Aim. To assess the methodological quality of non-randomized interventional studies of the outcomes of prevention and surgical treatment of postoperative ventral hernias using a systematic approach.

Material and methods. We searched the indexed literature for non-randomized studies of VН surgery from January 1995 to December 2019. Each prospective study was combined with a corresponding retrospective study using predefined criteria to obtain comparable groups. The assessment of the following components was conducted: the choices of research methods, their rationale, design, inclusion criteria, reported results, and statistical methods

Results and discussion. 50 studies (17,608 patients) were selected: 25 prospective and 25 retrospective. In general, prospective studies showed slightly higher methodological quality scores than retrospective studies, with a mean score of 17 (IQR: 14-18) versus 15 (IQR 12-18). The studied subcategories of prospective studies obtained higher median scores for their “administration”, “design” and “participants”. 18 (36%) studies had a primary outcome, and only 2 studies (4%) described research power. None of the studies mentioned a standardized definition of VH recurrence, while methods for detecting recurrence varied widely. The methodological quality of the study did not depend on the year of publication or the increase in the impact factor of the magazine.

Conclusion. Currently, non-randomized interventional studies of the results of surgical treatment of VH are methodologically ineffective. A clearer analysis of the research results and the establishment of a minimum standardized set of data is necessary.

Aim. To analyze the prevalence of diabetes mellitus in the Republic of Tajikistan.

Material and methods. An analysis of the prevalence of diabetes mellitus among the adult population of the Republic of Tajikistan in the period 2015-2019 according to the annual reports of the State Institution “Center for Statistics under the President of the Republic of Tajikistan” was conducted.

Results and discussion. During the study period, there was a dynamic increase in the prevalence of diabetes mellitus in the country, either by region of residence or in the general population. Thus, in comparison with 2015 (529 cases per 100000 population) in 2019 (627 cases per 100000 population) in the republic, the incidence of diabetes mellitus increased by 98 cases per 100000 population, i.e. by 18.5%.

Conclusion. The findings show that in Tajikistan, during the reviewed period, there has been a significant epidemiological increase in the number of the population suffering from diabetes mellitus. Compared to 2015, the increase in the incidence of diabetes mellitus in 2019 was 18.5%. The lack of a national register suggests the need for its early creation to improve assessment and clinical and epidemiological monitoring of patients with diabetes mellitus. Carrying out an early screening of diabetes mellitus in the adult population, especially in the risk group remains urgent.

Aim. Study of changes in peripheral blood parameters in patients with COVID-19

Materials and methods. The current study uses treatment results of 300 patients with coronavirus infection. It was diagnosed based on laboratory tests, an X-ray, and computed tomography.

Results and discussion. The inflammatory processes in the respiratory tract decrease the supply of oxygen to tissues and organs and cause hypoxia. As a compensatory response, the number of erythrocytes and hemoglobin increases in the bloodstream. A decrease in oxygen saturation of organs and tissues enhances the process of erythropoiesis in the red bone marrow.

Conclusion. In response to the development of hypoxia of organs and tissues, the deposited blood is released into the bloodstream, and erythropoiesis increases. Laboratory study shows that patients have an increase in the count of red blood cells. These changes should be taken into account in the complex treatment of patients.

Aim. To study the indicators of tooth caries intensity growth in patients with congenital cleft lip and palate depending on the mineralizing capacity of mixed saliva.

Material and methods. The level of mineralization potential of mixed saliva was studied in 98 children with congenital cleft lip and palate aged 6 to 16 years using the enamel resistance test and the clinical assessment test for the rate of remineralization of the enamel surface.

Results. Studies have shown a significant increase in the rate of dental caries among patients with congenital cleft lip and palate and the presence of low levels of oral mineralization.

Conclusion. Among the examined cohort of children with low and very low mineralization potential of mixed saliva, the rates of dental caries intensity increase markedly over the entire three-year observation period.

Aim: To evaluate the clinical significance of factors predisposing to the severe form of SARS-CoV-2 virus infection during pregnancy.

Material and methods of study. 240 pregnant women with signs of acute respiratory disease were examined. All pregnant women were subjected to general clinical, obstetrical, and clinical-laboratory methods of examination (general analysis of blood, urine, biochemical blood tests, coagulogram, and PCR diagnostic test to verify SARS-CoV-2). To confirm the diagnosis of “community-acquired pneumonia” chest X-ray in two projections or computed tomography was performed.

Results. Severe forms of coronavirus infection were most frequently diagnosed in the 20–29-year (34.3%) and 30–39-year (51.4%) age groups, in pregnant women who lived in an urban setting (82.9%), in pregnant women with a low level of education (85.7%), in pregnant women with a high index of extragenital pathology (100%), and women in the third trimester of pregnancy (67.7%).

Conclusion. Risk factors for the severe form of SARS-CoV-2 include pregnant women in the age ranges 20-39 years; pregnant women who live in the urban setting; pregnant women with a low level of education; pregnant women with extragenital pathology; third-trimester pregnant women.

Aim. To analyze modern strategies for the prevention of respiratory distress syndrome and the possibility of their use in RT.

Material and methods. The analysis was carried out based on directives of the Government of the Republic of Tajikistan, regulations, and normative documents for obstetric institutions approved by the Ministry of Health and Social Protection of the Population of the Republic of Tajikistan, and the data from annual reports of structural units.

Results. The paper outlines an approach to monitoring a pregnant woman based on the 5th updated European Consensus Guidelines for the Management of Newborns with Respiratory Distress Syndrome. It presents positive and negative arguments for the effect of steroid drugs on the fetus and recommendations for their use at the stage of management of pregnant women with a high risk of preterm birth, depending on the gestation period. It also includes a brief comparative analysis with national clinical protocols for the management of preterm labor and tocolytic therapy.

Conclusion. Early identification of pregnant women at high risk of termination and providing them with effective care following modern strategies, reduce the adverse perinatal outcomes.

Aim. To study ambulatory records of HIV-positive patients and to identify patients suffering from tuberculosis and to assess risk factors for the development of TB.

Materials and methods. To achieve the objective we retrospectively analyzed the outpatient records (form 25/u) of 786 HIV-infected individuals, (509 children (64.8%) and 277 adults (35.2%), who were on the outpatient registry of the Centers for HIV Control and Prevention and evaluated the epidemiologic risk factors for high tuberculosis infection.

Results and discussion. Of the 509 examined children living with HIV (0 to 17 years), tuberculosis was detected in 47 (9.2%) and among 277 adults (18 to 59 years) in 36 (13%). Out of 786 (100%) HIV-infected patients examined, 83 (10.6%) had tuberculosis.

Conclusion. It was found that people living with HIV infection are at risk of developing active TB, especially its drug-resistant forms. The leading risk factor for tuberculosis was family contact with a patient with an active form of tuberculosis secreting MBT.

Aim. To study the immediate and long-term results of the use of non-free flaps in the treatment of patients with the consequences of burns of the upper limb.

Material and methods. The study included 32 patients with the consequences of burns of the upper limb, who were admitted to the Republican Scientific Center of Cardiovascular Surgery in the period from 2003 to 2020. The age of the patients ranged from 4 to 32years, the average value was 19.6 ± 1.9 years.

Results. There were no intraoperative complications. The average volume of blood loss during one operation was 125.6 ± 11.3 ml (determined by squeezing napkins). The average duration of the operation was 128.6 ± 15.7 minutes. There were no complications after transplantation of a non-free inguinal flap. To achieve a more acceptable aesthetic result, a non-free radial flap was used in a period of five to fifteen years after the primary operation.

Conclusion. Thus, the observance of surgical staging depending on the prevalence of one or another lesion component is decided individually and the principles of reconstruction of important anatomical structures shall be strictly followed.

Aim. To review the experience of managing patients with type 2 diabetes mellitus complicated by osteoporotic changes in a region with a high birth rate.

Materials and methods. We observed 110 patients with type 2 diabetes - 55 women with a normal parity, 55 women with a high parity in history. The control group consisted of 55 women of the same age who did not suffer from type 2 diabetes. The parameters of lipid, phosphorus-calcium metabolism, vitamin D, and markers of bone remodeling were studied. The method of dual-energy X-ray absorptiometry with an osteodensitometer was used to assess the possible loss of bone tissue.

Results. The choice of treatment tactics for patients with type 2 diabetes was based on the baseline level of glycated hemoglobin (HbA1c) and main clinical symptoms. When the level of glycated hemoglobin was more than 7% (7.5-8.0), metformin monotherapy was prescribed. At initially high levels of HbA1c (8-9%), a combination of antihyperglycemic drugs was prescribed (glipizide in combination with metformin; DPP-4-alogliptin inhibitor with metformin). In the group of patients with baseline HbA1c levels (9-9.5%), therapy with GLP-1 (liraglutide) was carried out. Over the past year, a new antihyperglycemic drug from the group and NGLT-2 (dapagliflozin) was tested. Its mechanism is based on a decrease in the reabsorption of glucose in kidneys. Stable preservation of the reduced HbA1c was noted against the background of combined use with metformin. Following osteoporotic drugs were used: Zolendronic acid (Aklasta), denosumab, teriparatide.

Conclusion. An individual treatment approach to patients with type 2 diabetes complicated by osteoporotic disorders through the combined use of hypoglycemic and osteotropic medicines gave a positive result. Prevention of osteoporotic changes in patients with type 2 diabetes of the postmenopausal period should be comprehensive, taking into account the maintenance of the glycemic level under the control of the HbA1c content ≤ 7%, the fight against complications of diabetes mellitus, the inclusion of regular dosed physical exercises and additional measures taking into account the multiple births factor.

Aim. To evaluate the possibility and expediency of the diagnostic laparoscopy of traumatic injuries of the abdominal cavity organs.

Material and methods. We performed the diagnostics laparoscopy of blunt injuries of abdominal cavity on 48 patients in the period from 2011 till 2020 in the Center of Internal Medicine “Varorud”. The age of the patients varied from 18 to 42 years, mean age was 32±1.5 years, all the injured were male. Ultrasound examination was performed in the first place on all the patients along with general clinical methods of investigation. It should be noted that ultrasound examination was effective in 12 (25%) patients with fluid accumulation in depressed areas of the abdominal cavity. Despite the positive results of ultrasound investigation, diagnostic laparoscopy was also performed in these patients in order to determine the topical diagnosis and assess the extent of injury.

Results and discussion. Diagnostic laparoscopy in 97,8% of cases allowed to verify the diagnosis of abdominal cavity injuries caused by blunt abdominal trauma.

Conclusion. Diagnostic laparoscopy is the method of choice in the diagnostics of the internal organs injuries at the blunt abdominal trauma.

Aim. To study the prevalence of cancer diseases in the high and middle mountains of the Republic of Tajikistan.

Material and methods. The current paper studies the incidence of cancer in mountainous areas of Tajikistan covers the period between 2010-2020. We used materials from the Statistical Yearbook of the Republican Center of Medical Statistics and Information under the Ministry of Health and Social Protection of the Republic of Tajikistan (2020), statistical data from the Department of Health of GBAO, and medical and statistical data from the Central Regional Hospital in Khorog.

Result. A comparative analysis of the data for the last ten years shows that the primary incidence of cancer in Tajikistan has been increasing: the incidence rate per every 100,000 people has changed from 34.6 to 40, and in the middle and highlands from 63.1 to 85.1 cases of the disease. Between 2010 and 2020, there was a serious increase in the incidence of breast and cervical cancer among highland residents: breast cancer increased from 2.9 to 18.0 and cervical cancer from 6.8 to 13.4 cases per 100,000 population.

Conclusion. In recent years, the number of people in the middle and high mountains of Tajikistan who got cancer has increased, and they often seek medical care already at the last stage of the disease. Timely detection and treatment of precancerous conditions can improve the quality and increase the life expectancy of patients.

Aim. To study the frequency and validity of posterior aortoplasty for bioprosthetics of the aortic valve.

Materials and methods. To study the problem of the required aortoplasty frequency and reliability of the study, 99 patients with Neo-Cor “Uniline” 21-size bioprosthesis implantation were selected. According to the presence/absence of posterior arthroplasty, patients were divided into two groups. In the postoperative period the groups were compared according to the following criteria: left ventricular end-diastolic volume (LV EDV), ejection fraction (LV EF), stroke volume (LV SV), peak and mean valve gradients. Following parameters were calculated stroke volume index (SVI) and valve effective orifice area index (EOAI).

Results. There were no significant differences in postoperative data between the groups. In the group without an aortic aneurysm, left ventricular end-diastolic volume (LV EDV), stroke volume (LV SV), peak and mean valve gradients. were slightly larger. In the second group, ejection fraction (LV EF), and peripheral perfusion index were slightly larger. Which with lower gradients on the valve indicates more optimal contractility of the left ventricle.

Conclusion. In our practice in all cases, posterior aortoplasty was performed as indicated. Group of patients with aortoplasty demonstrated more optimal left ventricle function. Probably aortoplasty is to be applied more frequently.

Aim. To analyze the incidence rates of sexually transmitted infections in the Republic of Tajikistan for the period 2008-2017.

Material and methods. The dynamics of morbidity of sexually transmitted infections were studied based on data of the state statistical reporting, approved by the Order of the Director of State Statistics under the President of the Republic of Tajikistan, dated 11.11.2013, № 54: form № 9.

Results and discussion. The analysis of the form №9 revealed that the incidence of sexually transmitted infections in the republic in 2017 compared with 2008 decreased by 3 times. As for syphilis, morbidity in 2017 decreased by 1.4 times. The incidence of trichomoniasis (7.1 times), and gonococcal infection (2.1 times) decreased significantly. It should be noted that the statistics of chlamydial infection remained practically unchanged during this period. The decrease in the incidence of sexually transmitted infections in the republic does not correspond to reality, since many patients are treated in non-state medical institutions, where the registration and accounting system for these infections is not kept.

Conclusion. The results indicate that the epidemiological situation in the Republic is unstable. The most unfavorable regions have been identified. It is necessary to monitor the activities of non-governmental medical institutions for the identification and registration of patients with sexually transmitted infections to improve the preventive measures and complete treatment.

Aim. To analyze the immediate and long-term results of surgical treatment of patients with non-organ retroperitoneal tumors.

Material and research methods. A retrospective analysis of medical records (medical history, outpatient records) of patients with non-organ retroperitoneal tumors treated in the Uro-procto-oncology Department for the period 2017-2020 was carried out.

Results and discussion. It was found out that the prevalence of the tumor process according to the international TNM classification of UICC was as follows: stage II– 5 (21.7%), stage III - 14 (60.8%), and stage IV – 4 (17.4%). The inclusion of stage IV disease in our study is since this group includes locally distributed tumors with germination into neighboring organs and tissues, in the presence of affected lymph nodes, but without distant metastases. The specified diagnosis of the staging is based on operational findings. Before the operation, the prognosis of the possibility of radical surgery was 40%.

Conclusion. The main and only radical method of treatment of non-organ retroperitoneal tumors remains surgical treatment.

Aim. To study the efficiency of a new classification of the widespread peritonitis in the estimation of patients’ state severity.

Material and methods. 160 patients with widespread peritonitis aged 16 to 76 were examined; 104 (65%) were men and 56 (35%) were women. The patients were divided into 3 groups: 1 - endogenous intoxication (n=95), 2 - abdominal sepsis (n=46), and 3 - septic shock (n=19). The results of treatment were evaluated according to the incidence of postoperative complications, terms of hospitalization, mortality rate.

Results and discussion. When analyzing the results of clinical studies, it was found that according to the stages of endogenous intoxication, abdominal sepsis and septic shock, the indicators were as follows: APACHE II 13.8±0.5 - 16.1±0.4 - 18.5±0.5; MIP 22 - 25 - 25; SOFA 3.3±0.2 - 3.7±0.1 - 4.2±0.1; presepsin (pg/mL) 355.6±8.6 - 783.4±24.0 - 1587.7±70.5; tumor necrosis factor-α (pg/mL) 105.5±1.9 - 853.3±17.6 - 24.5±6.8 p/o complications (%) 13.6±3.6 - 35.1±6.1 - 41.9±7.1; hospital stay (days) 19.2±0.8 - 25.9±2.2 - 13.8±1.9; 12 patients died in the stage of septic shock. There were statistically significant differences between the groups (p<0,01).

Conclusion. The improved classification stratifies patients with diffuse peritonitis according to severity into the following groups: endogenous intoxication, abdominal sepsis, septic shock. It allows determining in time the necessary volume of intensive therapy and surgical tactics.

The article provides a review of modern literature on the epidemiology, etiology, and pathogenesis of epilepsy in children.

Epilepsy is considered one of the most common and serious disorders of the brain. Despite the achievements of modern science, epilepsy among children and adolescents remains an urgent problem.

The article looks into the issues of etiopathogenesis and surgical treatment of children with deformity of the nasal septum, combined with hypertrophy of the nasopharyngeal tonsil. The article reflects the negative impact of adenoid vegetations and deformities of the nasal septum on the functional state of the nose, nasopharynx, and auditory tube in childhood. Analysis of the literature indicates, that there is no consensus regarding the surgical treatment of deformities of the nasal septum, combined with hypertrophy of the pharyngeal tonsil. The development of more effective methods of surgical treatment remains open.