Aim. To study the prevalence of transfusion-related acute lung injury (TRALI).

Material and methods. A retrospective and prospective analysis of the medical histories of 3,750 women in labour and postpartum women with class III-IV (WHO) haemorrhage, 756 patients with acute gastroduodenal haemorrhage of ulcerative etiology, 150 victims of polytrauma complicated by massive haemorrhage was undertaken. In addition, the results of transfusion therapy of 7,325 oncological and haematological patients hospitalised at the Research Institute of Paediatric Oncology, Haematology and Transplantation named after R. Gorbacheva were analysed.

Results and discussion. TRALI was diagnosed in 24 patients and “possible TRALI” in 5 obstetric patients, or 0.77% of cases. The frequency of TRALI and “possible TRALI” was 1 case per transfusion of 870.3 doses of donated blood and blood components. In surgical patients - 4 and 2 (0.79%) respectively (1 case per transfusion out of 765 doses of blood components). In polytrauma patients, the diagnosis of “possible TRALI” was made in 3 patients (2.0%). 4 cases of TRALI and 5 cases of “possible TRALI” were diagnosed in patients with oncological and oncohematological profiles. The frequency of TRALI and “possible TRALI” was 1 case per 16,155 transfusions.

Conclusion. Transfusion of blood components is a high risk factor for the development of TRALI, especially from female donors with a history of multiple pregnancies and childbirth. In order to prevent TRALI, it is necessary to screen the blood of female donors for the presence of anti-HNA, anti-HLA antibodies, or to discontinue the clinical use of plasma-containing components of blood from female donors and to arrange for the preparation of platelet concentrate in an additional solution.

Aim. To optimize delivery methods for pregnant women with hemorrhagic stroke.

Material and methods. The study included 41 pregnant women aged 20 to 40 years with haemorrhagic stroke. All women underwent a general clinical examination, a haemostasis study, computed tomography, magnetic resonance imaging, cerebral angiography, consultations with a neurologist, neurosurgeon, anaesthesiologist and ophthalmologist.

Results. Surgical intervention was required in 21 (51.2%) cases due to haemorrhage. The extent of the surgical intervention was as follows: - cranectomy with removal of intracerebral haematoma (IH) in 6 (28.6%) cases, osteoplastic trepanation with removal of IH in 3 (14.3%) pregnant women, trepanation with drainage of subacute and chronic IH in 4 (19. 1%), ventriculoperitoneostomy for occlusive hydrocephalus due to subarachnoid haemorrhage in 5 (23.7%) cases, and AA/AVM clipping in 3 (14.3%) of the remaining cases. Conservative management was performed in 20 (48.8%) cases. Residual effects of the transferred GI were observed in 22 (53.6%) women. Fundus examination revealed signs of intracranial hypertension in 18 (43.9%) pregnant women.

Conclusion. Optimisation of the management of pregnant women who have had a haemorrhagic stroke with the participation of a group of specialists, timely diagnosis, adequate treatment of cerebral pathology allows to avoid errors in medical and obstetrical management, maintain pregnancy and safely increase the frequency of delivery of these patients through the natural birth canal. Timely detection and adequate treatment of brain pathology help reduce errors during treatment and delivery, which, in turn, supports the preservation of the gestational period and ensures the birth of a viable child.

Aim. To analyze the main groups of patients with individual vulnerability to tuberculosis (TB), as well as key risk groups for the development of TB.

Material and methods. This study identified and analyzed groups of patients with individual susceptibility to TB and key risk groups for the development of TB. WHO recommendations, TB program monitoring and evaluation reports, clinical guidelines and personal observations were used.

Research results. The study identified the following vulnerable populations and key risk groups for tuberculosis: HIV-infected people, drug addicts, contacts, prisoners, labor migrants, patients with diabetes, viral hepatitis, mental illness, and decreed population groups. The methods and frequency of screening in each of these population groups are described.

Conclusion. The findings showed that even with screening intervals as short as four months, 21% of patients were diagnosed with the disease at a moderately advanced stage, with a slightly lower percentage diagnosed at a late stage. For this reason, targeted screening among representatives of key high-risk groups for TB disease and vulnerable individuals allows for timely detection of cases of latent and active TB among them and improvement of clinical outcomes of the disease among these population groups.

Aim. To study the impact of risk factors on the development of brain damage in the perinatal period.

Material and methods. The work is based on a retrospective analysis of the medical documentation of the maternity hospital and the “mother and child” department of the state institution MC “Istiklol” in Dushanbe. The analysis included birth histories and developmental charts of newborns for the period from 2019 to 2021. In the process, data from statistical accounting form 32 “Report on medical care of pregnant women, women in labour, postpartum women and newborns” were used. Approved by the order of the State Statistics Service under the President of the Republic of Tajikistan No. 054 of 11 October 2013, the analysis covered the period from 2017 to 2021.

Results and discussion. The highest number of children with birth injuries in the republic over the five analyzed years was recorded in 2018, with 2,020 cases. In 2021, the total number of children with birth injuries was 1,879.

Over the five-year period, the incidence of birth injuries decreased by 20.9%; however, the number of affected children increased by 393 cases.

In the city of Dushanbe, the highest number of newborns diagnosed with intrauterine hypoxia was recorded in 2019, with 962 cases, accounting for 7.4% of all children born sick or who developed illnesses. In 2021, a decrease in the proportion of children born sick was observed, with a reduction rate of 53.3%.

Conclusions. An unstable trend in the reduction of the number of children born sick or who developed illnesses has been identified, with an increase in this indicator observed in 2021 compared to other years.

The proportion of children who experienced intrauterine hypoxia has shown a clear downward trend over the fiveyear period. The number of children born with asphyxia in Dushanbe exhibits a pronounced tendency toward reduction.

Aim. To study the impact of risk factors on the recurrence rate of acute adhesive small bowel obstruction (AASBO) and to determine the indications for laparoscopic adhesiolysis.

Materials and methods. To investigate the causes of AASBO recurrence, a statistical analysis of patients’ medical records was performed. The study included 50 patients who were divided into two groups according to the recurrence of the disease. The first group included 28 patients (56.0%) who experienced a recurrence of AASBO. The second group included 22 patients (44.0%) with no recurrence. This analysis allowed us to identify potential factors influencing the likelihood of AASBO recurrence and to assess the effectiveness of therapeutic measures aimed at preventing recurrences.

Results and discussion. The primary factors associated with the risk of recurrence of AASBO include multiple episodes of AASBO in the patient’s history, elevated white blood cell levels, absence of colonic pneumatosis on radiographs of small bowel obstruction, significant volume of gastric contents drained by tube, and delayed transit of contrast medium through the small bowel. These indicators can serve as important predictors in determining the risk of disease recurrence and the need for additional medical intervention.

Conclusion. The scale used in the study to assess the intensity of the adhesion process in the peritoneal cavity demonstrated its effectiveness. Based on the factors identified, a system for predicting the risk of recurrence after conservative treatment was improved, achieving an accuracy of 86%. This supports its recommendation for use in planning conservative therapeutic approaches.

Aim of the study. To optimize the diagnosis, treatment, and prevention of postoperative complications in children with infected hydatid cysts of the lungs complicated by rupture into the bronchus or pleural cavity.

Materials and methods. The study analyzed the results of diagnosis and treatment of infected hydatid cysts of the lungs that had ruptured into the bronchus and pleural cavity in 120 children. Depending on the size and volume of the hydatid cysts, the following groups were diagnosed: small – 22 (18.3%), medium – 56 (46.7%), large – 24 (20.0%), and giant – 18 (15.0%). Rupture into the pleural cavity was identified in 17 (14.2%) patients, rupture into the bronchus in 103 (85.8%), and pericystic inflammation in 32 (26.7%). In 15 (12.5%) children, parasitic cysts involved both lungs, while in 13 (10.8%) combined echinococcosis (liver + lungs) was diagnosed. Diagnosis was carried out using clinical and laboratory studies, radiography, computed tomography (CT), multislice CT with 4D imaging, and functional diagnostic methods.

Results and discussion. After confirming the diagnosis, targeted preoperative preparation was performed in 89 patients from the main group. The preparation aimed to reduce intoxication, decrease allergic sensitization, and alleviate inflammatory processes in the bronchopulmonary system. Surgical treatment involved the elimination of the residual cavity of the fibrous capsule by creating an interlobar or intersegmental fissure (74 cases), as well as performing subtotal pericystectomy.

Conclusions. The choice of intensive therapy considers the nature of inflammatory processes and the degree of endogenous intoxication. The method for eliminating the residual cavity of the fibrous capsule is determined based on the size of the residual cavity and is tailored individually for each patient.

Aim. To study the perinatal outcomes of women, living in the Khatlon region with late spontaneous preterm birth (LSPB).

Material and methods. 146 women with late spontaneous preterm birth were studied, according to the gestational age at which the birth occurred: subgroup A - gestational age 34 weeks + 6 days (27 women), subgroup B - gestational age 35 weeks + 6 days (51 women), subgroup B – gestational period 36 weeks + 6 days (68 women). Parametric and nonparametric methods of biological statistics (Student and Whitney-Munny tests).

Results. One in five newborns born to mothers with late spontaneous preterm labour was found to be small for gestational age, with fetal growth restriction diagnosed in 75.8% of these cases. A statistically significant reduction in mean Apgar scores at 1 and 5 minutes was observed in neonates born at 34+6 weeks’ gestation. Respiratory failure was the cause of early neonatal mortality in 56.3% of cases. In the structure of early neonatal morbidity, respiratory failure is a leading cause, with its frequency and severity depending on gestational age. A strong inverse correlation was found between gestational age and the incidence of respiratory failure in the early neonatal period in neonates born to mothers with late spontaneous preterm labour and fetal growth restriction.

Conclusion. It is advisable to further conduct research on the effectiveness of differentiated approaches to preventing respiratory distress syndrome in late preterm birth.

Aim. To assess the clinical characteristics and epidemiological status of patients with fixed prosthetic restorations made from various composite materials.

Material and methods. A sociological survey was conducted among 787 patients treated at Dushanbe City Dental Clinic No. 3 and the Department of Prosthetic Dentistry at the Medical-Social Institute of Tajikistan. A total of 1032 prosthetic restorations were analyzed. Statistical processing of the data was performed using the LDS Basis chromatograph computing module.

Research and discussion. The epidemiological study revealed the following distribution of prosthetic restorations: stamped steel crowns — 629 units (60.94%), gold crowns — 149 units (14.43%), silver-palladium alloy crowns — 51 units (4.94%), metal-ceramic crowns — 71 units (6.88%), and metal-plastic crowns — 132 units (12.79%) of the total restorations.

Conclusions. Steel crowns are used significantly more often than other materials (p<0.05), particularly in older patients, due to their affordability and durability. Gold and metal-ceramic crowns are chosen mainly by middle-aged patients for their aesthetic and functional properties. Silver-palladium alloy crowns and metal-plastic restorations are used less frequently.

Aim. To study the results of endoscopic treatment of choledocholithiasis in patients with metabolic syndrome.

Material and methods. A total of 49 patients with choledocholithiasis and metabolic syndrome were studied between 2021 and 2023. The patients were between 36 and 82 years old. There were 12 men and 37 women among the patients studied. Of the 49 patients who underwent surgery, 9 were admitted for elective surgery. These patients were diagnosed with choledocholithiasis without obstructive jaundice and chronic calculous cholecystitis. The remaining 40 patients were admitted on an emergency basis. All patients underwent endoscopic retrograde cholangiopancreatography (ERCP) using the FUJIFILM ED-580XT duodenoscope and Mobile Surgical C-ARM X-ray systems.

Results. Endoscopic retrograde cholangiopancreatography and endoscopic papilosphincterotomy were performed under endotracheal anaesthesia in standard left lateral decubitus position. The average duration of surgery was 39±9.3 minutes. Postoperative complications were noted in 5 (%) patients and included bleeding from a papiltomous wound in 2 patients and postoperative pancreatitis in 3 patients. The average length of hospital stay after ERCP EPST was 2.6±1.6 bed days. The condition of the patients before and after surgery was satisfactory, haemodynamics were stable. No fatal outcomes were noted in the postoperative period.

Conclusion. Endoscopic treatment of choledocholithiasis in patients with metabolic syndrome allows one to avoid the use of traumatic traditional approaches and perform the operation completely, even in cases where laparoscopic surgery is contraindicated.

Aim. To describe the structure of infectious complications and determine the risk of their formation in patients with combined TBI.

Material and methods. The study was conducted at the Department of Neurosurgery and Combined Trauma of the Avicenna Tajik State Medical University at the State Medical Centre “Shifobakhsh” from 2020 to 2024. Participants were included according to the following criteria: hospitalisation in a national medical institution in the first 72 hours after TBI, age between 18 and 75 years, and stay in the intensive care unit (ICU) for more than 48 hours. A total of 124 patients with TBI were included.

Research results. The acute phase of TBI is characterized by a significant prevalence of intracranial infectious complications, observed in 16% of cases. The most common infectious complication was meningitis, found in 18.7% of patients. The highest frequency of infectious complications was found in patients with category 4-8 intracranial injuries.

Conclusion. Combined traumatic brain injury is associated with a high incidence of infectious complications, which were detected in 18.6% of study participants.

Aim. To assess vitamin D levels in young patients with primary hyperparathyroidism (PHPT) combined with thyroid gland pathology.

Materials and methods. A total of 48 patients with PHPT were studied from September 2021 to December 2023. The patients were divided into two groups: those with PHPT and those with primary hyperparathyroidism combined with thyroid pathology. Blood levels of parathyroid hormone (PTH), calcium, phosphorus, vitamin D, thyroid-stimulating hormone (TSH) and free thyroxine were measured. In addition, ultrasound and scintigraphy of the parathyroid and thyroid glands were performed.

Results and discussion. . Patients with PHPT and thyroid pathology had lower calcium levels (2.49±0.07 mmol/L) and higher vitamin D levels (19.1±2.9 ng/mL) than patients with PHPT alone (2.71±0.1 mmol/L and 10.6±1.5 ng/ mL, respectively). These differences may be related to the compensatory function of the body in the presence of both conditions. Ultrasound showed differences in the degree of parathyroid hyperplasia between the two groups.

Conclusion. Monitoring vitamin D and calcium levels is essential to accurately assess the condition of patients with PHPT, especially when combined with thyroid pathology. This will help to plan comprehensive treatment and reduce the risk of complications.

Aim. To study and identify the correlation between the clinical forms of congenital cleft lip and palate and the activity of the carious process during the periods of primary and transitional dentition.

Material and methods. The study, which lasted 6 months, involved 75 children aged 5 to 12 years with various clinical forms of congenital cleft lip and palate. All examined children were found to have various dental pathologies of a carious and periodontal nature.

Results and discussion. Children with isolated clefts of the upper lip and soft palate, exhibiting grade I and II carious activity, demonstrated a satisfactory level of oral hygiene, mild to moderate gingivitis, and a slight shift in oral pH toward acidity. In contrast, children with complete clefts of the lip and palate and grades II and III carious activity were found to have poor oral hygiene, severe gingivitis, and an insignificant shift in salivary pH toward acidity.

Conclusion. In patients with complete clefts of the lip and palate and the highest levels of carious activity, the oral cavity’s buffering system operates in a consistently active mode, ultimately maintaining the stability of this parameter in mixed saliva.

Aim. To analyse the surgical treatment of hip joint diseases and to present perspectives for the development of total joint arthroplasty in the Republic of Tajikistan.

Material and methods. The material for this study comprised the medical records of patients hospitalized at the Republican Clinical Centre for Orthopaedics and Traumatology between 2009 and 2023. During this 15-year period, a total of 359 major joint replacements of the lower limbs were performed. The following parameters were analyzed based on the medical records: sex, age, diagnosis leading to the operation, method of anesthesia, patient’s place of residence, disability status after the operation, occurrence of complications and the number of revision joint replacements during the specified period.

Results and discussion. The analysis showed that the majority of operated patients were diagnosed with idiopathic degenerative coxarthrosis. The second most common diagnoses were aseptic necrosis of the femoral head, dysplastic coxarthrosis, medial femoral fractures and their complications (such as nonunion or pseudoarthrosis), and congenital hip dislocation.

Conclusion. Thus, although there has been a decline in the number of operations at the Republican Clinical Centre for Orthopaedics and Traumatology in certain years, the overall trend is a clear increase in the number of operations throughout the republic. This growth is observed not only in republican centers, but also in regional, city, central district hospitals and private medical centers.

Aim. To determine the share of patients with recent HIV infection in order to plan prevention programs.

Materials and methods. Statistical data from all newly identified HIV cases in 2022 were analysed to determine the estimated time of HIV infection using the ELISA method. The study utilised a variety of reporting and medical documentation, including epidemiological records, outpatient medical records of people living with HIV, and data from the laboratory module of the electronic HIV case surveillance system. Statistical analysis of new cases of HIV infection was conducted within the framework of the electronic HIV case surveillance system of Tajikistan.

Results and discussion. In 2022, a total of 1 037 new cases of HIV infection were identified and registered in the Republic of Tajikistan, of whom 975 (94.0%) were aged 18 years or older. A total of 923 persons participated in the study of the timing of HIV infection, representing 94.5% of all newly identified HIV cases among persons aged 18 years and older. The proportion of recent HIV infections among newly identified cases in Tajikistan in 2022 was 18.3%.

Conclusion. Across the country, the proportion of new HIV infections remained at the same level as in 2018, with a slight increase observed in 2022. As in previous years, the highest proportion of recent HIV infections was observed in the Khatlon region (27.3%). A higher proportion of new HIV infections was observed in the under-25 age group (34.9%), which is more than twice as high as in the 25+ age group.

Aim. To study the characteristics of the obstetric history of pregnant women observed in urban health centers for the period 2013-2022.

Material and methods. The study focused on pregnant women of reproductive age who were registered at urban health centres. The number of pregnant women, their parity and the time of their registration at the urban health centres were examined. Data from the individual medical records of pregnant women (form 111/y) were used for the analysis. The database of the Urban Reproductive Health Centre was used for the study.

Results and discussion. The analysis of socio-demographic indicators shows an increase in the number of pregnant women. In the last 10 years, the number of pregnant women has increased by 1.4 times, from 18,070 in 2013 to 26,094 in 2022. There is a noticeable trend of decreasing registration of pregnant women after 22 weeks of pregnancy. The proportion of primiparous and multiparous women will also increase by a factor of 1.4 between 2014 and 2022.

The frequency of high-parity pregnancies shows an upward trend from 2015 to 2020. However, from 2021 onwards, the proportion of women with high parity starts to decrease..

Conclusions. The study of socio-demographic indicators of pregnant women in urban areas, observed by family doctors and obstetrician-gynaecologists at urban health centres, showed a trend towards an increase in the number of pregnant women, as well as in the proportion of primiparous and multiparous women. While the frequency of multiparous pregnancies reached significant levels, it has shown a decreasing trend over the last two years.

Aim. To assess hemodynamic changes during the use of epidural anesthesia in laparoscopic cholecystectomy.

Materials and methods. The study included 184 patients who underwent surgery for cholelithiasis, with epidural anaesthesia in 105 cases and combined general anaesthesia in 79 cases. The majority of patients were female, 163 (88.6%), and 21 (11.4%) were male. The age of the patients ranged from 21 to 88 years. Anaesthetic risk was assessed according to the ASA (American Society of Anesthesiologists) classification. The epidural space was punctured in the sitting position between vertebrae Th8-Th11.

Results. Patients were divided into two groups according to the chosen method of anaesthesia and haemodynamic characteristics. In the first group, laparoscopic cholecystectomy was performed under epidural anaesthesia. This group was further divided into two subgroups according to haemodynamic parameters: patients with a normokinetic type of circulation (20 individuals) and those with a hypokinetic type of circulation (19 individuals).

The second group consisted of patients undergoing laparoscopic cholecystectomy under general endotracheal anaesthesia. The baseline haemodynamic status of these patients was characterised by a normokinetic type of circulation.

Conclusion. A key advantage of epidural anaesthesia is the maintenance of spontaneous breathing throughout the operation. This allows adequate compensation for the adverse effects of capnoperitoneum in laparoscopic surgery

Vesicoureteral reflux is an anatomical and functional pathology of the upper urinary tract resulting in retrograde flow of urine from the bladder into the ureter. The prevalence of this pathology is approximately 1% of all children. The main goals in the treatment of vesicoureteral reflux are to preserve renal function and minimise the risk of pyelonephritis. Although endoscopic treatment of PMR has become a priority in recent decades, its effectiveness in high-grade reflux is rather low. Therefore, surgical correction remains the main treatment for high-grade reflux. Most surgeons disagree on the choice of a universal surgical technique for the treatment of vesicoureteral reflux. This review presents the most commonly used ureterocystostomies in children with modifications: Lich-Gregoir, Cohen, Glenn-Anderson and Politano-Leadbetter. The prospects of treating reflux megaureter using modifications of the Bischof technique are also analysed.

This article reviews recent publications on tuberculous meningitis. The pathomorphology of the changes, clinical differences from other types of meningitis, diagnostic features of CSF examination and neuroradiological disorders detected by MRI are described.

Conclusions. Tuberculous meningitis is more common in countries with a high burden of tuberculosis, in children who have not received BCG vaccination, in HIV-infected individuals, and in patients with untreated pulmonary tuberculosis. The duration of symptoms may vary from 1 day to 9 months and the prodrome is usually non-specific. Diagnosis of tuberculous meningitis is complex and often delayed, and it is therefore necessary to use the full range of diagnostic tools available when tuberculous meningitis is suspected, including clinical and radiological methods, MRI and examination of cerebrospinal fluid.

This article focuses on obesity in women, which is a global medical problem. Obesity is the result of a complex interaction of epidemiological, socio-economic, geographical, hormonal, genetic, metabolic, psycho-emotional-behavioural and environmental factors. Numerous etiopathogenetic factors are involved in the pathogenesis of adiposopathies, such as polygenic inheritance, physical inactivity, dysmetabolic nutritional behaviour, nicotine addiction and various forms of nutritional dysregulation. Recently, the correlation between obesity and dysbiotic changes in the oral and intestinal microbiota has been actively studied, highlighting the multicomponent and systemic nature of this pathology. Despite the introduction of therapeutic and preventive programmes aimed at reducing the prevalence of adiposopathy, there is a steady trend towards an increase in the number of obese people in the Republic of Tajikistan.

This scientific review analyzes the socio-epidemiological, clinical and immunological aspects of communityacquired pneumonia against the background of overweight in children. The main points regarding the prevalence of community-acquired pneumonia among children of early and older age, with overweight are outlined, and along with this, the relevance of this problem was considered not only in the Republic of Tajikistan, but in the world as a whole. The distinctive features of the immunological status of the body of children with community-acquired pneumonia against the background of excess body weight and other forms of pneumonia were noted. The clinical and immunological dependence of the body in community-acquired pneumonia on the background of chronic malnutrition in children is discussed.