Aim. To improve the results of treatment of pregnant women with acute calculous cholecystitis.

Material and methods. This study is a prospective analysis of the observation results of 120 patients with acute calculous cholecystitis in different periods of pregnancy who were examined and treated at the city institution “Medical Complex Istiqlol” in Dushanbe for the period from 2018 to 2021. Patients were divided into two groups: group 1 (intervention) included 70 pregnant women with ACC in different trimesters of pregnancy, where individual treatment methods were used; group 2 (control) included 50 pregnant women who received generally accepted existing methods of treatment.

Results and discussion. Postoperative complications after cholecystectomy in patients of the intervention group were observed in 3 (7.3%) cases, and in the control group, in 9 (26.5%) cases. There were no lethal outcomes and 2 (5.9%) cases in the main group.

Conclusions. Thus, minimally invasive interventions are the operation of choice during the preservation and absence of signs of intrauterine fetal hypoxia and the ineffectiveness of complex conservative therapy, regardless of the timing of gestation. The implementation of modern minimally invasive surgical interventions has a significant advantage over the generally accepted traditional tactics.

Aim. To evaluate the results of treatment of renal hypertension in varicocele after the formation of the proximal intervenous anastomosis.

Material and methods. A survey was conducted among 167 patients with varicocele aged 16 to 39 years. The evaluation of the Varicocele degree was made by the classification of the Amerla Cubin, which is used in the WHO Classification (1997). All patients had clinical signs of varicocele. Ipsilateral testicle hypotrophy was detected in 21 (12.6%) and hydrocele 6 (3.6%) patients. All patients before and after the operation went through the analysis of ejaculate.

Results and discussion. The renotesticular hemodynamic type of varicocele was found in 115 (68.9%) of 167 surveyed patients. Varicocele of 1 degree was detected in 17 (14.8%) cases, 2 degrees in 31 (26.9%) and 3 degrees in 67 (58.3%) patients. With doppler ultrasonography of the veins of the spermatic cord, the inner diameter varied from 3 to 6 mm. On average, this value was 4.3±1.1 mm. All these patients received subinguinal varicocelectomy by Marmar. Therefore, the vein drainage operations to reduce renal hypertension was carried out for 65 (56.5%) patients.

Conclusion. The formation of intervenous anastomoses is a pathogenetically justified method of treating regional venous renal hypertension in varicocele.

Aim. To study the association between the prevalence of caries and the fluorine load in children according to fluoride in the urine.

Materials and methods. Fluoride level examination was conducted among 45 patients aged 3,6,12,15 years old. The assessment of the intensity of dental caries was carried out according to the KPU / kp index as recommended by WHO (1997). Dental examination in children was carried out in the Scientific Clinical Institute of Dentistry and Maxillofacial Surgery of the Ministry of Health and SZN of the Republic of Tajikistan, Dushanbe.

Results and discussion. The fluorine status of breastfed children corresponded to a low level of fluoruria. In children aged 4-6 years fluorine load corresponded to a low level in 15.7% of the children, the optimal level was noted in 61.6% of the children, and a high level of the trace element over 2.5 mg/day was found in 22.7% of the children. High KPU index (3.1 and 5.7, respectively), determined in those cases where there was a low level of access to fluoride.

Conclusion. In infants, the level of urinary fluoride excretion depends on the feeding pattern. The level of fluoruria in (60.0%) children aged 12 years and (66.6%) 15 years old was below the standard indicators. The intensity of caries in 15-year-old children was higher than in 12-year-old children.

Aim. Improve the results of diagnosis and surgical treatment of Hirschsprung’s disease in the neonatal period.

Materials and methods. The article presents an analysis of the diagnosis and results of surgical treatment of 15 children with Hirschsprung’s disease in the neonatal period, in the Department of Neonatology and Neonatal Surgery of the Scientific Center of Pediatrics and Pediatric Surgery from 2017 to 2020.

Results. All children were found to have a rectosigmoid form of the disease. 10 (66.6%) newborns underwent radical surgery-transanal endorectal proctoplasty according to Svenson-like. Immunohistochemical examination with the use of calretinin confirmed Hirschsprung’s disease in all operated children.

Conclusions. Our results of surgical treatment in the neonatal period indicate that early diagnosis and early surgical correction contribute to the rapid restoration of gastrointestinal motility, and the method of choice is Svensonlike transanal endorectal proctoplasty, which has proven to be an effective and gentle method of surgical correction for this pathology. Also, the use of immunohistochemical studies with calretinin is a highly sensitive diagnostic method.

Aim. To estimate the condition of acid-main balance of oral cavity in patients with fracture of the mandible in combination with parodontal pathology.

Material and methods. 40 patients with fractures of the mandible in combination with parodontal pathology were observed in the study. They were divided into three groups. Patients of the first group had a fracture of the mandible in combination with chronic periodontitis. Patients of the second group had fractures of the mandible and chronic gingivitis. Patients of the third group had no bone-traumatic damages and parodontal pathology.

Results and discussion. The activity of the parodontal microflora of the oral cavity in patients with the bone trauma of the mandible in combination with periodontitis is higher and characterizes the quick response component of the acid-main balance regulation in the oral cavity.

Conclusion. Lingual raid is the main reservoir of oral microflora and its role under existing bone-traumatic damage on the background of parodontal pathology in maintaining microbiocenosis not only increases but also becomes the factor of destabilization regenerators processes at fracture of the mandible.

Aim. To assess the effect of iron deficiency anemia on the state of the oral mucosa in pregnant women.

Materials and methods. On the basis of the State Institution “NKI of Dentistry and Maxillofacial Surgery” of the Ministry of Health and the SZN of the RT, a clinical assessment of the effect of moderate iron deficiency anemia (IDA) on the state of the oral cavity was given in 48 pregnant women, where the hemoglobin level was below 100 g / l. The nature and severity of lesions of the oral mucosa were determined. Disturbances of taste sensations were assessed, a quantitative assessment of the varieties of taste disturbances was made, the nature and tonality of the color of the tongue were established.

Results and its discussion. In 48 examined women with IDA of moderate severity with hemoglobin below 100 g / l, local color changes were revealed on the anterior part of the tongue in the form of a bright red color. Paresthesia of the tongue was detected in 39.6% of women, for whom the most characteristic signs were burning sensations, tingling, tingling, and bursting. Sometimes these signs intensified with mechanical irritation - brushing teeth. The survey showed that 64.2% had a violation of taste sensations. The phenomenon of paresthesia of the tongue was in 39.6% of women; in 22.4% of women, a condition accompanied by a perversion of taste, dysgeusia, was recorded.

Conclusion. Iron deficiency anemia in pregnant women leads to significant changes in the oral mucosa in the form of pallor of the oral mucosa, paresthesia, impaired taste sensations (hypogeusia, dysgeusia), thinning of the epithelial layer and papillae of the tongue, difficulty in swallowing due to dry mouth, as well as whitish color gums mainly in the projection of the roots of the teeth.

Aim. To analyze the maternal and perinatal outcomes in repeated caesarean section. The first group included 50 laboring women who received combined endotracheal anesthesia for a repeat cesarean section. The second group included 50 laboring women who received spinal anesthesia during the operative delivery. The condition of 100 newborns born by repeated cesarean section was studied.

Results. In postpartum period in the women of first group very often, develop endometritis (24%), in second group – 36%, hematometra in first group we see in 12%, in second – 26%. Tracheobronhitis occur in first group among 30%. Research of the condition and course of early neonatal period in newborns showed, that combined anesthesia initiates pathological course of this period. The main complications were asphyxia (28%), and neurological disorders (22%).

Conclusions. Different types of analgesia initiate different types of complications in the postoperative period, but better neonatal outcomes with the use of regional anesthesia techniques qualify them as the anesthesia method of choice for repeat cesarean section.

Aim. To study the features of the plasma hemostasis in newborns with congenital IUI.

Material and methods. The observation of 52 newborns with intrauterine infections was conducted. All the children were divided into two groups. The first group included 36 (69, 2%) patients with a severe IUI and the second - 16 (30,8) patients with a very slow course of the pathological process.

Results and discussion. The results of the study showed that IUI in children has a generalized form of the course, with symptoms of microcirculatory dysfunction of the internal organs and systems.

Conclusion. The study of the plasma component of hemostasis showed multidirectional changes in it in the form of activation of plasma clotting factors, at the same time there was an increase in the duration and time of blood clotting, indicating the development of consumption coagulopathy in this category of patients, whose severity depends on the course of fetal infections and tropism of the pathogen to the organs and tissues. Identified changes in the plasma component in children with intrauterine infections dictate the need for timely adequate corrective therapy.

Aim. To assess the effectiveness of modern methods of therapy for children with complicated dacryocystitis.

Materials and methods. We have studied the results of clinical observations of 75 children in the Pediatric ophthalmological department of the SI “NMC Shifobakhsh” of the MoHSP of RT. The age of children ranged from 7 days to 3 years. 60 children had chronic and 15 phlegmonous dacryocystitis. Immediately after the patients were admitted to the department, clinical and laboratory studies were carried out before the start of antibiotic therapy, inoculum (the contents of the lacrimal sac) was examined to determine the nature of the microflora.

Results and discussions. It was found that one of the main causative agents of a purulent inflammatory process in children with dacryocystitis is Staphylococcus epidermidis (n = 34; 45.3%) and Staphylococcus aureus (n = 11; 15%). Also, 6 (8.7%) children were diagnosed with mixed infection - association of Staphylococcus epidermidis and Pneumococcus pneumoniae. In 5 (7.3%) cases, the culture was sterile.

Conclusion. Thus, the current strategic direction in the antibacterial treatment of these diseases is the use of the latest generation of antibiotics, to which there are few resistant strains. Such medicines include fluoroquinolones - levofloxacin and ofloxacin.

Aim. To study the features of the gas composition and acid-base state in newborns with specific intrauterine infections.

Material and methods. The examination was conducted based on the neonatal pathology unit of the SI NMCShifobakhsh.

The degree of oxygenation of blood and skin was determined using daily pulse-oximetry. The partial pressure of gases and the study of the acid-base state (CBS) of blood was carried out using Convergys/liquid device.

Result and discussion. The results of our study of blood gases and the acid-base indicator of blood in newborns with severe IUI showed noticeable hypoxemia, moderate hypercapnia, and a deficiency of buffer States, which indicate a violation of gas exchange function in the lungs with the development of compensatory respiratory-metabolic acidosis in children of this group. In patients with a very severe course of IUI, as the syndrome of respiratory disorders and the severity of hyperventilation syndrome increased, deeper changes in blood gas parameters and the acid-base state of the blood were noted. It indicates significant damage to the ventilation function of the lungs, diffuse perfusion processes, gas, and acid-base homeostasis.

Conclusions. Impairment of the function of organs and systems that developed against the background of a severe or very severe course of IUI, depending on the degree of severity of deviations in blood gas parameters and acid-base balance, shows the need for adequate corrective therapy.

Aim. Justify the use of low-frequency laser radiation (LFLR) treating chronic salpingoophoritis of chlamydial etiology, taking into account the assessment of the immune status.

Material and methods. The study included 110 women, of which 80 women had chronic salpingo-oophoritis of chlamydial etiology, and 30 were practically healthy. In addition to conventional methods, patients underwent examinations like immunological analysis, ultrasound examination of the pelvic organs, enzyme-linked immunosorbent assay (ELISA), polymerase chain reaction (PCR) analysis.

Results and discussion. When comparing changes in the immune status in patients after LFLR and who underwent traditional therapy in the group of patients with sexually transmitted infections (STIs), there was a slight increase in the number of T-lymphocytes and T-helpers, as well as a decrease in the number of T-suppressors. Also, in these patients, there is a slight decrease in the number of IgA and IgM against the background of an increase in IgG and an increase in the phagocytic activity of neutrophils. In patients with traditional therapy, the above-described changes persisted, while an aggravation of the disturbed T-cell balance was observed.

Conclusions. Thus, according to the results of a comparative analysis of the obtained data on changes in the immune status in patients with chronic salpingo-oophoritis after the use of laser therapy, a statistically significant increase in the number of T-lymphocytes, an increase in subpopulations including T-helpers, a decrease in the number of T-suppressors, an increase in immunoglobulin G and an increase in phagocytic activity of neutrophils was observed.

Aim. To analyze and assess the clinical course and changes under instrumental-functional examination (MRI) in the muscles of the obturator apparatus of the rectum in women with anal sphincter insufficiency (ASI).

Material and methods. Clinical and instrumental research methods, as well as modern scales for assessing ASI (Wexner score scale), were used in the current study.

Results and discussion. The study showed that 110 out of 228 patients with anal sphincter deficiency showed only an organic form of ASI, and 118 (51.8%) had a mixed form (organic and functional). This study shows that the degree of postpartum perineal rupture depends on the factors producing the damage to the pelvic floor muscles.

Conclusion. Analysis of the clinical course of ASI in women showed that gender-related factors in 51.8% of cases contributed to the development of a mixed form of the disease. Functional research methods showed that along with the external and internal sphincters of the rectum, the pubo-rectal muscle is damaged in patients with ASI, which should be taken into account when choosing a treatment strategy for the mixed form of ASI.

Aim. To improve diagnostics of fat embolism syndrome in patients with multitrauma.

Material and methods. The study included 250 patients with multitrauma at the age of 18 to 60 years that received treatment during 2014-2010. There were 174 (69.6%) men and 76 (30.4%) women. The patients were divided into two groups. The main group included 128 (51, 2%) patients with multitrauma, in whom the diagnosis, prevention, and treatment of fat embolism syndrome were carried out using improved approaches. The control group of 122 (48, 8%) patients with multitrauma received a diagnosis, prevention, and treatment of fat embolism syndrome using traditional approaches.

Results and methods. Comprehensive analysis of data with the formalization and standardization of data by comparing the frequency of symptoms in the group of patients with and without fat embolism syndrome helped to reveal integral criteria for the diagnosis of various clinical manifestations of this symptom-complex were identified. Based on the data obtained, a highly effective method for the diagnosis of fat embolism syndrome has been developed. In the main group, differentiated treatment of patients using the developed approaches contributed to an increase in the proportion of positive results (43.7%) and a decrease in unsatisfactory results (8.6%) and mortality (8.6%). In the control group, satisfactory (36.0%) and unsatisfactory results (15.6%), as well as lethal outcomes (16.4%), prevailed.

Conclusion. The use of improved approaches in the diagnosis and treatment of fat embolism syndrome and the construction of treatment tactics on this basis are among the effective ways to improve the results of multitrauma.

Aim. To evaluate the results of surgical treatment in older patients with lumbar spinal stenosis.

Materials and methods. The study is based on the results of a comprehensive examination and surgical treatment of 20 patients who were hospitalized in the neurosurgery department of the SI NMC “Shifobakhsh” in the Department of Neurosurgery and Combined Trauma of the ATSMU with stenosis of the lumbar spine with various options for the clinical course. Assessment of the neurological status in degenerative spinal disease was conducted using a visual analog scale (VAS.)

Results. When comparing subgroups, it was noted that decompressive interventions show the best results for lumbar spinal stenosis in the older age group.

Conclusion. The use of differentiated microsurgical decompression techniques in older patients with degenerative lateral and central spinal canal stenosis provides an improvement in quality of life.

Aim. To determine the total polyphenols and antioxidant capacity and their correlation with antimicrobial and fungicidal properties in some species of the genus Allium growing in Tajikistan.

Materials and methods. The objects of the study were 15 kinds of the Amaryllidaceae family. Antibacterial onions were studied by the disk diffusion method against 4 types of microorganisms (test strains) and 1 type of yeast fungus. In the presence of total polyphenols, the content in μg of Gallic acid (GA) per ml of plant extract was measured. To determine the antioxidant activity, a solution of ABTS K2S2O8 was used. Trolox was used as a standard.

Results. The maximum content of total polyphenols is characterized by ethanol extracts of A. Carolinianum, A. altaicum, A. elatum, A. oschaninii, A. ramosum, A. hymenorhisum. At the same time, their lowest amount was found in the bulbs of A. longicuspis. A. shoenoprasum, which is statistically significantly lower than in all the above-listed species of this plant group. The extracts from the stems of A. carolinianum, A. elatum, and A. pamiricum had the highest antioxidant effect. There is a direct weak correlation between biologically active components with antimicrobial and fungicidal activity in A. oshaninii and A. suworowii, depending on the altitude gradient.

Conclusions. The results allow suggesting that the above-ground and underground parts of some wild-growing endemic species of the genus Allium have different degrees of antioxidant activity due to total polyphenols. The content of total polyphenols and the antioxidant capacity of extracts obtained from various plants in different in large ranges. In some cases, there are direct correlations between the content of polyphenols, antioxidant properties, antimicrobial and fungal properties.

Aim. To present the clinical and functional characteristics of chronic kidney disease at the hospital stage.

Material and methods. The material for the study included retrospective analysis of medical records (case histories, statistical card, individual cards) of patients with a diagnosis of CKD who were admitted to the nephrology department of the NMCShifobakhsh (clinical base of the Department of Internal Medicine) in Dushanbe for the period 2018 to - 2020. All patients underwent laboratory and instrumental examinations.

Results. During the study period, n=680 patients with a diagnosis of CKD (n=251 men and n=429 women) were hospitalized. Among the reasons for the development of CKD, the most frequent were diabetic nephropathy - 45.9%, Arterial Hypertension - 27.9%, and glomerulonephritis - 18.1%. The majority of patients with CKD are represented by the age categories 60–70 years (38.1%) and 50–60 years (28.2%). Obesity was observed in 37.1%, overweight in 38.7%, and normal body weight in 24.2% of patients.

Conclusion. A retrospective analysis of medical records revealed a high frequency of inpatients with DN in the structure of CKD, which characterizes inadequate metabolic control and low adherence to hypoglycemic drugs. Assessment of RF and comorbidities revealed several features depending on gender, as well as the presence of high cardiovascular risk in patients with CKD.

The article provides a review of the current literature to study the issues of planning and optimization of the number of medical and pharmaceutical personnel. The Republic of Tajikistan is going through a process of restructuring of the industry, which is based on the development of family medicine with the in-depth use of stationary replacement therapy technology, reduction, and intensification of the use of bed resources, improving the quality of specialized care requires efficiency increase of the existing staff.