Aim. To improve the results of treatment of patients with acute calculous cholecystitis Material and methods. The results of the diagnosis and treatment of 90 patients with AOC were analyzed. The main group (the 1st group) included 38 patients who received a two-stage treatment approach with laser therapy. The control group (2nd group) included 52 patients for whom the treatment concept comprised only laparoscopic cholecystectomy. Results and discussion. The complications of AOC before the operation included 9 (23.7%) cases of peri-vesical infiltration in the first group and 11 (26.2%) cases in the second group. Gallbladder empyema made 2 (5.3%) cases in the first group, and 4 (9.5%) cases - in the second group. Most of the patients of the second group patients were operated in 72 hours from the moment of obstruction, while the first group patients received the improved two-step approach in 72 hours from the moment of obstruction. In the postoperative period, local complications were observed more often in the second group. Conclusion. The comprehensive diagnostic approach induces correct and timely diagnosis and makes possible the start of adequate therapy. In the case of the gallbladder obturation, after 72 hours improved two-stage tactic is preferable.

Aim. To evaluate the effectiveness of the implementation of the Fast Track program in the surgical treatment of cholelithiasis in patients with concomitant valvular and coronary defects. Material and methods. The work is based on the results of the surgical treatment of 21 patients with cholelithiasis with concomitant valvular and coronary defects for the period of2015-2019. The comprehensive preoperative examination included ultrasound examination, electrocardiography, echocardiography, examination of the respiratory functions, chest x-ray, esophagogastroduodenoscopy, CT, MRI (individually), and laboratory research examination. Results. The duration of the surgery averaged 31±10 minutes. There were no cases of intraoperative complications and conversions. The average hospital stay of patients made 2.2±0.8 days. No complications were noted in the early postoperative period. There were no fatal outcomes. Conclusion. The use of the program for accelerated patient rehabilitation - Fast track in patients with cholelithiasis with concomitant valvular and coronary malformations can significantly reduce the length of hospital stay and restore patients to work more quickly without reducing the effectiveness of treatment.

Aim. To study the results of diagnostics and treatment of children with hiatal hernia. Materials and methods. The analysis of the results of diagnostics and treatment of 41 patients at the department of surgery of the Scientific Center of Pediatrics and Pediatric Surgery for the period of2002-2019 was performed. The asymptomatic (accidentally detected) form was found in 2 (5%) children, para-esophageal hernia in 8 (20%) cases, and the sliding hernia was observed in 24 (58%) patients with symptoms of cardia failure. Secondary hernias against the background of gastrointestinal diseases were observed in 7 (17%) cases of which 5 children had gastroduodenitis and 2 patients had stomach ulcers as a background disease. Results and discussion. 26 (67%) patients received anti-reflux surgery by the Nissen method, and 13 (33%) patients received valvular gastroplication by the Thall method. The surgery resulted in the resolution of symptoms in all cases. Conclusion. The use of a set of instrumental diagnostic methods and comparative analysis of the data obtained allows/ identifying clinical variants of hiatal hernia, assess the functional state of the digestive tract, which is fundamentally important in the choice of pathogenetically based treatment, including surgical.

Aim. To optimize the approaches to the diagnostics of pathological insulin resistance and associated complications. Materials and methods. Clinical analysis of the pregnancy course and outcomes of 85 patients in various terms of gestation was carried out. Patients were divided into two groups. The test group included 61 patients with risk factors of metabolic disorders during this pregnancy. The comparison group included 24 healthy people without metabolic disorders risk factors. Results and discussion. The index of insulin resistance (HOMA-IR) was measured in various terms. With an increase of the gestation time, the insulin resistance index tended to increase by 2.436±0.96 on 36-38 weeks. It exceeded the value of this index in a standard condition out the pregnancy. In the test group, the index values are 20% more than the standard index values of insulin resistance. Conclusion: Insulin resistance influences pregnancy negatively, causing complications like threatening miscarriage, preeclampsia, chronic placental insufficiency.

Aim. To study the state of general and local immune reactivity in male patients with non-gonococcal urethritis. Materials and methods. 90 men aged 20 to 50 with non-gonococcal urethritis were examined. The test group included 67 patients while the control group included 23 healthy men. The average age of patients in the test group was 27,2+1,7 years and 28, 6 ± 1.6 years in the control group. The diagnosis of non-gonococcal urethritis based on the anamnesis, clinical picture of the disease, and laboratory methods of study. Verification of the non-gonococcal urethritis diagnosis was carried out by direct immunofluorescence methods, polymerase chain reaction, and immune-enzyme methods. Results and discussion. Studies have shown that patients had a decrease in absolute and relative T-lymphocyte values and an increase in relative and absolute B-lymphocyte values. Despite the increased numbers of B-lymphocytes, a significant decline of IgA IgM, and a tendency to decrease of IgG was observed. It was found that in 60.0% ofpatients an increase in Circulating immune complexes, and a decrease in phagocytosis in 50.7% cases and phagocytic activity in 53.7% cases. There was an increase in the number of TNF-a andIL-1f in 61.2% and 56.7% cases respectively, and a decrease in the number of IL-10 in 44.7% of cases. Conclusion. A decrease in the relative and absolute values of T-lymphocyte and an increase in the absolute and relative values of B-lymphocyte were revealed by immunological studies. The analysis showed a significant decrease in IgA and IgM and a tendency to decrease of IgG. A significant decline in phagocytosis was found.

Aim. To study and conduct the clinical and echocardiographic examinations of the left ventricle in patients with rheumatoid arthritis depending on the activity of the inflammatory process. Material and methods. Examination of 95 patients with confirmed diagnoses of rheumatoid arthritis according to the criteria of the American colleague of Rheumatology were observed in the rheumatology department of the SI State Medical Center №2 in the city of Dushanbe. Patients aged 18 to 68 years (average age 46±3,4). Among the examined patients, there were 84 (81,5%) women and 19 (18,5%) men, the average duration of rheumatoid arthritis was 8,2±1,6 years. Echocardiography was performed for all examined patients, and the level of inflammatory activity was calculated using the DAS-28 index. Results and discussion. The results of the study showed that patients from the second group of activity had a significant increase in the end-diastolic dimension of the left ventricle and sphericity index along with a decrease in left ventricular ejection fraction and integral systolic remodeling index in comparison to the control group. Low numbers of integral systolic remodeling index, that reflects the relation of left ventricle systolic function with geometric features were observed in patients of a second group with rheumatoid arthritis. Conclusion: Thus, the most pronounced changes in intracardiac hemodynamics are observed in patients with rheumatoid arthritis with the second level of activity.

Aim. To improve the results of surgery ofpatients with combined cicatricial and ulcerative duodenal-stenosis with the ulcer penetration. Materials and methods. The results of the examination and surgical treatment of 182 patients with cicatricial and ulcerative duodenal-stenosis with the ulcer penetration were analyzed. Patients were divided into three groups: the first group of 90 patients included patients that received selective proximal vagotomy in combination with duodenoplasty; the second group of 60 patients included patients that received selective proximal vagotomy in combination with drainage surgeries like cross-gastroduodenal-anastomosis (52), gastroduodenal-anastomosis according to Jaboulay (2), pyloroplasty according to Finney (6); the third group included 32 patients that received duodenoplasty or drainage operations without selective proximal vagotomy. Results and discussion. It was found, that ulcer penetration is an immanent feature of cicatricial and ulcerative duodenal-stenosis that manifests in three morphological forms: ulcerative-infiltrative, cicatricial-ulcerative, cicatricial. Selective proximal vagotomy was conducted considering the indicators of secretory and motor evacuatory functions of the stomach, duodenoplasty variants, and drainage operations. Conclusion. The choice of the duodenoplasty and drainage operation depends on topographical-anatomical features of the duodenal-stenosis and morphological form of the ulcer penetration.

Aim. To improve the results of surgery of complicated forms of liver echinococcosis using minimally invasive technologies and considering indicators of endogenic intoxication. Material and methods. The work presents the results of the surgical treatment of 80 patients with liver echinococcosis and its complications. 30 (37,5%) patients had a suppurative cyst, and another 30 (37,5%) patients had mechanical jaundice of parasitic origin. The severity of the endogenic intoxication was assessed by the fluorescent method of the albumin examination. Effective albumin concentration, general albumin concentration, reserve albumin binding capacity, toxicity index, indicators of the level of lipid peroxidation products, and C-reactive protein were studied. Results and discussion. The main method of liver echinococcosis diagnosis was an ultrasound examination that allowed to establish the diagnosis in 92,4% cases. The group of patients with complicated forms of liver echinococcosis showed higher indicators of CD, MDA, and MSM than in patients without complications. Patients with complicated forms of liver echinococcosis received two-staged surgery with minimally invasive approaches along with detoxification therapy, antioxidant therapy, and antihypoxic therapy. Conclusions. The conduction of primary minimally invasive operations, detoxification, and strengthening therapy allowed improving the general state of patients and provide surgery in more favorable conditions for patients.

Aim. To study features of clinical picture and treatment of intestinal and non-intestinal manifestation of giardiasis in children. Materials and methods. The diagnosis of 98 patients with giardiasis was confirmed based on clinical picture and findings of vegetative forms and cysts of giardia in the stool. Results and discussion. Most of the giardiasis cases were found among children of older age - 57 (58,1%) and relatively less in children under the age of 7 - 41 (58,1%). In 42 (42,8%) cases patients had intestinal manifestations like gastroenteritis, while in 30 (30,6%) cases children were diagnosed with duodenitis. The non-intestinal appearances of giardiasis were characteristic of older children - 55 (56,1%). 24 (24,5%) children had skin allergic manifestation, and 11 (11,2%) patients had severe asthma in the form of dry cough with the obstructive syndrome. Conclusion. 1. Children under the age of 3 had an acute form of giardiasis with dominating intestinal manifestation, intoxication symptoms, duodenitis, allergic manifestations, and enteritis with severe dehydration. 2. Non-intestinal manifestations of giardiasis were often noted in children of older age as darkening of the skin of the neck, thinning and poor hairs and nails growth, dry lips, and angular cheilitis

Aim. To analyze the effect of polymorphisms rs1800012 and rs1107946 of the gene COL1A1, rs1800255 of the gene COL3A1 on the development of pelvic organ prolapse. Materials and methods. This paper describes the relationship of polymorphisms of the collagen genes COL1A1 and COL3A1 and pelvic organ prolapse in women. In 2018 we analyzed 268 women who were residents of the city of Belgorod and the Belgorod region, which were divided into 2 groups. The study was carried out by the genotyping of blood samples. Genotyping of polymorphic variants rs1800012 (1245G> T) and rs1107946 (C> A) of the COL1A1 gene and SNP rs1800255 of the COL3A1 gene was performed using real-time PCR. Results. The frequencies of minor alleles of the COL1A1 and COL3A1 genes in the population of the Belgorod region were comparable with those among European populations. A statistically significant association of SNP rs1800255 of the COL3A1 gene was identified with a reduced risk of pelvic organ prolapse. A SNP rs1800255 minor allele was more common among healthy women than among women with pelvic organ prolapse. Conclusion. In our study, a high association of rs1800255 polymorphism of the COL3A1 gene and pelvic organ prolapse in women of the Belgorod region was confirmed. At the same time, no connection between the rs1800012 and rs1107946 polymorphisms of the COL1A1 gene and genital prolapse was detected.

Aim. To study features of the course of pneumonia in children of early age with congenital heart defects. Material and methods. 47 children under the age of 3 with congenital heart defects, which were under the treatment in the pediatric cardio-rheumatologic department of the National Medical Center of Tajikistan participated in the study. Results and discussion. Hypervolemia in the pulmonary circulation in children with congenital heart defects brings to a prolonged course of pneumonia with frequent complications. Regress of clinical symptoms was noted in average by the end of the second and beginning of the third week of hospitalization. Conclusion. Features of the clinical picture of pneumonia in children with congenital heart defects are severe course and acute onset of various complications. To avoid complications, children with congenital heart defects should be hospitalized with the manifestation of clinical symptoms of respiratory tract disorder.

Aim. To determine the frequency, clinical-anatomical features, and diagnosis of recto-urethral fistulas in boys. Materials and methods. 246 boys with various forms of ARM participated in the study. 51 (20.7%) patients had recto-urethral fistulas (recto-prostatic - 29, recto-bulbar - 22), 1 (0.4%) patient had recto-bulbar fistula with a normally formed anus. General clinical, x-ray, and other special examination methods were conducted. Research and discussion. In some patients, the fistula remains undetermined before and during the operation. A comprehensive examination allows not only identifying the fistula but also to clarify its anatomical type, localization, get an idea of changes in the urethra, distal intestines, and determine the nature of the associated pathology. Conclusion. The data indicate that in most cases, the examination of newborns with ARM allows us to establish the type of anomaly and decide on a tactical approach that correlates with those presented in the literature. An exception is a recto-urethral fistula, which is difficult not only at the stage of diagnosis but also during surgery.

The observation focuses on topical issues of chronic noncommunicable diseases epidemiology and Irisk factors. The literature review shows yearly growth of chronic noncommunicable diseases and their risk factors as a result of low physical activity of the population, excessive tobacco and alcohol use, and consumption of food rich in carbohydrates and fats. Despite some prominent preventive measures, cardio-vascular diseases, diabetes, chronic respiratory diseases, and kidney diseases keep taking leading causes of disability and lethality of the populations in low and middle-income countries. High frequency and spread of chronic noncommunicable diseases require regular preventive measures that include screening, treatment, and modernization of therapeutic services helping individuals in high-risk groups. Periodical screening of the main risk factors of chronic noncommunicable diseases allows assessing the actual health condition of the population and propagate a healthy lifestyle to mitigate those risk factors.

The article provides an overview of the current literature on the surgical treatment of chronic hemorrhoids. According to published data, the proportion of hemorrhoids among coloproctological patients is 34-41%. Most of the authors find 2-4 degrees of chronic hemorrhoids an indication for surgery. The issue of the most optimal option for surgical intervention remains unresolved to date, and data on the effectiveness of various techniques are often contradictory. Despite the improvements in the field of surgical treatment of the hemorrhoids, the results show a high number of postoperative complications and therefore are not sufficient.

In this observation, the authors describe the correct diagnosis and successful surgical treatment of a child with complicated Meckel’s diverticulum combined with ulcerative proctosigmoiditis. The surgery was performed with the use of a laparoscopy where resection of the intestine was performed with a video- assisted method.