Aim: To develop an optimal variant of complex treatment of the rhinocerebral form of mucormycosis in the postCOVID period.

Materials and Methods: Treatment data from 48 patients diagnosed with the rhinocerebral form of mucormycosis, sourced from various regions of the Republic of Tajikistan, was scrutinized for this analysis.

Results and Discussion: The analysis revealed that patients who had contracted COVID-19 (n=12; 0.9%) and had existing health conditions, experienced the onset of neurovascular insufficiency in the early stages of the post-COVID period, roughly 1-3 months subsequent to the infection. This condition was ostensibly triggered by the direct viral disruption of the blood-brain barrier, hypercoagulation, and ensuing neurovascular complications. It was also noted that these patients had been administered fifth-generation antibiotics and glucocorticosteroids during their treatment.

Conclusion: The study findings suggest that the emergence of the rhinocerebral form of mucormycosis in the postCOVID period, especially in patients with concurrent health conditions, could be linked to weakened immunity and immunodeficiency. These are often induced by the prolonged, unregulated use of antibiotics and glucocorticosteroids, consequently leading to an increase in pathogenic and opportunistic fungi. In light of these findings, it is recommended that such patients be admitted to specialized medical institutions for appropriate treatment.

Purpose of the study. To evaluate the results of the effectiveness of the use of the drug Phlebodia in pregnant women with hemorrhoids.

Object and methods of research. We examined 37 patients who were diagnosed with acute and chronic hemorrhoids, who were in the department of pathology of pregnant women No. 1 of the State Research Institute of AH and P for the period 2000-2021. These patients were consulted by a proctologist. After the discharge of pregnant women from the pathology department, further observation was introduced by a proctologist. Inclusion criteria - the presence of subjective and objective signs of the disease in pregnant women. Treatment with Phlebodia 600 was carried out according to a certain scheme: first, 4 days, 1 tablet 3 times a day with meals, and then 1 tablet 2 times a day.

Results of the study and their discussion. The leading symptom of hemorrhoids in pregnant women was pain, which occurred in 81.0%, discomfort (itching) was observed in 43.2%, bleeding from the anus in 32.4%, respectively. When prescribing the drug Flebodia, we achieved positive results. In the course of our study, it was possible in 91.8% of pregnant women with an established diagnosis of hemorrhoids to achieve such positive results as the elimination of such symptoms as the cessation of bleeding, perianal edema, pain and itching.

Conclusion. In pregnant women who used the drug Flebodia 600, there was a positive hemodynamics in the clinical symptoms of hemorrhoids.

Aim. To assess cognitive and speech functions in patients with cerebral palsy and their relationship with the location of the pathological focus and gender.

Material and methods. We examined 125 children aged 7-9 years with a final diagnosis of cerebral palsy, hemiplegic form (G80.2). The patients were divided into 2 groups depending on the location of the hemispheric focus. Group I consisted of 72 patients with left-sided hemiparesis (LHP), 33 girls and 39 boys. Group II consisted of 53 patients with right-sided hemiparesis (RHP), 23 girls and 30 boys. The control group included 30 practically healthy children (16 boys and 14 girls) without neurological pathology with an average age of 7.3±1.5 years.

Results and discussion. Children with LHP more often had disturbances in the tempo and prosodic characteristics of speech (43.7%). The rate of speech was disturbed in 33.8% of children, narrative speech - in 14.1%. These disorders are called "right hemispheric cortical dysarthria". Counting disorders were noted in 4.2% of children.

In the group with RHP, violations of expressive speech were stated: "monologic" - in 88.7%, "dialogical" - in 86.8%, "automated" - in 17.0% of patients, not fluent speech - in 66.0%, slow - in 64.2%.

Conclusion. The results of the study indicate a high degree of correlation of speech disorders and impaired cognitive functions with the severity of hemiparesis and structural changes on MRI of the brain. These results significantly differ from the corresponding indicators depending on the side of hemiparesis and sex. Determination of cognitive evoked potentials makes it possible to obtain additional information about the cognitive status of patients with cerebral palsy, depending on the lateralization of the lesion.

Aim. To evaluate the dental health of children in early childhood, middle childhood, and adolescence.

Materials and Methods. The prevalence and intensity of caries were assessed in 90 children from different age groups: 20 children from the early childhood group (6 years old), 45 children from the middle childhood group (12 years old), and 25 teenagers (15 years old).

Results. In the middle childhood group, the “Decayed” component of the DMFT index (Decayed, Missing, Filled Teeth) starts to appear, showing a clear increase with age. For instance, in teenagers, it is 4.04 ± 2.08, which is more than twice as high as in middle childhood children. A similar trend is observed with the “Filled” component of the index - while it was only 0.1 ± 0.02 in 6-year-old children, this indicator shows a clear increase with age, amounting to 2.15 ± 0.15 in teenagers. Consequently, in teenagers, the “Filled” component prevails at 2.15 ± 0.15, while the “Decayed” component is 1.57 ± 0.13, which is 1.3 times lower.

Conclusion. An age-related prevalence and intensity of caries have been established, with the “Decayed” component of the DMFT index characteristically being identified in middle-aged children, with a tendency to increase. Both mothers and children lack sufficient dental education to prevent dental caries and other dental diseases. The survey showed that about two-thirds (84.6%) of the respondents prefer soft foods. A comprehensive revision of the existing methodology for organizing and conducting educational work among children on caries prevention is required.

Aim. To evaluate comparatively the outcomes of diagnostic procedures and surgical treatment for combined echinococcosis of the liver and lungs, utilizing state-of-the-art diagnostic methods and innovative echinococcectomy technologies.

Materials and Methods. A comparative assessment was undertaken on the surgical treatment outcomes for 188 patients (100 in the control group; 88 in the main group) afflicted with combined liver and lung echinococcosis (CLLE). The main group of patients were subjected to contemporary diagnostic techniques and cryotechnology during the echinococcectomy process. A total of 188 patients with CLLE were hospitalized and underwent 234 surgical procedures. The surgical treatment for combined echinococcosis of the liver and lungs was conducted, adhering strictly to the principles of aparasitism and antiparasitism.

Results. Specific postoperative complications, such as localized hydrothorax and pneumothorax, bronchial fistula, biloma, perihepatic fluid accumulations, and wound suppurations, were identified in 24% of the surgically treated patients in the control group, leading to repeat surgical interventions in 6% of these cases. In the main group, postoperative complications were observed in 9.7% of patients, with only a single case (1.38%) necessitating relaparotomy. No fatalities were reported in either of the study groups.

Conclusion. The application of ultra-low temperature liquid nitrogen in surgery for combined echinococcosis of the liver and lungs, as an integral part of aparasitic and antiparasitic measures, proves to be a highly effective therapeutic technology. The uncomplicated progression of liver and lung echinococcosis facilitates a one-stage surgical operation.

Aim. To detect intestinal ischemia promptly in patients with acute adhesive small bowel obstruction.

Methods. A total of 124 patients with acute adhesive small bowel obstruction were studied. Logistic regression analysis was performed to determine the most significant prognostic factors for intestinal ischemia. The derived regression coefficient indicators were utilized in a scoring system.

Results. Six independent prognostic factors of intestinal ischemia were identified: age, duration of pain, body temperature, white blood cell count, reduced intestinal wall contrast, and localized mesenteric edema visible on a CT scan. Regression coefficient scores were attributed to each variable associated with intestinal ischemia. The predicted occurrence of bowel ischemia was computed as a sum of scores ranging from 0 to 24. A threshold of 6 points was used to define the low-probability group (risk of bowel ischemia was 1.13%). A score between 7 and 15 determined the intermediate-probability group (the risk of intestinal ischemia was 44%). A score of ≥16 defined the high-probability group (all patients in this group had intestinal ischemia).

Conclusions. The risk prediction assessment of bowel ischemia was performed with high accuracy (above 90%). This evaluation is reliable and reproducible, hence it may aid the surgeon to differentiate patients with intestinal ischemia for surgical intervention. Since ischemic disorders may be reversible, this could prevent the development of intestinal necrosis.

Aim. To ascertain the diagnostic reliability of puncture and trepan biopsy of salivary gland tumors under ultrasound control

Materials and Methods. The study included 26 patients diagnosed with benign tumors and 16 patients with malignant tumors of the salivary glands. To determine the final diagnosis, a cystology test was conducted using the Romanov Giemsa staining method on the materials. Histological examinations were stained using the hematoxylin-eosin technique.

Results and Discussion. All 42 patients (100% of cases) with salivary gland tumors were divided into two groups based on the morphological features of their tumors: Group I comprised 20 patients (47.6% of cases) from a retrospective study conducted from 2013 to 2016, and Group II encompassed 22 patients (52.4% of cases) from a prospective study conducted from 2017 to 2020. Our uniquely developed method of puncture and trepan biopsy under ultrasound control demonstrated that the results derived from this approach closely aligned with those obtained from incisional and excisional biopsies. This correspondence underlines the successful diagnosis and treatment of patients with benign and malignant tumors of the salivary glands.

Conclusion.

1. The method of puncture and trepan-biopsy under ultrasound control exhibits high diagnostic reliability in confirming cells of benign and malignant tumors of the salivary glands, thereby eliminating the need for incisional and excisional biopsy of these tumors in subsequent treatment strategies.
2. In Group I, the discrepancy between the investigative methods was 35%, while in Group II, which employed our method of puncture and trepan biopsy under ultrasound control, no inconsistency was observed.

Aim. To explore the potential of computed and magnetic resonance tomography in determining the extent of surgical intervention in juvenile angiofibroma of the skull base.

Material and Methods. The study is based on an analysis of patients diagnosed with juvenile angiofibroma of the skull base, who were hospitalized in the 1-ENT department of the State Institution NMC RT “Shifobakhsh” from 2015 to 2022. Over this period, 68 male patients were under our supervision.

Results. Data analysis from computed and magnetic resonance imaging revealed a sphenoethmoid form of tumor growth in 51.5% of patients. The basilar form was less common (25%), and the pterygomaxillary form of tumor growth occurred in 22% of cases. The tubar form of tumor growth was detected in one case. A significant proportion of patients (61.8%) had angiofibroma stage II, 10.3% had stage I, 19.1% had stage IIIA, and 4.4% of patients had stages IIIB and IV, respectively.

Conclusions. Computed and magnetic resonance imaging can be considered the gold standard in the study of patients with suspected juvenile angiofibroma of the skull base. These methods allow clinicians to determine the form of the tumor process depending on the initial site and the disease stage, which are critical criteria for selecting the extent of surgical intervention.

Aim. To analyze the causes and clinical course of hydrocephalus in infants and its association with various etiological factors.

Materials and Methods. The study involved a retrospective analysis of data from 47 infants who were hospitalized in the Pediatric Neurosurgery Department of the Republican Scientific Center of Neurosurgery named after Shifobakhsh between the years 2020 and 2022. The patients were evaluated using a comprehensive range of diagnostic techniques, including CT, MRI, neuro-ophthalmoscopy, and neurosonography.

Results. Among the infants with hydrocephalus, infectious-inflammatory CNS diseases were identified as the primary cause in 23 cases (48.9%), cranial-brain trauma in 12 cases (25.6%), brain tumor processes in 7 cases (14.9%), and congenital factors in 5 cases (10.6%). All 47 (100%) patients presented with generalized cerebral symptoms and exhibited signs of hypertensive-hydrocephalic syndrome.

Conclusion. Our findings demonstrate that hydrocephalus in infants most commonly develops following the occurrence of infectious-inflammatory CNS diseases, while congenital causes are relatively less prevalent. The investigation of the clinical features and etiology of hydrocephalus enables the selection of appropriate diagnostic strategies and optimal surgical treatment methods.

Aim. To investigate the state of the gustatory analyzer in dental patients in relation to clinical-biochemical homeostatic parameters of the oral cavity.

Material and Methods. We evaluated the functional condition of the gustatory sensitivity organ in 40 patients with common dental diseases (the main group examined) and 40 patients in the control group (with intact dental status), considering the dysfunction of the gustatory analyzer. Drop irritation methods were employed to determine gustatory dysfunction.

Results. Our findings suggest that patients in the main group experience disturbances in gustatory sensitivity. These data highlight the cumulative negative impact of local dental factors on the condition of their gustatory analyzer.

Conclusion. In dental patients with a high degree of intensity of primary dental diseases and low significance of oral fluid homeostatic potential, there exist impairments in the functional condition of the gustatory analyzer. This is frequently manifested as an increase in the absolute taste threshold.

Aim. To examine the morphology of the liver in controlled obstructive jaundice in experimental animals

Materials and Methods. This research was conducted through an experimental study involving 24 male Shingilla rabbits and 18 white rats of both sexes, all of which were maintained under identical conditions of care and diet. To establish a model of varying degrees of obstructive jaundice, the animals were divided into three groups. Group I comprised animals (n=8) which, following cholecystectomy and drainage of the choledochus, experienced a complete block of hepaticocholedochus within 48 hours. Group II (n=8) included animals wherein the block of hepaticocholedochus persisted for 48-60 hours, and Group III (n=8) involved animals experiencing more than 60 hours of hepaticocholedochus blockage.

Results. Histological examination of liver biopsy specimens from the experimental animals revealed distinctive morphological changes in the parenchyma based on the duration of obstructive jaundice modeling, as compared to the liver of a healthy animal. In the pathohistological study of the Group I animals, liver micro-preparations displayed uneven color throughout the entire area of the sections, central vein expansion with altered shape, and traces of a small number of erythrocytes. Analysis of biopsy specimens from Groups II and III revealed irreversible dystrophic and necrotic processes in hepatocytes.

Conclusion. Thus, experimental studies, premised on the modeling of controlled obstructive jaundice, revealed that complete blockage of the hepaticocholedochus, over varying time intervals, corresponded with hepatocyte damage, underpinned by escalating cholestatic processes.

Aim. To evaluate effectiveness of the scleroobliteration in the treatment of small-diameter varicose veins.

Materials and Methods. The analysis incorporated the results of sclerotherapy in 135 patients, comprising those with telangiectasias and reticular varicose veins (n=95) and those with varicose dilation of aberrant subcutaneous veins (n=40) with intact trunks of major and/or minor subcutaneous veins of the lower extremities. The sample included 111 women (82.2%) and 24 men (17.8%), with an average age of 35.2±6.5 years.

For the obliteration of expanded subcutaneous veins, two sclerotherapy techniques were employed: liquid (n=65) and foam-form (n=70), prepared as per the L. Tessari method. Sclerosants used were a 0.5–3% sodium tetradecyl sulfate solution (“Fibro vein”) (ATC code: C05BB04) (n=69) or a 1-3% polidocanol solution (“Ethoxisclerol”) (ATC code: C05BB02) (n=66).

A detailed analysis was carried out of all complications that developed during and at various times post-sclerotherapy, and the effectiveness of the treatment, which depended on the diameter of the expanded veins and the thoroughness of the procedure.

Results. The technical success of the procedure was registered at 100%. The overall frequency of complications post-sclerotherapy was 20.7%, including 27.7% with the liquid form and 14.3% with the foam form of sclerosants (p<0.001). Intradermal and subcutaneous hemorrhages were observed in 10 (7.4%) patients, allergic reactions in 8 (5.9%), localized skin necrosis in 3 (2.2%), folliculitis in 3 (2.2%), and localized purulent complications in 2 (1.5%). Micro-air embolism of the pulmonary artery branches due to exceeding the established norm of air volume during foam sclerotherapy was recorded in 2 (2.9%) cases.

Following one session, a positive sclerotherapy effect was noted in 45.9% of patients. The necessity for additional sclerotherapy courses was indicated for over half the patients, with the effectiveness rising to 97.8% after 3 or more courses.

Conclusion. Sclerotherapy, being an effective minimally invasive method, is significantly impactful in treating reticular varices and telangiectasias. Greater efficiency and a lower rate of complications have been observed with the use of foam form sclerosant. Proper selection of sclerosant volume and concentration is essential for the prevention and reduction of sclerotherapy complications.

Aim. To enhance the outcomes of surgical treatment of unstable uncomplicated vertebral fractures.

Materials and Methods. This research involves an analysis of surgical treatment data from 237 patients aged 18 to 74 years, all with unstable uncomplicated vertebral fractures. These patients underwent surgery using the technique of posterior transpedicular fusion. The primary group, constituting 51.9% of cases, utilized enhanced approaches, while the control group (48.1% of cases) employed standard methods. The treatment outcomes were evaluated using a newly developed scale, while the Oswestry scale was used to gauge the quality of life.

Results and Discussion. The primary components of the refined surgical treatment tactics used in the main group were low-traumatic manipulations, which aimed to minimize tissue trauma and avert intraoperative complications. Utilizing the proposed objective scoring method, a statistically significant improvement in long-term outcomes was established in the primary group compared to the control group, with scores of 95.5±0.4 points and 88.7±0.7 points respectively (P<0.05). According to the Oswestry scale, the sum of points in the main group was 2.5±0.05, compared to 5.1±0.06 in the control group. The Oswestry index in the analyzed groups was 7.1±1.6 and 22.4±1.2 respectively.

Conclusion. The findings demonstrate a statistically significant increase in the proportion of favorable outcomes, and the absence of unsatisfactory results, in the primary group as compared to the control group. Furthermore, an improvement in the quality of life for patients in the primary group was observed.

Aim. To enhance the treatment outcomes in children with complications following an esophageal burn caused by a disk battery.

Materials and Methods. We analyzed the treatment outcomes of 102 patients suffering from esophageal burns from a disk battery, who were treated at the N.F. Filatov Children’s City Hospital of the Moscow Healthcare Ministry from 2009 to 2021. Children who developed complications (n=57) were divided according to the treatment strategy employed: conservative tactics (n=36, 63.2%) and radical surgery (n=21, 36.8%).

Results and Discussion. The types of surgical interventions carried out for tracheoesophageal fistula (TEF) (n=31) included laparoscopic fundoplication and gastrostomy (38.7%), separation of TEF (41.9%), and tracheal plastic surgery with an esophageal flap and extirpation of the esophagus (19.4%). Assessment of the outcomes of TEF post laparoscopic fundoplication and gastrostomy demonstrated spontaneous closure in 63.6% of the cases. The average time until closure was 5 months. Among children with esophageal stenosis (n=24), esophageal bougienage was performed in 95.8% of the cases. All children identified with esophageal perforation (n=4) were successfully treated conservatively. Tactics for managing laryngeal paresis or paralysis included conservative therapy and observation in 33.3% of cases, tracheostomy in 29.2%, and lateralization procedures in 37.5%.

Conclusion. Conservative tactics demonstrated superior results in all complications, minimizing the number of postoperative complications (16.7%) and ensuring favorable long-term outcomes.

This work presents the results of studies on the extract obtained from the root of Ferula kuhistanica Korov, in relation to 2 strains of the influenza virus: A/Vlad/2/09(H1N1) and A/Almaty/8/98(H3N2). It has been shown that the F. kuhistanica Korov extract exhibits selective antiviral activity and primarily acts on the influenza virus strain A/Vlad/2/09(H1N1), not showing an inhibitory effect against another antigenic variant of this virus – the strain A/ Almaty/8/98(H3N2). The tested extract was characterized by high IC₅₀, EC₅₀, and IS₅₀ indicators. Its chemotherapeutic effect (XTI) is 23 times higher than that of the commercial anti-influenza drug - Tamiflu. The data obtained open up prospects for the possible use of extracts obtained from the root of various species of the genus Ferula, growing in our country, in the development of anti-influenza drugs.

Aim. To evaluate the shifts in demographic, clinical, and epidemiological characteristics of patients with multidrugresistant tuberculosis (MDR TB) amidst the COVID-19 pandemic.

Materials and Methods. A cross-sectional study was conducted on patients with MDR TB registered in Dushanbe, before (2017-2019) and during the COVID-19 pandemic (2020-2021).

Results. The average age of patients prior to the COVID-19 pandemic was 36.5±16.9 years (1.7-79.4), whereas during the COVID-19 period, it was 34.4±17 years (2.9-80.2). The pandemic era witnessed a statistically significant rise in the proportion of workers among MDR TB patients compared to the unemployed (OR = 1.4; 95% CI 1.02-1.91; p = 0.05). Furthermore, an increase was observed in the proportion of patients with lung destruction in both newly diagnosed (OR 3.4; 95% CI 1.99–5.87; p<0.001) and previously treated patients (OR 4.2; 95% CI 1.38–12.99; p =0.002). There was also an increase in extrapulmonary tuberculosis registration (OR=1.7; 95% CI 1.34-2.22; p<0.001), indicating an unfavorable epidemiological situation in terms of MDR-TB. However, there were no statistically significant changes in the registration of concomitant diseases.

Conclusion. We recommend the improvement of TB infection prevention and control measures at all levels, as well as the enhancement of early detection of TB and MDR TB patients by primary health care workers.

The study incorporated treatment for 75 patients experiencing chronic purulent maxillitis exacerbation, employing the use of phytopreparations. After comprehensive examination, all patients were prescribed antibiotic therapy and decongestants, and subsequently underwent a maxillary sinus puncture. Patients in the first primary group underwent thrice-daily sinus cavity washes with a medicinal sage infusion. In contrast, the second primary group was treated with a hypericum perforatum infusion. For the comparison group, a 0.02% furacilin solution was utilized as an antiseptic for the puncture and wash of the maxillary sinus. The findings substantiate the advisability of prescribing the examined drugs to patients enduring an exacerbation of chronic purulent maxillitis.

This article presents an analysis of both domestic and international publications, focusing on the aspects, diagnostics, and treatment of acute hematogenous osteomyelitis of the hip joint bones in children. While the etiology and pathogenesis of acute hematogenous osteomyelitis have generally been well-studied, the literature scarcely covers the early diagnosis and treatment of this disease as it impacts the bones of the hip joint in children. Modern diagnostic methods are often effective only after the disease has been present for three days, which is why traditional diagnostic methods continue to hold significance. The surgical treatment of acute hematogenous osteomyelitis of the hip joint bones in children remains an unresolved issue. The choice of surgical tactics is primarily complex because the disease often comes with complications such as osteomyelitic coxitis, which exacerbates the treatment process and hinders the prevention of orthopedic complications. Therefore, the selection of optimal surgical and preventive care, based on the stage of the disease, the extent of the purulent process, and the degree of destruction and compression of the osteoarticular system, is of utmost importance.