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Health care of Tajikistan

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No 2 (2024)
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5-12 251
Abstract

Purpose of the study. Identification of the main medical factors leading to the death of newborns.
Material and method of research. To determine the structure of child mortality in the Republic of Tajikistan for 2017-2021 and 9 months of 2022 for selected cities and regions (the cities of Kulyab, Bokhtar, Penjikent, Istaravshan, Khujand, Kanibadam, Isfara, Vahdat)., Tursunzade and the districts of Bobojon Gafurov, Rudaki, Rasht, Fayzabad and Sh. Shahin) data on infant mortality were collected and entered into special questionnaires.
To determine the structure of newborn mortality in the Republic of Tajikistan in 2017-2021 and the 9-month period of 2022 from selected cities and districts (the cities of Kulob, Bokhtar, Penjikent, Istaravshan, Khujand, Kanibadam, Isfara, Vahdat, Tursunzade and the districts of Bobojon Gafurov, Rudaki, Rasht, Faizabad and Sh. Shahin) data on newborn mortality were collected and entered into specially designed questionnaires. The study and evaluation used statistical, analytical and social criteria.
Research results. Preliminary results of the analysis show that in most cases (61.5%) newborns died in the early neonatal period, a third of their losses in the early neonatal period most often died in the first 6 days after birth. The age of mothers of deceased newborns is mainly from 20 to 29 years (62.2%). This situation is almost the same in all regions of the republic.
Conclusion. The analyzes indicate that mothers of deceased newborns had a low health index. During pregnancy, 47.2% of mothers experienced symptoms such as (preeclampsia, poliomyelitis, dehydration, eclampsia and preeclampsia, nephropathy, etc.). There are also discharges during labor such as preterm labor, meconium contamination of water, and cesarean section birth.

13-17 242
Abstract

Aim. To assess the effectiveness of collection, storage and transfer of statistical information on tuberculosis in the districts of Rasht region.
Material and methods. The material for the planned study was data on registered cases of tuberculosis for 2022 according to the National Tuberculosis Register “OpenMRS”, the Unified Health Management Information Network “DHIS2” and the initial data of primary documentation of the anti-tuberculosis service in five districts of the Rasht region (Rasht, Tajikabad, Sangvor, Nurabad, Lakhsh).
Results. The studies conducted revealed a significant discrepancy in the official statistical information on tuberculosis in the unified health management information system “DHIS2”, in the national tuberculosis data register “OpenMRS” and in the primary documentation of the anti-tuberculosis service: Form No. 036, Reporting Form 8, Patient Registration Journal - TB-03 and TB-03U, Quarterly Report Form - TB-07 and TB-07U in all five districts of Rasht region.
Conclusion. Frequent criticism of the specialists responsible for providing official statistics on tuberculosis for their inconsistency with WHO data, data from the unified health management information system “DHIS2”, data from the national registry “OpenMRS” and data from the primary documentation of the anti-tuberculosis service is justified. One of the ways to bring official statistical data into line with the real epidemiological situation of tuberculosis is to carry out systematic routine monitoring and evaluation of the quality of collection, storage and transmission of statistical information on tuberculosis from the district level to the central level, to organise continuous training of specialists responsible for this component, to minimise paperwork and to prioritise the digitalisation of this process.

18-24 221
Abstract

Aim. To study the clinical and instrumental characteristics of the course of coronary heart disease (stable angina and post-infarction cardiosclerosis) in association with type 2 diabetes mellitus.
Material and Methods. The study material consisted of 175 patients with coronary heart disease who met the selection criteria. All patients were divided into two groups according to the presence of diabetes mellitus: group I with type 2 diabetes mellitus (n=67) and group II without type 2 diabetes mellitus (n=108).
Results. Patients with coronary heart disease associated with type 2 diabetes mellitus were older and accounted for 38.3% of the total group. Among the risk factors, arterial hypertension, hypercholesterolemia and obesity were the most important in the compared groups. An analysis of the course of coronary heart disease in the compared groups showed that non-anginal or other symptoms (shortness of breath) were more common in the diabetics. According to the results of echocardiography, the size of the atria (left and right) was larger in the group of patients with diabetes.
Conclusions. The study showed that patients with coronary artery disease associated with type 2 diabetes were older, had a higher body mass index and cardiovascular risk factors.

24-29 214
Abstract

Aim. To study the aetiology, pathogenetic factors and prevalence of anal fissure in the Republic of Tajikistan.
Materials and methods. Approximately 600 patients with anal fissure are treated annually in specialized coloproctology centres of the Republic. During 2018-2022, 3,065 patients were admitted with this pathology. All patients underwent perianal examination. Anal and rectal reflexes were measured, digital rectal examination, sphincterometry, manometry and sigmoidoscopy were performed.
Results and discussion. The main factor in the pathogenesis is the formation of the so-called vicious cycle, in which the pain factor and spasm of the anal sphincter play an important role, as well as the formation of a caruncle, which was observed in 83% and 82% of the cases, respectively. Pectinosis of the anal sphincter occurred in 8% and thickening of the anal fissure margins in 115 cases.
Conclusions. Anal fissure is a polyetiological disease and an important factor in its development is mechanical damage of the posterior wall due to chronic persistent constipation. In the pathogenesis of anal fissure there is a vicious circle in which pain factor and spasm of anal sphincter play an important role.

29-36 210
Abstract

Aim. To increase the effectiveness of surgical treatment in patients with recurrent forms of extrasphincteric rectal fistula.
Material and Methods. Clinical data of 108 patients with recurrent extrasphincteric rectal fistulas were analysed. The patients were divided into two groups. The first, the main group, included 58 (53.7%) patients who underwent improved and developed surgical procedures. The second, control group, included 50 (46.3%) patients who were treated with traditional, well-known methods.
In 6 (5.6%) cases grade I complexity of extrasphincteric recurrent rectal fistula was observed, in 23 (21.3%) cases grade II, in 62 (57.4%) cases grade III and in 17 (15.7%) cases grade IV complexity of fistula was observed.
Results. In 13 (26.0%) cases, patients in the control group underwent surgery using the ligature method, and in 37 (74.0%) patients various known plastic surgery methods were used to close the internal hole. In patients with recurrent complex horseshoe-shaped extrasphincteric fistulas from the main group, a three-stage surgical procedure was performed, developed and improved in our clinic (n=18) to prevent disease recurrence and reduce the incidence of postoperative complications. In 21 (36.2%) patients, the method we developed for surgical correction of recurrent rectal fistulas of grade III-IV complexity with an extrasphincteric course was used.
Conclusion. The developed and improved methods of surgical correction of recurrent extrasphincteric fistulas of the rectum allow radical excision of scar-inflammatory altered parafistula tissue, especially in fistulas of III-IV degree of complexity. These methods help to minimise both early and late postoperative complications, in particular they reduce the frequency of disease recurrence.

37-45 197
Abstract

Purpose of the study. It is to show the difficulty of making a diagnosis and choosing surgical treatment as a rare disease - duplication of the rectum in combination with other anomalies of the development of organs and systems.
Material and research methods. Under our supervision there were 2 children diagnosed with congenital anomaly of the gastrointestinal tract. Isolated duplication of the rectum. Perineal hypospadias. Narrowing of the vesicoureteral segment on the right. Ureterohydronephrosis Ⅰ degree on the right.
Results. A control study did not reveal any pathology in the internal organs of the children. Ultrasound of the urinary system: the pyelocaliceal system is not dilated, no symptoms of megaureter were detected. Children do not lag behind their peers in mental and physical development. Today, the children’s condition is satisfactory, there are no complaints, they are under the supervision of a pediatric surgeon.
Conclusion. Duplication of the rectum is an isolated rare pathology in children in combination with malformations of the genitourinary system, with very diverse clinical manifestations, which poses a problem in making a diagnosis before surgery. Open surgery is safer and good results can be achieved.

46-51 208
Abstract

Aim. To evaluate the blood level of ascorbic acid in children with vitiligo according to skin phototype.
Material and Methods. Blood ascorbic acid levels were analysed in children of different ages (6-15 years) with different types of vitiligo, depending on skin phototype. Patients were divided into two groups according to the degree and localisation of the vitiligo lesions: with non-segmental (n=116) and with segmental (n=134) vitiligo. The area of distribution of the dermatosis and its stage of development were calculated using the VIMAN and VIDA indices, respectively. Serum ascorbic acid levels were determined by liquid chromatography-mass spectrometry. Patients were classified by phototype according to T. Fitzpatrick’s classification.
Results and discussion. Among the children with vitiligo studied, skin phototypes II, III and IV were identified, with a predominance of phototype III over the others. Their percentages differed in the two groups studied. In non-segmental vitiligo, there were more children with a light phototype and fewer with a dark phototype compared to the group of children with segmental vitiligo. Ascorbic acid levels were significantly reduced in children with vitiligo compared to a group of healthy children. The most pronounced decrease was observed in the group with non-segmental vitiligo in the 7-9 year age group. In both groups of patients, there was a tendency for ascorbic acid levels to decrease with age.
Conclusion. The data obtained indicate that children with vitiligo have lower ascorbic acid levels than healthy children. The tendency to decrease increases with age, especially in patients with a dark phototype. This fact indicates the need to correct vitamin C levels in the body of children with vitiligo.

51-55 232
Abstract

Aim. To clarify the epidemiology of endocrine diseases in different regions of Tajikistan.

Materials and methods. A retrospective analysis of the medical history of patients with primary hyperparathyroidism (PHPT) admitted to two medical centres in Dushanbe over a 10-year period (2011-2020) was used, along with data from an epidemiological analysis conducted by the Republican Endocrinology Clinical Centre from 2016 to 2021.
Results. More than 50,000 cases of diabetes were registered in Tajikistan between 2016 and 2021, including 3,424 cases of type 1 diabetes (6.8%) and 47,094 cases of type 2 diabetes (93.2%). There is a consistent trend towards an increasing prevalence of diabetes. There has also been an increase in the prevalence of thyroid pathology, particularly endemic goiter and related endocrine disorders. An increase in obesity was observed in both adults and children.
Conclusions. The epidemiological analysis indicates a high prevalence and increasing trend of endocrine disorders in Tajikistan. This underlines the importance of early diagnosis and timely implementation of preventive measures. The observed increase in obesity rates calls for additional attention to programmes aimed at improving the diet and lifestyle of the population. Continued basic research is needed to improve diagnostic and treatment capabilities, especially in the context of expanding national programmes for diabetes and other endocrine disorders.

56-64 237
Abstract

Aim. To improve the results of surgical treatment of lumbar disc herniation using biportal endoscopy.
Material and Methods. We analysed the diagnostic data and surgical results of 23 patients diagnosed with disc herniation and stenosis in the lumbar spine. The study period covers the years 2021 to 2023. During the study, all 23 patients underwent a series of diagnostic procedures: clinical neurological examination, CT, MRI and functional radiography. The patients were divided into 2 groups according to the method of surgical intervention: the main group (n=23), where unilateral biportal endoscopy was used, and the control group (n=20), where endoscopic discectomy was used.
Results. Long-term outcomes were assessed using the MacNab scale at 9 months after surgery. 82.6% of patients had excellent outcomes. In 2 (8.8%) cases, the results were good; these patients had moderate pain that had completely disappeared by the time they were discharged from hospital. One patient (4.3%) had a satisfactory result, but continued to have moderate nagging pain, which disappeared in the first seven days after discharge from the medical facility. Poor outcome was reported in 1 case (4.3%); this patient had persistent radicular pain due to the development of postoperative neuritis. There were no cases of recurrent disc herniation.
Conclusion. The unilateral biportal endoscopic discectomy (UBE) is a minimally invasive and promising technique that can be used as an alternative to the traditional open surgical approach.

64-70 203
Abstract

Aim. To study the effectiveness of using a collagen haemostatic membrane in the surgical treatment of extrasphincteric pararectal fistulae.
Materials and Methods. This paper presents the results of the examination and surgical treatment of 100 patients with extrasphincteric pararectal fistulas, and we performed a comparative analysis of three applied methods of surgical treatment of the above-mentioned rectal fistulas: the ligating method, which was performed in 31 patients; a method using the movement of the mucosa according to Maslyak (39 patients), and the proposed method with closing the internal opening using a cologenic hemostatic membrane (30 patients).
Results. When using traditional methods of surgical treatment of ESPC, the recurrence rate was 11.4%, and US - 22.9% of cases. When the authors used the method of excision of the fistula using a cologenic haemostatic membrane to close the internal opening, rectal sphincter insufficiency was noted in 13.3% and recurrence in -6.7% of cases.
Conclusions. The developed method of using a collagen hemostatic membrane to close the internal opening of the fistula minimises the frequency of disease recurrence. This method of surgical treatment of extrasphincteric rectal fistulas using a collagen hemostatic membrane is a sphincter-sparing procedure, reduces anal sphincter insufficiency and is a promising method of surgical treatment of extrasphincteric pararectal fistulas.

70-76 177
Abstract

Aim. To study the characteristics of the clinical manifestations of acute haematogenous osteomyelitis of the hip bones in children.
Material and methods. The clinical features of acute osteomyelitis of the hip joint were studied in 90 children aged between 2 and 16 years during 2017-2023. In the early stages of the disease, 9 (10.0%) patients were admitted before 3 days after the onset of the disease, and 81 (90.0%) patients were admitted later than 3 days. The proximal femoral metaepiphysis was involved in 78 (86.7%) cases, the iliac bones in 10 (11.1%), the pubic bone in 1 (1.1%) and the sacroiliac joint in 1 (1.1%).
Results and discussion. Examining the clinical picture of the disease, the main symptoms were: pain in the affected area - 87 (96.7%) patients, sometimes with pain radiating to nearby areas of the body, fever - 83 (92.2%), forced position of the affected limb with refusal to walk - 79 (88.8%), and limping in 11 (12.2%) patients. In addition, purulent leakage was observed in 2 cases, in the left pubic bone lesion purulent leakage was observed in the area of the inner surface of the left thigh and in the iliac bone lesion in the iliopsoas muscle.
Conclusions. Acute haematogenous osteomyelitis of the bones of the hip joint in children usually begins acutely against the background of a healthy condition of the child with a triad of symptoms: pain, increase in body temperature, forced position of the limb. Local symptoms of the disease depend on the location of the primary focus, the degree of involvement of joints and soft tissues in the process.

76-82 192
Abstract

Aim. To study the psycho-emotional state of pregnant women after IVF and to identify the factors influencing it.
Materials and methods. A total of 104 pregnant women were included in a comparative study. They were divided into two groups: one group consisted of women whose pregnancy occurred after IVF (main group), and the other group consisted of women whose pregnancy occurred naturally (comparison group). Psychodiagnostic questionnaires were used to assess the psycho-emotional state of the pregnant women. Statistical processing was performed using the STATISTICA 10.0 program, and differences were considered significant at a significance level of p=0.05.
Results and discussion. The results of the analysis showed that the mean age of pregnant women after IVF was 30.8±1.3 years, which was significantly higher than that of women with natural pregnancy (mean age 22.38±4.6 years). In the group of women who became pregnant after IVF, there were more women with a complicated obstetric and gynaecological history and with extragenital pathology. The results of psychodiagnostic studies showed that women in the IVF group had a high level of anxiety. Factors such as the age of the pregnant woman, history of infertility, longterm and unsuccessful infertility treatment, and the presence of somatic pathology negatively affect the mental health of pregnant women.
Conclusion. Thus, a high level of anxiety, fear about the course of the pregnancy and the health of the unborn child is characteristic of women whose pregnancy occurred after IVF. Psycho-emotional reactions are associated with the nature of the pathology of the pregnancy, the duration of infertility treatment and a burdened obstetric and gynaecological history. It is important to create special consultation rooms for psychological support. The help of a perinatal psychologist is necessary. Collaboration between the psychologist and the attending physician can achieve the best results.

82-88 206
Abstract

Aim. To assess the prevalence of HIV, syphilis and hepatitis C in prisons in the Republic of Tajikistan.
Materials and methods. The biobehavioural study included anonymous testing for 3 infections (HIV, syphilis and hepatitis C) and a survey. Participation was voluntary. Each participant was able to access the results of the study through their unique code, which was assigned prior to the start of the study. Data entry and analysis were performed using Epi-Info-3.5.2 analysis software.
Results and discussion. The prevalence rates of HIV, syphilis and hepatitis C in prisons were HIV - 3.4%, syphilis - 2.8%, hepatitis C - 8.9%. According to the results, drug use by injection is prevalent in prisons. The presence of homosexual contacts in prisons is also confirmed.
Conclusion. HIV prevalence among prisoners in Dushanbe has increased from 2.2 to 2.9 per cent. In Dushanbe, it increased from 2.5 per cent in 2020 to 3.5 per cent in 2023, while in Khujand it decreased (3.8 per cent and 3.3 per cent). Prisoners’ awareness of HIV/AIDS and use of preventive measures is low. In 2023, only 56 per cent of prisoners had been tested for HIV.

88-94 204
Abstract

Aim. To study the radiographic characteristics of the construction of the anterior area of the palatal suture and the tops of the interalveolar septum between the central incisors in children with thick locations, diastems of the central incisors.
Materials and methods. The construction of the palatine suture in 63 children in 6-14 years old without diastema, addressed on the cause of caries, its complications and defect crown incisor, was accepted for rate (I group). 75 children of the same age with full dentition and diastema formed the 2nd group. Condition of palatal suture after orthodontic treatment was studied in 60 children aged 6-12 years with diastema of 1,8-5,2 mm.
Results. At the time of removable bite, the palatal suture was wider in children with diastema than in the general population, which is probably related to its delayed and insufficient ossification. However, the width of the diastema did not depend on the width of the suture.
Conclusion. In rate and under diastema the interalveolar septum can have a jagged, smooth and cratered shape.

CLINICAL CASE

94-100 198
Abstract

 Two clinical cases of manifestation of clinical symptoms of Hirschsprung’s disease in infants in the form of necrotising enterocolitis in a premature newborn with spontaneous perforation of the terminal ileum and subsequent multiple surgical interventions due to recurrent perforations, failure of  anastomoses after intestinal tube reconstructions are described. The casuistic occurrence of the perforative form of acute appendicitis in a newborn of 3 days of age, the subsequent increasing clinical picture of intestinal dysfunction, considered as “peritoneal adhesions” - a rare example of the onset and course of colonic agangliosis. 

EXPERIMENTAL STUDY

101-107 173
Abstract

Aim. To evaluate the role of a 0.1% furagin solution in the treatment of the abscess cavity in experimental animals using a simulated intra-abdominal abscess.
Materials and methods. An experimental study was carried out on 54 chinchilla rabbits weighing 2300-3000 grams. The experimental animals were divided into 3 groups: group 1 - 18 rabbits which received a 0.1% furagin solution for abscess sanitation; group 2 - 18 rabbits with an experimental abscess in which the abscess cavity was sanitised with a 0.02% furacillin solution; group 3 - 18 rabbits with an experimental abscess in which a 0.9% sodium chloride solution was used. After modelling the abscess and sanitising with the indicated solutions, biopsy material taken from the parietal peritoneum and surrounding abscess tissue was subjected to microscopic examination.
Results. No pathological changes were observed when the micro-preparations of healthy experimental animals were examined. When the abscess was modelled, morphological changes were observed in the parietal peritoneum, characterised by a marked enlargement of all the paranasal sinuses. These sinuses were filled with serous fluid in which, on the second or third day after the formation of the abscess, fibrin appeared in large quantities, which contributed to further expansion of the sinuses. At the same time, on the 5-7th day of the postoperative period, a morphological picture of acceleration of reparative processes was observed in the group of animals in which furagin solution was used.
Conclusion. The use of Furagin’s solution in abdominal abscesses in experimental animals allowed to accelerate the reparative processes of the parietal peritoneum, which has a positive effect on the prognosis of the disease.

REVIEW

108-114 228
Abstract

The article reviews national and international studies that address current issues in the diagnosis and surgical management of occlusive hydrocephalus in infants. Currently, there is a considerable amount of work describing the clinical manifestations and pathogenesis of occlusive hydrocephalus, particularly in infants. However, there is a lack of evidence regarding the early diagnosis and choice of surgical treatment of occlusive hydrocephalus in infants. In recent years, with the introduction of diagnostic techniques such as ultrasound, CT and MRI, significant progress has been made in understanding the clinical features and course of occlusive hydrocephalus. However, a universal algorithm of diagnostic approaches for young children has not yet been developed. The method of choice for surgical treatment of occlusive hydrocephalus in infants is still controversial. The complexity lies in the variety of clinical courses and combinations of causes leading to this pathology. Therefore, the creation of a systematic approach in terms of diagnosis and surgical treatment allows to choose the right method of surgical treatment depending on the aetiology of this pathology.

114-121 219
Abstract

 The article presents a review of modern literature with the aim of studying issues of taxonomy, distribution, general characteristics and use of plants of the genus Ferula L. in medicine. The analysis of the literature shows that at this stage there is a considerable amount of scientific material devoted to the study of the properties of this genus of plants. There are 114 species of Ferula L. in Central Asia, 39 of which grow in Tajikistan, including 5 endemic species. The aerial and subterranean parts of these plants have been and are widely used in traditional and modern medicine. 

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ISSN 0514-2415 (Print)