Aim. To improve the ultrasonic methods of diagnostics in revealing the delayed uterine development in prepubertal and pubertal girls.
   Materials and methods. Subjects were divided into 4 groups according to their age. Group I included girls of nursery age (11.4 %), Group II included girls of preschool age (17.2 %), Group III included girls of primary school age (34.3 %), and Group IV included girls of high school age (37.1 %). We used the transabdominal method to scan the pelvic organs. The study was performed with a 5.0-7.0 MHz linear and convex transducer.
   Results and discussion. In the first group, the uterus could not be visualized in 2 (25.0 %) girls, and in the remaining 6 (75.0 %) girls the uterus was age normal. During this period, the uterus is located high, at the border of the abdomen and small pelvis, the uterus varies between 20-50 mm in length, 8-15 mm in thickness, and 10-20 mm in width, and has a cylindrical or drop-shaped shape with predominant cervical size. The myometrium is defined as a tissue of homogeneous structure, and reduced echogenicity, there is no image of the endometrium.

   Conclusions. Ultrasonography makes it possible to diagnose clinically undetectable structural changes in the internal genitalia on time.

   Aim. To determine the value of radiation imaging techniques such as US, CT and MRI for diagnosing liver hemangiomas.
   Materials and methods. The article presents the results of radiations diagnostics of 96 patients with the hepatics hemangiomas. Patients age ranged from 16 to 73 years (mean age 42 ± 10 years). There was a significant predominance of women 78 (83.1 %). And the ratio of women to men was 4.8 : 1. The tumor occupied the area of one segment of the liver in 21 (21.8 %) cases, two segments in 35 (35.4 %), three segments - in 17 (17.7 %), four or more segments - in 23 (23.9 %) cases.
   Results. Non-invasive diagnostic methods are very effective and allow timely detect of liver hemangiomas in most patients. According to the material, the informativeness of radiation diagnostic methods was at least 90 %.
   Conclusion. MRI, in comparison to CT and ultrasound, is considered a more sensitive and informative method. But taking into account the prevalence, safety and affordability, it is necessary to give preference to ultrasound diagnostics as the primary link in radiation imaging.

   Aim. To study the continuity of the provision of services in PHC facilities and the level of primary morbidity among young people in the Republic of Tajikistan.
   Material and methods. Data from the Republican Center for Medical Statistics and Information of the Ministry of Health and Social Protection of the Republic of Tajikistan; reports from Republican, regional and district reproductive health centers; the Republican Center for AIDS Prevention and Control; reports from Youth Medical Consulting Departments; data from outpatient records (Form 025/k - individual card of a contraceptive patient; Form 112/u - individual patient card) and self-developed questionnaires were analyzed.

   Results. Average level of general primary morbidity in 2018-2019 amounted to 638 % among the youth of the Republic of Tajikistan aged 15 to 30 years, while this indicator among boys was 778.2 % and among girls - 4392.5 %.
   Conclusions. A well-functioning system of referrals ensures the continuity of the necessary preventive, treatment, and diagnostic services provision to young people, thereby increasing their availability, evidence-based prescriptions and a positive economic effect.

   Aim. To study the course of pregnancy and perinatal outcomes in women with insulin resistance.
   Material and methods. A retrospective and prospective study of 102 women and their newborns who were born in the State Institution “Research Institute of Obstetrics, Gynecology, and Perinatology” for the period 2017-2019 was conducted. All pregnant women were divided into 3 groups according to the level of insulin resistance index (NOMA index). Group I - 42 pregnant women with developmental risk factors for diabetes with an insulin resistance index above 2.84. Group II consisted of 30 subjects with a NOMA index below 2.21, and Group III (n = 30) consisted of healthy pregnant women with a physiological course of pregnancy and labor.
   Results. Newborns born to women with a NOMA index above 2.84 (pathological insulin resistance) have a high incidence of perinatal complications: central nervous system defects, various degrees of asphyxia, hypotrophy, and immaturity.
   Conclusion. Insulin resistance in general affects pregnancy and has a negative impact on the course of pregnancy, causing a high incidence of complications such as threatened miscarriage, preeclampsia, chronic placental insufficiency and affecting perinatal outcomes.

   Aim. To study the pathogenesis of hepatic encephalopathy in patients with cirrhosis of the liver.
   Material and methods.141 patients with liver cirrhosis complicated by hepatic encephalopathy were examined. The diagnosis was established on the basis of anamnesis, clinical, biochemical, instrumental, virological methods of research, including the study of the level of pro-inflammatory cytokines and ammonia in the blood serum.
   Results and discussion. The level of interleukin-6 in patients with liver cirrhosis in the stage of decompensation averaged 118 ± 14 pg/ml (p < 0,01), and increased to 194 ± 14 pg/ml (p < 0,05) in hepatic encephalopathy. Levels of tumor necrosis factor – α almost doubled. The level of tumor necrosis factor (TNF-α) in patients with liver cirrhosis in the stage of decompensation averaged 121 ± 12 pg/ml (p < 0,001), while in patients with hepatic encephalopathy it made 244 ± 17 pg/ml (p < 0,005). A similar picture was also observed when studying the ammonia in blood serum. In liver cirrhosis
in the stage of decompensation level of ammonia was 93,1 + 4,2 (p < 0,001). In patients with hepatic encephalopathy, a decrease in the number of bifidobacteria, lactobacteria and eubacteria by 3-4 times compared with the norm was revealed. At the same time, the number of pathogenic microflora and yeast fungi increased.
   Conclusion. In the pathogenesis of hepatic encephalopathy, a high content of pro-inflammatory cytokines and nitrogenous compounds play an important role as a result of the syndrome of increased bacterial growth and persistence of Helicobacter pylori in the gastric mucosa.

   Aim. To study the causes of maternal mortality in fatal SARS-COV-2-associated pneumonia during gestation in order to optimize medical care for this category of pregnant women.
   Material and methods. 70 pregnant women with moderate, severe and critical course of SARS-CoV-2 were examined. The extent of study corresponded to the standard of examination of pregnant women with SARS-CoV-2 coronavirus infection. Out of all cases 7 (1 %) were lethal.
   Results and discussion. Analysis of organizational aspects of management revealed defects in the organization of medical care for pregnant women with SARS-CoV-2 coronavirus infection at the outpatient and inpatient levels. The reasons for late hospitalization were: self-treatment of pregnant women at home within 3 days, outpatient treatment within 7-10 days, primary hospitalization carried out in non-specialized hospitals. Routing breaches in pregnant women occurred in 2 (28.6 %) cases. Underestimation of the condition in the hospital contributed to delayed delivery in 5 (71.4 %) cases.
   Conclusion. Breaches in the organizational aspects of medical management of lethal SARS-CoV-2-associated pneumonia correspond with late hospitalization, late diagnosis and underestimation of the condition contributed to the delaying of delivery.

   Aim. To improve the existing classifications as the basis for the development of a pathogenetically substantiated treatment and diagnostic tactics that meets the modern requirements of surgical gastroenterology.
   Material and methods. The material is based on the results of diagnosis and surgical treatment of 658 patients with duodenal ulcerative colitis with combined complications. A combination of two or more complications occurred: stenosis + penetration - in 368 (55.9 %) patients, penetration + stenosis + bleeding - in 105 (16.0 %), penetration + stenosis + perforation - in 58 (8.8 %) ), perforation + bleeding - in 52 (7.9 %), perforation + penetration - in 18 (2.7 %), penetration + bleeding - in 51 (7.8 %) patients, a combination of multiple and rare complications - in 6 (0.9 %) patients, including penetration + stenosis + perforation + bleeding - in 1 (0.15 %) patient, a combination of penetration, stenosis and duodenocholedochal fistula - in 3 (0.45 %), a combination of penetration + bleeding + stenosis + chronic pancreatitis - in 1 (0.15%), a combination of penetration + choledochal stricture + obstructive jaundice - in 1 (0.15%) patient.
   Results and discussion. In the classification of each variant of combined complications, the main factors influencing the choice of treatment tactics are identified. The choice of the method of surgical treatment with a simultaneous combination of several complications, first of all, depends on the general condition of the patients, due to the severity of bleeding, the prevalence of peritonitis, and the stage of stenosis of the gastroduodenal junction. In emergencies, only intraoperative revision makes it possible to clarify the nature of the pathological process and the possibility of its elimination by radical or palliative methods.
   Conclusion. The proposed classification can become a new platform for conducting a pathogenetically substantiated diagnostic and therapeutic strategy with the possibility of improving the results of surgical treatment of patients with duodenal ulcerative colitis with combined complications.

   Aim. To study the incidence of rachitis in children of Tajikistan.
   Materials and methods. The main methodology used in the analysis of the incidence of rickets was a retrospective study (conducted between 2009 and 2016), using descriptive and analytical methods of modern epidemiology. The mean value (M) and mean error (m) were calculated, and the annual average rate of increase and decrease (Tpr/dec, %) were calculated. The dynamic analysis of rachitis incidence rates covered a 7-year interval.
   Results. An analysis of the incidence of rickets over a 7-year period showed that in 2009 the incidence rate across the country was 40733.4 %, and in 2016 it decreased to 13500.9 %. The rate of decline for this period was 66.8 %, and the average annual rate of decline was 9.5 %. In 2009, the incidence rate among rural residents was 72990.2 % which is 1.6 times higher than in the city. After seven years, the incidence rate tended to decrease but remained 1.9 times higher than in the city. The highest rate of rickets was found among children 1 year of age.
   Conclusion. The highest incidence rate of rickets was found in in 2009 in GBAO , Dushanbe, and RRS. In these regions, the rate of decline in 2016 was also significant. The morbidity rate among children living in rural areas in the analyzed years tended to decrease by 3.9 % on average. The highest incidence rate of rickets was found among children of 1 year of age.

   Aim. To improve the immediate results of surgical treatment of injuries, and diseases of the liver and biliary tract through the rational use of minimally invasive technologies.
   Material and methods. Over the past 18 years, 6548 surgical interventions on the liver and biliary tract were performed. Postoperative intra-abdominal complications were observed in 643 (9.8 %) patients. At the same time, in 420 (6.4 %) cases, various options for repeated surgical interventions were used.
   Results. In 46 (23.4 %) cases, patients of the main group underwent laparoscopic cholecystectomy with endoscopic papillosphincterotomy (n = 10). In 5 (2.5 %) cases, percutaneous transhepatic cholangiography was performed to stop obstructive jaundice. Traditional surgical interventions with the formation of various variants of biliodegistic anastomoses were performed in 103 (52.5 %) patients. Postoperative complications in the main group were 23.0 %, and mortality was 9.6 %, while in the control group of patients, these figures were 36.0% and 19.3%, respectively.
   Conclusion. In the treatment of early postoperative intra-abdominal complications after surgical interventions on the liver and biliary tract, minimally invasive technology per indication is certainly considered the method of choice.

   Aim. To improve the results of surgical treatment of patients with acute intestinal obstruction of tumor genesis during radical surgery.
   Material and methods. Results of observation and treatment of 31 patients with acute colonic obstruction of tumorous genesis at the age from 34 till 72 years are presented. The most frequently observed was rectosigmoidal location of the tumor. The study group included 14 patients (45,2 %), in the control group - 17 (54,8 %). For diagnostic purposes general clinical and biochemical blood tests, ultrasound, MRI, CT, colonoscopy, rectoromonoscopy and video laparoscopy when indicated as well as pathohistological examination of biopsy specimens, taken from macro preparations of removed celiac tumor were carried out.
   Results and discussion. It was found out that more expressed decrease of inflammatory processes and intoxication indexes is observed in the patients of the main group, which were preoperatively prepared according to the method suggested in the clinic; early normalization of the laboratory and instrumental indexes in the postoperative period in comparison with the control group of patients, in which preoperative preparation was performed according to the traditional schemes. In 2 (11,8 %) cases of the control group patients suture inconsistency was revealed, in 3 (17,6 %) cases - purulence of the postoperative wound. In 1 case (5.9 %) lethal outcome was registered due to myocardial infarction. Inflammation of the postoperative wound was observed only in 1 (7,1 %) case among the main group patients.

   Conclusion. Decompression of the upper section of the bowel loop in combination to enterosorption in the preoperative period is the effective method of the bowel preparation for the radical surgery and promotes to decrease the frequency of the early postoperative purulent-inflammatory complications.

   Aim. To optimize the surgical treatment of recurrent postoperative ventral hernias using synthetic alloplastic materials.
   Material and methods. The study was conducted among 139 patients with recurrent postoperative ventral hernias. According to the indications, all patients underwent abdominoplasty using mesh biologically inert alloprostheses using the “onlay” method and according to the original method with the displacement of the vaginal leaves mm. recti abdominis.
   Results and discussion. Recurrence of ventral hernias after the first year of follow-up was detected in 6 (4.3 %) patients. The causes of relapses in large hernias are dystrophic processes in the soft tissues of the anterior abdominal wall, caused both by the activation of fibroblasts upon contact with the polypropylene mesh, and directly by the defect of the mesh as a result of its rupture. In the event of a recurrence, reconstructive surgeries were performed in the scope of a modified technique with component separation to eliminate additional tissue tension.
   Conclusion. The developed method of surgical treatment of postoperative ventral hernias involves dissection of the anterior walls of the sheath of the rectus abdominis muscles along the the muscles, suturing the aponeurotic edges of the defect, connecting the rectus muscles along the midline, followed by fixing the mesh implant to the outer edges of the dissected aponeurosis of the rectus abdominis muscles, which makes it possible to prevent the occurrence of cicatricial degeneration and defect of functional activity, as demonstrated by monitoring the function of the rectus abdominis muscles.

   Aim. To evaluate the effectiveness of non-adjuvant polichemotherapy in the combined treatment of advanced ovarian cancer.
   Material and methods. The material for the study was the clinical data of the 238 patients who were examined and treated in the SI “Republic Oncology scientific center” of the MHSP of the RT with morphologically proved diagnosis of ovarian cancer. The average age of patients was 45,7 ± 0,92 years. Non-adjuvant polichemotherapy was performed in 64(27,9 %) patients: 61 patients with stage III and 3 patients with stage IV of the diseases. Perfomance status of patient was evaluated by EGOG scale (WHO). The effectiveness of non-adjuvant polichemotherapy to evaluate by clinical data (scale Registry for evaluate the effectiveness of the therapy solid tumors on 4 categories, recommended by EORTC&NCL,2000y. (data of recto-vaginal bimanual observation, ultrasound and markers of tumor until treatment and after 2 cycle of the polichemotherapy). Statistical methods included program SPSS 16.0

   Results and discussion. As a result of non-adjuvant polichemotherapy, complete tumor regression was noted in 16(25 %) patients, portial tumor regression was noted in 20 (31,2 %) patients, stabilization was noted in 18(28,1 %) and progression was noted in 10 (15,6 %) patients. The overall objective effectiveness of non-adjuvant polichemotherapy was equal to 84,4 %.
   Conclusion. The overall objective effectiveness of non-adjuvant polichemotherapy was equal to 84,4 % and allowed the achievement of optimal surgery of 43,7 % patients. Disruption of the rhythm of chemotherapy treatment contributes to the decrease in frequency of optimal cytoreductive operations and affects the outcome of the disease.

   Aim. To study the features of the hormonal function of the placenta in women with insulin resistance.
   Material and methods. To study the hormonal function of the placenta of women with insulin resistance, 86 pregnant women in the third trimester of pregnancy were tested for the insulin resistance index (HOMA index), and the level of hormones in the blood. Group I of women (main) consisted of 30 pregnant women with risk factors for diabetes mellitus with an IRI above 2,84. Group II included 26 women of the same group, but with an IRI below 2,84. Group III (control) – 30 healthy women.
   Results and discussion. With insulin resistance, the average level of hormones such as progesterone, placental lactogen, estradiol decreases, which indicates an unfavorable course of pregnancy and perinatal outcomes as a result of such a complication as placental insufficiency.
   Conclusion. The study of the features of the development of placental insufficiency under the influence of various risk factors will allow for timely prevention and treatment of this pathology, which will improve perinatal outcomes in women with insulin resistance. IR contributes to the metabolic needs of the fetus and is the result of circulating placental hormones.

   Aim. Improvement of the results of diagnostics and provision of pre- and hospital medical care to victims with concomitant and multiple trauma in road accidents.
   Material and research methods. Based on the analysis of the results of diagnosis and treatment, it was found that the Department of Traumatology and Orthopedics of the Regional Clinical Hospital named after B. Vohidov of the city of Bokhtar (former Kurgan-Tyube) for the period 2012 - 2020. there were 2120 patients with injuries. 1234 (58.2 %) victims were injured as a result of road accidents.
   Research results and their discussion. Prehospital care for victims with concomitant and multiple trauma:

1) Pain relief through the use of non-narcotic and narcotic analgesics, aseptic dressings on wounds;
2) Immobilizing position of the victim on the shield and stretcher for transportation;
3) Introduction of cardiac and respiratory analeptics (strophanthin, korglikon, cordiamine);
   Conclusion. Thus, in the provision of emergency care to patients with concomitant and multiple trauma on the background of road traffic accidents, the following seems justified.
1. Constantly train traffic police officers, drivers of passenger vehicles in the methods of providing first aid directly at the scene of the accident.
2. Strengthen the personnel and material - technical potential of regional hospitals located on the highway.
3. Improvement of diagnostic and treatment algorithms, training, regular discussion of tactical guidelines their possible correction.

   Aim. To assess the informativeness and acceptability of the use of the annual reporting form No. 8 on tuberculosis in the Republic of Tajikistan.
   Materials and methods. This article studied the formation of the TB annual reporting form (form No. 8), assessment of dependence of TB indicators from TB annual reporting form in the Republic of Tajikistan.
   Results. The data indicate that the form of annual reporting on tuberculosis (form 8) cannot provide complete and reliable information about the incidence and prevalence of tuberculosis, does not note the migration processes inside of country and changing trends in the TB and DR TB epidemic which were calculated in the basis of Dushanbe data.
   Conclusion. The authors recommend to revise the annual reporting form on tuberculosis according to World Health Organization recommendation.

   Aim. To present the results of the complex clinical-instrumental diagnostics and surgical treatment of patients with Powers’ anomaly.
   Material and methods. The results of complex diagnostics, surgical treatment and medical examination of 6 patients (4 females and 2 males) with Powers’ anomaly at the age from 17 till 36 years old were analyzed. In all cases, the Powers anomaly was unilateral - in 4 cases, the right side and in 2 cases, the left side. According to the classification of A. V. Pokrovsky (1978), only one patient was asymptomatic and the rest had grade II or III chronic cerebrovascular insufficiency.
   Results and discussion. Except for one case, all the remaining patients had the main triad of VBI symptoms - dizziness, gait disturbance, and visual disturbances, which were indicative of severe brainstem and cerebellar ischemia. The diameter of the Powers anomaly in the first segment was 2.9 ± 0.81 mm and in the second segment was 3.6 ± 0.55 mm. There was also a decrease in the linear velocity of blood flow, and 2 patients had hypoplasia of the opposite vertebral artery. The average inflection angle of Powers’ anomaly in the near-osteal segment was 87.5 ± 10.5^о.
   Conclusion. The nonspecific nature and similarity of clinical manifestations of Powers anomaly are the main causes of their late diagnosis and development of marked hemodynamic disturbances of the cerebral vertebrobasilar basin. Duplex scanning and contrast studies play a significant role in the diagnosis of hemodynamic abnormalities of the vertebrobasilar basin in Powers anomaly. The efficacy of reconstructive surgery for Powers’ anomaly in the long-term postoperative period is registered in all cases.

   Aim. To study antioxidant activity of roots and rhizomes of Rhodiola heterodonta Boriss, and herbs of Nepeta tythantha Pojark.
   Materials and methods. Roots and rhizomes of Rhodiola heterodonta Boriss and herbs of Nepeta tythantha Pojark served as a material for experiments. The amount of total phenols was determined using the Folin-Czocalteu reagent. The activity of antioxidants was determined by ABTS (2,2-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid) analysis.
   Results and discussion. The results obtained show that the content of polyphenols in Rhodiola multiflorum (1.45 %) is higher than in the herb Nepeta tythantha Pojark (1.05 %). As for the antioxidant activity, it was found that the extracts of both plants obtained on the basis of methanol (81.21 and 32.27 µg/ml, respectively), it was higher than the extracts obtained on the basis of ethanol (72.65 and 26.16 µg/ml, respectively). The antioxidant activity of an extract of rhodiola multiflorum roots and rhizomes based on ethanol and methanol (respectively 72.65 and 81.21 µg/mg), higher than that of catnip herb (respectively 26.16 and 32.27 µg/mg).
   Conclusions. The study showed that the roots and rhizomes of Rhodiola multiflorum and herb Nepeta tythantha Pojark have good antioxidant activity and can be a potential source of phytoantioxidant drugs.

   A patient with complaints of difficult passage of solid food through the oesophagus, putrid breath, general weakness, a CT scan of the oesophagus revealed signs of a fistulous passage in the lower third of the oesophagus with a cavity in 9-10 segments of the right lung, with fluid resembling an abscess with perifocal infiltrative changes in lung tissue. Esophagogastroduodenoscopy revealed a diverticulum in the lower third of the esophagus with two fistulous passages into the pleural cavity. The patient underwent right thoracotomy to empty the abscess cavity, excision of the fibrous capsule of the abscess wall, excision of the diverticula and restoration of the esophageal wall integrity. A complication of oesophageal diverticula in the form of a fistula with formation of an abscess in the pleural cavity is a casuistic case. The main treatment for this complication is surgery.

   The paper presents a case of the practice of diagnosis and surgical treatment of a 26-year-old woman with multiple liver echinococcosis. The diagnosis was established on the basis of ultrasound. The cyst in the left lobe located partially extreparenchymatous. An open drainage of the residual cavity was performed. According to intraoperative ultrasound data, there was also a second cyst located deep in the projection of VII and VIII segments with signs of suppuration. Due to the threat of massive bleeding and trauma to the liver tissue, it was decided to perform a transhepatic puncture of the cyst. Approximately 200 ml of thick pus was released. The cyst was dreined by echinococcectomy with «pig tail» 16Fr drainage. The postoperative period is also conservative complications. The patient was discharged on the 14 th day after surgery in Key multiple hydatid cysts.

   This review of the literature presents current understanding about the etiology, pathogenesis, complications, contemporary methods of treatment, outcomes, and the tactics of managing patients with deep venous thrombosis (DVT) of the lower limbs. Analysis of the data in a literature shows that despite significant advances in the diagnosis and treatment of DVT of the lower extremities, there are still many unresolved problems in terms of complex treatment and prevention of severe consequences of this pathology. The advent of new oral anticoagulants has led to a significant reduction in the incidence of post-thrombotic disease. However, the severity of post-thrombotic disease directly depends on the effectiveness of treatment in acute period of DVT, as well as the presence of hereditary risk factors. In this regard, the optimization of therapy in acute phase of disease and further rehabilitation therapy, management of patients in the long-term period, aimed at better recanalization of thrombosed segments of the lower limbs deep veins, seem to be relevant, requiring further research.

   The review is dedicated to the analysis of the accumulated data on the study of Helicobacter pylori (H. pylori) since the detailed description of this bacterium as the main etiological factor of gastrointestinal diseases. The work shows the dual role of H. pylori both as a bacterial pathogen for humans and as a potential representative of the normal microbiome of the stomach. In most scientific publications, the attention of researchers is focused entirely on the consideration of the pathogenic properties of H. pylori in the development of chronic gastritis, peptic ulcer disease (PUD) and gastric cancer (GC), and also considers the development of effective methods of eradication therapy. Along with this, in recent years, more and more often there are works that indicate a potentially positive effect of this bacterium on the human body and the occurrence of a number of negative consequences after eradication therapy. In this connection, the question of the probable affiliation of H. pylori to the composition of the human microbiome is discussed. Data on the high prevalence of the microorganism in the population and its asymptomatic coexistence with humans indicate the persistence of the bacterium in the body, most likely as a representative of the microbiome. The accumulated data on the effect of H. pylori on human health demonstrate a clear ambiguity of the problem. In this regard, it is important to answer the question whether it is necessary to create programs for mass eradication of H. pylori, or whether it is necessary to approach the implementation of eradication therapy in a more personalized way.