Aim: To study the opinion of legal representatives of children on the quality of medical care provided in urban health centres.

Material and research methods. The study is based on a survey of official representatives of children from 0 to 6 years old. One hundred sixty questionnaires containing 28 questions and 125 answers were analyzed.

Results and discussion. Relatively low respondents’ satisfaction with various aspects of medical services in urban health centres (53%) was revealed. The reasons for dissatisfaction were: long waiting time for appointments (20,5%), difficulty in obtaining consultations with narrow profile doctors due to their absence in the centre (32,5%), the unsatisfactory sanitary condition of rooms (16%), the low technical infrastructure of health centres (23,2%). The reasons for dissatisfaction with the district doctor included a rushed examination (36.4%), insufficient attention to the child (22.7%), superficial examination (12.3%), prescription of expensive drugs (18.2%), and incompetence of the doctor (11.4%). Almost half of the patients (43.2%) turned to fee-for-service medicine for more qualified care. The survey results showed a high need for paediatricians (86.4%).

Conclusion. The data obtained during the internal audit in a medical institution, in order to identify negative factors, can be used as an algorithm for action, i.e. to develop ways to improve the quality of medical services, with their subsequent adjustment and, as a consequence, to increase patient satisfaction with medical care. 

Aim: To study the features of morpho-functional changes in the small intestine mucosa in acute adhesive small bowel obstruction.

Material and methods. The results of a comprehensive study of morphological and functional changes in the small intestine’s mucous membrane in 20 patients out of 50 with acute adhesive small intestinal obstruction were analyzed. Patients underwent resection of the small intestine with a biopsy from the mucous membrane, followed by a pathomorphological and biochemical examination of biopsy specimens.

Results. The study results show that more pronounced pathomorphological changes in the mucous membrane of the small intestine were observed in patients with acute adhesive small intestinal obstruction with widespread (multiple) adhesions compared with limited (single) adhesions. In the study of biochemical parameters in the small intestine mucosa in patients with acute adhesive small intestinal obstruction with the presence of multiple (widespread) adhesions, there was a significant and critical increase in lipid peroxidation and proinflammatory cytokines, a decrease in antioxidant protection compared to the patient group with the presence of single (limited) adhesions. There was also a decrease in the concentration of serotonin in the mucosa of the small intestine. In the presence of single (limited) adhesions in these patients, it decreases to 0,50±0,3 units, and in patients with multiple (common) adhesions - to 0,20±0,2 arb. units.

Conclusion. The severity of morpho-functional changes in the mucosa of the small intestine directly correlates with the severity of the development of the adhesive process and acute adhesive small bowel obstruction. 

Aim. To compare the effectiveness of the impact of pulsed currents from the ELAV-8 device and the combined effect of pulsed currents and biologically active agent «Pelamine» on microcirculation in the rabbit ear.

Materials and methods. Experiments were carried out on six rabbits of the same weight and one litter. The ears of rabbits were used as the object of the study because they are pretty thin and covered with a small amount of wool, and the vessels of the ear are well visualized. The effect of pulsed electric currents from the ELAV–8 device and the biologically active substance «Pelamine» on microcirculation in the rabbit ear was investigated for the first time.

Results and discussion. As a result of our experiments, we found that pulse currents from the ELAV-8 device with a frequency of 50 and 100 Hz have a vasodilatory effect on the microcirculatory bed of the rabbit’s ear vessels. When exposed to a current with a frequency of 100 Hz, the effect of vasodilation was 5% higher than at a frequency of 50 Hz. The biologically active agent «Pelamine» applied to the rabbit’s paravertebral region using pulsed currents from the ELAV-8 device causes a vasodilator effect and the formation of additional collaterals in the rabbit’s ear. When exposed to a current with a frequency of 100 Hz, the effect of vasodilation was 6% higher than at a frequency of 50 Hz. The effect of vasodilation, when exposed to pulsed currents from the ELAV-8 device, reaches its maximum at the 5th-10th minute. The introduction of the biologically active agent «Pelamine» with the help of currents from the ELAV-8 device has a more prolonged effect on the expansion of the vascular bed. The changes are consistent and reach the maximum effect at the 15th minute.

Conclusions. We have shown that the combined effect of pulsed electric current from the ELAV-8 device and the biologically active agent «Pelamine» has a more prolonged effect on the expansion of the vascular bed than only pulsed currents. 

Aim. To evaluate the performance of implant prostheses depending on the extent of supraconstruction.

Materials and methods. During implant treatment of 96 patients with occlusal defects the examined patients were divided into 3 groups: Group 1 - patients who had implant prostheses with short length of supraconstruction; Group 2 - patients who had implant prostheses with medium length; Group 3 - patients with implant prostheses with long length. The index of dental implants functioning efficiency depending on the length of implant prostheses was determined by the scoring system proposed by M.Z. Mirgazizov.

Results and discussion. In patients with short implant prostheses in the long-term period of fixed prosthetics the value of the performance index of dental implants in 87.3% of clinical situations was one, which indicates the high performance of their functioning. During the above-mentioned follow-up period, this index for the patients with medium- and high-extension implant prosthesis was 83.7% and 63.8% respectively.

Conclusion. The results obtained in patients with short, medium and long implant prostheses have shown that orthopedic constructions fixed to osteointegrated implants provide high clinical effectiveness depending on the length of supraconstruction. 

Aim. To conduct a medical and social assessment of the effectiveness of rehabilitating people with disabilities in the Republic of Tajikistan on the example of the Sughd region.

Materials and methods. The study materials included specially designed questionnaires comprising questions related to the social status of the respondents and the availability of various rehabilitation services in the Sughd region.

Results and discussion. The results of the study showed that out of all the respondents, there were more men than women both in cities, 578 (55.0%) men and 469 (45.0%) women, and in rural areas, 148 (60.4%) men and 97 (39.6%) women, respectively. Moreover, this difference is more significant in rural areas. According to the survey, working people made up the bulk of the disabled in urban and rural areas. Disabled children and people of working age with disabilities are among the population’s main groups that significantly impact the state’s economy, welfare and development.

Conclusion. Most families with disabilities are disadvantaged in several medical and social indicators. The existing system of rendering medical and social services in the republic has shown that the most demanded services today are social-medical and social-household services. 

Aim. To analyze modern approaches to the diagnosis and treatment of Respiratory-Stress Syndrome (RDS) in premature babies at the stage of the delivery room and the possibility of their use in the conditions of the Republic of Tajikistan.

Material and methods. We analyzed the provisions and regulatory documents for obstetric facilities, including their annual reports, and national protocols on neonatology approved by the Ministry of Health and Social Protection of the Republic of Tajikistan. The data were compared with the provisions of the 2019 European Consensus on RDS in terms of its diagnosis and stabilization of newborns in the delivery room.

Results and discussion. The paper reflects current evidence-based approaches to diagnosing and managing preterm infants born with very low and extremely low birth weights. Taking into account the current recommendations of the European Commission on RDS concerning the issues of diagnosis, respiratory support and surfactant treatment to be performed at the stage of the delivery room, the possibilities of their use in the Republic of Tajikistan are determined.

Conclusion. Practical use of scientifically grounded modern strategies for nursing preterm infants with RDS will help to reduce mortality and complications. 

Aim. To study the effect of antiseptic sorption dressing “Vita Wallis” on the course of the wound process in acute purulent inflammatory diseases of the oral cavity.

Materials and methods. We have conducted a cytological examination of 30 patients with the acute odontogenic purulent inflammatory process of the oral cavity. Among them were 17 men (56,7%) and 13 women (43,3%). The patients were divided into two clinical groups equally. Cytological research was carried out on the specimen preparations, which were taken by putting slides to the purulent wounds on the 1st, third and fifth days of the postoperative period.

Results and discussion. The cytological study showed that the wound process had a distinct phase character on the first day after the operation in both groups. On the third and fifth day decrease of neutrophils, number was observed in the wounds (control group - from 65,0 to 90,5% and 56,0 to 66,0%, the main group - 52,0 to 80,5% and 40,0 to 53,0%). During this period, the number of epithelial cells in the main group patients increased more than threefold compared with the control group; it varied from 25.0 to 33.5%.

Conclusion. Application of antiseptic sorption material “Vita Vallis”, in comparison with the conventional method of treatment, cleanses purulent wounds more intensively, contributing to the intensified migration of inflammatory infiltrate cells and further regeneration in the damaged area. 

Aim. To study the immediate results of extended modified mastectomy with the closure of the soft tissue defect in the chest wall using the patient’s tissues in diffuse forms of breast cancer.

Materials and methods. Advanced modified mastectomy with soft tissue defect closure of the chest wall by the thoracodorsal and lower abdominal horizontal flap on the rectus abdominis was performed in 24 patients with diffuse forms of breast cancer.

Results and discussion. Primary healing of the wounds was observed in 21 (87,5%) patients. Marginal necrosis of the displaced flap was found in 2 cases, and necrosis of 2/3 of the displaced flap was found in 1 case, which was 12,5%.

Conclusions. The use of TD- and TRAM-flaps to close the defect of soft tissues of the chest wall after intraoperative complications did not accompany extended modified mastectomy. Local complications in the form of marginal necrosis occurred in 12.5% of cases. 

Aim. To establish the factors and prevalence of congenital malformations in the Republic of Tajikistan.

Materials and methods. This study was conducted based on statistical data from the State Institution “Republican Center for Medical Statistics and Information”, the State Institution “National Center for Reproductive Health” and other sectoral reports of the Ministry of Health and Social Protection of the Population of the Republic of Tajikistan. Statistical data processing was performed based on MS Office 2019.

Results. An analysis of 600 cards showed that in the structure of risk factors causing congenital malformations, the first place is occupied by acute and chronic non-genital infectious diseases (38%), second anaemia (29.8%). The third place is poor obstetric history: multiple voluntary abortions, intrauterine growth retardation, stillbirth, the birth of a child with defects, preeclampsia), (20.8%) with circulatory failure in the mother-child system (16.3%). The percentage of children born with congenital birth defects from marriages of close relatives is 5% of the analyzed charts.

Conclusion. Thus, the main reasons for the growth of CM in newborns are burdened obstetric history and heredity, bad habits and occupational hazards, past viral and bacterial infections, and late prenatal diagnosis. 

Aim: To identify the peculiarities of the clinical course of intracranial hematomas taking into account age factors.

Material and methods. One hundred twelve victims with traumatic compression of the brain were examined. The diagnosis was made based on the results obtained during a comprehensive examination, including a dynamic clinical and neurological examination, radiography, CT and MRI.

Results and discussion. More than half of the victims, 31 (56.5%), were admitted in consciousness, 65 (58.0%) in moderate stun, and 8 (7.1%) - in deep stun. Headache was detected in 86 out of 112 patients with ICH (76.8%). In some patients, it was impossible to identify headaches due to severe impairment of consciousness. They are usually considered in the circle of cerebral symptoms, and they are relatively rare - only 13.4% of patients with ICH Aphasic syndrome included a motor or sensory speech disorder and was noted in 16% of patients with intracranial hematoma. If we take only left-sided intracranial hematomas, their specific weight among focal symptoms significantly increased (up to 22%).

Conclusion. Statistical analysis of the results of this study showed that the introduction of new methods into the medical complex in recent years contributed to improving treatment results and decreasing mortality. 

Aim: To compare the course of severe community-acquired pneumonia caused by Kl. pneumonia in patients with acute lymphoblastic and myeloblastic leukaemia.

Materials and methods. The study was designed as a retrospective, single-centre, controlled and non-randomized study and included 40 patients. They were divided into two groups: patients with acute myeloblastic leukaemia (22), mortality of 59% (13 patients) and patients with acute lymphoblastic leukaemia (18), mortality of 38% (7 patients).

Results and discussion. The combination of acute myeloblastic leukaemia and severe community-acquired pneumonia caused by Kl. pneumonia showed a higher mortality rate, a longer duration of respiratory support, as well as a greater frequency of involvement of organs and systems in the infectious process than in acute lymphoblastic leukaemia.

Conclusions: The development of pneumonia caused by Kl. pneumonia in patients with acute myeloblastic leukaemia is characterized by a more severe course. SOFA, APACHE-II, and PSI/PORT scales have limited predictive ability in patients with acute leukaemia and severe community-acquired pneumonia caused by Kl. Pneumoniae. 

Aim. To study the indices of standard coagulogram and thrombodynamics test in native plasma and in the test with phospholipids in relation to the activity of rheumatoid arthritis (RA) and the ongoing therapy.

Material and methods. We examined 28 patients with rheumatoid arthritis and eight age- and sex-matched healthy controls: 11 patients with high rheumatoid arthritis activity (DAS28>5.2) (Group 1), nine patients with low and moderate rheumatoid arthritis activity (DAS28<5.2) (Group 2) and eight rheumatoid arthritis patients receiving anticoagulants (Group 3). Results. Elevated fibrinogen was more common in the RA patient groups: 5/11(45%) in group 1, 3/9(33%) in group 2 and 3/8(38%) in group 3. In the control group, fibrinogen was normal, p><0.05. Increased SFMC was found in all patients in all three groups (100%) and only in 2 of the controls (25%), with p><0.05. Mean clot density was significantly higher in RA groups than in controls: 26811, 25437 and 24740 versus 20631 c.u. in groups 1, 2, 3 and control, respectively, p><0,01. In patients with anticoagulants, lag time (1.4 minutes) was longer than without anticoagulants (1.1-1.2 minutes), with p><0.05 in all cases. Spontaneous clots were detected only in patients: 3 in groups 1 and 1 each in groups 2 and 3. Hypocoagulation was detected only in group 3 in 1/8(12%) patients, and thrombotic readiness status was detected in groups 1 and 2: in 2/11(18%) and 1/9(11%) patients, respectively. The frequency of normal- and hypercoagulation did not differ between the patient and control groups. Conclusion. According to the thrombodynamics test, hypercoagulability is present in RA patients. Thrombodynamics test can be used to identify the risk of thrombosis and to individualize therapy in RA patients. Keywords: prothrombotic state, hypercoagulation, rheumatoid arthritis, thrombodynamics>˂ 5.2) (Group 2) and eight rheumatoid arthritis patients receiving anticoagulants (Group 3).

Results. Elevated fibrinogen was more common in the RA patient groups: 5/11(45%) in group 1, 3/9(33%) in group 2 and 3/8(38%) in group 3. In the control group, fibrinogen was normal, p˂ 0.05. Increased SFMC was found in all patients in all three groups (100%) and only in 2 of the controls (25%), with p˂ 0.05. Mean clot density was significantly higher in RA groups than in controls: 26811, 25437 and 24740 versus 20631 c.u. in groups 1, 2, 3 and control, respectively, p˂ 0,01. In patients with anticoagulants, lag time (1.4 minutes) was longer than without anticoagulants (1.1-1.2 minutes), with p˂ 0.05 in all cases. Spontaneous clots were detected only in patients: 3 in groups 1 and 1 each in groups 2 and 3. Hypocoagulation was detected only in group 3 in 1/8(12%) patients, and thrombotic readiness status was detected in groups 1 and 2: in 2/11(18%) and 1/9(11%) patients, respectively. The frequency of normal- and hypercoagulation did not differ between the patient and control groups.

Conclusion. According to the thrombodynamics test, hypercoagulability is present in RA patients. Thrombodynamics test can be used to identify the risk of thrombosis and to individualize therapy in RA patients.

Aim. To study features of endogenous intoxication syndrome (EI), oxidative stress (LPO) and antioxidant defence (AOS) in patients with acute lower limb ischemia (LLI).

Materials and methods. Some parameters of EI, LPO and AOS were studied. EI syndrome was studied in 86 patients with LLI who underwent complex examination and treatment in 2020-2021 in the Department of Vascular Surgery of the RNCfCS. POL and AOS parameters were studied in 14 patients out of 86. There were 51 (59.3%) men and 35 (40.7%) women, mean age was 56.0±5.8 years. Acute occlusion of the iliofemoral segments was noted in 33 (38.4%) patients, in 32 (37.2%) - the femoral segment, and in 21 (24.4%) - the popliteal and femoral vessels. In all cases, ischemia had a unilateral localization - on the right in 59 (68.6%) cases and on the left in 27 (31.4%) cases. In 52 (58.1%) cases, there were clinical signs of grade II b ischemia, and in 36 (41.9%) cases - grade III A (according to V.S. Saveliev, 1987). The average duration of ischemia was 77.9±28.3 hours.

Results and discussion. In all cases of LLI before revascularization, there were signs of acute inflammatory reaction and EI syndrome in the form of increased ESR (42.3±7.1 mm/h), CRP concentration (16.1±4.2 mg/L), fibrinogen (8.5±0.9 g/L) and leukocytosis (12.7±1.5×109/L). Also, all patients had a slight elevation of blood glucose against the background of EI (7.5±1.8 mmol/L), a significant increase of creatinine concentration (128.9±6.1 µmol/L), urea (9.2±0.6 mmol/L) and aminotransferases as compared to normal indices. Results of LPO and AOS indices study in 14 patients showed that in LLI, malondialdehyde (MDA) increases 2.6-fold (3.9±0.1 μmol/L), diene conjugate increases 3.7-fold (0.77±0.04 units a/mL). However, after the elimination of ischemia, there was no significant decrease for 12.2±2.4 days, which confirms the presence of reperfusion syndrome. AOS indices - superoxide dismutase (20,8±1,0 u/l) and catalase (128,9±11,2 μl/l) increased 1,2 and 1,1 times in the examined patients cohort, respectively. Statistically significant associations were established between the following indices: Ischemia level and urea (r=0.89), Ischemia level and white blood cell count (r=-0.82), Hb and Er (r=0.99), Hb and creatinine (r=0.79), Hb and urea (r=0.79), Er and urea (r=0.79), creatinine and Er (r=0.90), ACTV and creatinine (r=-0.77), creatinine and urea (r=0.90).

Conclusion. Acute lower limb ischemia is accompanied by ischemia-reperfusion damage manifested by endogenous intoxication syndrome, impaired glucose metabolism and activation of lipoperoxidation processes and antioxidant system. After the elimination of acute ischemia, there is not always a significant decrease in lipid peroxidation and some inflammation parameters. Therefore, prolonged use of antioxidants in the reperfusion period is recommended. 

Aim. To evaluate the hypocoagulatory role of the lungs in postpartum women with multiple organ failure using thromboelastography.

Materials and methods. Sixty-six postpartum women aged 19 to 45 with multiple organ failure were examined. Postpartum women were divided into three groups depending on the nonrespiratory lung function impairment stage.

The first group included 23 (34.8%) postpartum women with compensated nonrespiratory pulmonary function; the second group included 24 (36.4%) postpartum women with subcompensated stage of nonrespiratory pulmonary function disorder; the third group included 19 (28.8%) postpartum women with a decompensated form of nonrespiratory pulmonary function disorder.

Results and discussion. When analyzing the results of studies in healthy individuals noted TEG constant R reflecting the rate of thromboplastin formation. Thrombin constant K, nonspecific coagulation constant R+K, prothrombin use constant R/K, T - total clotting, syneresis (compaction) C are prolonged in the arterial blood flowing from the lungs compared to the mixed venous blood.

Conclusions. In healthy humans, the lungs act as a coagulation filter, reducing the hemostatic potential of the blood. The hypocoagulatory function of the lungs in postpartum women with multiple organ failure is impaired in stages. The thromboelastographic hemostasis study allows rapid and complete assessment of the hypocoagulatory role of the lungs in parturient women with multiple organ failure. 

This article considers a clinical case of a combination of four complications of duodenal ulcer. Against the background of chronic complications of penetrating ulcer and decompensated duodenostenosis, two acute complications were simultaneously observed - perforation of the ulcer and bleeding from it into the lumen of the GI tract and abdominal cavity. A prolonged course of the disease and the absence of timely surgical treatment of penetrating stenotic ulcer were the reasons for the simultaneous development of two acute complications of duodenal ulcer. Against the background of the severe general condition of the patient, caused by decompensated stenosis with profound homeostasis disorders, alimentary dystrophy, widespread purulent-fibrinous peritonitis and hemoperitoneum, suturing of the perforating ulcer was a necessary operation. At the second stage, it is recommended to perform radical surgery as a planned procedure. 

The incidence of acute destructive pancreatitis is steadily increasing worldwide and, according to the recent literature, is 300-900 patients/mil per year. The increased lethality rate of acute destructive pancreatitis in recent decades, which according to global statistics, ranges from 5% to 20% depending on the severity of the disease, is a cause for concern. It should be noted that most patients with acute destructive pancreatitis are working-age patients, which significantly increases the socio-economic aspect of the problem and urgently requires an active search for ways to solve it. It has been established that the leading pathogenetic mechanism of acute destructive pancreatitis development is enzymatic autolysis of pancreatic parenchyma by its enzymes with their subsequent release into the bloodstream and damage of other organs. 

The article is devoted to the problem of the effect of pregnancy on alloimmunization in women with stage 5 chronic kidney disease and the choice of a donor and immunosuppression for kidney allotransplantation. The analysis showed that alloimmunization of pregnant women is common and remains poorly studied. Studies suggest that endogenous mechanisms contributing to maternal-fetal tolerance during pregnancy may persist in the postpartum period. Moreover, it remains to be determined whether this immunological balance can be used to improve transplant outcomes. Thus, significant opportunities remain for clinical researchers to contribute to this field and improve transplant outcomes for sensitized women.