Purpose of the study. Comprehensive assessment of the health status of children of early and preschool age in Dushanbe.

Results and its discussion. Indicators of physical development within the age norm were revealed only in half of the examined children - 50.6%. The rest of the children had deviations in physical development and in most cases towards low indicators - 34.5%. Neuropsychic development corresponding to age had at an early age - 78.9%, in preschool - 87.6% of children, developmental delay was diagnosed in 12.4% of cases. The dominant pathology at an early age in children was the pathology of the respiratory system (36.3%), and in the preschool period - the pathology of the digestive system (47.8%). The results of a comprehensive assessment of the health status revealed the I health group in 19.4% of children, II - 66.1%, III - 11.3% and IV health group in 3.2% of children.

Conclusions. It is necessary to carry out dynamic preventive medical examinations with the involvement of narrow specialists, in order to carry out individual correction of both primary and concomitant pathology, even before admission and during the period of the child's stay in a preschool institution.

Aim. To optimize the treatment of patients with CGP with the sulfide mud application.

Material and methods. The study included 64 patients with CGP aged 20 to 60 years. The average age of patients was 38,9±0,16 where 47.6% were women and 52.4% men. All the patients were practically healthy. To assess the effectiveness of the therapeutic mud, all patients were randomized to the main (1) and comparison groups (2). The comparison group consisted of 15 patients with CGP, who received standard treatment with professional oral hygiene (applications, rinsing with a 0.05% solution of chlorhexidine digluconate).

Results and discussion. The results show that the complex treatment of a severe form of CGP using a course of applications and electrophoresis with silt sulfide mud of the “Kayakent” sanatorium contributes to a more persistent and long-lasting anti-inflammatory effect on the gum tissues, which exceeds the standard treatment in most indicators.

Conclusion. The inclusion of a 10-day course of peloid therapy in the complex treatment of CGP in the form of applications and electrophoresis with silt sulfide mud of the Kayakent sanatorium contributes to the earlier and more pronounced relief of parodont tissues inflammation than in the comparison group.

Aim: A comparative study of the results of treatment of acute postoperative pain after abdominal interventions based on epidural analgesia.

Materials and methods: 96 patients (mean age 42.13 ± 2.1 years) who underwent surgery on the abdominal organs who were in the early postoperative period under treatment in the intensive care unit of the National Medical Center of the Republic of Tatarstan for the period 2014-2018 were examined.

Results and its discussions. A criterion for the effectiveness of postoperative analgesia is considered to be a decrease in the intensity of the pain syndrome of more than 3 points out of 10. At the initial assessment of the strength of the pain according to YOUR after extubation at rest and during coughing, no significant intergroup differences were revealed.

Conclusion: The method of epidural analgesia allows you to quickly form and maintain adequate analgesia at the required level compared to traditional methods of epidural analgesia and helps to reduce the risk of opioids due to side effects (excessive sedation, skin itching and dyspeptic symptoms) compared with infusion and bolus peridural analgesia.

Aim. To improve the results of diagnosis and surgical treatment of abdominal forms of tuberculosis using video laparoscopy.

Material and methods. The work is based on the analysis of the results of the diagnosis and treatment of 106 patients who were on treatment for AT. Patients were divided into two groups. The first group included 60 (56.6%) patients who underwent laparoscopic interventions, the second group - 46 (43.4%) patients treated with traditional open interventions. There were 48 men (45.3%), and 58 women (54.7%). The diagnosis of abdominal tuberculosis is based on the analysis of complaints, anamnesis, objective examination, laboratory, and instrumental methods of examination.

Results and discussion. According to clinical and morphological criteria, the most common form was the exudative form 30 (28,3%). The exudative adhesive form was confirmed in 25(23,6%) of cases with video laparoscopy, and in 28 (26,4%) cases with laparotomy. The caseous-ulcerative form was detected in 6 patients of the main group and in 3 patients of the control group. Postoperative complications were noted in 3 (5.0%) patients of the main group, in 6 (13.0%) patients of the control group.

Conclusions. Video-laparoscopy in emergencies can reduce the time to establish a final diagnosis by 60%, and reduce the number of adverse outcomes in patients with AT by 45%.

Aim. To assess the clinical and immunological effectiveness of immunomodulating drugs in the treatment of pertussis.

Material and methods. 144 children with a diagnosis of pertussis were observed from birth till the age of 17. Patients were divided into 4 group depending on the method of therapy received. The first group of patients received only basic therapy, the remaining groups in addition to basic therapy received targeted immunomodulators.

Results and its discussion. The comparative assessment of the frequency of the main symptoms of pertussis in the group of patients on immunotherapy, a positive dynamic was found compared with the group of children on basic therapy. In the period of the disease before treatment, the indicators of cellular and humoral immunity in patients of all groups did not significantly differ. In the period of convalescence in all groups of patients receiving immunomodulators, indicators of the cellular and humoral immunity tended to increase with the exception of IgG, which was high in all group.

Conclusion. The use of immunotropic drugs in the treatment of pertussis in children made it possible to achieve an earlier normalization of the main clinical manifestation of pertussis, impaired immunoregulatory mechanisms and cytokine regulation in childre.

Aim. To develop objective predictive risk factors for the development of anal sphincter pectenosis in patients with severe forms of rectal fistulas to improve the long-term results of surgical treatment. Material and methods. We have conducted a retrospective analysis and a prospective study of 170 patients with rectal fistulas. The study groups were formed according to the nature of the course of the postoperative period: the first group consisted of patients with severe rectal fistulas with the development of pectenosis of the anal sphincter (83). The second included patients with a smooth course of the postoperative period (87). Results and discussion. It was found that 23.6% of patients with severe rectal fistulas complicated by pectenosis of the anal sphincter developed various degrees of anal sphincter insufficiency. An objective prognostic risk factor for the development of the pectenosis of the anal sphincter in patients with severe rectal fistulas is the form of the disease (anaerobic clostridial, non-clostridial and recurrent); localization (posterior rectal wall); type of infection caused by acute paraproctitis (anaerobic clostridial and non-clostridial). Conclusion. Objective criteria for the prognosis of the development of anal sphincter insufficiency in patients with severe rectal fistulas complicated by anal sphincter pectenosis are the severity index of anal sphincter pectenosis and the degree of rectal fistula dysfunction.

Aim. To conduct an assessment of the influence of various factors on the development of recurrence of ventral hernias.

Material and methods. We have analyzed the results of the treatment of 64 patients with ventral hernias. All patients were divided into two clinical groups: group I included 28 patients who underwent mesh transplant; group II included 36 patients who underwent surgery, with the anterior wall strengthened with local tissues.

Research and discussion. Studying the medical history of patients, it was found that in both clinical groups, the mistakes were often made in the selection of indications for using the hernia gate repair method. In the II clinical group (the hernia gate repair group with their tissues), the main reason for the development of relapses was an inadequate examination of the local tissue properties in the intraoperative period.

Conclusion The obtained data show the importance of individualizing the choice of hernia gate repair method for the treatment of relapses, and even in the initial treatment. The stereotyped use of one technique, whether it is a hernia gate surgery using local tissues or a mesh implant, entails the development of relapses and adverse events in this group of patients.

Aim. To study the efficacy of SEPS in the treatment of chronic venous insufficiency (CVI) of the lower limbs.

Material and methods. 27 patients with CVI of the lower extremities due to varicose veins and post-thrombotic disease at the Republican Scientific Center for Cardiovascular Surgery from 2003 till present participated in the study. There were 17 men and 10 women. The average age of patients was 39 years.

Results and discussion. After the surgery, according to Linton-Felder, the frequency of such complications like purulent necrotic complications of wounds (up to 20% of cases), hematomas, lymphorrhea increases. It le to prolonged stay of patients in the hospital worsened their general condition. However, applying the method of endoscopic dissection of perforating veins in CVI, the following was achieved: complete surgical elimination of the pathological veno-venous reflux, with significantly minor trauma of the surrounding tissues. It improved the quality of patients’ life and had a good cosmetic effect.

Conclusion. Endoscopic dissection of perforating veins, both in case of varicose veins and post-thrombotic disease, eliminated the CVI. The benefits like the prevention of the main link of the disease pathogenesis, low invasiveness, good cosmetic effect, minimal risk of postoperative purulent-necrotic complications, a significant economic effect due to the reduction of patients’ rehabilitation period, are the main advantages of this method.

Aim. To improve the results of treatment of patients with severe forms of generalized peritonitis by optimization of surgical tactics.

Materials and methods. The results of the treatment of 266 patients with severe forms of generalized peritonitis, which were divided into two groups, were analyzed. The 1st group consisted of 140 (61.9%) patients with generalized peritonitis in the stage of abdominal sepsis. The 2nd group included 86 (38.1%) patients in the stage of septic shock. Patients of both groups underwent relaparotomy (on-demand or programmed).

Results and discussion. The mortality of patient that underwent “relaparotomy on-demand” was 40.5%. For patients who underwent “programmed relaparotomy,” it was 62.5%. For patients in the group of relaparotomy on-demand with severe generalized peritonitis in a stage of the septic shock, the mortality was 69.2% versus 58.8% for patients in the group of programmed relaparotomy.

Conclusion. In the stage of abdominal sepsis, relaparotomy on demand is a method of choice. For severe patients with generalized peritonitis in the stage of septic shock, the use of a programmed relaparotomy approach with repeated abdominal sanitation is indicated.

Aim. To study the prevalence of some parasitic diseases (ascariasis, enterobiasis, and giardiasis) among the population of the Republic of Tajikistan according to the official statistical data.

Material and methods. A retrospective analysis of the annual reports of regional and Republican centers of state sanitary and epidemiological surveillance for the period 2015-2019 on the prevalence of parasitic diseases was carried out. The prevalence of ascariasis, enterobiasis, and giardiasis among the population of Sughd, Khatlon, GornoBadakhshan regions, Regions of Republican Subordination, and the city of Dushanbe was studied.

Results and discussion. An analysis of the annual official reports on the population morbidity in regions and the Republic of Tajikistan as a whole for the period of 2015-2019 showed a high incidence rate in the Khatlon region, Regions of Republican Subordination, in the dynamics of the studied years, these indicators are significant decrease. In the Sughd region, there is a clear decrease in the incidence of ascariasis while incidence rates of enterobiasis and giardiasis are stable. In Dushanbe, the incidence of parasitic diseases is relatively low.

Aim. To assess the clinical-immunological effectiveness of Lycopid medicine in the treatment of scarlet fever in children.

Material and methods. 78 patients with moderate and severe forms of scarlet fever aged 2 to 14 years were under the observation. Depending on the nature of the therapy, children have divided into two groups: the main-group, in addition to the basic-therapy, received the immunomodulator Lycopid, and the control group received only the basic-therapy.

Results and discussion. The results of clinical studies have shown that the inclusion of Lcopid to the complex therapy of patients of the main-group, accelerated the clinical recovery. There was a significant reduction of intoxication symptoms duration and a local inflammatory process in the throat of the main-group patients compared to the control group (p <0.001). Also, the use of an immunomodulator in the complex therapy of scarlet fever significantly faster led to the normalization of cellular and humoral immunity indicators in patients of the main-group.

Conclusion. The clinical and immunological efficacy of the use of the Lycopid immunomodulator in the treatment of patients with scarlet fever has been established. It indicates the feasibility of using the drug in the treatment of scarlet fever in children.

Aim. To improve the methods of combined anti-relapse treatment of laryngeal papillomatosis in children.

Materials and methods. A comparative analysis of the results treatment of 42 patients with laryngeal papillomatosis with the use of combined anti-relapse treatment with Laferobion, Immunomax, and bio supplements containing calcium and zinc and a traditional therapy was carried out.

Results. The clinical effectiveness of the treatment was evaluated by improved voice function and reduction of the relapse number. In patients of group-I, relapses were observed in 5% of patients after a year. Almost 50% of patients got back the normal state of T and B-cells and significantly improved local immunity. In patients of group-II, relapses were observed in 18.2% of cases, almost four times more. They had to be hospitalized again and get repeated courses of combined surgical and complex conservative treatment.

Conclusion. The proposed method of the combined anti-relapse treatment of laryngeal papillomatosis in children fulfills the deficiency of the immune state of the patient’s organism, prolongs the recurrence periods, and most importantly, is a pathogenetically justified method. It allows recommending its implementation in clinical practice.

Aim: Clinical comparison of nutritional therapy for the rehabilitation of severely malnourished children.

Materials and methods. We have analyzed the results of examination and treatment of 58 children with severe malnutrition. The criterion for inclusion was children from 6 to 59 months with severe malnutrition, standardized score (Z-SCORE) Z≤3 and those in the stage of rehabilitation of standard treatment of children with TNP.

Research results. Every two days, all the examined children were weighed, the edema was assessed and examined (more often if the child made a specific complaint). Each child in both groups was selected on the 6th day of the rehabilitation phase to measure energy consumption. Energy intake was calculated based on the amount eaten by the child at each meal. Recovery was assessed by weight.

Conclusions. The high energy intake received in the mixed-fed infants results in an average weight gain compared to that obtained with F100 alone in the first group (which themselves exceed the minimum weight gain expected in this phase of treatment).

The article provides a review of modern literature in order to study the issues of etiology, risk factors, prevention, detection and modern treatment of congenital malformations.

Studies have shown that the main preventive measures to reduce the birth of children with developmental defects and improve the health status of pregnant women should be aimed at improving diagnostic technologies and solving medical and social problems of pregnant women.