Aim. To study the usage of duodenoplasty and traditional drainage surgery in a combination with selective proximal vagotomy for ulcerous cicatricial duodenal stenosis. Materials and methods. Analysis of the common experience treating 150 patients with ulcerous cicatricial duodenal stenosis, which in addition to selective proximal vagotomy for the restoration of the duodenum passage received duodenoplasty (90 patients) and traditional drainage operation. The age of patients ranged from 16 to 67 years. 31 (20,6%) patients had compensated stenosis, 74 (49,3%) patients had sub-compensated and 45(30,1%) patients had decompensated duodenal stenosis. To find out the requirements for the selective proximal vagotomy, secretory test and examination of the stomach contractile ability with cerukal were conducted. Results and discussion. Intraoperational revision of the pyloric-duodenal segment allows defining the requirements and type of the pyloric preserving operation. From the position of the gastro-duodenal complex function restoration, duodenoplasty and stomach drainage operations are not equivalent Duodenoplasty restores the normal anatomy of the duodenum and preserves pylorus and creates optimal conditions for full rehabilitation of lost digestive functions. Conclusion. Selective proximal vagotomy is the most rational approach in a treatment of ulcer disease complicated by duodenal stenosis, which preserves the function of the pylorus and restores normal morphofunctional relations in the gastro-duodenal complex.

Aim. To improve the results of diagnostics and treatment, and to decrease the mortality of postpartum women with an acute massive blood loss. Material and methods. Observed postpartum women with acute massive blood loss (n=210) were divided into two groups according to the severity of the condition, and for more detailed research of the stages of homeostasis disorder, according to hemodynamics, consciousness and the condition of central hemodynamics. The control group included 30 healthy women of the reproductive age that were considered as a 3rd group. Results and discussion. The following changes were observed in postpartum women after the arrival of the resuscitation-transfusion team with a hemostatic laboratory to the hospital: hemorrhagic shock characterized by tachycardia, arterial hypotonia, low indicators of heart output, weak contraction ability of the hearth and deep homeostasis disorders. Patients also had a decrease in the stroke volume characterized by a weak contraction ability of the heart. Indicators of the central hemodynamics were in the sub-compensated functional condition amidst blood circulation centralization. Conclusion. After the infusion-transfusion therapy on a background of the blood loss liquidation, observed changes tended to reverse. Normalization of the heart and stroke indexes and total peripheral resistance were noted. The condition of postpartum women after the Implementation of the complex of intensive showed that this process was effective in dynamic.

Aim. To improve the result of the abdominal hernias surgery by efficient implementation of the polypropylene endoprostheses. Materials and methods. Results of the complex diagnosis and treatment of 120 patients with abdominal hernia were analyzed. All patients were divided into 2 groups. The first group included 58 (48,3%) patients that should have received radical operative intervention on organs of the abdominal cavity. The second group included 62 (51,7%) patients, that should have received surgery on organs of the retroperitoneal cavity. Results and discussion. Results of the complex clinical examination show that patients of first and second groups had anatomic and functional insufficiency of II - III stage in the abdominal and lateral walls of the abdomen in 42% and 67% cases respectively, which was a precursor of postoperative abdominal hernia. Conclusion. One of the ways to optimize postoperative abdominal hernia prevention is a wider and more efficient implementation of minimally invasive methods that are not followed by high traumatic interventions and injury of the neuromuscular structures of the lower back and anterior abdominal wall.

Aim. To improve the results of surgical treatment of patients with chronic anal fissures in the remote period. Materials and methods. The current work analyzes the results of a clinical study of 112 patients with chronic anal fissures (CAF) in the remote period after the surgery that ranged from 6 months to 4 years. The examination methods included a visual examination, functional examination of the rectal obturator with sphincterometry and manometry, as well as the study of the final products of lipid peroxidation and the state of antioxidant protection of the blood plasma and biopsies of the rectal mucous layer. Results and discussion. Evaluation of the surgical treatment of chronic anal fissures was based on the long-term results of two groups of patients: the main group - 64 patients and the control group - 48 patients. Positive treatment results were managed to achieve in 58 (91%) out of 64 cases of patients with chronic anal fissures in the main group. Satisfactory treatment results were achieved in 4 (6.2%) patients, unsatisfactory results were observed in 2 (3.1%) patients with severe chronic anal fissures, after 6 months. Following results were observed in the control group: good results - 37 (77.0%) cases; satisfactory results - 6 (12.5%) cases; unsatisfactory results - 5 (10.5%) cases. Conclusion. The use of differentiated surgical approach, taking into account the severity of the chronic anal fissures, lipid peroxidation and antioxidant protection, significantly improved the long-term results of surgical treatment of chronic anal fissure in 91% of cases and significantly reduced the recurrence rate of the disease to 7.5% in comparison to patients of the control group.

Aim. To assess the state of lipid peroxidation and antioxidant protection in patients with coronary heart disease (CHD) living in various high-altitude regions of Tajikistan. Material and methods. All 430 examined patients with CHD were residents of mountain regions of various altitudes. Based on altitude patients were divided into following groups: low mountains - 150 patients (Dushanbe, 860 m a.s.l.), mid mountains - 140 patients (Khorog, 2200 m a.s.l.) and high mountains - 140 patients (Murgab, 3600 -5600 m a.s.l.). The control group comprised 25 healthy people, the age of 55-65, living at an appropriate altitude.Results and discussion. More explicit and progressive changes in the primary part of the oxidation process are found among patients of high altitude mountain regions that can be described as a progressive increase of oxidative stress. It is confirmed by the excess of primary products of lipid peroxidation (LP) by 3 times (0.317-0.02 units), in comparison to the control group indicators. Conclusion. Patients with CHD living in low altitudes had prevailing lipid peroxidation processes over antiradical protection factors; inhabitants of mid altitudes had stabilization of the antioxidant system processes. More clear changes were observed among residents of high mountain regions with coronary heart disease. The peroxidation indicators showed prevalence of the formation of toxic products (p<0.001) over the factors contributing to their inactivation and formation of antiradical protection (catalase activity).

Aim. To improve the results of surgical treatment of echinococcosis of the organs of the abdominal cavity using minimally invasive technology. Material and methods. 135 patients with the echinococcosis of the organs of the abdominal cavity at the age of 18-72 years received surgery at МSP SUE TALKO, MDC “Varorud” andMDC Avicenna Tajik State Medical University. The number of women prevailed - 78 (57,8%), men - 57 (42,2%). The main group included 85 (63%) patients, and the control group - 50 patients. The diagnosis was based on a general clinical and biochemical blood and urine tests, Ultrasound examination, thorax X-my, ECG, МЯТ, and КТ. Results and discussion. During laparoscopic echinococcectomy, the introduction points were chosen individually and the number and diameter of trocars depending on the circumstances. Use of the five-petal retractor and vacuum-aspirator with replaceable five- and ten-millimeter header in addition to traditional tooling facilitates the course of operation, and intraoperative compliance with aparasitic and antiparasitic principles decreases the frequency of purulent postoperative inflammatory complications. Conclusion. Laparoscopic echinococcectomy as a minimally invasive method of surgical treatment of patients with echinococcosis of the organs of the abdominal cavity is a method of the choice with a minimum frequency of purulent inflammatory postoperative complications that facilitates the improvement of life quality of these patients and positive outcome of the surgery.

Aim. To conduct optimization of the approach in the treatment of patients with the failed back syndrome in the lumbosacral part of the spine. Materials and methods. 60 patients previously operated for degenerative dystrophic lesions of the lumbosacral part of the spine were studied. Among them 48 (80.0%) patients had previously been operated for disc herniation: L4-L5 level - 24 (50%) patients; L3-L4 level - 6 (12.5%) patients; L5-S1 level - 17 (35.4%) patients; S1 (2.1%) patient with spinal canal stenosis. Results and discussion. The regress of sensitive disorders among 48 reoperated patients was not observed. According to the Japanese Orthopedic Association (JOA) scoring system in the group of patients with failed back surgery syndrome, excellent results were observed in 29 cases, good results in 17 cases, satisfactory results in 8 cases and bad results in 6 cases. Conclusion. Conclusion. The approach in the treatment of the failed back surgery syndrome should be based on the assessment of the balance of power vectors at the systemic, organ, and segmental levels, taking into account the syndrome complex of compression, instability, and structural failure.

Aim. To analyze the condition of the cervix of women in reproductive age with concomitant gynecological pathology. Materials and methods. The work focuses on 106 women of active reproductive age (from 19 to 35 years) and 290 women of late reproductive age (from 36 to 45 years). All women underwent bacteriological examination, PCR of the smear and colpo-cytological examinations. Results and discussion. The article analyzes the condition of the cervix of women in active and late reproductive age (396 women) and its possible connection to concomitant gynecological pathology. Diseases such as old cervical rupture and cervicitis are more common in women of late reproductive age (23.4% and 37.6% respectively) than in patients in active childbearing age (11.3% and 21.7%, respectively). A comparative analysis of concomitant gynecological diseases showed that the frequency of chronic metroendometritis and ovarian cysts is 1.2-1.4 times higher in women of active reproductive age. Conclusions: The results of the study proved the need for the use of antibiotics and antiviral agents in the treatment of cervical uterus pathology, taking into account identified pathogen and its medicine sensitivity, stimulating specific resistance of the body.

Aim. To study the frequency and structure of risk factors of type 2 diabetes mellitus among people of reproductive age, diabetes, and pre-diabetes morbidity. Material and methods. Method of continuous observation allowed monitoring the population of the reproductive age with active reproductive function in the Russian Federation. Results and discussion. Multi-year observation revealed that the population of reproductive age in modern conditions has a high frequency of type 2 diabetes mellitus with an increasing tendency over the past five years (2013-2017) accompanied by a high level of risk factors in this population. The rate of mostly modified risk factors is quite high (85.0%). Conclusion. It was found that the population of reproductive age with an active reproductive function had a high frequency of type 2 diabetes mellitus, pre-diabetes and a high number of people at risk with an increasing tendency, according to long-term dynamics. With the risk of diabetes mellitus more frequent manifestation ofperinatal risks was observed. This makes necessary the analysis and design of institutional-organizational events improving the premorbid prevention of this pathology.

Aim. To evaluate the effectiveness of the use of auto- and homo-cartilages of the nasal septum in reconstructive operations on the nose and fixation methods in a case of deformation of the nose and nasal septum. Material and methods. In 3 years, 1987 patients were hospitalized in the ENT department for reconstructive operations of the external nose and nasal septum. All patients during the hospital stay underwent general clinical, otorhinolaryngological, radiological examinations, and photo documentation of the organ. Results and discussion. Among observed patients 23 (1,2%) had a deformation of the external nose, 98 (4,9%) patients had combined deformation of the external nose and nasal septum. All patients received rhinoplasty and rhino-septoplasty respectively. Conclusion. Positive long-term functional and cosmetic results of reconstructive surgeries with the application of auto- and homo-cartilage grafts of the nasal septum allows recommending this available material in rhinoplasty. Strong fixation of the graft with plastic splints and gypsum joints helps to achieve better cosmetic and functional results.

Aim. To assess indicators of nutrition status of children with type 1 diabetes. Materials and methods. The research included 32 children with a diagnosis of type 1 diabetes at the age of 2-7 years. To analyze the nutrition frequency special questionnaire was used. It allowed assessing the frequency of consuming a product during a certain amount of time, the calorie content of the product, chemical composition of a daily diet, taking into account loss on clearance and loss of components during preparation. The results of received data were compared to norms of physiological needs in nutritious substances and energy for children according to WHO. Results and discussion. Average intake of fats by children of 2-3 years old - 74,0 g/d, which is higher than normal value by 60%; 3-5 years old children received 118,64 g/ that was higher by 89,35%; children of 6-7years old received 126,48 g/d, where increase of the value was by 92,4% mainly through cholesterol and saturated fatty acids. Conclusion. The results of the research show that it is important to correct the diet and include deficient macro and micronutrients and mineral complexes (Vitamin A, B9, D).

Aim. To study the functional condition of the detoxication function of lungs in patients with terminal stages of chronic kidney disease, complicated by congestive heart failure. Materials and methods. The work conducts a prospect analysis of 100 patients treated during the years 2012 -2018, with the terminal stage of chronic kidney disease, complicated by congestive heart failure. Chronic kidney disease was classified according to NKF-K/DOQI (2003) and congestive heart failure according to the criteria of the European Cardiologists Society (ECS). Three main groups were formed out of 100 patients with terminal stage of chronic kidney disease, complicated by congestive heart failure: 1 group - 19 patients; 2 group - 54 patients; 3 group - 27 patients. They were compared with the control group of 30 healthy volunteers. Results and discussion. The syndrome of endogenic intoxication of various severity stages that brings to polysystem failure was the reason for the worsening of the condition of patients with terminal stages of chronic kidney disease and the development of organ complications and an increase in the mortality rate. The basis of the syndrome of endogenic intoxication in patients with terminal stage of the chronic kidney disease complicated by congestive heart failure is a composition of toxic substances of various molecular mass and chemical structure in the circulatory systems: oligopeptides of low, average and high mass. Conclusion. 19,0% of patients with terminal stage of chronic kidney disease complicated by congestive heart failure with an ejection fraction of more than 50% had a syndrome of endogenic intoxication in 1, 2 stages and detoxication function of lungs in a stage of compensation. 54,0% of patients with an ejection fraction of the left ventricle of 40% -50% had a 2nd stage of the syndrome of endogenic intoxication and sub-compensation stage of the detoxication function of lungs. 27,0% of patients with an ejection fraction of left ventricle less than 40% had a functionally compensated stage of the syndrome of endogenic intoxication.

Aim. To study and raise awareness of the medical staff about the legal basis of the public health and offenses for drawing up untrue documents. Materials and methods. Current work analyzes the normative and legal documents in the field of social protection, including health care, adopted in the years of independence. Research methods included analytic, expert and special juridical. Results and discussion. The research analyzes modern legislative progress that manages the relationship between medical staff and patients in the post-Soviet period and focuses on the potential and inevitability of drawing up various false medical documents by officials. It indicates motives including vested and anti-social incentives that are subjected to administrative or criminal liability. Conclusion. Service offenses in healthcare, including forgery, are happening due to the low level of professionalism of medical staff and general population poverty. There is a need for awareness in the fundamentals of the relevant legislation and other regulations managing the relationship between officials and patients (or their representatives), in a case of connivance, lack of control and impunity of the responsible people for the majority of forgery.

This scientific literature review attempts to analyze the main directions of the current study of issues related to the development of the atherosclerotic process as a component of coronary heart disease, the clinical manifestation of which is the ischemic heart disease. The acceleration of these processes is directly associated with impaired adaptation of the body to negative environmental factors such as high-altitude hypoxic state, high level of ultraviolet radiation of the skin, the gas composition of the atmospheric air, as well as sharp changes of environment temperature, which exacerbate the process of atherosclerosis.

The article presents an analytical review of current scientific literature assessing the burden of chronic noncommunicable diseases, taking into account global trends in the light of studying the prevalence of cancer diseases and risk factors of their development. The analysis confirms that cancer is a serious threat to public health around the world, and its incidence rates in the first decades of the XXI increased in most countries. This trend represents a particular threat to the health systems of developing countries, which are poorly equipped to treat complex and expensive cancerous diseases. Proper allocation of resources for cancer prevention, early diagnosis, and treatment and palliative care requires detailed knowledge of the burden of cancer that depends on the ethnocultural characteristics of the population, which should be considered evaluating factors of the cancer development and planning the treatment. Meanwhile, the results of various studies show that progress in the fight against cancer is achievable. However, the main results also indicate an unmet need for cancer prevention, including smoking control, vaccination, promotion of physical activity and healthy nutrition.