Aim. To evaluate the outcomes of mini-laparotomy choledocholithotomy in patients with choledocholithiasis and metabolic syndrome using “Mini-Assistant” instruments.

Materials and Methods. This study is based on the outcomes of surgical interventions performed on 54 patients diagnosed with choledocholithiasis accompanied by metabolic syndrome, conducted between 2009 and 2022. A minimally invasive laparoscopic approach was utilized, employing “Mini-Assistant” instruments. Preoperative assessments included laboratory tests, ultrasound examination, electrocardiography, echocardiography, respiratory function testing, chest radiography, esophagogastroduodenoscopy, and magnetic resonance cholangiopancreatography (MRCP). The miniaccess operation was performed using a transrectal incision, 6-7 cm in length. The technical steps of the operation were similar to traditional cholecystectomy and choledocholithotomy.

Results. The average duration of the procedure was 68 ± 9.3 minutes. The patients’ condition before and after surgery was satisfactory, with stable hemodynamics. No hypertensive crises or tachycardia were observed. No mortality was reported. Postoperative complications were observed in three patients, including accumulation of serous fluid in the subcutaneous tissue (2 cases) and postoperative pancreatitis (1 case). The average length of hospital stay after choledocholithotomy via mini-access was 6 ± 1.6 days.

Conclusion. Mini-laparotomy choledocholithotomy using the “Mini-Assistant” instrument set allows for avoiding conventional, more invasive techniques, facilitating effective surgical intervention even in cases where laparoscopic procedures are not feasible.

Aim. To study the variability of intra-abdominal pressure and the choice of hernioplasty method for large and giant abdominal hernias.

Material and Methods. This study analyzed the outcomes of various hernial orifice repair methods in 134 patients with large and giant hernias of the anterior and lateral abdominal walls. The majority of cases involved incisional hernias (n=52), while 47 patients presented with recurrent hernias, and 35 cases involved primary hernias. In 84.3% of cases, the hernias were localized in the anterior abdominal wall, and concomitant comorbidities were identified in 82 patients. Preoperative evaluations included clinical examination, imaging studies, and assessment of intra-abdominal pressure. Research results. In 31 (29.2%) observations, hernia repair was performed using the inlay method due to high intra-abdominal pressure. Anterior and posterior component separation with prosthetic reinforcement using the sub lay technique was carried out in 21 patients (7.5%). Additionally, the placement of a mesh prosthesis using the on lay method was performed in 54 patients (20.7%). The overall mortality rate was 2.2% (n=3), while 11 patients experienced recurrence in the late postoperative period, resulting in a recurrence rate of 8.2%.

Conclusion. The increasing frequency of abdominal and retroperitoneal surgeries has led to a rise in the incidence of abdominal hernias. Traditional hernia repair techniques continue to evolve, and new, minimally invasive approaches are being developed to enhance patient outcomes. Despite ongoing advancements in surgical techniques for large and giant abdominal hernias, several challenges remain unresolved, necessitating further research and innovation in this field.

Aim. To evaluate the severity of pathomorphological changes in the wall of the large intestine at various stages of chronic colonic stasis.

Materials and Methods. This study examined pathomorphological changes in biopsy specimens of the mucous membrane and resected sections of the large intestine from 92 patients with different stages and etiologies of chronic colonic stasis. The distribution of patients by disease stage was as follows: 31 patients (33.7%) were in the compensated stage, 33 patients (35.9%) were in the subcompensated stage, and 28 patients (30.4%) were in the decompensated stage of chronic colonic stasis.

Results. Pathomorphological changes in the mucosa and other layers of the large intestine in patients with chronic colonic stasis varied in severity, ranging from minor superficial alterations to pronounced and extensive changes. Focal dystrophic processes with signs of diffuse inflammation, destructive changes in the glands of the mucous membrane, and focal inflammatory infiltrates were observed. The intestinal villi were elongated and showed divisions with swollen vessels.

Conclusion. The severity of pathomorphological changes in the mucosa and other layers of the large intestine directly correlates with the stages and duration of colonic stasis. These findings indicate the presence of both degenerative and inflammatory processes in the mucosal-submucosal and muscular layers of the large intestine.

Aim. To evaluate BMI in pregnant women with SARS-CoV-2-associated pneumonia and its influence on the severity of the course of viral pneumonia.

Materials and Methods. Seventy pregnant women with SARS-CoV-2-associated pneumonia underwent general clinical and laboratory evaluations. SARS-CoV-2 infection was confirmed using PCR diagnostic testing, and imaging studies, including chest radiography in two views or computed tomography, were performed.

Results. Analysis of BMI in pregnant women with SARS-CoV-2-associated pneumonia revealed that 11 patients (15.7%) were classified as overweight (BMI 25 to 30). Obesity was identified in 9 patients (12.9%), including 6 cases (8.6%) with first-degree obesity (BMI 30 to 35) and 3 cases (4.3%) with second-degree obesity (BMI 35 to 40). A body weight deficit (BMI < 18.5) was observed in 9 patients (12.9%).

Conclusion. In the study group, BMI-related pathology was prevalent, with half of the pregnant women with SARS-CoV-2-associated pneumonia presenting as either overweight, obese, or underweight. BMI correlated with the clinical forms of SARS-CoV-2-associated pneumonia. The frequency of BMI-associated pathology increased fourfold in complicated forms of SARS-CoV-2-associated pneumonia compared to moderately severe forms.

Aim. To evaluate hemodynamic indicators of the kidneys in children with obstructive uropathies.

Materials and Methods. The study was conducted at the Republican Scientific and Clinical Center of Pediatrics and Pediatric Surgery, involving 32 children aged 1 to 14 years, comprising 18 girls (56.3%) and 14 boys (43.7%). The children were divided into 3 groups: Group I with unilateral hydronephrosis - 14 (43.7%) children, Group II with bilateral hydronephrosis - 10 (31.3%) children, and Group III with ureterohydronephrosis - 8 (25%) children.

Results and Discussion. Obstructive uropathy resulting from congenital kidney malformations, such as organic obstruction (hydronephrosis), causes dilation of the renal collecting system, increased ureteral pressure, reduced intrarenal blood flow, renal parenchyma atrophy, and progressive chronic renal failure.

Conclusion. The above findings demonstrate that ultrasound using pulsed-wave Doppler and color Doppler mapping is an optimal non-invasive method for assessing renal hemodynamics.

Aim. To assess the effect of preeclampsia in combination with premature rupture of membranes (PROM) on the condition of newborns in the early neonatal period.

Materials and Methods. The study included 984 mothers and their newborns, divided into four groups. The main group comprised 94 women whose pregnancies were complicated by severe preeclampsia and PROM. The comparison group consisted of 840 patients, further divided into two subgroups: subgroup A included 70 patients with severe preeclampsia, and subgroup B included 770 patients with PROM. The control group comprised 50 healthy pregnant women.

Results and Discussion. In the main group, 31 (33%) newborns were premature; in subgroup A, 21 (30%); and in subgroup B, 69 (9%). Newborns with extreme prematurity were born in the main group 3.1 and 5.4 times more often than in subgroups A and B, respectively (p = 0.013). It was found that the main group had a higher incidence of respiratory distress syndrome, apnea, and neonatal encephalopathy. Hypoglycemia was diagnosed in the main group 5.6 times more frequently than in cases of isolated PROM (p < 0.001) and 1.3 times more frequently than with preeclampsia alone (p > 0.05). In the Republic of Tajikistan, neonatal mortality reaches 56.3%.

Conclusion. Reducing early neonatal morbidity and mortality in women with preeclampsia and PROM is possible through referral and delivery in tertiary care facilities.

Aim. To evaluate the diagnostic significance of structural changes in the anal sphincter (AS) in patients with complex rectal fistulas (CRF).

Materials and Methods. This study analyzed the results of examination and surgical treatment of 87 patients with rectal fistulas. Following a comprehensive assessment, the structural changes in the anal sphincter (SCAS) among patients with complex rectal fistulas were classified into several categories. The first subgroup included 16 patients (18.4%) with complex rectal fistulas accompanied by inflammatory infiltration of the anal sphincter (reactive sphincteritis, RS). The second subgroup consisted of 24 patients (27.6%) who exhibited fibrotic changes in the anal sphincter (anal sphincter pectenosis, ASP). The third subgroup comprised 17 patients (19.5%) with complex rectal fistulas and defects (diastasis of AS muscles) in the anal sphincter fibers. The fourth subgroup served as the comparison group, consisting of 30 patients (34.5%) with complex rectal fistulas but without organic changes in the AS.

Results and Discussion. The primary complaint among all patients with complex rectal fistulas was the presence of a fistula opening with purulent discharge, although additional symptoms varied depending on the type of structural changes in the AS. The study demonstrated that ultrasound showed a sensitivity of 87%, specificity of 69%, and overall accuracy of 92% in diagnosing rectal fistulas, consistent with data reported by other researchers. On ultrasound, reactive sphincteritis presented as a homogeneous or heterogeneous structure of anal sphincter fibers with varying shapes and sizes, characterized by hyperechogenicity intimately adjacent to fluid accumulations (or intersphincteric localization), filled with contents of varying degrees of echogenicity depending on the stage of inflammation. The ultrasound characteristics of anal sphincter pectenosis (ASP) differed from RS, showing a decrease in sphincter fiber volume and deformation of the AS with retraction of the muscular ring. Defects in the internal sphincter were characterized by varying degrees of hypoechogenicity, with lengths ranging from 0.3 to 1.2 cm, and were more frequently observed along the posterior rectal wall.

Conclusions. Complex rectal fistulas are often associated with organic changes in the structure of the anal sphincter, manifesting as reactive sphincteritis, anal sphincter pectenosis, and defects in the muscle fibers of the external anal sphincter. The clinical course of the disease in patients with ASP is influenced by both the type of rectal fistula and the nature and severity of SCAS.

Aim. To optimize the treatment of liver trauma by analyzing surgical outcomes.

Materials and Methods. A retrospective analysis was conducted on data from 98 patients who underwent reconstructive liver vascular surgeries for combined trauma between 2018 and 2023. Patients were categorized into three groups based on the type of liver vascular injury: Type A (30 patients), Type B (40 patients), and Type C (28 patients). Diagnostic methods included computed tomography (CT) scans, angiography, and blood tests. Surgeries were performed using microsurgical techniques and innovative materials.

Results and Discussion. The average duration of surgery increased with the severity of liver injury: Type A surgeries averaged 1.81 hours, Type B averaged 2.84 hours, and Type C averaged 3.04 hours. Blood loss was also significantly higher in patients with Type B and Type C injuries. Complication and reoperation rates were highest among Type C patients (20.84% complication rate and 18.36% reoperation rate), while Type A patients had the lowest rates. Survival rates were highest in Type A patients (99.11%) and lowest in Type C patients (82.53%).

Conclusion. The results indicate that reconstructive liver vascular surgeries for combined trauma yield outcomes that vary by the type of vascular injury. Arterial injuries (Type A) are associated with more favorable prognoses, whereas venous and mixed injuries (Types B and C) present greater challenges. Enhancements in diagnostic techniques and surgical approaches are essential for reducing complications and improving patient survival.

Aim. To study the composition and medicinal properties of water from natural mineral springs in the Republic of Tajikistan.

Materials and Methods. This study analyzed the climatic and geographical regions, as well as the water quality and chemical composition of four mineral springs: Khoja-Obi-Garm, Obi-Garm, Garm-Chashma, and Shoambary. The research also investigated the influence and effectiveness of these mineral waters in treating skin diseases.

Results and Discussion. The Republic of Tajikistan has numerous mineral springs that are used for treating skin conditions and other health issues. Mineral waters in Tajikistan are classified into five types based on their chemical composition: bicarbonate, chloride, sulfate, nitrate, and mixed composition waters. In addition, there are waters with active ions and gaseous elements such as hydrogen sulfide, radon, nitrogen, and methane. Based on temperature, these waters are categorized as cold, warm, or hot/thermal waters. The springs at Khoja-Obi-Garm, Obi-Garm, Garm-Chashma, and Shoambary are hot thermal baths of the bicarbonate-chloride-sulfate-sodium type. In addition to the primary salts and gases, these waters contain biologically active trace elements, including aluminum, titanium, manganese, copper, silicon, molybdenum, strontium, barium, boron, fluorine, and others.

Conclusion. Tajikistan holds a leading position in Central Asia regarding the abundance of mineral springs, and the mineral waters from these springs meet the requirements for therapeutic use. These waters contain a variety of chemical elements that exert significant biological effects, and, when used appropriately, can effectively treat many diseases.

Aim. To analyze the existing system of medical care organization and timely diagnostics for prostate cancer (PC).

Materials and Methods. The study utilized data from official statistics to analyze the system of medical care organization and the diagnostic methods applied for prostate cancer at different stages.

Results. In the country, medical care for patients with prostate cancer is organized into three levels. The first level involves family physicians, urologists, and oncologists in oncology clinics, where access to modern diagnostic facilities is limited. The second level provides advanced diagnostic services through regional oncology centers and major urology departments. The third level offers specialized care at the National Cancer Research Center (NCRC) and select urology clinics. Based on the experience of other countries, it is recommended to improve the system of medical care for prostate cancer by establishing four stages of care. The proposed model takes into account the real situation, emphasizing the need for prevention, timely diagnosis, and effective treatment in accordance with clinical protocols, as well as the coordinated use of human and technological resources from oncology, urology, and morphological services at all stages.

Conclusions. The proposed model for organizing medical care, based on evidence-based practices, aims to improve early detection of prostate cancer, enhance the clinical effectiveness of treatment, and optimize the use of resources.

Aim. To assess the baseline condition of periodontal structures in civil aviation flight personnel in order to improve the algorithm for treatment and preventive dental care.

Materials and Methods. A periodontal examination of the oral cavity was conducted for 120 flight personnel at the physician-sanitary unit of Dushanbe International Airport. The participants were divided into five groups: flight personnel with mild chronic gingivitis, moderate chronic gingivitis, mild chronic periodontitis, moderate chronic periodontitis, and a control group of flight personnel with healthy periodontium. The clinical course of chronic gingivitis and periodontitis was evaluated using oral hygiene and periodontal indices.

Results and Discussion. Inflammatory periodontal diseases, such as chronic gingivitis and periodontitis of moderate severity (Groups II and IV), presented with more pronounced symptoms, including severe inflammatory reactions of the periodontal tissues and poor oral hygiene, compared to those in Groups I and III.

Conclusion. The study demonstrated that papillary-marginal-alveolar (PMA) index, bleeding index, and oral hygiene scores were significantly elevated in flight personnel with mild to moderate chronic periodontitis, highlighting the need for targeted treatment and preventive care.

Aim. To evaluate central hemodynamic changes during laparoscopic cholecystectomy in patients with cholelithiasis and concurrent coronary heart disease.

Materials and Methods. The baseline hemodynamic status of 78 patients with cholelithiasis and chronic calculous cholecystitis was analyzed during their hospitalization for surgical treatment between 2020 and 2023. Dynamic echocardiography was performed on all patients at various stages of laparoscopic cholecystectomy. Among these, 36 patients with cholelithiasis but no concomitant diseases demonstrated a normodynamic (eukinetic) type of blood circulation.

Results. Blood circulation types (normodynamic, hypodynamic, and hyperdynamic) were identified in the 78 patients and were considered when planning preoperative preparation, surgical strategies, and anesthesia approaches. Intraoperative monitoring of central hemodynamics revealed significant changes, especially in patients with concomitant cardiovascular disease and a hypodynamic circulation type. Creation of pneumoperitoneum in all patients was associated with decreased stroke volume, cardiac index, and cardiac output, alongside an increase in systemic vascular resistance (SVR). Therefore, for patients with coronary heart disease and a hypodynamic type of circulation, a gentle pneumoperitoneum regimen at 8-9 mmHg is recommended.

Conclusions. Laparoscopic procedures involving carbon dioxide insufflation into the abdominal cavity result in increased intra-abdominal pressure. To minimize hemodynamic disturbances, it is recommended that laparoscopic cholecystectomy in patients with cholelithiasis and concurrent cardiovascular disease be conducted under a low-pressure pneumoperitoneum regimen (8-9 mmHg).

This article summarizes the research conducted by the Department and Clinic of Otorhinolaryngology over the years. Significant progress has been made in understanding the prevalence, clinical features, and treatment of allergic diseases affecting the upper respiratory tract and ear across different regions of Tajikistan. The research evaluated immune status in individuals with allergic ENT conditions living at different altitudes, leading to the development of treatment protocols using immunomodulatory agents. Further studies focused on modern diagnostic and treatment approaches for combined pathologies of the nose and paranasal sinuses (PNS). Key types of combined nasal and PNS pathologies were identified, functional assessments of nasal health were conducted, and diagnostic algorithms, as well as methods for simultaneous functional and cosmetic surgeries, were developed. Currently, research efforts aim to improve the diagnosis, treatment, rehabilitation, and prevention of various forms of hearing loss combined with upper respiratory tract pathology, utilizing innovative technologies.

A 33-year-old female patient was admitted following a car accident, presenting with a diaphyseal fracture of the humerus (wedge-shaped, intact, classified as type B2 according to the AO classification). Osteosynthesis using a plate was initially performed; however, an incorrect choice of plate thickness led to migration of the metal structure three days post-operation. The causes of this error, diagnostic approaches, and corrective surgical treatment are discussed. To prevent such complications, careful selection of the osteosynthesis method and implant type is essential, along with close attention to the donor site during bone autografting.

This paper presents a case of successful surgical treatment of a child with jejunum injury. The procedure involved laparoscopy and video-assisted resection of the jejunum with insertion of a direct end-to-end interintestinal anastomosis.

This paper addresses the specific challenges involved in the intensive treatment of acute obstructive laryngitis (OL) in young children by reviewing current literature, including both domestic and international publications. The analysis reveals that healthcare systems worldwide have significant experience in employing diverse pharmacological and non-pharmacological treatment approaches for this condition. According to the literature, the most effective treatments for OL in children are glucocorticoids and inhaled adrenaline, while there is no evidence supporting the use of oxygen therapy. The paper outlines the main routes of administration, considerations for dose selection, and potential side effects of the medications most frequently used in pediatric practice for OL. A comprehensive understanding of the specific aspects of intensive therapy in this medical emergency can significantly enhance the quality of care provided to pediatric patients.

Chronic kidney disease represents an increasing health burden worldwide. Chronic kidney disease and cardiovascular disease are closely interlinked, with dysfunction in one organ often causing dysfunction in the other, ultimately leading to the failure of both. Patients with end-stage renal disease are at significantly higher risk of mortality due to cardiovascular complications. Shared risk factors for both chronic kidney disease and cardiovascular disease include age, hypertension, diabetes mellitus, dyslipidemia, tobacco use, family history, and male gender. This review focuses on whether early-stage chronic kidney disease serves as an important risk factor for the presence, severity, and progression of cardiovascular disease.