Aim. To improve the effectiveness of prevention and metaphylaxis in complicated nephrolithiasis among children.

Material and methods. Based on many years of experience in a pediatric urology department of a children’s surgery clinic, we have accumulated significant data on risk factors and their importance in practical work. Using data from 152 patients, we have developed a clinical classification and a list of risk factors.

Results of the stady. The study identified various risk factors such as: age of children; variants of nephrolithiasis (unilateral, bilateral, solitary, multiple, staghorn, obstructive); stages of CP, CG, CKD, pyonephrosis and paranephritis; stages, volume and methods of surgery; dysmetabolic nephropathy and dysplasia of the renal parenchyma. By studying and analyzing risk factors in 152 patients with complicated nephrolithiasis, covering etiopathogenesis, volume of surgery, errors during surgery and factors of recurrent stone formation, we developed a clinical classification of risk factors, which was introduced into the scientific and practical activities of doctors.

Conclusion. Summarizing the importance of risk factors for complicated nephrolithiasis, it is necessary to consider a combination of etiopathogenetic, clinical-laboratory, reconstructive-restorative, rehabilitative, and prognostic risk factors, to improve the quality of life for children with nephrolithiasis.

Objective: To determine prognostic value of instrumental methods in the diagnosis of complicated forms of malignant forms of focal liver lesion.

Material and methods: The experience of treating 112 patients with primary and secondary tumor lesions of the liver was analyzed. Life-threatening complications, such as spontaneous rupture of the tumor node leading to massive intraperitoneal bleeding and cancerous peritonitis, were noted in 32 (28.5%) cases. Clinical and echographic signs of the threat of this complication developing were observed in 26 (23.2%) patient. Ultrasound (US) and CT semiotics of the tumor node rupture included signs of hemoperitoneum, focal heterogeneous formation with the presence of perilesional hematoma, active extravasation of contrast medium, and focal discontinuity of the liver contour at the site of the focal formation.

Results and discussion: Most often, the size of the tumor node exceeded 8.0 cm (in 65% of patients). Protrusion of the tumor through the liver surface was noted in 23 (39.6%) cases. Invasion of the tumor into adjacent organs and tissues was observed in 16 (27.5%) patients. Sites of phlebothrombosis, predominantly in the system of hepatic veins, detected by echo-Dopplerography of liver vessels, were present in 12 (20.6%) patients.

Conclusion: Predictors of spontaneous rupture of the tumor node may include: size of the formation more than 5 cm; protrusion of the tumor through the liver surface; phlebothrombosis by tumor masses, leading to increased intramural pressure; extraliver invasion of the tumor into adjacent organs and tissues.

Aim. To study the outcomes of surgical interventions using the anterior cervical approach in spinal cord injuries.

Material and Methods. This study examined 86 patients with SCIWORA (Spinal Cord Injury Without Radiographic Abnormality) who were hospitalized from June 2018 to March 2021. Based on treatment methods, patients were divided into two groups: a control group (n=38) and a primary group (n=48). In the control group, patients received conservative treatment. In the primary group, patients underwent anterolateral total laminectomy with decompression, internal fixation, and spinal fusion using a bone graft.

Results and Discussion. The JOA (Japanese Orthopedic Association) score in the primary group was 14.98±2.75 six months post-operation, compared to 12.16±2.54 in the control group (p<0.05). The improvement coefficient of the JOA index in the postoperative period was higher in the primary group than in the control group (p<0.05). Postoperative health status, physiological function, and role physical condition scores in the primary group were 23.18±1.09, 22.75±1.54, and 22.64±1.46 respectively, significantly higher than in the control group, which scored 20.94±1.65, 20.26±1.78, and 19.56±1.82 respectively (p<0.05).

Conclusion. Performing anterolateral total laminectomy with decompression, internal fixation and spinal fusion using a bone graft in patients with SCIWORA contributes to a more effective restoration of the function of the cervical spinal cord and improves the prognosis and quality of life. Independent prognostic factors for patients include: type of cervical spinal cord injury according to the ASIA classification; MRI findings, the extent of cervical spinal cord injury; time from the moment of injury to the start of treatment.

Aim: To optimize the immediate outcomes of surgical treatment of patients with postoperative ventral hernias.

Material and Methods. This prospective cohort study analyzed the results of comprehensive diagnostics and surgical treatment of 114 patients with postoperative ventral hernias, admitted to the Dushanbe City Emergency Medical Center between 2014 and 2022. Patients were divided into two groups based on the surgical treatment method used. The control group included 59 (51.8%) patients who underwent hernioplasty using tension techniques. The main group consisted of 55 (48.2%) patients who underwent hernioplasty using non-tension techniques.

Results and Discussion. The two groups differed not only in hernioplasty methods but also in pain management techniques, both intraoperatively and postoperatively. Among the 59 patients in the control group, general endotracheal anesthesia was used in 57 (96.6%) patients, while regional pain relief methods were employed in the remaining 2 (3.4%). Coexisting pathologies affecting the degree of surgical risk were identified in 21 (35.6%) patients. Large hernia sizes were observed in 29 (49.2%) patients. Among 55 patients of the main group, the presence of concomitant diseases affecting the degree of operational risk was detected in 23 (41.8%). Large hernias were found in 37 (67.3%) patients. In 41 (74.5%) cases, endotracheal anesthesia was used in patients of this group, and in the remaining 14 (25.5%) cases, regional methods of anesthesia were used, the use of endotracheal anesthesia was combined with the use of spinal anesthesia.

Conclusion. Selecting the most optimal anesthesia method, hernioplasty technique using high-quality synthetic material, local application of the drug Diprospan, and extensive use of ultrasonic methods for postoperative monitoring in patients with postoperative ventral hernias (PVH) can improve the outcomes of their surgical treatment.

Aim: The study aimed to improve the treatment outcomes of combined pulpal-periodontal lesions in patients with various multisystem disorders.

Material and Methods: The study included 150 patients with associated lesions of the intracanal-periradicular complex and various multisystem disorders. The age of the patients ranged from 20 to over 50 years. The patients were grouped based on the method used for endo-periapical therapeutic and preventive intervention. The first (main) group of somatic patients (n=50) received Hyaludent №4 and a calcium hydroxide preparation for prolonged endo-periapical effect over a month, coupled with macrophage reprogramming procedures using autoplasm.

Results and Discussion: In the somatic patients of the main group, by the end of the year from the start of the endoperiapical treatment and after 24 months, the visual-instrumental examination indicator of the intracanal and periradicular status was zero. In the first control group of patients, the total indicator of the visual-instrumental examination of the endo-periapical state after the first month was 17.1% less than that of the second group, and after 6 months, it was 10.2% less. In the second control group of patients, the minimum value of the visual-instrumental examination of the intracanal-periradicular status was noted one year from the beginning of the pulpal-periodontal treatment.

Conclusion: The maximum effectiveness of endo-periapical treatment was achieved in the main group of patients with intrasystem pathology, where the efficacy of endo-periapical treatment was nearly 90.0%.

Aim. To improve early diagnosis of postoperative obstetric and gynecological peritonitis.

Material and Methods. This study was conducted among 110 women who developed peritonitis in the postoperative period following primary surgical interventions for obstetric and gynecological pathologies. Comprehensive approaches in clinical and laboratory diagnostics of postoperative obstetric and gynecological peritonitis were applied, including the assessment of hemostasis parameters, endogenous intoxication, acute phase proteins, and cytokines.

Results and Discussion. The analysis of the results shows that in the clinical and laboratory parameters, there are relative changes observed in localized peritonitis, and significant shifts in widespread postoperative obstetric and gynecological peritonitis, with and without abdominal sepsis. For instance, in this group of patients, the average values of middle molecular weight molecules were 1674.6±143.5 µg/ml, malondialdehyde - 5.6±0.21 mmol/l. In the group with widespread peritonitis, the level of procalcitonin in the blood was 5.6±0.04 ng/ml, C-reactive protein levels averaged 235.2±0.8 mg/ml, and interleukin-6 levels were 134.5±3.7 ng/ml. In the group with peritonitis without abdominal sepsis, these indicators were lower, being 3.67±0.04 ng/ml, 180.77±18.3 mg/ml, and 112.7±2.1 ng/ml, respectively.

Conclusions. The identified pathogenetic changes in homeostasis, particularly the shifts in the levels of procalcitonin, C-reactive protein, and interleukin-6, serve as markers for the early diagnosis of infectious-inflammatory pathologies in the abdominal cavity.

Aim. To determine the morphofunctional characteristics of tissue changes in the structure of the gallbladder in chronic calculous cholecystitis.

Materials and Methods. The macro- and microscopic structural walls of the gallbladder were studied using the method of injection anatomical dissection, histology, and morphometry in 61 patients (aged 36 to 60) with chronic calculous cholecystitis.

Results and Discussion. The results of a morphological study show that in chronic calculous cholecystitis, changes are always observed in all layers of the gallbladder wall. The most severe dystrophic and sclerotic changes are observed in the mucous membrane and submucosal base, since, this layer has in functional, topographical and quantitative features, as well as a direct contact with stones (mechanical impact).

Conclusion. Transformation of the gallbladder in chronic calculous cholecystitis are characterized by vascular tissue restructuring of the structures of the organ wall, accompanied by the phenomena of adaptive, exudative and proliferative transformations, and in the later stages (5-6 years) undergo sclerotic changes in the gallbladder wall.

Aim: To evaluate the effectiveness of mechano-chemical obliteration in the treatment of varicose enlargement of the great saphenous vein.

Material and Methods: The results of mechano-chemical obliteration of 57 patients (49 (85.9%) women, 8 (14.1%) men; average age 27.2±4.1 years) with varicose disease were analyzed. In 39 patients (36 women and 3 men), the second, and in 18 (13 women and 5 men) – the third class of varicose transformation of subcutaneous veins was observed. The average body mass index of patients was 28.2±2.4 kg/m2, and the average duration of varicose disease was 7.6±1.8 years.

Results and Discussion: The average diameter of the great saphenous vein was 10.4±2.1 mm. Insufficiency of perforating veins with an average diameter of 3.2±0.8 mm was detected in 31 (54.4%) cases. The technical success of the procedure was 100%. No intraoperative complications occurred in any patient. The average duration of mechanochemical obliteration was 24.2±4.8 minutes, and the entire operation – crossectomy, mechano-chemical obliteration, and excision of dilated tributary veins – lasted 98.5±25.5 minutes. The average length of the great saphenous vein subjected to mechano-chemical obliteration was 94.2±6.1 cm. The level of pain on the first day after surgery was 3.8±0.6 points, decreasing to 0.9±0.1 points before discharge. Only on the day after the intervention, patients required narcotic analgesics (average volume of used anesthetics – 1.5±0.5 ml); on other days, patients received non-steroidal anti-inflammatory drugs (average duration 3.5±0.5 days, volume – 10.5±1.5 ml).

Conclusion: Mechano-chemical scleroobliteration is one of the effective methods for eliminating pathological vertical reflux, with its effectiveness observed in the vast majority of patients in the long term.Moreover, due to its minimal invasiveness and capability for repeated application, it can be recommended for widespread clinical use. To improve the results of mechano-chemical obliteration and reduce the frequency of recanalization of the great saphenous vein, it is necessary to supplement the procedure with crossectomy and miniphlebectomy.

Aim. To determine the diagnostic effectiveness of modern methods of examination in patients with benign breast neoplasms.

Material and methods. The results of the examination of 290 patients with benign breast neoplasms hospitalized in the gynecological department of the “Research Institute of Obstetrics, Gynecology and Perinatology of the Republic of Tajikistan” from 2015 to 2022, were analyzed.

Results and Discussion. The article evaluates modern methods of examination of the pathology of the mammary glands in women. Ultrasound examination, elastography, as well as elastography in combination with color Doppler mapping – are non-invasive, effective and safe methods, applicable across all age groups. Mammography, widely recommended by many authors for the differential diagnosis of benign and malignant neoplasms, has, however, age restrictions and should be used in combination with ultrasound. The study of the tumor marker CA-15-3 has an important laboratory and diagnostic value for clarifying pathology.

Conclusion. Thus, the study shows the need to use a differentiated diagnostic algorithm and an integrated approach in the management of patients with benign diseases of the mammary glands against the background of inflammatory diseases of the pelvic organs and benign ovarian neoplasms.

Aim. To assess the frequency of functional gastrointestinal diseases after COVID-19 and identify factors associated with the post-COVID esophageal syndrome.

Materials and methods. The study included data from 72 (31 men and 41 women) patients over the age of 18 who had COVID-19. Patients were divided into two groups: with or without gastroenterological symptoms during acute coronavirus infection.

Results and Discussion: After 6 months from the onset of the coronavirus infection, Irritable Bowel Syndrome (IBS) developed in 29% of patients with gastrointestinal symptoms and only in 7% of patients without symptoms in the acute stage of infection. The concurrent development of two digestive system diseases (more often a cross syndrome of Functional Dyspepsia and IBS) was 2.6 times more common in the first group of patients. Statistically significant risk factors for the development of post COVID functional digestive diseases were: diarrhea, abdominal pain, anorexia, anosmia, and agenesis.

Conclusion. The presence of gastrointestinal symptoms at the baseline level of COVID-19 was more frequently associated with the development of functional gastrointestinal tract disorders during a six-month follow-up.

Aim. To improve the results of neurosurgical treatment of patients with acute cerebrovascular disorders.

Material and Methods. An analysis of the results of neurosurgical treatment of 48 patients admitted to the Department of Neurosurgery of the State Institution National Medical Center - “Shifobakhsh” was carried out. The age of patients ranged from 30 to 75 years. In each case, patients underwent clinical and laboratory studies, including using CT and MRI, as well as using three-dimensional (3D) and four-dimensional (4D) reconstruction methods of cerebral vessels.

Result and Discussion. The most common cause leading to the formation of intracranial hematomas was hypertension, found in 32 (66.6%) patients, while other causes were identified in 12 (25%) patients (including angiopathy, cerebral vascular pathologies, amyloidosis, and the use of certain medications, among others). All patients underwent neurosurgical operations. The highest frequency of recurrences (4.1%) was observed after surgical interventions performed within the first 24 hours following the hemorrhagic event.

Conclusion. With early detection of intracranial hematomas and with the optimal choice of method for their treatment, good functional results are observed with a low incidence of deaths.

Aim. To assess the human resources capacity of the dental service in Dushanbe, regardless of the form of ownership of the dental institution.

Material and methods. An analysis was made of the data of the official statistical reporting “Report on medical personnel” form 17, approved by order No.054 of the Agency for Statistics under the President of the Republic of Tajikistan dated October 11, 2013. The analysis covered data from the period 2017 to 2021, focusing on state medical organizations providing dental care to children. Statistical data, the determination of extensive and intensive indicators, the significance of their differences using the t-criterion of reliability (differences were considered significant at t>3), and analysis of dynamic series were used.

Results and Discussion. Of the total number of dentists in Dushanbe, about 70% are dental therapists. Among all dentists, every fifth dentist is a pediatric dentist, which is twice as many as the national average. The number of orthodontist dentists does not differ significantly from the data for the republic. Dentists and surgeons work 1.5 times more in Dushanbe compared to the national data.

Conclusions. The indicator of the number of dentists of all qualifications in Dushanbe is several times higher than the national average. Over the past five years, there has been a tendency to reduce the number of pediatric dentists. The number of doctors with the highest qualification category decreased by 13%, the indicator is identical to the national data.

The purpose of the study. Improving the results of diagnosis and surgical treatment of patients with secondary nephrolithiasis by renal parenchymal dysplasia on the background of renal failure caused in children.

Material and research methods. Clinic of Pediatric Surgery, Avicenna TSMU Abualiibn Sino analyzed 34 patients with renal failure of calculous etiology. In all cases, the biopsy was taken from the cortex – medulla of the kidney during nephrotomy, and during pyelotomy from the site of the nephrostomy tube. Studies of biopsy materials were carried out in laboratorits at the departments of histology, anatomy and oncology.

Research results. We analyzed the results of a morphological study of 34 patients with CKD of calculous etiology. Chronic calculous pyelonephritis was detected in 32 (94,1%) patients, in whom the diagnoses coincided with the clinical and morphological ones. Of these, dysplasia of the renal parenchyma was detected in 8 patients. In 2 patients, histological examination did not reveal structural changes, possibly a biopsy was taken from healthy areas of the kidney tissue, although clinically and laboratory 100% calculous pyelonephritis occurred.

Conclusion. Thus, in case of obstructive-calculous pyelonephritis, against the background of dysplasia of the kidney parenchyma, early clinical and morphological diagnostics, radical decompressive and sanitation surgery with reliable external urine wood is restored, the process of further wrinkling of the kidney is suspended.

Aim. To assess the state of the vascular endothelium in patients with myocardial infarction in terms of desquamated endotheliocytes before and after treatment.

Material and methods. The results of morphological study of 30 patients with coronary heart disease: post infarction cardio sclerosis and 20 healthy volunteers are presented for comparison with the mean age of 65,1±3,6 and 62,7±3,7 years, respectively. In order to determine the number of DECs, we used the morphological method proposed by N.N. Petrishcheva et al. (2001), before and after impatient treatment.

Results. Statistically significant DEC parameters were obtained in patients with myocardial infarction. The highest rates of DEC were found in 10% of patients (19±0,1×104 cells/l). Most patients (53.33%) had a moderate level of endotheliocytemia (11,2±0,7×104 cells/l). The control group, taken for comparison, had the upper limits of the physiological norm (3,9±0,9×104 cells/l). This shows a significant role of endothelial dysfunction in the pathogenesis of myocardial infarction. A group of patients who had up to 10 years of a heart attack history revealed a direct correlation with the level of DEC.

Conclusion. The number of DECs was significantly increased in patients with myocardial infarction compared with the control group before treatment. Against the background of complex therapy, the level of endotheliocytemia is significantly reduced, but does not reach physiological parameters.

Aim. To present the echocardiographic picture of the presence of thrombi in the left atrial appendage in patients with atrial fibrillation in the outpatient stage.

Material and research methods. The study involved 56 patients with permanent atrial fibrillation, observed in outpatient conditions at the National Medical Center of the Republic of Tajikistan “Shifobakhsh” between 2019 and 2022. All patients underwent transesophageal echocardiography using standard methodology.

Research results. According to the results of transesophageal echocardiography, all patients (n=56) were divided into two groups: Group I - 42 (75%) with no thrombosis in the left atrial appendage; Group II - 14 (25%) with the presence of a thrombosis. Patients with thrombosis of the left atrial appendage had a high degree of thromboembolic, hemorrhagic risk, left atrial enlargement and a low level of peak blood flow velocity. At the same time, the phenomenon of spontaneous echo contrast in patients with thrombosis was on average 22% higher compared to the subgroup without thrombosis.

Conclusions. Our data showed that during transesophageal echocardiography in patients with atrial fibrillation, peak blood flow velocity and spontaneous echo contrast can be taken as predictors of thrombosis of the left atrial appendage.

Aim. To assess the effectiveness of antianemic therapy in patients with severe iron deficiency anemia.

Material and Methods. For inpatient treatment, 30 patients with severe iron deficiency anemia, who exhibited significant cardiovascular system disturbances in the form of developed cardiomyopathy of anemic origin, were selected.

Results and discussion. Therefore, the therapy conducted on average contributes to an increase in hemoglobin level by 5.0-6.0 g/l, serum iron by 1.25 µmol/l, and erythrocytes up to 4.0±0.03. In addition to the pronounced clinical effect, patients showed an increase in hemoglobin levels from 75.0±4.5 g/l to 95.0±5.0 g/l. The content of total lipids did not change significantly.

Conclusion. The treatment course conducted in patients with severe forms of anemia was found to contribute to an increase in the number of erythrocytes, and levels of hemoglobin, hematocrit, serum iron, and ferritin. This suggests its effectiveness and safety as a treatment method for patients with iron deficiency anemia in the context of developed cardiomyopathy of anemic origin.

This paper presents a review of the literature, which covers the main issues of the etiology and pathogenesis of chronic colonic stasis, starting from the era of Avicenna to modern views. Various classifications are provided, covering all the nuances of this polyetiological problem, and risk factors that contribute to the development of such a severe pathology.

The provided review reflects the modern methods of early diagnosis of primary open-angle glaucoma applied today, evaluating their positive and negative aspects. One of the diagnostic criteria for glaucoma is the thickness of the retinal nerve fiber layer. A high diagnostic value has been established for determining the thickness of the retinal nerve fiber layer in primary open-angle glaucoma. Literature analysis shows that early diagnosis and treatment of glaucoma at the initial stage of its development are most effective in preventing the progression of the glaucomatous process and exacerbating its course, which can lead to blindness and disability. This underscores the necessity for further refinement and study in this field.