Ruziboyzoda Kahramon Ruziboy - Candidate of Medical Sciences, Associate Professor of the Department of Surgical Diseases No.1, Avicenna Tajik State Medical University, Tel: +(992)930807777. E-mail: dr.hero85@mail.ru

Aim. To optimize the surgical tactics for “difficult” duodenal ulcers by increasing the tightness of the duodenal stump.

Material and methods. The results of complex diagnostics and surgical treatment of 104 patients with “difficult” duodenal ulcers were analyzed. All patients were divided into two groups. The first - main group consisted of 53 (51.0%) patients, the second - control group - 51 (49.0%) patients. In 76 (73.1%) cases, the ulcer was localized in the duodenal bulb, in 38 (36.5%) cases in the post-bulbar duodenum.

Results. After resection of the stomach with various methods in patients of the main group, with “difficult” duodenal ulcers, to increase tightness and prevent failure of the duodenal stump, improved methods of processing the duodenal stump were used, and for patients in the control group, well-known methods of handling the duodenal stump were used. Among the patients of the control group (n=51), in the postoperative period, in 7 (13.7%) cases, various complications occurred in the form of failure of the sutures of the duodenal stump (n=2), postoperative pancreatitis (n=4) and eventration (n=1). In 3 (5.9%) cases, a fatal outcome occurred. In patients of the main group (n=53) in the early postoperative period in 3 (5.6%) cases, postoperative pancreatitis occurred, which was treated conservatively. No lethal outcome was noted.

Conclusion. Тhe treatment of patients with “difficult” duodenal ulcers presents significant difficulties, which requires a strictly individual approach.

Aim. To conduct a comparative study of the effectiveness of treatment of MDR-TB patients by using short-term and individual chemotherapy regimens and including the drug Cholecalciferol in the treatment complex.

Material and methods. The group of MDR-TB patients with a short-term treatment regimen included 40 patients, and 40 patients were included in the group of MDR-TB patients with an individual treatment regimen. Both observation groups were divided into two subgroups of patients with MDR-TB of the lungs (20 people from each group). In one group treatment included Cholecalciferol 300,000 U intramuscularly weekly (6-8 times in total) in the complex of the above treatment; comparison groups: patients with MDR-TB of the lungs (20 people from each group) received a complex of the above chemotherapy without the drug Cholecalciferol.

Results. In the group of patients with the inclusion of Cholecalciferol in a short-term treatment regimen, a favorable treatment outcome was noted in 100% of cases, while in the group of patients without Cholicalciferol - in 80% of cases. With an individual treatment regimen in the group of patients with the inclusion of Cholecalciferol, conversion by sputum culture also occurred in 100% of cases, while in the group of patients without Cholicalciferol - in 70% of patients.

Conclusion. Thus, the introduction of a new short-term chemotherapy regimen for MDR-TB patients has increased the effectiveness of their treatment. In two subgroups of MDR-TB patients with different chemotherapy regimens, who received injections of Cholecalciferol in the chemotherapy treatment plan, the effectiveness of treatment based on the results of the timing of the development of conversion by sputum culture was assessed as significantly higher than in the subgroups that did not receive vitamin D3.

Aim. To detect viral infection of the oral mucous membrane in individuals with dentures.

Material and methods. 110 patients with removable and 100 - with fixed prostheses were examined. Diagnostics of virus infection were carried out by ELISA and PCR methods (Kvant-21).

Results and discussion. It has been revealed that patients with removable prostheses revealed oral mucosa diseases in 91 (82,7%) persons and with fixed prostheses - in 75 (75,0%) patients. Viral infection in patients with removable dentures is detected in 58 (63.7%;91) and with fixed dentures in 43 (57.3%;75) patients. Among patients with removable dentures, HPV types 11 and 16 occur 1.3 times more frequently than in patients with fixed dentures, and HPV type 6 - 4.6 times less frequently. HPV types 11 and 16 are most frequently detected in patients with removable prostheses in the case of red lichen planus while in the group of patients with fixed prostheses they are more frequently observed in patients suffering from periodontal disease.

Conclusion. Viral infection plays an important role in the development of diseases of the oral mucosa, which differ depending on the presence of removable and fixed dental structures. Papillomavirus types 6, 11, and 16 have the most pronounced effect on the course of oral mucosa diseases.

Aim. To study the effectiveness of bacteriophage therapy with the combined medicament “Complex pyobacteriophage” and “Sextafag”.

Material and research methods. We examined 44 patients (24 women and 20 men) on an outpatient basis at the Department of Otorhinolaryngology of the Avicenna Tajik State Medical University.

Results and its discussion. The results of the study of the microflora of the tonsils of patients with CT showed in 52% (13) of cases in 1st group of patients and in 56% (14) of cases in the second group presence of S. aureus, in 25%

(6) and 28% (7) of cases mixed microflora - S. pyogenes together with S. salivarius was found and 25% (6) and 20% (5) cases showed S. aureus together with S. Pyogenes. It turned out that bacteriophage therapy with the “Complex pyobacteriophage” reduced a bit more the total contamination of the pharynx. However, there was no complete elimination of Staphylococcus aureus strains; single colonies remained in 5 (28%) patients with chronic tonsillitis.

Conclusions. 1. The use of the medicament “complex pyobacteriophage” as a part of local therapy in patients with chronic tonsillitis is an effective and safe method of sanitation of the palatine tonsils.

2. The specific selective antibacterial action of this drug prevents a prolonged stay of the focus of infection, thereby prolonging the period of remission.

3. Prevention of the focus of infection in the tonsils contributes to the increase of local and general immunity of the body.

Aim. To study the features of the clinic, diagnostics, and evaluate the effectiveness of the treatment of solitary and primarily multiple malignant tumors of the skin and surrounding structures of the periorbital region (SPMMTLPSSSPR).

Materials and methods. A retrospective analysis of clinical data of case histories of 39 patients with various solitary, primarily multiple malignant tumors of the skin and surrounding structures of the periorbital region was performed and the effectiveness of treatment was evaluated in the conditions of the State Institution “Republican Oncological Scientific Center” of the MOH and SPP of the RT 2015 to 2016.

Results. Evaluation of the effectiveness of treatment in 39 (100%) patients with solitary and primarily-multiple malignant tumors of the skin of surrounding structures of the periorbital region (SPMMTSSSPR) showed in 20 (51,28%) excellent results, in 13 (33,35%) – good results, in 2 (5,12%) - satisfactory results and in 4 (10,25%) patients unsatisfactory results. The quality of life of 33 patients with SPMMSSSPR assessment by the Karnowsky scale was improved from a minimal of 60% to 100%.

Conclusion. Surgical treatment of SPMTLPSSSPR made it possible to achieve а complete treatment in 85% of patients.

Aim. To improve the surgical treatment tactics of gastroduodenal ulcerous bleeding combined with pyloroduodenal stenosis.

Material and methods. Results of diagnostics and surgical treatment of 105 patients with DUD, divided into two groups were analyzed: the first - 54 patients, in which individualized tactics with maximum use of modern endo- and pharmacological hemostasis was used, mainly planned operations were executed; the second - 51 patients, in which active surgical tactics without endohemostasis was used, mainly “traditional” variants of gastric resection were used.

Results. In case of active surgical tactics the number of urgent operations made up 29,4%, delayed - 54,9%, planned operations - 15,7%. The use of resection (76,4%) and palliative (19,6%) operations was one of the causes of a high frequency of postoperative complications (37,2%) and lethality rate (13,7%). The use of modern endo- and pharmacological hemostasis techniques contributed to the efficacy of treatment, a decrease in urgent (11,0%) and delayed (9,2%) operations, and an increase in elective operations (79,8%), which promoted the decrease of postoperative complications (9,2%) and absence of lethality.

Conclusion. In DUD the tactics based on endo- and pharmacological hemostasis contributes to a decrease of operation activity by urgent and delayed indications, transfer of the situation to the category of the planned operations that promotes the decrease in the frequency of postoperative complications and lethality.

Aim. To improve treatment outcomes of children with acute leukemia after chemotherapy.

Materials and Methods. Eighty-five children with AL who were treated at the Department of Pediatric Hematology of the National Medical Center of Tajikistan “Shifobakhsh” and the Regional Cancer Center of Bokhtar during the period 2015-2019 were studied. The study group included 32 children diagnosed with AML and 53 with ALL.

All children underwent a comprehensive examination including clinical, X-ray and endoscopic, laboratory tests, ultrasound, CT scan, sternal puncture, and analysis of cerebrospinal fluid.

Results and discussion. On admission to the hospital, all hospitalized children had a complete clinical and laboratory picture of AL.

We studied 2 groups of patients with AL who received KIT by two schemes. Group 1 - patients with AL received standard therapy. Group 2 - patients with AL, in addition to the standard regimen, received reamberine in combination with remaxol. These medications can protect patients with AL from the toxicity of chemotherapeutic agents used for the treatment of AL, at the same time they don’t decrease the antitumor action of chemotherapeutic agents.

Conclusions.

1. A marked impairment of hemostasis in children with AL compared to healthy children is observed.

2. Conducting KIT in children in combination reamberine with remaxol is more effective compared to standard therapy, as markers of intoxication are significantly reduced.

Aim. To conduct a clinical test of the unguent form of human leukocyte interferon in somatic patients with relapsing of herpetic stomatitis.

Material and methods. 98 somatic patients with viral pathology of the oral mucous at the age of 20 to 60 years and older were studied to identify the clinical efficiency of the leukocyte interferon. The order of the clinical studies was specified by a special program: preparations were decrypted, decryption was conducted after the analysis of the results of the clinical study. Preparation 1 – placebo (2% emulsion of lidocaine on vinilin), preparation 2 – interferon’s unguent, preparation 3 – 0.5% oxoline unguent. After active implementation of the complex treatment of patients with mucologic pathology were divided into 3 groups: 1st group included 31 patients who got a course of the treatment by preparation 1; 2nd - 34 persons, 2 have taken preparation; 3rd - 33 patients, 3 used preparation.

Results. The most expressed clinical effect in the treatment of relapsing of herpetic stomatitis in somatic patients with combined dentistry pathology was shown by preparation 2, which had local anesthetic and anti-inflammation action. Indicators of the recovery of patients who got this preparation in contrast with patients of the third group decreased on average by 2 days, the 1st groups - by more than 1 day.

Conclusion. Using oxolin’s unguent and preparation 1 in course of the treatment of herpetic stomatitis did not prevent the development of secondary elements in the oral mucous (24.0% and 44.0% accordingly) in most of the patients. Using preparation 2, new elements on oral mucous were observed only in 6.0% of cases, which shows it good antiviral effect.

Aim. To reduce maternal mortality by examining the clinical features of the course of lethal SARS-COV-2-associated pneumonia in pregnant women to further optimize diagnosis, obstetric management, and treatment.

Material and Methods. 70 pregnant women were examined: 34 (48.6%) with moderate, 11 (15.7%) with severe, and 25 (35.7%) with extremely severe SARS-CoV-2. The scope of the study corresponded to the standard examination of pregnant women with SARS-CoV-2 coronavirus infection. Of the total number examined, 7 cases (1%) were fatal.

Results and discussion. The main symptoms of lethal cases of pneumonia, which manifested from the first days of the disease and progressed rapidly were: an increase in body temperature to febrile values from the beginning of the disease - 7 (100%), marked weakness - 7 (100%), increasing dry and unproductive cough - 7 (100%). Increasing dyspnea and tachypnea on admission to the hospital were also determined in all pregnant women who died. Chest pain predominated in the majority, 4 (57.1±20.2%) of the pregnant women who died. The symptoms of intoxication were pronounced and manifested as arthralgia - 4 (57.1±20.2%), myalgia - 3 (42.9±20.2%), headache - 3 (42.9±20.2%). Toxic lesion of the cardiovascular system was manifested by tachycardia in 7(100%) and hypotension in 4 (57,1±20,2%) cases.

Conclusion. The combination of febrile fever, low-productive cough, increasing dyspnea, and tachypnea should be considered as specific clinical symptoms of lethal SARS-CoV-2-associated pneumonia in pregnant women in the second half of gestation.

Aim. To evaluate the results of a survey of medical specialists on the problems of organizing and conducting a comprehensive rehabilitation of patients with cleft lip and palate.

Material and Methods. In the process of conducting a study to assess the awareness of medical specialists on the issues of complex rehabilitation of patients with congenital cleft lip and palate, we used the questionnaire method. The research process involved various specialists who, by the nature of their activities, deal with children suffering from this pathology.

Results. According to the results of the questionnaire, the interviewed maxillofacial surgeons in 100% of cases indicated that patients with congenital pathology of the maxillofacial region are admitted almost several times a month (from 2 to 8 children); while 70% of orthodontists indicated that they are initially treated with such a pathology 5 times a year, 25% - 3 times a year, 5% - more than 8 times.

Conclusion. The results of the survey showed that a great responsibility in organizing care for patients with congenital cleft lip and palate rests with maxillofacial surgeons.

Aim. To differentiate clinical signs in intrauterine and early neonatal pneumonia.

Materials and methods. The studies were carried out in the Maternity ward and the “Mother and Child” ward of the second stage of nursing of the State Institution “Istiklol” in Dushanbe. In total, a retrospective analysis of 260 newborn development records and medical records was carried out. Two groups were formed, group 1 consisted of 110 (42.3%) newborns with a confirmed diagnosis of intrauterine pneumonia, the second group - of 150 (57.6%) with early neonatal pneumonia. Statistical analysis of the material was performed using the Statistica 10.0 software package (StatSoft, USA).

Results. According to the anamnesis, 45.7% of 1st group mothers had premature childbirth, while in the second group 37.3% of mothers. Among the mothers of group 1, real pregnancy was characterized (p> 0.05) by colpitis (76.9%), anemia (71.3%), threatened abortion (48.6%), chronic fetal hypoxia (57.4%), high frequency of premature rupture of amniotic fluid (34.6%), discoordination of labor (25.0%). Statistically significant (p <0.001) (40.6%) in children of the second group observed an increase in temperature (above 38°C). The majority of newborns with intrauterine pneumonia did not have the act of sucking - 74.8%, 32.2% of newborns (p <0.01) noted the absence of the act of swallowing. Dyspnea was observed in 97.7.5% of children with intrauterine pneumonia and 74.7% of children with early neonatal pneumonia, auxiliary muscles were involved in the breathing, and therefore 69.6% of newborns with intrauterine pneumonia and 76.3% with early neonatal pneumonia (p<0.05) needed respiratory support.

Conclusion. The course and the type of complications of pregnancy in mothers with infected children were different. Differential diagnostic signs between intrauterine and early neonatal pneumonia were established.

Aim. To study the effectiveness of improving the accessibility of testing for key populations by introducing a new method of rapid HIV testing by pericardial swabs in the Republic of Tajikistan.

Materials and methods. Analysis of the normative legal documents of the Republic of Tajikistan in the field of HIV / AIDS and statistical processing of materials from the State Institution “Republican Center for the Prevention and Control of AIDS”.

Results. The article presents the results of the analysis of the recommendations of international legal documents, in particular, the materials of the WHO Regional Office for Europe, UNAIDS, and the State Institution “Republican Center for the Prevention and Control of AIDS” on the introduction of a new method of rapid HIV testing through saliva tests. This method made it possible to expand the coverage of testing for a vulnerable group of the population, which for any reason refused to be tested in existing medical institutions. In the period up to March 2018, a total of 18,849 beneficiaries were tested. Of the total number of tested, 739 cases were identified with a positive result on the first test. Of these, 484 cases were confirmed based on the Republican Center for the Prevention and Control of AIDS, of which 403 cases were confirmed as newly diagnosed.

Conclusion. Rapid saliva testing for HIV among key populations, such as sexual and injecting partners, is highly effective and affordable. Patients, without any fear, agreed to undergo testing. The high sensitivity and specificity of the tests reduce the number of patients with “false positive” and “false negative” results. Ease of use, safety, and painless testing procedure led to the fact that the method was successfully introduced in a short time both among government institutions and among public organizations that work towards the prevention of HIV infections.

Aim. To evaluate the role of video laparoscopy in the diagnosis and treatment of concomitant urgent pathologies of the abdominal organs and genitals.

Material and methods. The study is based on an analysis of the treatment of 240 women with combined acute pathologies of abdominal organs and genitalia, who were admitted for the period 2012 to 2020. According to the frequency of the combination of acute pathologies of abdominal organs and genitalia, acute appendicitis and various complicated forms of cysts of the right ovary prevailed, which amounted to 33.3% (n=80) of patients. Along with this, there were such combinations as acute calculous cholecystitis (ACC) + uterine fibroids - 20.0%, ACC + ovarian cyst - 18.3%, complicated forms of uterine fibroids + hernia of the anterior abdominal wall - 13.7%, complicated forms of ovarian cyst + hernia of the anterior abdominal wall - 7.9%, complicated forms of ovarian cyst + adhesive disease - 6.7%.

Results. In certain cases (19.2%), video laparoscopy initially turned out to be diagnostic, and in the remaining 80.8%, it was purposefully performed for surgical correction. Postoperative complications in women of the main and comparison groups were 7.5% and 13.3%, respectively. Postoperative bed-day continued 4.8±1.7.

Conclusion. Videolaparoscopy is an important way to determine diagnostic tactics, which can be easily transformed into a therapeutic one.

Aim. To study the frequency, risk factors, and course of labor in women with post-term pregnancies in the city of Dushanbe.

Material and methods. The study is based on the retrospective analysis of childbirth in the city maternity hospital No. 2, which is the clinical base of the Department of Obstetrics and Gynecology No. 2 of TSMU named after Avicenna for the period 2007 - 2011.

Results and discussion. The frequency of post-term pregnancy among women in Dushanbe over 7 years ranges from 3.9 to 0.83% of cases. The study shows that after the introduction of national standards on the induction of labor, the number of post-term pregnancies and, along with it, the complications associated with it decreased. Among women with post-term pregnancy, each 2 had the first pregnancy. The course of pregnancy and childbirth with a post-term pregnancy is characterized by a high percentage of complications, which is 6.7 ± 2.09% and 70.8 ± 2.16%, respectively. 382 (72%) women delivered through the vaginal birth canal, and 77 (15%) women had a cesarean section.

Conclusion. In spite of the declination tendency of post-term pregnancies frequency after the introduction of national standards on induction of labor, the obstetric and perinatal outcomes of postmature pregnancy deserve attention.

Aim. To present clinical and functional characteristics of chronic heart failure in association with diabetes mellitus type 2.

Material and methods. 105 patients with a verified diagnosis of chronic heart failure in association with diabetes mellitus type 2 who were hospitalized at the cardiology department of State Institution “RCRC” of Ministry of Health and Social Welfare of RT during the period 01.09.2020 - 01.08.2021 were examined. Of them, men were 48 (45.7%), women 57 (54.3%). All patients underwent general clinical, laboratory, instrumental, as well as functional examinations.

Results and discussion. Complex evaluation of patients with chronic heart failure in association with diabetes mellitus type 2 (n=105) showed that the majority of patients (96,2%) had metabolic subcompensation of carbohydrate metabolism - HbA1c>7%. The results of assessing the severity of clinical symptoms according to the clinical evaluation scale, indicators of renal function, and hemodynamic parameters of the heart in the group of patients with chronic heart failure in association with type 2 diabetes mellitus with arterial hypertension + coronary heart disease were significantly different from the group of patients with chronic heart failure in association with type 2 diabetes mellitus also with arterial hypertension and chronic heart failure in association with coronary heart disease.

Conclusion. The etiology of chronic heart failure in our study group is CHD and arterial hypertension, which have distinctive features depending on gender and age. The degree of clinical symptomatology manifestation is directly dependent on the functional class of chronic heart failure. The most frequent companions of chronic heart failure in association with type 2 diabetes mellitus are obesity and chronic kidney disease. Left ventricular hypertrophy is considered to be one of the unfavorable predictors of cardiovascular complications, and its fluctuations were observed in our patients.

In this case, the authors describe the successful treatment of a severe complication caused by iatrogenic damage to the esophagus with a purulent-septic process in an 8-month-old child, leading to the progression of septicopyemia with the development of mediastinitis, destructive pneumonia with pyopneumathorax on the left, erosive bleeding from the pleural cavity, phlegmonous chest with a soft tissue defect around the drainage tube.

The article presents an analysis of modern domestic and foreign publications on the research of the etiology and pathogenesis of the alopecia areata in children. The article brings up the information on the incidence of this type of alopecia in the population, its relationship with heredity, immune and environmental factors. According to generalized literary data, the authors focus on the importance of the role of violations in the lipid peroxidation system and antioxidant protection in the development of the nest alopecia. According to the authors, these processes lead to violations of the function of organs and systems which is reflected in the state of local blood flow and the functional parameters of the skin. The article indicates the literature data on the role of microcirculation violations in the development of the alopecia areata, as well as the pathophysiological mechanisms of its development in children with vitamin D deficiencies The results of a study on the mechanisms for the development of the alopecia areata in children indicate that when conducting children with this pathology, it is necessary to envisage individual approach taking into account the local blood flow, functional parameters of the skin, concomitant pathology, level of vitamin D in the blood and violations in the antioxidant protection system.

The article reviews the literature on some aspects of diagnosis and treatment tactics of femoral neck fractures and their consequences in osteoporosis. Analysis of the literature shows that osteoporosis mainly occurs in postmenopausal women. Many issues of diagnostics and treatment of osteoporosis in our region refer to poorly studied problems. The specific weight of risk factors for osteoporosis development among the population of our region is 55.8%. Goiter, diabetes mellitus, low body weight and hypodynamia prevail among them. However, there are few or no comprehensive works devoted to this problem with consideration of the relationship between osteoporosis and complex (surgical and conservative) treatment of femoral neck fracture. In the light of the above, the need for a comprehensive study of the problem of diagnosis and treatment of femoral neck fracture and its consequences in menopausal osteoporosis in multiparous women becomes evident.