Objective. The study seeks to explore the medical, social, and psycho-sociological characteristics of families within the population served by family doctors in the Yavan region.

Materials and Methods. The study encompassed 450 patients under the care of general practitioners. The subjects were adult family members from various age groups, social standings, financial backgrounds, and health conditions, ensuring representative outcomes. Data was collected using a custom questionnaire comprised of 30 questions. This data was mathematically processed, and the findings are presented as indicators.

Results and Discussion. The data revealed that the majority of surveyed patients primarily possess secondary or specialized secondary education. Men were more educated, with 44.7% holding a secondary specialized education or higher, while only 31.6% of women reported this level of education. Education levels appeared to influence family and marital statuses. As education levels rose, the number of children in families decreased (by 10.0%-15.0% in nuclear families and 5-7% in single-parent families). Conversely, the percentage of those married or in committed relationships increased with a rise in education, from 45.4% to 51.1%. A correlation analysis between respondents’ marital status, family type, and educational level indicated a weak relationship (r = 0.21 + 0.7 and 0.11 + 0.3, respectively). 

Conclusions. To enhance the accessibility of medical and social services for the community, it’s essential to address core challenges in the implementation of rural health development programs. This includes formulating a sound personnel policy and bolstering primary rural healthcare to tackle social issues. Additionally, establishing a regulatory and methodological structure is vital to guide family doctors serving in rural regions.

Objective. To analyze the immediate results of treatment of patients with acute arterial obstruction of the lower limbs during advanced stages of ischemia.

Material and methods. The results of a comprehensive examination and treatment of 244 patients (135 men, 109 women, average age 67,2±8,4 years) with acute arterial obstruction of lower limbs were analyzed. Acute thrombosis was observed in 105 (43,1%) patients and embolism of the main arteries in 139 (56,9%) patients. 197 (80.7%) patients had ischemia of one (102 left, 95 right lower limbs) and 38 (15.6%) of both lower limbs. In 244 patients acute ischemia was noted in a total of 281 lower extremities. 86.9% of patients were hospitalized 24 hours after the onset of the disease. In 190 cases the affected limbs had II degree ischemia (54 cases (19,2%) of IIA degree, 136 (48,4%) IIB degree), and 91 (32,4%) patients had ischemia of III degree.

Results and discussion. The main component of the operation for vascular embolism was thromboembolectomy (n=110), which in 56 cases was supplemented by vessel reconstruction (n=13), fasciotomy (n=34), and necrectomy (n=12). Primary amputation of the limb was performed in 13 cases. Conservative angiotropic therapy was performed in 16 cases.

In acute thrombosis of lower limb arteries, conservative treatment was performed in 28 cases, primary limb amputation was performed in 10 cases, thrombectomy with a local reconstruction of the vessel (n=31), also with bypass (n=14), with reconstruction and fasciotomy of the tibia (n=13) and with reconstruction and necrectomy (n=7) were performed in 93 cases.

Conclusion. Despite the delayed treatment in 67.6% of cases, the acute ischemia presented less severely, suggesting that the level of obstruction is more influential than the timing of the onset in the development of ischemic limb injuries. The choice of treatment method and extent at advanced stages of limb ischemia primarily depends on the degree and severity of ischemic disorders. The outcomes of treatment were less satisfactory in acute arterial thrombosis than in embolism, largely due to chronic obliteration of the distal arterial channel.

Objective. To study the prevalence of metabolic syndrome among the adult population of Tajikistan in the example of pilot districts.

Material and methods. A total of 1304 individuals (718 women, 586 men, average age 41.1±13.6 years) from Dushanbe city and the pilot districts of Rudaki and Gissar were screened for metabolic syndrome without prior randomization. The diagnosis was based on clinical and laboratory indicators according to WHO (1999) and IDF (2005) criteria. All participants provided voluntary written consent to partake in the screening.

Results and discussion. Using the WHO criteria, metabolic syndrome was identified in 94 (7.2%) people 38 (6.5%) men and 56 (7.8%) women. Hyperglycemia was detected in 97 (7.4%) respondents with a median fasting glucose level of 7.0 (6.8; 8.3) mmol/L. Increased waist to hip circumference ratio (n=174; 13.3%) was observed twice as often in women (n=117; 16.3%) compared to men (n=57; 9.7%) (p<0.001).

Dyslipidemia in the form of increased triglycerides (n=372; 28.5%) or decreased high-density lipoproteins (HDL) (n=77; 5.9%) from reference values was identified in one in four participants.

Arterial hypertension of varying severity was present in 20 (1.5%) respondents, with no significant difference between men (n=9; 1.54%) and women (n=11; 1.53%) (p>0.05). The median CAD and MAP in this group of respondents was 140.0 (130.0; 145.0) / 95.0 (90.0; 110.0) mmHg, with no discernible gender disparity.

Based on the IDF (2005) criteria, metabolic syndrome was identified in 176 (13.5%) participants: 71 (12.1%) men and 105 (14.6%) women. As participant age increased, there was a corresponding rise in the occurrence of metabolic syndrome. Thus, among 18-44-year-old respondents (n=820), 39 (4.8%) had metabolic syndrome, among 45-59 year old (n=328) 36 (10.9%), among 60-74 year old (n=150) 17 (11.3%) and among 75-90 year old (n=6) 2 (33.3%).

Conclusion. Metabolic syndrome is detected in 7.2-13.5% of the adult population. Young men and middleaged to elderly women are the most affected demographics. Due to the high prevalence of metabolic syndrome, it is necessary to strengthen organizational measures for its broad prevention among the general population by promoting a healthy lifestyle, healthy diet, and increasing physical activity.

Aim. Improving the immediate results of the treatment of patients with acute pancreatitis.

Material and methods. We studied the results of diagnosis and treatment of 126 patients diagnosed with acute pancreatitis. In our observation, the main causes of acute pancreatitis in 92 (73.0%) patients were cholelithiasis (biliary genesis), in 25 (19.8%) patients, acute pancreatitis (AP) had an alcoholic genesis, in 4 (3.2%) cases, pancreatitis occurred as a result of duodenal ulcer penetration into the head of the gland, and in 5 (4.0%) cases, АР had a traumatic genesis.Results. In 38 observed patients, extracorporeal detoxification methods were used in complex treatment, in addition, hemofiltration was used in 17.0% of cases, plasmapheresis was performed in 71.0% of patients, and peritoneal dialysis was performed in combination with plasmapheresis in 12.0% of cases. Minimally invasive methods of treatment were performed in 27 (21.4%) patients with acute pancreatitis.

In 17 patients, we performed percutaneous drainage interventions with ultrasound navigation. Surgical interventions were performed in 36 (28.6%) patients with acute pancreatitis. Of these, 9 (7.1%) patients were operated on within 5 days, 21 (16.7%) patients were operated on within 14 days, the remaining 6 (4.8%) patients were operated on within 24 to 14

days. 30 days.

Against the background of the use of a complex differentiated individual approach in the patients we observed with destructive forms of AP, the incidence of fatal cases was 9.5% (n=12), which were due to the development of progressive multiple organ failure.

Conclusion. The main tasks in the treatment of patients with acute pancreatitis should be the urgent elimination of etiopathogenetic factors in the development of this pathology, the timely appointment of intensive therapy with the implementation of minimally invasive surgical interventions.

Objective. To analyze the needs of the Republic of Tajikistan in radiotherapy equipment.

Materials and methods. A comprehensive bibliographic and informational search was employed, accompanied by a semantic analysis. Scientific literature and regulatory legal documents were reviewed, and an economic mathematical modeling method was utilized.

Results. The demand for radiotherapy devices in Tajikistan can be determined through three models: “by the number of the population served” 12 devices, “by the number of oncological dispensaries in the country” 5 units, “by oncological prevalence” (Lean management approach) one system. The proposed models should be adjusted taking into account the territorial accessibility of the method for the population, current clinical recommendations, as well as the availability of other radiotherapy equipment.

Conclusion. X-ray therapy is of particular interest to the organization of oncological care due to the low cost of devices in comparison with other radiotherapy equipment, as well as the low cost of their maintenance, high operational efficiency, and ease of use. Heads of medical institutions need to know different approaches to calculate the needs.

Objective. This study aims to determine the prevalence of congenital cleft lip and palate (CCLP) in newborns within the Sughd region..

Material and methods. A retrospective epidemiological study was performed on 346 newborn patients with CCLP who attended to the dental departments of medical institutions in the Sughd region from 2016 to 2021.

Results and discussion. The Sughd region revealed a high incidence of CCLP in newborns, with 69.2% (n=346) affected. The highest incidence was observed in 2018 at 25.7% (n=89), and the lowest in 2020 at 5.5% (n=19). The significant reduction in 2020 might be related to fewer consultations during the COVID-19 pandemic. Out of the total cases, 223 were boys and 123 were girls, giving a ratio of 1.8:1. The majority of the affected newborns, 61.0% (n=211), were between ages 0-3, followed by those aged 3-8 years at 23.7% (n=82). Notably, 83.0% (n=287) of these patients resided in rural areas. Unilateral CCLP was predominant, representing 79.5% (n=241), with the remaining 20.5% (n=62) being bilateral.

Conclusion. The frequency of occurrence of the number of newborns with congenital cleft lip and palate in the Sughd region significantly prevailed compared to other regions of the republic, which requires further study of the causative factors leading to the development of this pathology in the region.

Objective. To study psychosomatic health in adynamia in cyber addicts and students.

Material and methods. 100 people at the stages 3-4 of cyber addiction underwent rehabilitation and reintegration into society, and 82% of them got employed. Surveys, research on autonomic balance, calculation of the health coefficient, and assessment of psycho-emotional state based on the characteristics of the HTP test, were conducted among 24 cyber addicts and 24 students.

Results and discussion. The health coefficient of the cyber addicts averaged 2.38, while that of the students averaged

• The average emotional tension index is 10.53 for students and 10.63 for those with cyber addiction. Autonomic disorders were identified in the female subgroup of gamers using the Kerdo Students displayed normotonia. The Hildebrandt index for students averaged 4.51, while for those with cyber addiction it was 3.03. These indicators are within normal limits.

Conclusion.

1. The effectiveness of treatment methods for cyber addiction and the social rehabilitation of cyber addicts has been identified based on health coefficient A low level of this metric was observed in the control group.
2. Students require such rehabilitation in the process of
3. A comprehensive and informative set of tests has been selected to determine the psychosomatic health and adaptation of addicts and individuals who spend extended periods on the computer in a state of

Objective. Determination of the significance of endothelial dysfunction in postoperative purulent-septic complications of pathologies of the hepatobiliary zone.

Material and methods. An analysis was conducted on 57 patients who underwent surgery for pathologies of the hepatobiliary zone and subsequently developed postoperative purulent-septic complications. Among these, there were 17 cases of postoperative peritonitis, 20 cases of postoperative intra-abdominal abscesses, and 20 cases of postoperative pancreatic necrosis. Of the patients, 19 were men (33.3%), and 38 were women (66.7%). Their ages ranged from 20 to 71 years.

Results. Out of the 57 patients, when classified based on the severity of endotoxemia: 26.3% had a mild degree, another 26.3% had a moderate degree, 15% had a severe degree, and 21.0% had an extremely severe degree. High levels of oxidative stress markers and decreased SOD levels were particularly evident in patients with postoperative intra-abdominal abscesses. Furthermore, even greater acceleration of lipid peroxidation processes was observed in patients with severe endotoxemia resulting from widespread postoperative peritonitis and extensive to nearly total postoperative pancreatic necrosis. Additionally, significant changes were noted in endotoxemia predictors in portal blood, endothelial dysfunction markers, and cytokines in patients with postoperative intra-abdominal purulent-septic complications.

Conclusion. Endothelial dysfunction in patients with postoperative purulent-septic complications is associated with profound pathomorphological changes in hepatocytes. These changes are evident in alterations to rheology, microcirculation, and increased levels of endothelial dysfunction markers.

Objective. The objective of this study was to optimize the treatment for Hirschsprung’s disease in young children.

Material and methods. A total of 71 children, ranging in age from 3 days to 3 years, were observed. Patients were categorized into three groups based on the surgical procedure performed: 23 underwent transanal endorectal proctoplasty according to De La Torre Mondragon (32.4%), 17 according to the Swenson-like method (23.9%), and 31 according to Soave-Lenyushkin (43.7%).

Results and discussion. The results of the maternal examination revealed the presence of cytomegalovirus, herpes virus and toxoplasmosis. The basis for the success of surgical treatment is timely diagnosis. After surgical intervention, histological examination of the surgical material confirmed intestinal agangliosis. Peritoneal-promesenteric proctoplasty according to SoaveLenyushkin in the modification of the clinic, with wedge-shaped excision of the serous-muscular case, is effective in terms of prevention of inter-sheath hematomas and fluid accumulation. The De La Torre-Mondragon and Swenson-like technique of transanal endorectal relegation, without abdominal access with demucosation of the rectum, is considered an effective and minimally invasive access for rectal and rectosigmoidal forms of Hirschsprung’s disease.

Conclusions. Transanal endorectal relegation at an early age in children showed rapid recovery of intestinal motility in the postoperative period without skin incision. The results of early surgical intervention contribute to the achievement of good results in the immediate and distant period after the surgical intervention.

Objective. Improving the results of treatment of nephrolithiasis in the intrarenal pelvis.

Material and methods. The study involved 154 patients with nephrolithiasis in the intrarenal pelvis. They were divided into two groups: the main group comprised 78 (50.6%) patients who underwent personalized surgical procedures using modern technologies, while the control group of 76 (49.4%) patients received conventional one-stage traditional surgical interventions. Results. In the main group, one-stage percutaneous puncture nephrolithotripsy was conducted for 55 patients, representing 70.5% of the cases. However, in 5 (6.4%) cases of complex variants of nephrolithiasis, it was required to convert the access to a lumbotomy with subcortical pyelolithotomy. Of note, 11 patients (14.1%) presented with either complicated purulent calculous pyelonephritis (5 patients) or II-degree hydronephrosis (6 patients). For these patients, the treatment was staged. Initially, a nephrostomy was carried out using ultrasound guidance. Following this, 7 patients underwent percutaneous puncture nephrolithotripsy, while 4 patients had a lumbotomy subcortical pyelolithotomy paired with nephrostomy. In another subset of the main group, 12 patients (15.4%) required one-stage traditional surgery through lumbotomy access due to specific medical criteria. Patients in the control group (n=76) underwent open libotomy for removal of kidney stones. Postoperative complications in patients of the main group were noted in 7 (9.0%) cases, with no lethal outcomes. Whereas in patients of the control group, postoperative complications occurred in 18 (23.7%) cases. Lethal outcomes were recorded in 3 (3.9%) cases.

Conclusion. In determining the appropriate surgical approach for patients with nephrolithiasis in the intrarenal pelvis, it’s essential to prioritize a personalized treatment plan. Minimally invasive interventions are recommended wherever possible

Objective. Describe the system of epidemiological surveillance of COVID-19 and evaluate its effectiveness by qualitative and quantitative characteristics to provide recommendations.

Material and methods. To evaluate the surveillance system, “Updated Recommendations for evaluating Public Health Surveillance Systems: Recommendations of the updated guidelines of the US Centers for Disease Control 2001” were used. 8 public and 6 private providers of medical services were involved in the surveillance system of the city of Khujand. From August 21 to March 27, a review of incoming quantitative data, an electronic list of patients and a review of paper forms of reports related to COVID-19 in 7 state institutions was conducted. We also conducted personal interviews using standardized questionnaires with 15 medical workers from 5 state institutions.

Results. It was found that the surveillance system in the Republic of Tajikistan is flexible. It quickly adapted to the conditions of the pandemic. From August 21 to March 27, only for 19 of the 36 observed weeks (53%), all 7 objects provided report on time. Overall, weekly timely reporting was 92% (range 71-100% for 36 weeks). 706 cases were registered, 662 correctly met the definition, which led to a specificity of 94% (662/706). 46 more cases were not reported, which led to sensitivity of 88% (662/(662+46)).

Conclusion. In general, the system of epidemiological surveillance for COVID-19 fulfills its goals and objectives. It is possible to improve the system: by creating a common database and uniform forms of accounting and reporting on COVID-19; provide employees with a computer and Internet access; hold seminars on the current laws of the Ministry of Health and Social Protection of the Population of the Republic of Tajikistan.

Objective. Determine the prevalence of the congenital neural tube defect, Spina bifida.

Materials and methods. This study utilized data from epidemiological monitoring of statistical registration forms, the National Register of Congenital Malformations F32, and the Report on Medical Assistance provided to Pregnant Women, Postpartum Women, and Newborns from 2016 to 2021.

Results. Throughout the study duration, a total of 1,442,030 newborns were recorded in the republic. Of these, 11,320 had congenital malformations of the CNS, with 9,682 being born alive. Neural tube defects were diagnosed in 1,447 (14.9%) of these children: 102 (7.0%) had anencephaly (Q00), 112 (7.7%) had encephalocele (Q01), and 667 (46.0%) had Spina bifida (Q05). Notably, in the post-COVID years of 2020 and 2021, births of children with Spina bifida decreased by almost half compared to prior years, a statistically significant difference (P<0.001). Concurrently, there was a rise in antenatal death rates for these children, reaching 15.5% and 18.3% for the two respective years.

Conclusion. Spina bifida has a multifactorial etiology. Its population prevalence does not exceed 1.5‰, majority of lethal outcome occurs in early neonatal period in the first 168 hours of life accounting for 96.5%.

Objective. Determine the content of electrolytes in the blood serum depending on the severity of anemia in children with hereditary hemolytic anemia.

Material and methods. Observations were made on 36 children with hereditary hemolytic anemia (NGA) aged between 3 to 14 years. The distribution by gender was as follows: 16 girls (44.5%) and 20 boys (55.5%). The average age of the participants during the study was 9.5±0.45 years. These children were categorized into three groups based on anemia severity. Primary school-aged children formed the majority, followed by preschoolers, with senior school-aged children being the least in number. Upon admission to the clinic, a thorough examination of each child was conducted, encompassing a detailed complete blood count, erythrocyte morphology, biochemical blood tests (measuring total bilirubin and its fractions), blood serum electrolyte levels (K+, Na+, Ca+, Fe+), and an analysis of bone marrow punctate.

Results and discussion. Electrolyte analysis yielded these findings: In children with mild HHA (14 patients), compared with the control group, the concentration of blood electrolytes (K+, Na+, Ca+, Fe+) were within the normal range. In children with moderate HHA (12 patients), the concentration of Fe+ was slightly higher compared with the control and the first group, respectively, and there was also a slight increase in the concentrations of K+, Na+, Ca+ compared with healthy children and children with mild HHA. In children with severe HHA (10 patients), as a result of the development of a hemolytic crisis, the concentration of electrolytes in the blood serum is significantly higher than K+, Na+, Ca+, Fe+ compared with children in the control group K+, Na+, Ca+, Fe+ and patients with mild and moderate, respectively.

Conclusion. The study revealed significant clinical changes in the internal organs, as well as pronounced metabolic disorders in the body, due to chronic hemic hypoxia and impaired blood electrolyte composition.

Objective. To evaluate the effectiveness of the algorithm of diagnostics and treatment of benign breast diseases in women.

Material and methods. Data were collected from 290 patients with benign mammary gland tumors who were treated at the Gynecological Department of the Institute of Obstetrics, Gynecology, and Perinatology in Dushanbe between 2015 and 2022. The study exclusively involved women of reproductive age, ranging from 18 to 45 years. The average age of the participants was 23.4±24 years. Notably, there were no recorded cases of disability or fatalities among these patients.

Results and discussion. The developed algorithm includes a number of diagnostic and therapeutic manipulations, streamlining the process of disease identification, as well as increasing the effectiveness of therapy.

Conclusion. his algorithm proves to be both user-friendly and efficient for patients within this demographic. Its implementation has led to a decrease in the progression of adverse conditions and complications in patients with benign mammary gland conditions and associated genital organ pathologies.

Objective. Development of recommendations for improving the system of epidemiological surveillance of drug-resistant tuberculosis.

Material and methods. The surveillance system for drug-resistant tuberculosis in Dushanbe and the Rudaki district was evaluated, following the guidelines provided by the US Centers for Disease Control and Prevention (CDC).

Results. The tuberculosis (TB) surveillance framework is multifaceted with multiple reporting tiers. The reporting forms provided by the government do not provide information on the indicators needed to track the spread of multidrug-resistant TB. An evaluation of timeliness revealed that appropriate treatment commenced promptly in 52% of cases (42 out of 80): 54% (29 out of 54 cases) in Dushanbe and 50% (13 out of 26) in the Rudaki district. Delays were associated with multiple drug resistance in comparison to other types of drug resistance (OR-4.3; 95% CI 1.7-11.1), outpatient in contrast to inpatient treatment (OR-5.3; 95% CI 1.1-27.0).

Conclusion. The epidemiological surveillance system for TB with drug-resistant strains in both regions achieves its intended goals and objectives. However, the system’s flexibility, timeliness, and acceptability require further refinement.

The article offers a review of contemporary literature focusing on the diagnosis and treatment of intra-abdominal postoperative complications using minimally invasive techniques. The literature analysis underscores that there is a substantial body of knowledge worldwide regarding the use of minimally invasive approaches, including relaparoscopy and percutaneous methods, in treating intra-abdominal postoperative complications. The literature suggests that employing these minimally invasive techniques has enhanced treatment outcomes and lowered economic costs. However, in spite of these advancements, clear guidelines and comprehensive surgical algorithms for addressing postoperative complications using these techniques remain underdeveloped.

Acute necrotizing pancreatitis is a prevalent acute abdominal condition, presenting a wide array of clinical symptoms. These can vary from mild interstitial inflammation to severe forms, leading to significant regional and systemic complications. Even with advancements in treatment methods and critical care for acute pancreatitis, it continues to carry a high mortality rate. For a long time, contrast-enhanced CT has been regarded as the gold standard for diagnosing acute pancreatitis. However, there exists some inconsistency in the terminology used across both literature and guidelines, which can affect treatment outcomes and prognoses. This study focuses on the radiological terminology and classification of findings related to acute and necrotizing pancreatitis. We discuss recommendations and indications for using CT, MRI, and ultrasound diagnoses, along with their methodologies. In cases of infected pancreonecrosis, staged combined surgical treatments are often preferred. Merging laparoscopic and retroperitoneoscopic methods facilitates the effective removal of sequesters and purification of purulent areas. This combination results in a substantial reduction in complications and mortality when compared to laparotomic operations. The primary aim of this research is to amalgamate findings from both international and local studies, providing a holistic view of the developmental stages of acute necrotizing pancreatitis. This understanding is primarily derived from their radiologic characterizations and potential complications.