of patients with breast cancer and obesity were in the age group of 40-69 years, and the highest degree of obesity was found in the age group of 50-69 years. In both 2022 and 2023, stages III and IV breast cancer were most common in obese women.

Conclusion. Overweight and obesity are an independent factor of poor prognosis for patients with breast cancer; estrone is synthesized in adipose tissue, the monotonous concentration of which leads to an inadequate increase in cell proliferation, leading to an increase in breast cancer incidence, relapse and mortality. Further research examining the impact of obesity on breast cancer is needed.

Key words: breast cancer (BC), body mass index (BMI), obesity, age

 

Shokirov M.K., Tagaeva Sh.O., Makhmudov D.T.

INCREASE OF PREVALENCE, INTENSITIES AND STRUCTURED FACTORS OF CARIES INTENSITIES BESIDES FLYING PERSONAL AND EMPLOYEE OF THE OVERLAND SERVICE OF CIVIL AVIATION

Aim. Conduct the clinical study of dentistry diseases in dynamic besides flying personnel and employee of the overland service of civil aviation of the Republic Tajikistan.

Material and methods. In the article presented results of the study of the leading indexes of dentistry diseases besides flying personnel and employee of the overland service of civil aviation at age 20-60 years and senior. During of studies, realizable in 2003, were examined 660 persons of the flying composition and 679 employees of the overland service of civil aviation. Repeated clinical and epidemiological examination of oral cavity (in 2023) organized beside 568 employees of the flying composition and 627 – an overland service. Study of cariesology status amongst examined persons with using of WHO card carry has allowed to calculate following factors: prevalence and intensity of caries; the structure of the index of caries intensities.

Results. Comparative increase of the specific gravity of the caries complications, subjecting to treatment (element «P») and removing (element «X»), enables to judge about need of the increase the volume of the rendering to flying personnel of civil aviation therapeutic, surgical and orthopedic help, need, in rendering which to moment repeated clinical and epidemiological examination (in 2023) realistically increased.

Conclusion. The high increase of caries defeat amongst aircraft workmen of the flying composition and overland service, probably, is connected with absence of the comprehensive program of prophylactics main dentistry diseases and raised by consumption of the examined contingent carbohydrate and flour product.

Key words: caries, flying personal, gingivitis, civil aviation, overland service, air workman.

 

Yulchiev R.I., Dzhonibekova R.N.

ESTIMATION SOME PARAMETERS CHARACTERIZING COMBINED LOCAL ACTIVATION OF POLYMORPHIC-NUCLEUS LEUKOCYTE AND THROMBOCYTE BESIDE PATIENTS WITH SMALLHOLE’S BLEEDINGS

Aim. Study the role of thrombocyte activity factor in change the functional condition of polymorphic-nucleus leukocyte and thrombocyte in bleeding center of the smallhole after extraction of the teeth.

Material and methods. Under observation was found 24 patients with primary smallhole’s bleeding. For polymorphic-nucleus leukocyte used the estimation to activities in shelters their granular enzyme (ecstasy and ß-glucorinadasy). About activities thrombocyte of smallhole’s blood in vivo judged on condition of thrombocyte factor 4 and ß-thromboglobuline.

Results. Level of the marker’s activations of polymorphic-nucleus leukocyte realistically increases under at smallhole’s bleeding all degrees beside patient of the main group.

Conclusion. Activity of elastase under smallhole’s bleeding I degree increases very small, but under II and III degree it’s increasing greatly and realistically.

Key words: smallhole’s bleeding, polymorphic-nucleus leukocyte, thrombocyte, smallhole, extraction of teeth

 

REVIEV

 

Yatimova S.A., Narzullaeva A.R., Tavarova S.Kh.

MODERN ASPECTS OF DIAGNOSTICS CORONAROGENIC VENTRICULAR ARRHYTHMIAS

Early diagnosis, based on the study of etiopathogenetic and pathophysiological prerequisites for ventricular arrhythmias (VA), improves the prognosis of health and life in patients with coronary heart disease with rhythm disturbances. The review covers the etiology and pathogenesis of coronary ventricular arrhythmias, their detection and early diagnosis. Analysis of indicators of electrical instability of the myocardium, as well as stress tests to determine the genesis of ventricular ectopy, its qualitative and quantitative characteristics in patients with coronary artery disease and high-grade ventricular arrhythmias both before and 6-12 months after surgery in order to predict the antiarrhythmic effectiveness of myocardial revascularization and timely diagnosis of recurrent ventricular arrhythmias is relevant not only from the point of view of practical cardiology, but also public health, family medicine, as well as the integration of scientific research into the formation of specialist tactics at each stage of providing care to this category of patients. By analyzing the rates of ventricular arrhythmias of ischemic and non-ischemic origin, data from randomized controlled trials were provided, which also emphasize the need for early detection of these rhythm disturbances. However, despite the large number of studies conducted among patients with coronary artery disease and VA, the results of which are both contradictory and inconclusive, the question of the clinical meaning of VA, so common in patients with coronary artery disease, is still the subject of debate. The problem of managing patients with VA, especially high grades, i.e. life-threatening in patients with coronary artery disease, despite advances in the development of new antirhythmic drugs (AAP), in the surgical treatment of coronary artery disease, improvement of technical support for operations, and implantable devices, still remains unresolved. That is why our study was aimed at studying the most controversial features of VA in patients with chronic ischemic heart disease, the poorly studied relationship with the severity of the underlying disease, the incompletely defined role of myocardial revascularization (RM) in modifying the electrophysiological substrate of arrhythmias of various origins, triggers of VA and in changing the parameters of a number of risk factors. -stratifying techniques.

Key words: coronary heart disease, ventricular arrhythmias, ventricular tachycardia, electrical instability of the myocardium, sudden arrhythmic death, myocardial revascularization

 

CASE FROM PRACTICE

 

Davlatova S.N., Mukhammadnabieva F.A., Sharipova M.M., Kurbonov N.M.

SCLERODERMATOMYOSITIS (OVERLAPSYNDROME) IN CHILDREN

The article deals with a rare case of cross syndrome in a 13-year-old girl. The disease is characterized by a combination of clinical symptoms of scleroderma and dermatomyositis and is observed in adolescence. Severe visceral changes are rare. In practice, it is very important to distinguish this syndrome from scleroderma and dermatomyositis. The treatment of patients with cross-syndrome causes certain difficulties due to resistance to conventional therapies for dermatomyositis.

Key words: children, Overlap-syndrome, scleroderma, dermatomyositis

 

Rasulov S.R., Dilshodov S.A., Safarzoda N.

EXTRASCELETAL MESENCHYMAL CHONDROSARCOMA OF THE MEDIASTINUM

We demonstrated a case of surgical treatment of a rare phenomenon – extraskeletal mesenchymal chondrosarcoma of the mediastinum in a 30-year-old man. The method of surgical treatment is subtotal removal of the tumor, leaving part of it that grows into the blood vessels of the roots of the lung, main bronchus, pericardium and aorta.

For radical tumor removal, adjuvant radiation therapy is indicated; for non-radical surgery, adjuvant chemoradiotherapy is recommended.

Key words: rare tumors of the mediastinum, chondrosarcoma, surgical treatment

 

 

 

2-2024

THEORY AND PRACTICE OF MEDICINE

 

Blashkova S.L., Krikun E.V., Fazylova Yu.V., Blashkova J.V.

IMPROVEMENT OF METHODS OF COMPLEX TREATMENT INFLAMMATORY PERIODONTAL DISEASES

Aim. Increasing of efficiency results complex therapy of chronic generalized periodontitis.

Material and methods. Clinical examination including index assessment of individual oral hygiene level in 110 patients with chronic generalized periodontitis (CGP) of moderate and severe severity at different stages of follow-up (before treatment and in 10 days, 1, 3 and 6 months after treatment) was carried out. In the main group (n=54) the conventional treatment was supplemented by decontamination of periodontal foci with dental diode laser with a wavelength of 980 nm. In the control group (n=56) the generally accepted complex treatment was carried out.

Results.  Analysis of the dynamics of the simplified hygiene index indicators depending on the chosen method of treatment, at all stages of the study (before, after 10 days, 1,3,6 months after treatment) showed that if at the initial stage the level of hygiene in patients in both groups was relatively comparable (p>0,05), then after 3 months from the beginning of treatment values in the group where laser treatment was applied, hygiene index indicators significantly decreased compared to the control group (p<0,001). The similar tendency was maintained during further observation, having reached a reliable maximum by the end of the 6th month due to a pronounced decrease in the index values – almost 3 times from the initial one in the main group (p<0,001), and only 1,8 times in the control group. Improvement of hygienic status of patients contributed to the positive dynamics of clinical signs of the disease, which was confirmed by the decrease of the median periodontal index (PI according to Russell) in 1,5 times in the main group of the study already after 10 days from the beginning of therapy, continuing statistically significant decrease by the end of the 6th month – 3 times from the initial value, compared to the control group, where the PI index by the end of the observation period amounted to 2,2 points, which is only 2 times lower than the initial one.

Conclusion. The obtained results indicate the expediency of including diode laser in the complex of basic therapy of chronic generalized periodontitis. The visible effect of treatment creates a higher level of motivation of patients to maintain a proper level of individual hygiene.

Key words: chronic periodontal disease, treatment, OHI-S, diode laser

 

Goibzoda M.A., Ibodzoda Z.H., Gaibov A.G., Oymakhmadov Kh.D.

DOMESTIC VIOLENCE AS A SOCIAL PHENOMENON IN THE SPHERES OF JURISDICTION AND PUBLIC HEALTH IN THE REPUBLIC OF TAJIKISTAN

Aim. To study the current state of domestic violence as a phenomenon in the areas of jurisdiction and public health in Tajikistan.

Materials and methods. The work used materials from relevant ministries and departments and information from international and public organizations, as well as the results of a questionnaire survey of 450 women aged 18-63 years living in Gissar, Vakhdat Shakhrinav and Fayzabad districts in 2022. The obtained data was processed using statistical, analytical and sociological methods using standard programs.

Results. Domestic violence is a particularly serious problem in poor and developing countries, including Tajikistan, in which women respondents work in enterprises and organizations in only 17,2% of cases and are engaged in self-employment in only 3,0% of cases. activities.Moreover, in 58,6% of cases they are legally married, and in 17,7% of cases they live in a civil marriage – as second wives, being in active reproductive age. In addition to that, in 26,5% of cases, separation from first husbands occurred as a result of cruel treatment of them – regular beatings, insults, humiliation, contributing to the development of neuropsychic disorders and exacerbation of chronic diseases. In particular, in 65,0% of cases, husbands hit their wives at least once.For more than 50,0% of women, psychological violence became everyday, and in 33,4% of cases it came from relatives, friends and husband’s relatives in the form of disdain for her tastes, actions, emotions, isolation from her family and friends. Often in such an atmosphere there are not only women, but also adolescents suffering from chronic diseases or congenital pathologies. In addition, one in five women has experienced sexual violence, even during pregnancy.

Conclusion. Domestic violence remains one of the most pressing social and legal problems in Tajikistan.. The tension of life, stress, depression, lack of spirituality, unemployment, labor migration, lead to the loss of family and moral values, alcoholism and drug addiction, creating fertile ground for the denial of legislation and its legal norms. The specificity of family violence has been established, determined by various damage to the human body, social nihilism, cruelty and legal impunity, especially in relations with women and children.

Key words: Violence, family members, medical, social, criminal, legal problems, Tajikistan

Zarqua N.E., Kumykov A.A., Trunin E.M., Akimov V.P., Krivov A.P., ⁴Mukhiddinov N.D.

SURGICAL TREATMENT OF PATIENTS WITH UNINTENTIONAL DAMAGE OF THE EXTRA HEPATIC BILEDUCTS DURING LAPAROSCOPIC CHOLECYSTECTOMY

Аim. Improving treatment outcomes in patients with unintentional extrahepatic bile duct injuries through innovative early diagnostic methods and differentiated surgical tactics.

Materials and methods. The study included 67 patients aged 20 to 71 years (mean age 42) with unintentional injuries to the extrahepatic bile ducts that occurred during laparoscopic cholecystectomy.

Results. The most effective methods of topical diagnosis of damage to the extrahepatic bile ducts are MRI cholangiography, endoussis, RHPG, MSCT. Of the 67 patients during surgery, damage to the bile ducts was detected in 18 (26,8%) patients, in 49 (73,13%) patients, duct injury was detected 1-8 days after surgery. Most often, injuries were observed, with the intersection or excision of a part of the hepaticocholedochus with clipping of the proximal stump. Performing reconstructive surgical interventions in the presence of liver failure, intraperitoneal or intracurrent purulent-inflammatory complications is associated with the risk of insolvency and the development of early anastomosis stricture in the postoperative period. Therefore, a reasonable way out of this situation is the formation of a complete external biliary fistula before the relief of inflammatory phenomena in the abdominal cavity. Reconstructive surgery is performed after 4-5 weeks.

Conclusions. With lateral and complete transverse clipping of the duct, without disturbing its continuity, it is advisable to perform a simultaneous hybrid intervention, the first stage of which is relaparoscopy and removal of the clip, followed by endoscopic transduodenal stenting of the duct with a metal self-expanding stent. In the absence of purulent-septic complications, the serum bilirubin level is less than 100 mmol/l, reconstructive surgery is performed – hepaticoejunoanastomosis with a switched-off loop with a length of at least 80 cm.

Key words: unintentional damage to the bile ducts, diagnosis, surgical treatment, treatment results

 

Kosimova Z.N., Zununov G.B., Kaumova M.А., Аkhmedov S.А., Zununova M.G.

PATIENTS WITH PRIMARY IMMUNE TROMBOCYTOENA DURING THE PREGNANCY

Aim. Analysis of observation results, pregnancy course, birth outcome and obstetric complications in pregnant women with idiopathic thrombocytic purpura (ITP).

Material and methods. An analysis of the histories of 27 pregnant women diagnosed with ITP was conducted for the period 2015–2022.

Results. Among the examined women, pregnant women with hemorrhagic syndrome predominated (51,6%). All those hospitalized were under supervision of an obstetrician-gynecologist and hematologist. A platelet count of less than 20,000 was observed in 36,1% of women. In 63,9% of cases, the platelet count was more than 30,000. Drug preparation for delivery was carried out in 88,8% of cases. Therapy with corticosteroid hormones was effective in 59,3% of women. In 92,5% of women, childbirth was spontaneous, through the natural birth. In 7,5% of cases, a cesarean section was performed for obstetric indications. Splenectomy in 4 cases was performed laporoscopically without complications. Bleeding in the early postpartum period was observed in 48,4%.

Conclusion. Provided that a hematologist and obstetrician-gynecologist closely monitor the disease, pregnancy is not a contraindication for women with ITP. However, pregnancy can serve as a trigger factor for the development of both relapse and newly diagnosed ITP. Timely and adequate therapy for women with thrombocytopenia ensures pregnancy and delivery without complications.

Key words: trombocitopenia, pregnancy, corticosteroids, splenectomy

 

Kasymova S.D., Sadullozoda T.S., Narzullaeva A.R.

DYNAMICS OF PREVALENCE OF DIABETES IN THE REPUBLIC OF TAJIKISTAN

Aim. Assessment of the dynamics of the prevalence of diabetes mellitus (DM) and its risk factors in the Republic of Tajikistan.

Material and methods. A screening study was conducted in a free cohort sample of individuals over 40 years of age in different regions of the Republic of Tajikistan. The results of the study were compared with a screening study conducted in 2012.

Results. In 2023, the blood glucose level above 6,1 mmol/l was observed in 16,2% of examined individuals over 40 years old in Dushanbe. Elevated fasting blood glucose levels were more often observed in 17,3% of men and 16,0% of women. In 2012, a high level of carbohydrate metabolism disorders was also established among the population aged 45 years and older in residents of 2 districts of the Khatlon region. 21,2% (every 5 of those examined) had overt diabetes, and 9,4% of those examined had impaired glucose tolerance (prediabetes). In 2022, 54,711 patients with diabetes were registered in the Republic of Tajikistan, which amounted to 0,58% of the population of the Republic of Tajikistan.

Conclusion. The analysis showed that program screening studies are needed to identify the true prevalence of diabetes in the republic. The creation of a register of patients with diabetes will allow systematizing not only official statistics, but will also allow diagnosing the presence of complications of diabetes, the effectiveness of treatment, which will improve the quality of medical care for patients with diabetes.

Key words: diabetes mellitus, prevalence, risk factors, Tajikistan

 

Kakharova R.A., Ibrohimov Yu.H., Sirojev D.N., Rabiev A.H.

EXPERIENCE IN SURGICAL TREATMENT OF RECTOVAGINAL FISTULAS

Aim. Improving the results of surgical treatment of rectovaginal fistulas, taking into account their location, size, and condition of the rectal obturator apparatus.

Materials and methods. The results of surgical treatment of 49 women with rectovaginal fistulas were analyzed. The average age of patients is 29+-7.2 years. 89.3% of patients were operated on within 6-12 months from the moment of fistula formation, which is the most optimal period for surgical treatment. All patients were examined by a gynecologist before surgery and a colposcopic examination of the cervix and colonoscopy were performed.

Results. The best clinical and functional results are achieved with low postpartum fistulas, when the rectum is healthy and the patient is young. For this category of patients, it is preferable to eliminate the rectovaginal fistula using a vaginal flap. In complicated rectovaginal fistulas, after repeated unsuccessful operations, it is recommended to perform several operations, starting with the imposition of a double-barrel sigmoid colostomy. For fistulas less than 1 cm in diameter, the intussusception method of surgical treatment is recommended.

Conclusion. An individual approach and choice of surgical treatment method for each patient reduces the frequency of disease recurrence.

Key words: rectovaginal fistula, surgical treatment, complications, anal incontinence

 

Kurbonov S., Asanbekova S.Kh., Kodirova F.R., Usmanov M.

QUANTITATIVE ANALYSIS OF THE STRUCTURE OF THE UTERINE ARTERY AND FALLOPIAN TUBE

Aim. Determination of the permeability of intraorgan vessels of the internal female genital organs using the Kernoghan index.

Material and methods. The structural and functional organization of the bloodstream of the indicated organs in 26 corpses of women of reproductive age was studied.

The blood vessels of the organ complex were injected with different dyes through the internal iliac artery and vein. The sections were stained using standard histological methods.

Results. The throughput capacity of the ordinal arteries of the uterus and fallopian tube (Kernoghan index) varies depending on the organ layer and the simplification of the structure of the ordinal artery wall. The obtained data indicate the adaptive capacity of the blood vessels of the internal genital organs during the reproductive period.

Conclusion. The Kernoghan index decreases accordingly with each subsequent order of branching due to the thinning and simplification of the structure of the wall of small arteries.

Key words: uterus, fallopian tubes, vessels, Kernoghan index

 

Makhmadaliev B.G., Sirodzhzoda M.S., Sirodzhov K.Kh.

CONCEPTUAL APPROACH TO FRACTURES OF LONG BONES OF THE LIMB IN THE BACKGROUND OF ISOLATED AND MULTIPLE DAMAGE

Aim. Improving the results of surgical treatment of fractures of long bones of the lower extremities based on the development and implementation of predictive tests for the prevention of infectious complications.

Material and methods. The results of diagnostics and surgical treatment of 110 victims with fractures of long bones of the lower extremities were analyzed, 60 men, 50 women, aged 20 to 63 years. The patients were divided into 2 groups: the main group (51 victims) – the tactics of the surgical approach was based on the prediction of infectious complications by assessing the indicators of procalcitonin, CRP, ESR and leukocytes of venous blood and the control group (59 victims) – traditional treatment tactics.

Results. Upon admission, the patients of the main group had elevated procalcitonin, C-reactive protein, ESR, and venous blood leukocyte levels compared to the norm. On the 7th day of the post-traumatic period, against the background of optimized complex intensive therapy, the above laboratory indicators approach the norm, and on the 10th day after the injury and on the 3rd day of the postoperative period, the indicators began to increase, which is associated with surgical aggression, on the 8th day of the postoperative period, the above laboratory indicators approach the norm.

Conclusion. Procalcitonin is a marker of infectious and septic complications, which predicts the development of this complication in fractures of the long bones of the lower extremities in the postoperative period. Assessment of this parameter at the stage of preoperative preparation helps to optimize the measures taken to prevent infectious complications and determines the timing and types of osteosynthesis.

Key words: fracture of the long bones of the limb, infectious complications, prevention

 

Muradov A.M., Mukhamedova U.M., Nazirov J.Kh.

VARIATIONS OF DIASTOLIC DYSFUNCTION OF THE LEFT VENTRICLE IN PATIENTS WITH CARDIORENATAL SYNDROME TYPES I AND III

Aim. To study variations in diastolic dysfunction of the left ventricle of the heart depending on the severity of patients with cardiorenal syndrome types I and III.

Material and methods. An analysis of 100 patients with cardiorenal syndrome (CRS) types I (group 1) and III (group 2) was conducted – 50 people in each group, men – 47 (47.0%), women – 53 (53.0%). Based on the scoring of severity and prognosis, patients were conditionally divided into 3 subgroups: 1 subgroup – with moderately severe, 2 subgroup – with severe and 3 subgroup – with extremely severe condition. Standard clinical, laboratory and instrumental studies were performed, including assessment of diastolic function of the left ventricle.

Results.  In patients with CRS types I, III, depending on the severity of the pathology, 3 main types of left ventricular diastolic dysfunction (LV DD) of the heart or 4 degrees of its severity are revealed: type I hypertrophic LV DD stage 1 mild was observed in 35 (35,0%) (p<0,001) cases, type II pseudo normal blood flow LV DD stage 2 moderate – in 39 (39,0%) (p<0,001), type III restrictive LV DD severe with reversible changes – in 16 (16,0%) (p<0.001), type III restrictive LV DD stage 4 severe with irreversible changes – in 10 (10,0%) (p<0,001).

Conclusion. The severity of LV DD in patients with CRS types I and III increases to the III restrictive variant of LV DD as the severity of the pathology progresses, which requires individual correction of these disorders.

Key words: cardiorenal syndrome types I and III, diastolic dysfunction of the left ventricle of the heart, variation of the type

 

Mukhsinzoda G.M., Ruziev М.М., Мirzoaliev Y.Y., Sattorova M.Kh., Sharipov А.А.

COLLECTIVE IMMUNITY FROM VACCINATION AGAINST COVID-19 AMONG THE HEALTH MEDICAL WORKERS OF THE REPUBLIC OF TAJIKISTAN BY NOVEMBER 2023

Aim. Assessment of population immunity to the COVID-19 virus among medical workers of the Republic of Tajikistan in the post-COVID-19 pandemic.

Material and Methods. A virological analysis of immunity to the COVID-19 virus was conducted among 2,000 health workers in five cities of the Republic of Tajikistan: Dushanbe, Khujand (Sughd region), Bokhtar, Kulob (Khatlon region) and Vahdat (RRS). The presence of antibodies (AT) in the blood of those who have had COVID-19 was determined by determining the level of two viral antigens (AG): nucleocapsid (Nc) and the receptor-binding domain of the S protein (RBD).

Results. The total seroprevalence (presence of antibodies to one of the antigens or a combination thereof) to SARS-CoV-2 in the examined medical workers was 79,1% (95% CI 74.5-88,8), antibodies were absent in 418 respondents (20,9 %).

Conclusion. The results obtained indicate high herd immunity among medical workers and it can be assumed that one of the likely factors in the formation of highly stable herd immunity could be the simultaneous use of several vaccines produced on different platforms.

Key words: COVID-19, vaccination, collective immunity, medical health workers

 

Nazirova N.K., Abdulkhaeva Sh.R., Vositzade Z.F., Salimova M.D.

RESULTS OF ASSESSMENT OF CHILDREN PHYSICAL DEVELOPMENT OF THE FIRST YEAR OF LIFE USING Z-SCORES IN THE STATE INSTITUTION CITY HEALTH CENTER №1 OF DUSHANBE

Aim. To evaluate indicators of children physical development of the first year of life using the Z-score scale in the practice of a family doctor (GP) at the primary health care level in the City Health Center No.1 in Dushanbe, Republic of Tajikistan.

Material and methods. A retrospective assessment of anthropometric indicators (height and weight, weight-to-height ratio) was carried out selectively in 326 children under the age of 1 year for 3 months of 2023 using data recorded in the registration log of the pre-medical room in the City Health Center No.1 in Dushanbe. To assess the indicators of children physical development and determine the proportionality of anthropometric data (weight-to-height ratio), the corresponding Z scales for height, weight and weight-to-height ratio were used to determine standard deviations (SD) depending on the children gender (boys and girls).

Results. Among the examined 326 children, 190 (58.3%) were boys and 136 (41,0%) were girls. The number of children whose physical development corresponded to the age norm (SD values in the range from -1Z to +1Z) was 66,3% (216), among them 35,9% (117) boys, 30,4% (99) girls. The number of children with malnutrition and mild protein-energy malnutrition (SD ranging from –1Z to –2Z) was 14,4% (47), among them there were more boys 9,8% (32) than girls 4,6 % (15). The development of children included in this range of SD values is assessed as a risk group; such children require an individual analysis of the causes of identified deviations and dynamic monitoring of SD. The number of children with SD indicators from -2Z to -3Z (moderate acute malnutrition) was 1,5% (5), boys 0,6% (2), girls 0,9% (3). The number of children with SD lower than –3Z curve (severe acute malnutrition) was 1,8% (6), boys 1,5% (5), girls 0.3% (1). Such children require urgent (immediate) help, hospitalization, further examination, adequate treatment and mandatory dynamic monitoring by a GP and/or specialist.

Conclusion. The using of the Z-score scale in the practice of GP at the primary health care level allows to assess the children physical development, assess nutritional status, identify children with deviations in physical development, determines further management tactics, and allows to monitor the child’s development over time. Children with deviations are subject to additional examination, hospitalization (if necessary), regular medical checkup by a GP, and consultation with specialists.

Key words: standard deviation, Z-score, parameters of physical development, anthropometry, height and weight, weight-to-height ratio, assessment of physical development, deviations in physical development, acute malnutrition, overweight, obesity

 

Nurov A.M.

TO ASSESS THE STATE OF HEALTH CARE AND SOCIAL PROTECTION OF DISABLED CHILDREN IN RURAL SETTLEMENTS OF TAJIKISTAN

Aim. Assessment of medical, sanitary and social protection of disabled children in rural settlements of Tajikistan

Materials and methods. Reports and information materials of ministries and departments, international and public organizations, the Agency for Statistics under the President of the Republic of Tajikistan. Using a specially adapted questionnaire, in May-June 2022, medical and sociological studies were carried out among 650 children with disabilities: in the districts of the Republican District (Rudaki, Vahdat, Gissar, Shakhrinav) -382 people (58.7%), in the districts of Vakhsh, Dusti, Nosiri Khisrav(Kulyab group), Temurmalik, Vose, Kulyab, Hamadoni( Khatlon region) – 268 (41.2%) people.

Results. The leading causes of childhood disability are diseases of the nervous system, mental and neurological disorders, congenital anomalies, birth injuries, diseases of the musculoskeletal and connective tissue, gastrointestinal tract, ear and mastoid process, as well as the consequences of domestic and road accidents. In the structure of disability in children, the main nosological forms are mental disorders (23,7%), diseases of the nervous system (21%), congenital developmental anomalies (18,5%). Distribution of disabled children by disability groups: Group III – 402 (61,8%), Group II – 204 (31,4%), Group I – 44 (6,7%) people. 68,6% of disabled children live in complete families, 31,4% in single-parent families or with close relatives. The needs of disabled children for rehabilitation and social assistance are growing.

Conclusion. The indicators and structure of disability are an important indicator indicating the direction and ways of improving the sphere of medical and social assistance to the rural population.

Key words: health care, social assistance, disabled children, rural settlements, Tajikistan

 

Olimov T.Kh., Kasirov I.M., Shaydoev S.S., Gaffarova M.A., Shamsidinov B.N.

THE IMPORTANCE OF MICROBIOLOGICAL ASSESSMENT OF ISOLATED CULTURES IN THE COMPREHENSIVE TREATMENT OF PATIENTS WITH CHRONIC RHINOSINUSITIS

Aim To study the microflora in patients with purulent rhinosinusitis and their complications and evaluate the effectiveness of a combination of antibiotics in the complex therapy of this pathology.

Material and methods. Taking into account the microflora and their sensitivity to antibiotics, the clinical course of the disease, and the development of an appropriate treatment regimen, we examined 43 patients aged 18 to 65 years. There were 24 men, 19 women. The first group included patients with acute rhinosinusitis (20 people), two of them with intraorbital complications (reactive edema of the upper eyelid). The second group consisted of 23 patients with chronic rhinosinusitis, including three patients with intraorbital complications (2 with abscesses of the upper eyelid and 1 with orbital phlegmon), who received antibacterial therapy taking into account sensitivity as part of complex treatment.

Results. All patients underwent a microbiological study of pathological secretions from the nasal cavity and maxillary sinus, during which in patients with acute rhinosinusitis, monoflora was predominantly determined in 12 out of 20 (62%) patients, while polyflora was observed only in the remaining 8 (38%) patients, at the same time mixed flora in patients with chronic rhinosinusitis was observed in 15 (62%) cases. In patients with acute rhinosinusitis, the pure culture was dominated by coccal flora, 75% (15 out of 20), and in patients with chronic rhinosinusitis, rod-shaped flora was predominantly found, 78,3% (18 out of 23), especially Proteus in 12 (52,2%) cases.

The flora was most often sensitive to penicillin drugs and cephalosporins, and in uncomplicated and complicated forms of chronic sinusitis, in most cases, to cephalosporins and macrolides.

Conclusion. In order to most effectively treat inflammatory diseases of the nose and paranasal sinuses, it is necessary to base the choice of antibiotics on determining the sensitivity of the flora to antibiotics.

Key words: purulent rhinosinusitis, bacterial flora, antibacterial therapy, sensitivity, complex therapy

 

Rasulov S.R., Obidov D.S.

OVERALL AND RECURRENCE-FREE SURVIVAL IN PATIENTS WITH DIFFUSE BREAST CANCER, DEPENDING ON THE MODIFICATIONS OF MASTECTOMY

Aim. To give a comparative assessment of the overall and relapse-free survival in patients with diffuse breast cancer, depending on the volume of mastectomy performed.

Materials and methods. General and relapse-free survival was studied in 50 patients with diffuse breast cancer, depending on the volume of surgery. In 24 (main group) patients, an extended modified mastectomy was performed with closure of the defect of the soft tissues of the chest wall with TDL and TRAM flaps, in 26 (control group) patients, radical mastectomy was performed with closure of the defect of the anterior chest wall with local tissues. Overall and relapse-free survival was studied from the moment the patient was discharged after surgery to the time of death.

Results. During the follow-up period from 3 to 63 months, it was found that the median overall survival in the main group was 38 months, in the control group – 18 months. The overall survival rates were studied separately depending on the presence (M1) or absence (M0) of distant metastases at the time of surgery. In the main group with M0, the five-year survival rate was 33,6%, with M1 – 25,0%. In patients of the control group with M0, the three-year overall survival rate was only 32,4%, no one lived up to five years. Patients with M1 lived only up to two years. The 63-month relapse-free survival rate in patients of the main group is 14,4%. In the control group, only 10,4% of patients lived for 35 months without local recurrence.

Conclusion. Extended modified mastectomy with closure of the soft tissue defect of the anterior chest wall with TDL and TRAM flaps in patients with diffuse breast cancer has an advantage in overall and recurrence-free survival over traditional radical mastectomy.

Key words: diffuse breast cancer, surgical treatment, general and relapse-free survival

 

Rakhimova L.D., Muhamadiev R.О., Makhmadzoda SH.Q.

OPTICS COHERENT TOMOGRAPHIC ASSESSMENT OF THE EFFECTIVENESS OF XENOPLASTY IN CHORIORETINAL RETINAL DYSTROPHY

Aim. Assessment of the condition of the retina before and after xenoplasty in patients with chorioretinal retinal dystrophy by optical coherence tomography.

Material and methods. Research research methods the subjects of the study were 27 patients with chorioretinal dystrophy. The research methodology included a package of traditional ophthalmological methods and optical coherence tomography (OCT) for studying the retina.

Results. In the initial stage, xenoplasty stops the multiplication of reflective formations, the pigment epithelium thickens and visual functions improve. In the advanced stage, the development of the xenoplasty process stabilizes the process of thinning of the pigment epithelium. Visual functions are maintained at a fairly high level. In the atrophic stage, xenoplasty stops further deformation of the macula and accumulation of exudates.

Conclusion. Xenoplasty for chorioretinal dystrophy is a very effective treatment method for the early stages of development of chorioretinal dystrophy. In the later stages of development of the process, it retains existing visual functions.

Кey words: chorioretinal dystrophy, xenoplasty, optical coherence tomography, reflective deposits

 

Khamidov A.I., Ashurov G.G., Karimov S.M.

CLINICAL AND X-RAY’S CHANGE OF THE STRUCTURED CONDITION OF THE BESIDETEETH’S TISSUE AT ANATOMICAL AND FUNCTIONAL DISORDERS OF THE MUCOGINGIVAL COMPLEX

Aim. Study the structured condition an nearteeth tissue beside patient with anatomist-functional disorders of mucogingival complex.

Material and methods. Conducted the clinical and x-ray study beside 82 patients at the age from 18 to 40 years with anatomist-functional disorders of mucogingival complex. Examined patients were grouped on four: 24 patients were enclosed in first clinical group with average threshold of oral cavity, II type of the correlation division free and attached gums, average and thick biotype of the gums, II type of the fastening lips frenula without clinical symptoms of the needs the thresholds, frenula or lateral bridle of mucous of oral cavity in correction. In second group entered 24 patients with small threshold of the oral cavity, which had a correlation division free and attached gums on II type, average and thick biotype of the gums, and II type of the fastening frenula lips or bridle of the mucous of oral cavity, as well as their hypertrophy, with positive symptoms of the needs enumerated anatomical structures in correction. In the third group entered 24 patients with afore-mentioned anatomist-functional disorders, discovered in the second group. Amongst these patient discovered recession of gum’s III type, characterizing losses of the height of interdental papilla and (or) interdental bone partiton apicaled cement-enamel join. Fourth group (10 persons, checking) was characterized by clinical intact parodont, with deep threshold of the oral cavity, normal correlation division of gums, thick biotype of the gums, and fastening frenula lips or lateral bridle I type.

Results. At presence of mucogingival disorders beside patient of the second group average degree of inflammations in parodontal structure of marginal parodont meets approximately equally in comparison with patient of the first group (28.7% and 20.8% accordingly). Together with that, beside patient of the second group light degree of gingivitis (25.1%) meets in 2.7 times less, but heavy degree of the gingivitis – in 3.7 times more often in contrast with patient of the first group (46.2%).

Conclusion. Got x-ray results amongst patient second and the third group with anatomist-functional disorders of mucogingival complex is indicative of plate’s resorbtion in the field of under investigation teeth. Local resobtion  process of alveolar bone occurs exactly because of disorders of occlusion articulation relations of the under investigation zone.

Key words: mucogingival complex, threshold of the oral cavity, free gum, attached gum, alveolar off shoot

 

Esanov M.A., Sharipov Kh.S., Ismoilov A.A.

SOURCE IMPORTANCE CLINICAL AND X-RAY CONDITIONS OF DEVITALY SUPPORTING TEETH IN PROCESS OF THEIR ADAPTATION TO FUNCTIONNING ORTHOPEDIC DESIGN

Aim. Analyzed the clinical and x-ray condition of devitaled supporting teeth, residing under orthopedic design.

Material and methods. For the reason determinations quality of filling root channel supporting teeth, used under orthopedic design, and methods filling channel of supporting teeth with provision for degree of their obturation, beside 289 patients is organized estimation of the filling root channel in the field of 1042 teeth, residing under metalceramic prosthetic device: 313 molars, 300 premolars, 259 incisors and 170 canines. At estimation result earlier treatments of supporting teeth were used clinical and x-ray criteria: the absence clinical postfilling’s sign and presence of periapex center resorbtion; finding the presence of clinical and x-ray symptoms periapex destruction.

Results. From total number of 939 explored root channels of supporting molars of upper and lower jaw, in 509 (54.2%) of the events was noted full filling of root channel up to apically of the part, but in rest 430 (45.8%) events was noted partial their obturation. Value factor data for first and second molars of upper and lower jaw corresponded to importance 277 (55.3%), 224 (44.7%) and 232 (53.0%), 206 (47.0%).

Conclusion. The percent of qualitative filling root channel in the field of frontal function-oriented groups teeth noticeably above, than this exists in molars and premolars.

Key words: supporting teeth, orthopedic design, root channel, obturation, nearapex destruction

 

Yunusov D.A.

OPTIMIZING WOUND CARE AFTER REMOVAL OF AN IMPACTED THIRD MOLAR

Aim. Comparative evaluation of different treatment methods and derivation of an optimized wound management after extraction of impacted third molars.

Materials and methods. Surgical treatment of 201 patients was performed, who had 277 teeth extracted with the diagnosis of “retention of the third molar (K 01.0)”. The average age of the patients was 28.2 years.

All patients were referred for extraction of impacted teeth. They had difficult eruption of third molars, for which they received optimized wound treatment. The patients were divided into 3 groups, taking into account the degree of trauma of the operation to remove the third impacted molar (low, medium, high). Depending on this, wound treatment with the lowest risk of complications was proposed. This group was compared with a group of 85 people who had teeth extracted using the generally accepted method.

Diagnostics were performed by radiation examination (dental X-ray, orthopantomogram – OPG) and computed tomography (CT). To optimize postoperative wound care after removal of impacted third molars, a comparative assessment of the wound treatment results was used.

Results. Of the 277 surgeries performed to remove impacted wisdom teeth, in which an optimized wound treatment technique was used, depending on the complexity of the extraction and the degree of trauma during the operation. In 238 cases, the postoperative period was uneventful, in 39 cases (14,4%) there were edema, pain, hematomas, alveolitis, fever, hyperemia, contractures.

Conclusion: When wound management is performed using an optimized technique, the risk of complications is reduced to a minimum, which improves the patient’s quality of life in the postoperative period.

Key words: impacted third molars, extraction wounds, wound healing

 

REVIEV

 

Shamszoda H.A., Nabiev Z.N., Rahmatova R.A., Giesov H.A.

SOME ASPECTS OF COGNITIVE DISORDERS DUE TO CRANIO-BRAIN INJURY

The article presents the results of the analysis of the data of modern world literature on some aspects of the diagnosis of cognitive impairment after traumatic brain injury. It has been proven that with mild TBI, the consequences can manifest themselves within a few months or years – the so-called post-traumatic syndrome, mental or physical abilities are reduced to a certain extent, which can lead to professional maladaptation and burnout.

The identification of such changes makes it possible to predict the course of a traumatic brain disease in this category of patients, to establish further professional adaptation, and to plan adequate rehabilitation to improve the quality of life of victims of TBI.

Key words: trauma, TBI, bruises, cognitive impairment, brain

 

CASE FROM PRACTICE

 

Kholikova N.N., Akhmedov F.S., Zoidboeva N.Z., Sangova F.

CLINICAL CASE OF PULMONARY ENDOMETRIOSIS

The article considers a clinical case of pulmonary endometriosis in a patient of reproductive age. The difficulties of diagnosing extragenital endometriosis, in a specific case of endometriosis of the respiratory organs, the need for an individual approach in the tactics of a practicing physician in managing patients with spontaneous hemothoraces and attacks of hemoptysis are presented. This clinical example is presented for pulmonologists, general practitioners in the aspect of increasing their attention to the increasing cases of extragenital endometriosis in the Republic of Tajikistan.

Key words: endometriosis, extragenital endometriosis, pulmonary endometriosis, hemothorax, hemoptysis, women of reproductive age

 

 

 

3-2024

THEORY AND PRACTICE OF MEDICINE

 

Abdulloev S.Kh., Saraev A.R., Makhmadzoda F.I., Karimov P.Sh., Dodokhodzhaev A.A.

DIFFERENTIATED SURGICAL APPROACH IN THE TREATMENT OF PATIENTS WITH VOLVULUS OF THE SIGMOID COLON

Aim. Improving the results of treatment of patients with sigmoid volvulus using a differentiated approach in choosing the method of surgical intervention.

Material and methods. The results of treatment of 112 patients with sigmoid volvulus were analyzed. All patients underwent radical surgery (resection of the sigmoid colon) on an urgent order; the patients were divided into 3 groups: group 1 – 43 patients that underwent a Y-shaped anastomosis with a colostomy after resection of the sigmoid colon, group 2 – 27 patients who had a end-to-end anastomosis, group 3, 42 patients who underwent end colostomy. The results of surgical treatment of patients using various methods were analyzed in accordance with demographic and morphological characteristics, postoperative complications in groups.

Results. In the group of patients with a Y-shaped anastomosis with a colostomy, better results were noted in terms of the non-traumatic nature of the second stage of surgery, minimizing the development of adhesive intestinal obstruction in the long-term period, compared to the group with an end colostomy.

Conclusion. The use of a technique for resection of the sigmoid colon with the imposition of a Y-shaped anastomosis with a colostomy creates conditions for performing an easy-to-perform restorative stage of surgical intervention from access to the stoma area, and reduces the risk of developing early and late postoperative complications.

Key words: intestinal volvulus, intestinal resection, interintestinal anastomosis, colostomy

 

Gulomova M.O., Davlyatova D.D., Niyazova M.A.

ASSESSMENT OF THE VOLUME OF MEDICAL CARE PROVIDED BY FAMILY DOCTORS IN RURAL AREAS

Aim. To assess the volume of medical care provided by family doctors in rural areas.

Material and methods. The volume of medical care provided by family doctors in rural areas was studied, the incidence rate identified by family doctors for the period 2020-2021 in the rural health center (former rural medical outpatient clinic) of the Varzob district, serving 143909 (1,7) population, was analyzed.

Results.  When analyzing morbidity, it is noteworthy that, in general, in 2020, compared to 2021, there was a decrease in both the overall morbidity rate according to visits registered by family doctors and the primary morbidity rate from 6638,6 to 6613,7. This can be explained by the more efficient organization of the work of family doctors: an increase in active visits, the organization of home hospitals, and preventive work among the population, including medical examination of the population.

Conclusion. Regardless of geographical, economic, social, cultural, organizational or linguistic barriers, health services were freely accessible to the population for medical care.

Key words: the household physician, rural population, disease, rural centre of the health

 

Dzhabborov N.Kh., Muradov A.M., Saydulloev L.

ELIMINATION AND DETOXIFICATION OF UROSEPSIS MARKERS

WITH A COMBINATION OF PLASMAPHORESIS AND INDIRECT ELETROCHEMICAL OXIDATION OF PLASMA, HEMODIAFILTRATION

AND SELECTIVE HEMOSORBTION

 

Zakirova K.A., Radzhabzoda A.S., Makhmudova P.U., Makhmudova R.U.

EFFECTIVENESS OF IMPLEMENTATION A NEW TECHNOLOGY OF USING CAD – ULTRAPORTABLE X-RAYDEVICES FOR EARLY DETECTION OF TUBERCULOSIS

Aim. to study the effectiveness of early detection of TB with new technology of digital X-ray fluorography devices, and comparison with bacteriological analysis, for the first quarter of 2024.

Material and methods. study of the results based on the submitted reports and accounting documentation of State Institution “Centers for Protection of the Population from Tuberculosis” examined with the new technology of digital X-ray fluorographic devices from the “risk group” for TB of the rural population (in the regions of Rudaki, Rasht, Matchinsky, Penjikentsky, Khurosonsky, J. Balkhi and Dangara). An analysis of the effectiveness of early detection of tuberculosis was conducted in the seven above-mentioned rural areas.

Results. In total, in the first quarter of 2024, using the new technology of digital X-ray fluorographic devices, 11342 people from the “risk group” for TB among the rural population were examined, of which 322 (2,8%) were suspected of having TB, and further examination confirmed the diagnosis of tuberculosis in 41 (12,7%) patients. During a bacteriological examination of 41 TB patients, 27 (65,9%) patients were diagnosed TB with destruction of lung tissue and the release of Mycobacterium TB, which indicates a late diagnosis of TB among the risk group of the rural population, and in only 14 (34,1%) patients with TB detected in a timely manner without decay of lung tissue and bacterial excretion.

Conclusion. The conducted study indicates an unfavorable epidemiological situation with TB among the population from the “risk group” in the studied areas.

Key words: new technologies, digital X-ray fluorography, early detection of TB among the “risk group”.

 

Zarqua N.E., Kumykov A.A., Akimov V.P., Trunin E.M., Krivov A.P., Mukhiddinov N.D.

MECHANICAL JAUNDICE AFTER LAPAROSCOPIC CHOLECYSTECTOMY AT THE OUTPATIENT STAGE OF TREATMENT AND DURING THE REHABILITATION OF PATIENTS

Aim. To improve the results of treatment of patients with obstructive jaundice after laparoscopic cholecystectomy, after discharge to outpatient treatment and in the immediate period using transluminal endoscopic and traditional surgical technologies.

Material and methods. We observed 89 patients with obstructive jaundice in the first 100 days after planned laparoscopic cholecystectomy, who underwent clinical and biochemical blood tests, ultrasound, and FGDS.

Results. All patients experienced an attack of hepatic colic, with the development of obstructive jaundice. 39 (43,8%) patients with choledocholithiasis and obstructive jaundice underwent transluminal endoscopic interventions to restore passage. In 4 (4,4%) patients, it was not possible to perform cannulation of the major duodenal papilla due to the localization of the major duodenal papilla in the lumen of the duodenal diverticulum. 22 (24,7%) patients underwent percutaneous transhepatic drainage of intrahepatic ducts. In 24 (21,4%) patients, bile passage was restored through transluminal endoscopic interventions.

Conclusion. Surgical tactics in patients with hepaticocholedochal strictures, due to the high risk of developing liver failure and other complications, imply a staged treatment. Reconstructive interventions are carried out after the elimination of jaundice and normalization of liver functions through the formation of a hepaticojejunostomy on a Roux-enhanced loop.

Key words: choledocholithiasis, cicatricial strictures of the bile ducts, diagnosis, therapeutic tactics

 

Zoidova F.M., Shukurova S.M., Kurbonova F.U., Goibnazarov A.A., Abdukodirova Sh.M.

IMMUNO-INFLAMMATORY RHEUMATIC DISEASES: MORPHOFUNCTIONAL CHANGES IN THE HEART AND THEIR CLINICAL SIGNIFICANCE

Aim. To study the morphofunctional characteristics of the heart in patients with immuno-inflammatory rheumatic diseases using transthoracic echocardiography.

Material and methods. The study included 118 patients with confirmed immuno-inflammatory rheumatic diseases, of which 44 had systemic lupus erythematosus (SLE), 16 had systemic sclerosis (SSc), and 58 had rheumatoid arthritis (RA). The control group consisted of 118 healthy individuals matched by age and sex, who visited the “Istiqlol” Health Complex from 2021 to 2024. All study participants underwent transthoracic echocardiographic examination.

Results. The echocardiographic analysis showed statistically significant changes in patients with rheumatic diseases compared to the control group: an increase in the end-diastolic and end-systolic dimensions of the left ventricle, as well as an increase in the size of the right atrium; more pronounced dilation of the inferior vena cava; increased systolic pressure in the pulmonary artery; decreased systolic excursion of the tricuspid annular plane and systolic velocity of the right ventricular myocardium. The echocardiographic data analysis revealed similar changes indicating the presence of cardiac dysfunction in patients with SLE, RA, and SSc. However, some differences were found: patients with SSc showed a more pronounced increase in systolic pressure in the pulmonary artery, which may indicate the presence of pulmonary hypertension; the diameter of the left atrium in patients with RA did not differ from the control group.

Conclusion. Patients with immuno-inflammatory rheumatic diseases have an increased cardiovascular risk and the likelihood of developing irreversible cardiovascular complications. This underscores the need for high vigilance among practicing physicians, as “silent” changes in the heart can occur, affecting the overall prognosis of these patients. Transthoracic echocardiography is a safe and accessible tool that allows for the early detection of structural pathologies and the development of adequate treatment strategies.

Key words: rheumatic diseases (RD), systemic lupus erythematosus (SLE), systemic sclerosis (SSc), rheumatoid arthritis (RA), echocardiography (EchoCG)

 

Mukhamedova U.M., Muradov A.M., Rustamova M.S., Shumilina О.V.

SYSTOLIC DYSFUNCTION OF THE LEFT VENTRICLE IN PATIENTS WITH TYPE III CARDIO-RENAL SYNDROME

Aim. To study the systolic function of the left ventricle in patients with type III cardiorenal syndrome, depending on the severity of the disease.

Material and methods. Studies were conducted on 30 practically healthy women of childbearing age (1st control group); 50 patients with type III cardio-renal syndrome – 2nd main group. The patients of the main group were conditionally divided into subgroups based on the severity score and prognosis: 2.1 subgroup – 13 (26,0%) with moderate severe condition, 2.2 subgroup – 26 (52,0%) with severe condition and 2.3 subgroup -11 (22,0%) with extremely severe condition.

For determination of the structural and functional parameters of the left ventricle, electrocardiography and echocardiography were performed. The volume of the left ventricle cavity in diastole and systole was calculated – end-diastolic and end-systolic volumes, end-diastolic and systolic sizes – according to the generally accepted method, the systolic function of the left ventricle was determined by the ejection fraction of the left ventricle (according to Simpson) and stroke volume.

Results. The conducted studies indicate the presence of systolic myocardial dysfunction of the left ventricle and the development of heart failure of varying severity in all patients with type III cardio-renal syndrome. In the case of moderate severity of the course in 1.1 and 2.1 subgroups, there is a tendency for it to decrease to the lower limits of the norm of the ejection fraction and is maintained due to compensatory mechanisms, in 1.2, 2.2 with severe and 1.3, 2.3 subgroups with extremely severe course, severe cardiovascular failure progresses as the severity of cardiorenal syndrome type III increases.

Conclusion. In patients with cardiorenal syndrome type III, remodeling of the left ventricle of the heart occurs, progressing as the severity of the pathology increases, subsequently causing the development of systolic and diastolic dysfunction.

Key words: type III cardio-renal syndrome, acute renal injury, cardiac remodeling, systolic and diastolic dysfunction

 

Mukhiddinov N.D., Abdullozoda F.A., Boltuev K.H., Ruziboyzoda K.R.

ENDOVIDEOLAPAROSCOPIC HERNIA CORRECTION ESOPHAGUEAL HOLE OF DIAPHRAGM

Aim. To evaluate the role of endovideolaparoscopy in the surgical correction of hiatal hernia using a composite mesh prosthesis.

Material and methods. The results of complex diagnostics and surgical correction of 140 (100%) patients with hiatal hernia are analyzed, which were divided into two groups: the 1st (retrospective) control group, in which 67 (47.9%) patients were included, and well-known open surgical, traditional interventions were performed, and the 2nd (prospective) main group, in which included 73 (52.1%) patients and for whose treatment a developed method of videolaparoscopic correction of hiatal hernia was performed. Recurrent hiatal hernia occurred in 21 (15.0%) cases.  In 95 (67.9%) cases, there was a small hernia size, large ones were detected in 34 (24.3%) patients, and giant hernias were detected in 11 (7.8%) cases.

Results. In 68 (93.2%) cases, various versions of videolaparoscopic fundoplication with posterior crurorrhaphy were performed in patients of the main group; only in 5 (6.8%) cases, according to strict indications, laparotomy and Nissen fundoplication in a clinical modification with posterior crurorrhaphy were performed. In order to prevent the risk of developing a recurrent hernia, in 30 (41.1%) cases, the method of video laparoscopic fundoplication according to Nissen with posterior crurorrhaphy, developed by us in the clinic, was performed. In the long-term period, no relapse of the disease was observed in patients of the main group. Whereas in patients in the control group, recurrence of hiatal hernia occurred in 8 (15.3%) cases.

Conclusion. An alternative surgical method for the treatment of hiatal hernia is to combine videolaparoscopic fundoplication with posterior crurorrhaphy, additionally using a composite mesh prosthesis in a clinical modification, which is justified to prevent relapse and reduce the incidence of postoperative complications.

Key words: hiatal hernia, endovideolaparoscopic correction, composite mesh prosthesis

 

Obidov S.A., Olimov A.M., Ismoilov A.A.

ASSOCIATED ESTIMATION THE DEGREE CARIES ACTIVITY FROM CLINICAL FORM OF CONGENITAL UNJOINING LIP AND PALATE

Aim. Determination of the possible reasons of the origin tooth decay beside children with temporary and removable occlusion correlation in depending of clinical form congenital unjoining lip and palate.

Material and methods. In the study by length of 6 months have took part 75 children with different clinical forms innate unjoining lip and palate at the age from 5 to 12 years. Beside all examined children discovered different dentistry pathology of cariesology and parodontology natures. In depending of clinical forms of innate pathology maxilla-facial area and activities of the carious defeat examined children were divided into 4 groups: 1-st group – with insulated unjoining of upper lip, I and III degree activities of the carious defeat; 2-nd group – with insulated unjoining of soft palate, I and III degree of activities of the carious defeat; 3-d group – with insulated unjoining of soft and hard palates, II and III degree of activities of the carious defeat; 4-th group – with end-to-end unjoining upper lip, soft and hard palates, I and III degree of activities of the carious defeat. The caries intensity beside children with innate fissure of the lip and the palate defined with using of the standard index of CFMt+kft. Hygiene of oral cavity amongst examined contingent children valued with use the simplified index hygiene of oral cavity. Also defined some physical and chemical parameters of oral liquid: pH, buffer capacity of the mixed saliva.

Results. Beside children with insulated unjoining upper lip and soft palate at presence beside them I and II degree activities of the carious defeat was a satisfactory level of hygiene oral cavity, light and average degree of the gingivitis, the small deflection aside tart ambience of oral cavity. Beside children with end-to-end unjoining of the lip and palate, when revealing beside them II and III degree of  the activities of carious process fixed unsatisfactory level  hygiene of oral cavity, the heavy degree of the gingivitis and unauthentic deflection pH saliva’s in tart side.

Conclusion. Beside patient with end-to-end unjoining lip and palates and maximum activity of the carious defeat, buffer system of oral cavity is constantly found in active mode of the operation, that, finally, provides the stability given parameter of the mixed saliva.

Key words: congenital unjoining, lip, palate, mixed saliva, activity of the carious defeat, hygiene oral cavity

 

REVIEWS

 

Asadov S.U., Shukurova S.M., Kabirzoda R.H., Safaraliev Sh.M.

REVASCULARIZATION STRATEGIES IN PATIENTS WITH ACUTE CORONARY SYNDROME IN ASSOCIATION WITH DIABETES MELLITUS

Patients with diabetes have higher rates of morbidity and mortality from cardiovascular disease and undergo a disproportionate number of coronary interventions compared with the general population. The correct choice of treatment methods is of paramount importance. Treatment strategies include drug therapy and interventional approaches, including coronary artery bypass grafting and percutaneous coronary intervention. The purpose of this review is to summarize new data comparing coronary artery bypass grafting and percutaneous coronary interventions in patients with diabetes and to provide an overview of recent advances in percutaneous interventions to complement optimal medical management of patients with diabetes.

Key words: acute coronary syndrome (ACS), diabetes mellitus (DM), revascularization, coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI)

 

Mirzoev A.S.

FEATURES OF THE POLIO EPIDEMIOLOGICAL SITUATION IN THE REPUBLIC OF TAJIKISTAN

The article presents the results of the analysis of the epidemiological situation since the beginning of registration of polio cases (since 1940) in the Republic of Tajikistan. Specific characteristics of individual cases of the outbreak in the country were studied. A large amount of statistical data was collected that characterize the course of the disease among various population groups. The two most recent outbreaks, which were unique both in terms of the number of cases and the source of infection, are covered in detail. For the first time, an assessment was made of the introduction of a new oral polio vaccine (nOPV2) in response to an outbreak of vaccine-derived poliovirus type 2 (VDPV2).

Key words: poliomyelitis, vaccine-derived poliovirus, nOPV2, polio outbreaks, Tajikistan

 

Rakhmatullaeva M.A.

COMORBIDITY IN CHILDREN SUFFERING FROM CONGENITAL HEART DISEASE – VENTRICULAR SEPTAL DEFECT

The review presents the main indexed scales frequently used in practical healthcare and research work to assess comorbidity. The literature review is devoted to the assessment of comorbidity in children suffering from congenital heart disease – ventricular septal defect (VSD). Various scales for assessing comorbid conditions are analyzed, which provide information on the prognosis of the underlying disease in both somatic diseases and surgical pathology. The relationship between most congenital diseases and the presence of concomitant pathology that worsens the course and prognosis of the underlying disease is also traced.

Key words: comorbidity, children, congenital heart diseases, ventricular septal defect

 

CASE FROM PRACTICE

 

Karim-zade G.D., Malikov M.Kh., Murodov J.K., Saidov I.S.

USE OF INGUINAL FLAP IN AVULSION AMPUTATION OF INDEX FINGER WITH CIRCULAR DEFECT

The article presents a clinical case of covering a circular defect of the index finger resulting from a traumatic avulsion of the finger using an inguinal flap. The presented case shows the stages of the operation, starting with preoperative marking and cutting out the flap based on knowledge of anatomical landmarks, the method of covering the defect and postoperative results. The inguinal flap remains the flap of choice in emergency surgery for covering extensive defects of the palmar and dorsal surfaces of the forearm and hand.

Key words: hand injury, soft tissue defect, inguinal flap, hand reconstruction

 

Farzonai Ibrokhim, Kholmatov P.K., Kandakov O.K., Dodikhudoev R., Rakhimova S.U., Kholmuratova M.Sh.

RARE FORMS OF COMBINED ECHINOCOCCUS

This article describes rare forms of combined echinococcus in an elderly woman who, for a number of reasons, was not diagnosed for long time due to the peculiarities of the course of the development of complications. The stages diagnosis, features of surgical treatment and postoperative are described. The presented clinical case confirms the need for timely diagnosis and treatment of   echinococcal cysts.

Key words: echinоcoccosis, combined echinоcoccus, rare forms of localization echinococcus, hydatid cyst of abdominal cavity, hydatid cyst of hip, diagnosis, surgical treatment