Aim. To study the features of the clinic, diagnose and evaluate the effectiveness of the treatment of solitary and primarily multiple tumors of the skin of the nose and nasolabial fold (SPMTNSNF).
Material and methods. Work is based on a prospective analysis of clinical data of case histories of 74 patients with various solitary and primarily multiple tumors of the skin of the nose and evaluation of the treatment effectiveness in the State Institution “Republican Oncological Scientific Center” of the MoH and SPP of the RT 2015 to 2019.
Results and its discussion. Evaluation of the effectiveness of treatment of 70 (100%) patients with malignant SPMTNSNF in 63 (90%) cases showed excellent result, in 4 (6%) - good results and in 3 (4%) cases unsatisfactory results. The quality of life of patients according to Karnowski scale improved from a minimum of 60% to 100%.
Conclusion. Adequate treatment methods for SPMTNSNF made it possible to achieve satisfactory and excellent results in 96% of patients, which accelerated rehabilitation and improved the quality of life of these patients.

Aim. To study the dynamics of changes in the registration of cases of tuberculosis and the frequency of recurrence of the disease in the Republic of Tajikistan between 2011-2020.
Material and methods. The work is based on an analysis of official statistics of TB cases between 2010-2020 (National TB register).
Results and discussion. Analysis of official statistics for the last 11 years has shown a steady decline in the number of registered TB cases. Thus, this indicator decreased from 7641 cases in 2010 to 4315 in 2020. A deeper analysis of the structure of registered TB cases shows that this decrease is mainly due to a decrease in the number of new TB cases. The dynamics of detection of relapses and repeated cases of the disease over this period were chaotic: either increased sharply or tended to decrease. It should be noted that the dynamics of the decrease in the number of registered TB cases over the 11 years had a similar trend with the number of cases of TB susceptible to anti-TB drugs, while the dynamics of changes in the number of TB cases with resistance to mycobacterium TB also had a chaotic character.
Conclusion. An analysis of official statistics over the past 11 years has shown a steady decline in the number of registered TB cases, which is mainly due to a decrease in the number of new TB cases with preserved sensitivity to anti-TB drugs. An analysis of the dynamics of changes in the number of relapses after successful treatment of TB over the past 11 years showed that relapses of the disease are recorded annually in 4.16% and up to 12.9% of the total number of registered TB cases. There are regional differences in incidence and relapse from TB.

Aim. To study the five-year experience of using a modified subclavian-pulmonary anastomosis according to BlelokTaussig in the surgical treatment of complex congenital heart disease in patients with univentricular hemodynamics and depleted pulmonary blood flow.
Material and methods. From 2012 to 2020, 32 children with complex CHD, with duct-dependent blood flow, underwent operations to impose a modified subclavian-pulmonary Blelock-Taussig anastomosis (MBTA). The average age of the children was 13±6.7 months, and the average weight was 8.8± 5.2 kg.
Results and discussion. Fatal outcome in the early postoperative period was observed in 3.13% of cases. Bleeding in the early postoperative period was observed in 6.25% of patients. In 28.1% of patients with Fallo’s tetrada thereafter radical correction of the defect was performed. Bidirectional cavopulmonary anastomosis was performed in 40.6% of patients with a single ventricle. Postoperative follow-up results were studied in 96.8% of patients.
Conclusion. The use of a modified left subclavian-pulmonary anastomosis according to Blalock-Taussig is the optimal palliative procedure in children with depleted pulmonary blood flow. This surgery is performed to prepare the patient for subsequent correction of a complex heart defect and allows the right pulmonary artery to be preserved intact for future use during radical or hemodynamic correction of the defect.

Aim. To study and evaluate risk factors and analyze carotid artery intima-media thickness parameters as an early predictor of atherosclerosis in patients with rheumatoid arthritis.
Materials and methods. The study involved 86 patients (women - 67, men - 19) observed in the State Institution “City Medical Center №2”, Dushanbe, aged from 37 to 67 years (mean age - 56.5±2.9 years). The diagnosis of rheumatoid arthritis was established according to the American College of Rheumatologists/EULAR 2010 criteria.
The examination program included general clinical and instrumental methods (examination of common and accessible parts of internal and external carotid arteries), estimation of lumen size, the thickness of intima-media complex (TCIM), straightness of its course, atherosclerotic plaques of carotid arteries (ABS), echocardiography (ECHO-KG).
Results and discussion. Thus, in the absence of significant gender differences in the frequency of arterial hypertension and increased intima-media thickness (the earliest manifestation of atherosclerotic vascular lesions), hypercholesterolemia and long-term glucocorticoid intake were more frequently recorded in women. Undoubtedly, each of the considered risk factors makes a definite contribution to the development of vascular atherosclerosis and the instability of their organic changes. However, the significance of these risk factors in the thickening of the intima-media complex of vessels may differ.
Conclusion. Data correlated with intima-media thickness show sex differences, the significance of risk factors, and an increase in intima-media thickness despite the duration of glucocorticoid therapy. The factors mentioned are more significant in men, while in women, intima-media thickness is closely related to the duration of rheumatoid arthritis, total cholesterol levels, and blood pressure.

Purpose of the study. To evaluate the effectiveness of minimally invasive methods of treatment in children with congenital obstructive ureterohydronephrosis.
Material and research methods. We performed ureteral stenting in 78 (70.9%) children with congenital obstructive ureterohydronephrosis: I degree of ureterohydronephrosis -18 (23.0%), II degree -34 (43.6%) and III degree. -19 (24.3%), IV degree -7(9.0%). Children under the age of 16. Children with impaired urodynamics in the distal ureters underwent a complete clinical-biochemical laboratory and X-ray study.
Results of the study and their discussion. Stenting of the ureters was carried out in order to dynamically monitor the contraction of the urinary system. In children, stenting is performed under general anesthesia by performing cystoscopy. After assessing the topographic location of the orifice from the side of the pathology of the vesicoureteral segment, the ureteral orifice is expanded by balloon dilatation, followed by stenting of the ureter. It turned out to be effective in 26 (23.6%) children.
Conclusions. With neuromuscular dysplasia of the ureters in children of the first year of life, bougienage, balloon dilation of the ureterovesical fistula, followed by stenting of the ureter and pyelocaliceal system in 34.0% of patients lead to a significant improvement in urodynamics.

Aim. To assess the impact of maternal Covid-19 infection on the physical and neuropsychological development of children.
Materials and methods. The data for this study were the primary medical documentation of 98 pregnant women who gave birth in obstetric institution No. 1, and the city clinical hospital named after K.A. Akhmedov, as well as a history of the development of the child f.024.
Research results. 11 (11.2%) respondents had the first birth, 3 (3.1%) had the second birth, and the vast majority 84 (85.7%) had repeated birth giving. The range of births ranged from 3 to 9 births. In addition to the main Covid-19 infection, 94.9% of women in labor had from 3 to 5 extragenital and concomitant pathologies. The average body weight of children at birth was 3027.7±602, and the average height was 49.3±3.8.
Conclusions. More than 85% of women with Covid-19 had a history of 3 to 9 births. The physical development of children born to mothers with confirmed COVID-19 is normal according to WHO standards.

Aim. To evaluate the dental polymorbidity index in combined lesions of the pulp and periodontal complex in somatic patients.
Materials and Methods. 75 somatic patients diagnosed with combined lesions of the pulpal-periodontal complex took part in the study. All patients who took part in the study had a stomatological level of health determined using the index of stomatological polymorbidity. The index value was determined according to the following criteria: from 0 to 5 - mild degree of dental polymorbidity, from 6 to 10 - medium degree of dental polymorbidity, and from 11 to 16 - severe degree of dental polymorbidity.
Results and discussion. The average value of the stomatological polymorbidity index of mild, moderate, and severe degree in somatic patients with combined lesions of the pulpal-periodontal complex was 29,4%, 41,2%, and 29,4%, respectively. Among the patients of the control group with similar combined lesions, the average value of the stomatological polymorbidity index was 76,0% and 24,0% respectively in the absence of a severe degree of the named index.
Conclusion. The present article analyzes the existing methods of accounting, correction, and prediction of somatogenic and somatic conditions of patients. The integrated way of evaluation of combined lesion of the pulp and periodontal complex in patients associated with intersystem disorders has been suggested; it allows a doctor to evaluate objectively the revealed pathology of the oral cavity of endoperiodontal character; to make a complex plan of intracanal and projection-periodontal treatment and to analyze the effectiveness of treatment and prophylactic measures.

Aim. To improve the immediate results of treating postoperative bleeding in hepatobiliary surgery.
Material and methods. The paper presents the results of a study of 155 patients with postoperative intra-abdominal bleeding after operations in the hepatobiliary zone. The main reasons for the development of postoperative intraabdominal bleeding are analyzed.
Results. The study substantiated a clinical classification of postoperative intra-abdominal bleeding is proposed and the use of laparoscopy in the correction of postoperative intra-abdominal bleeding after operations in the hepatobiliary zone. Based on the results obtained, with an individual approach, the authors recommend using laparoscopy in patients with postoperative intra-abdominal bleeding.
Conclusion. Relaparoscopy for postoperative intra-abdominal bleeding, regardless of the nature of the previous operation, allows, with minimal aggression of re-intervention, to reliably stop bleeding and eliminate its causes.

Aim. To evaluate the effectiveness of assisted reproductive technologies in women with infertility after surgical interventions on the pelvic organs.
Material and methods: We analyzed the data of 90 women who approached the Nasl Medical Center due to infertility for IVF in 2017-2020, to whom different approaches in surgical treatment and without surgical interventions on the pelvic organs in the anamnesis were applied at the first stage.
Results. “A differentiated approach during the surgical stage and a complex of rehabilitation anti-adhesion measures in the postoperative period, as preparation for the IVF program, ensured a frequency of clinical pregnancy occurrence in 69% of cases, and a cumulative frequency coefficient of live births (CLBR) of 44.8% in the main group.”
Conclusions. Decreased fertility of women who underwent abdominal surgery without observing organ-sparing principles and rehabilitation anti-adhesion measures justifies the wider introduction of endoscopic organ-sparing interventions on the pelvic organs with a mandatory postoperative complex of restorative measures in adolescent girls and women of reproductive age to preserve their fertility.

Aim. To assess the prospects for introducing visual screening for cervical cancer in the healthcare system of the Republic of Tajikistan.
Material and methods. This study is based on an assessment of the quality of preventive services based on the results of an organized visual screening pilot study of cervical cancer in two districts of the Republic of Tajikistan.
Results and discussion. Pilot implementation of organized visual screening has shown high efficiency, availability and financial sustainability. Taking into account the experience gained, based on the successes achieved, the health care system of Tajikistan has demonstrated its readiness to introduce a visual screening of cervical cancer at the national level, and the need for the introduction of vaccination against papillomavirus infection has been identified.
Conclusion. The health system of Tajikistan is making every effort and allocating the necessary resources to build capacity for the detection, diagnosis and treatment of precancerous diseases to prevent and reduce mortality from cervical cancer.

Aim. To study some clinical and epidemiological aspects of HIV/hepatitis C coinfection in the Republic of Tajikistan.
Materials and methods. The material for the study was the data from clinical, epidemiological and virological examinations of 70 patients with HIV/hepatitis C coinfection. In all observed patients, the diagnosis was confirmed based on clinical and epidemiological data and confirmed by rapid testing, ELISA, and PCR.
Results discussion. The disease in patients with HIV/hepatitis C coinfection clinically proceeds with weakness and general malaise (92.8%), loss of appetite (67.1%), heaviness in the liver (45%), heartburn (25%), bitterness in the mouth (19%), nausea and anorexia (32.8%), bleeding from the gums (13%), yellowness of the sclera (11.4%), weight loss (41.4%), hepatomegaly (83%). Opportunistic pathology is represented by candidiasis (32.8%), herpes infection (22.8%), CMV (7.1%), pneumocystis pneumonia (4.2%), Kaposi’s sarcoma (4.2%), cerebral toxoplasmosis (1.4%). People who practice intravenous drug administration, as well as their sexual partners, are more likely to be infected. It has been established that males under the age of 45 predominate among coinfected patients. As for secondary and opportunistic infections, they are associated with a decrease in the immune status in the face of CD4+ - lymphocytes in patients with coinfection.
Conclusion. The studies carried out make it possible to identify the category of people most at risk of infection with HIV and hepatitis C, which must be taken into account when screening the population. Early diagnosis of HIV/ hepatitis C coinfection will help reduce the number of complications and mortality in this category of patients.

Aim. To study the state of care of patients suffering from cardiovascular diseases at the prehospital stage.
Materials and methods. A survey was conducted among employees of the service of the City Clinical Emergency Hospital in Dushanbe, as well as respondents, regarding the care of patients suffering from cardiovascular diseases at the prehospital stage.
Results and discussion. Servicing patients suffering from cardiovascular diseases at the prehospital stage remains a socially significant problem, as there are issues with the level of training and staffing of health workers. The situation requires the adoption of organizational measures, including the transfer of authority to specialists and an increase in the level of integration work.
Conclusions. The results of a survey of EMS specialists showed that the staffing of EMS teams, including the cardiological profile, with the means to provide assistance, including medicines, is insufficient.
Most of the interviewed respondents believe that the level of integration work of EMS doctors and family doctors is low. It is necessary to improve the medical examination of patients in this category.

Aim. To study morphological changes in the lymph nodes of experimental animals vaccinated with BCG vaccine in high and low mountains.
Material and Methods. Guinea pigs from the vivarium of the Central Research Laboratory of the Avicenna Tajik State Medical University were used as experimental animals. All animals were vaccinated subcutaneously with the BCG vaccine at a dose of 0.05 mg of dry matter in 0.1 ml of solvent. The difference in morphological changes of sections made from regional lymph nodes of experimental animals vaccinated with BCG in high and low mountains was analyzed.
Results. The animals were divided into 2 groups: 1 group was placed in expeditionary conditions in high mountains, and group 2 - in low mountains. A week after vaccination, the inguinal lymph nodes in animals of group 1 increased. Mantoux test 1:10 (ATK) was positive - 5 mm. In animals of group 2, less pronounced reactions of the lymph nodes were noted. Tuberculin tests were equivocal (2 mm) and negative. After 1.5 months, in animals of groups 1 and 2, regional lymph nodes were enlarged and indurated, and an increase in the cervical groups of lymph nodes was also noted. The Mantoux test was 1:10 on average - 7 mm in the first group, and 12 mm - in the second group.
Conclusion. Under conditions of low mountains, in the lymph nodes, the first signs of specific cellular appeared later than in animals in high altitude conditions, then large specific foci were formed, with caseosis.

Aim. To optimize the rehabilitation of edentulous patients during orthopaedic treatment on dental implants.
Materials and methods. We analyzed the results of cephalometry in 126 patients divided into two groups according to skeletal and facial types using Dentium “Rainbow CT”. We compared the data obtained in the patients of the general group in the process of the prosthesis without using cephalometry with the data of patients of the main group in the diagnosis and treatment of which cephalometry was used.
Results and discussion. The cephalometric analysis revealed the following complications in the study group (70 subjects): underbite - 23.4%; overbite - 19.3; chips and mechanical damage - 7.2%; muscle pain dysfunction (MPD) - 24.8%; TMJ dysfunction - 21.1%. At the same time, in the main group (56 patients) these indices were 2.2%, 3.1%, 2.1%, 1.8%, and 2.3%, respectively.
Conclusion. As a result of cephalometric analysis studies, the number of complications in the main group was significantly lower than in the general group, which is associated with the use of cephalometry in the diagnosis and treatment planning of orthopaedic patients.
The author considers expedient the use of cephalometric analysis for the treatment and prevention of possible further complications during prosthetics by fixed orthopaedic constructions on dental implants in case of complete mandibular adentia.

Aim. To present the diagnostic criteria for Behcet’s disease and its frequency in the structure of systemic vasculitis.
Materials and methods. The material for the study was the medical documentation of n=101 patients with suspected BD who were referred to the rheumatology department of the NMC “Shifobakhsh” for the period of 2017-2022. Information was collected on the speciality of the referring physician, and demographic data were recorded, including age, gender, and ethnicity. A complete history of current symptoms was obtained, which included the type, severity, and duration of symptoms, as well as a family history of BD. Subsequently, all patients were examined by a group of multidisciplinary experts, including rheumatologists, dermatologists and ophthalmologists. All patients underwent the Pathergy test.
Results. Of the total list of referred patients, 54 (53.5%) were women, and 47 (46.5%) were men. General practitioners were the most common speciality of attending physicians (33.7%) referring patients with suspected BD, followed by dentists (18.8%), ophthalmologists (16.8%) and rheumatologists 12.9%. The most common symptom referred for was oral lesions in 85.1%, followed by eye lesions in 31.7% and genital lesions in 22.8%. Out of 101 patients, 42.6% were diagnosed with BD, 18.8% had a probable diagnosis, and in 38.6% of patients, BD was ruled out. In patients who did not receive a diagnosis of BD, simple aphthous lesions were most common in 23.1%, followed by lichen planus in 4 (10.3%) and isolated eye involvement in 3 (7.7%).
Conclusion. BD can mimic several other disease processes as it manifests itself through non-specific changes in several organ systems. A constellation of findings put together eventually leads to a diagnosis. The results of this study can be used by rheumatologists who deal daily with patients with a high probability of BD and atypical manifestations. However, the alternative diagnoses established in this study can be used as a list of the most common differential diagnoses for systemic vasculitis.

Introduction. Template approaches to the formation of strategies and action plans to combat chronic noncommunicable diseases (CNCDs) are fraught with low efficiency, a mismatch between the resources spent and the results obtained. There is a need for "individualization" of strategies, taking into account local characteristics, capabilities and needs of individual administrative-territorial units.
Objective. Scientifically substantiate a set of programs and activities to combat chronic NCDs, taking into account the characteristics and needs of each administrative-territorial unit of Turkmenistan.
Material and methods. A general benchmarking of the administrative-territorial units of Turkmenistan was carried out. The rating parameters are determined by the logical and methodological deduction procedure. The included parameters reflect in a balanced way the socio-economic and demographic status of the region, the readiness of the healthcare system, the development of prevention, treatment and diagnostic work in relation to chronic NCDs.
Results and discussion. For the first time, a rating was compiled and benchmarking of the administrative-territorial units of Turkmenistan was carried out in the aspect of combating NCDs; for the first time, the corresponding needs, opportunities and characteristics of each region were objectively characterized, which is the basis for planning and management decisions. Based on the rating and benchmarking, an original tool for strategic planning has been developed - a matrix of the prevailing influence of typical barriers to combat NCDs in the administrative-territorial units of Turkmenistan.
Conclusions. A matrix of the prevailing influence of typical barriers to combat NCDs in the administrative-territorial units of Turkmenistan has been developed, which serves as the basis for strategic planning of a set of measures.

The paper considers the issues of two-level continuous precision suturing in patients with pyloroduodenal ulcerative stenosis. Transverse gastroduodenal anastomosis and duodenoplasty are proposed as alternatives to traditional surgeries. The latter have the best results due to preservation of anatomic, functional integrity of the pylorus and modeling of the pylorus “mechanism” during formation of transverse socket.
Formation of the sutures with the use of the precision two-level continuous suture allows reducing the duration of surgical interventions, providing its high reliability and functionality.

The article presents the results of the analysis of data from modern world literature on the etiology and clinical manifestations of diffuse forms of breast cancer. It has been proven that diffuse breast cancer is about 15-17% among other forms of breast cancer. They are characterized by diffuse compaction of the entire breast tissue due to tumor infiltration, an increase in its size, hyperemia of the breast skin and local hyperthermia with a pronounced symptom of "lemon peel" over the entire surface of the mammary gland, a sharp thickening of the nipple and areola folds, retraction and firm fixation of the nipple, in the vast majority of cases have affected axillary lymph nodes.

Primary biliary cholangitis, previously known as primary biliary cirrhosis, is a rare autoimmune liver disease that mostly affects women. Disorder of biliary excretion and enterohepatic circulation of bile acids in patients with primary biliary cholangitis in the early stages of the disease leads to their insufficient flow into the intestine and ingestion of bile acids into the general bloodstream. Insufficient intake of bile acids into the duodenum contributes to malabsorption, energetic malnutrition, and a slowly progressing weight loss. Pathophysiological mechanisms of the development of weight loss are related to impaired emulsification of fats and decreased absorption of hydrolyzed products - fatty acids and monoglycerides, steatorrhea in patients with primary biliary cholangitis as well as to dysbiosis of intestinal microflora. Already in the early stages of the disease, this leads to accelerated ß-oxidation of fatty acids, which is aimed at compensating for the developing nutritional energy deficiency. Entry of bile acids into the general bloodstream in primary biliary cholangitis is accompanied by dyslipidemia. The mechanism of hyperlipidemia in patients with primary biliary cholangitis differs from that in other conditions because along with the increase in total cholesterol, there is an increase in high-density lipoproteins and the appearance of unusual lipoprotein X (Lp-X). The appearance of the latter is most likely a protective reaction of the body aimed at the inactivation of bile acids detergent action on membrane structures of blood-forming elements and vascular endotheliocytes. Exactly bile acids, but not the content of total cholesterol, correlates with the level of lipoprotein X and determine its formation. Concomitant hypercholesterolemia in patients with primary biliary cholangitis is also aimed at neutralizing the detergent action of bile acids that entered the general bloodstream and is most likely a compensatory reaction of the body. “Abnormal” hypercholesterolemia in primary biliary cholangitis can serve as a model system to search for and develop new ways of dyslipidemia treatment, as it proceeds without increasing the frequency of cardiovascular events.