Objective: to investigate the sphincter of the lymphovenous junction under normal conditions.

Material and methods: twenty post-mortem tissue samples were analyzed. The samples were divided into 2 groups: the study group 40-59 years old (n=10, 5 male/5 female) and the comparison group 60-80 years old (n=10, 5 male/5 female). Methods included dissection of the terminal segment of the thoracic duct, sonolipodestruction using the LySonix 3000® system for tissue clearing, light microscopy, Masson’s trichrome staining, and computer angiolymphography.

Results: a circumferential arrangement of muscle fibers forming a sphincter in the region of the terminal thoracic duct segment was identifie. Three fiber types were distinguished morphologically: (1) encircling fibers tightly surrounding the duct, (2) globular fibers, and (3) longitudinal fibers oriented along the duct. Morphometric parameters of the sphincter were obtained. Angiolymphography demonstrated accumulation of contrast in the terminal thoracic duct segment proximal to the sphincter. Conclusion: the morphology of the sphincter of the lymphovenous junction is described. Muscle fibers and valves of the terminal thoracic duct segment form a sphincter apparatus.

Objective: to develop an optimal facial skin incision design for excision of facial skin tumors, incorporating plastic surgery to prevent postoperative skin defects.

Material and methods: this study included 18 (100%) patients with skin tumors located in various facial regions. Of these patients, 11 (61,1%) had benign tumors, and 7 (38,8%) malignant facial tumors. The diagnosis was confirmed using cytology (Romanovsky/Giemsa method under a light microscopy OLYMPUSCX 21, with 10-40x magnification) and histology (hematoxylin and eosin staining using light microscopy, OLYMPUSCX 21, with 10-40x magnification).

Results: In all 18 (100%) patients the tumor size varied from 1 cm to 2–3 cm in length, and 0.5 cm to 1–2 cm in width. Tumor shape also varied, ranging from round to the most polygonal and atypical forms, which requires careful selection of the treatment method (tumor excision and restoration of the previous skin condition). Based on these considerations, the author developed an optimal incision shape around facial skin tumors, followed by tumor removal and subsequent plastic surgical repair to eliminate the postoperative defect.

Conclusion: this proposed plastic surgical method for eliminating postoperative facial skin defects after excision of fascial skin tumors demonstrated good outcomes in of 85-90% of cases, supporting its recommendation for broad clinical use across different facial locations and tumor shapes. 

Objective: to evaluate the effectiveness of herbal hepatoprotective mixture as an adjunct treatment in patients with chronic lymphocytic leukemia.

Material and methods: the study was based on an analysis of 42 patients with confirmed diagnosis of chronic lymphocytic leukemia, who were treated in the hematology department of the National Medical Center “Shifobakhsh”. The herbal blend was used in patients whose clinical course was accompanied by hepatomegaly. The study group included 30 patients (71.4%), and the control group included 12 patients (28.5%). Patients in the study group received an herbal infusion of medicinal plants described by the authors as hepatoprotective: Silybum marianum, birch, mint, and immortelle. The control group did not receive the infusion.

Results: use of the herbal hepatoprotective infusion was associated with a positive effect, namely a reduction and normalization of liver size within a short period. In the main group, a liver size reduction of 1.5 cm was recorded in 7 patients (23.3%), 1.2 cm in 19 patients (63.3%), and 1.0 cm in 4 patients (13.3%). A slower decrease in liver size was observed in the control group, which did not receive the infusion (0.7 to 0.8 cm).

Conclusion: use of an herbal hepatoprotective mixture as an adjunct to standard therapy improves treatment outcomes and reduces the time to recovery of liver function in patients with chronic lymphocytic leukemia. 

Objective: to assess the impact of labor migration on HIV case detection and clinical outcomes among people living with HIV in the Sughd region of Tajikistan during 2013–2022.

Materials and methods: a retrospective cohort study was conducted among adults aged 18 years and older with HIV, who were newly registered between 2013 and 2022 at AIDS centers in the Sughd region, and received antiretroviral therapy (ART) for at least 6 months (n = 1871). For the purposes of this study, migrants were defined as citizens of Tajikistan who resided outside the country for more than 3 months for work purposes, while non-migrants were defined as individuals who had not traveled abroad for employment. Data were collected from the national electronic surveillance system, and epidemiological and outpatient records. Statistical analyses were performed in RStudio using descriptive statistics, the χ² test, and Poisson regression models to identify independent predictors of mortality (incidence rate ratio [IRR], 95% confidence interval [CI]). Statistical significance was set at p < 0.05.

Results: of 1871 participants, 38% had a history of labor migration. Men predominated among migrants (76%), and mortality was also higher among men (12% vs. 6.8%, p < 0.001). The main route of transmission was a sexual contact (89%). Most patients received the standard ART regimen TDF/3TC/DTG (94%). The proportion of migrants among newly diagnosed HIV cases ranged from 27% to 43% between 2013 and 2022. In a multivariable Poisson model, independent predictors of higher mortality were employment status (unemployed: IRR = 2.60; employed: IRR = 3.37) and rural residence (IRR = 1.18), whereas viral load >1000 copies/mL was not significant (IRR = 0.98).

Conclusion: labor migrants represent a vulnerable group with higher mortality and unfavorable clinical outcomes. These findings highlight the need for targeted programs for early diagnosis, continuity of treatment, and improved access to ART in rural areas to enhance treatment effectiveness among migrants. 

Objective: to improve the effectiveness of surgical treatment of hiatal hernia (HH) by timely prevention of complications associated with Nissen fundoplication.

Material and methods: the study included 140 patients with НН who were divided into two groups. The control group consisted of 67 patients who underwent traditional laparoscopic Nissen fundoplication combined with cruroplasty (hiatal crural repair). The study group consisted of 73 patients, who underwent a modified technique of laparoscopic Nissen fundoplication with cruroplasty, and the use of a composite mesh implant. The study group also underwent proprietary procedures for preventing early postoperative complications were implemented, that allowed for a more complete assessment of their impact on treatment outcomes.

Results: in the study group, early postoperative complications of varying severity occurred in 12 (16.4%) patients: dysphagia - in 4, reflux esophagitis grade A - in 7 cases, postoperative pneumonia - in 1 case. In the control group, after standard laparoscopic Nissen fundoplication with cruroplasty, early postoperative complications were noted in 29 (43.3%) cases: early dysphagia in 13 (19.4%) cases, failure of the fundoplication cuff in 2 (3.0%) cases, reflux esophagitis grades A and B in 12 (17.9%) cases, postoperative pneumonia in 2 (3.0%) cases.

Conclusion: the study results confirm that implementation of the proposed preventive measures reduces the risk of mechanical dysphagia after surgery. Therefore, the proposed approach can be considered an effective strategy for preventing these postoperative complications. 

Objective: to evaluate the significance of spleen ultrasound elastography in the diagnosis of portal hypertension.

Material and methods: thirty-three patients (18 men and 15 women, mean age 48.47±1.97 years) with liver cirrhosis were examined. In 23 cases, the cause of cirrhosis was hepatitis B virus, while 10 patients had hepatitis C virus as the cause. Liver and spleen elastography were performed using FibroScan. Child-Pugh class A was diagnosed in 15 patients (45.4%), class B in seven patients (21.2%), and class C in 11 patients (33.3%); the mean Child-Pugh score was 8.24 ± 1.6. Esophageal varices were grade I in 12 patients, grade II in five, grade III in six, and grade IV in seven; varices were absent on endoscopy in three patients. Large varices were present in 18 patients (55%). Spleen stiffness values ranged from 8 to 24 kPa in healthy individuals and from 18 to 75 kPa in patients with cirrhosis. Spleen stiffness was significantly higher in patients with large varices than in those with small varices or no varices (61.91 ± 2.94 kPa vs. 43.72 ± 3.35 kPa; p < 0.05), which supports the use of elastography in the detection of large esophageal varices. Multivariable analysis indicated that splenomegaly, dilatation of the portal and splenic veins, decreased peripheral platelet count and spleen elastography may predict bleeding from esophageal varices.

Results: spleen stiffness measurement is an effective method for identifying large varices at risk of bleeding and complements other noninvasive methods used in screening for esophageal varices in patients with liver cirrhosis.

Objective: to assess key features of antenatal care delivery in family medicine practice, including preventive interventions and approaches to reducing pregnancy complications.

Material and methods: a comparative retrospective study of antenatal care delivery for pregnant women was conducted at the City Health Center for 2023–2024. Data were extracted from routine medical records and administrative reporting documentation (forms No. 024 and No. 029; consolidated City Health Center report form No. 12).

Results: a comparative analysis showed that early initiation of antenatal care was very high: in 2023, 99.6% of pregnant women were registered early, compared with 98.7% in 2024. A substantial proportion of women received co-managed follow-up by family physicians together with obstetrician–gynecologists; however, in 2024 this proportion was approximately half that observed in 2023. This may reflect a reduction in the share of pregnancies requiring specialist co-management. As a preventative measure, patients received supplementation with folic acid, iron, and iodine. More than a third of births occurred among women aged 18 to 35 years. Improved socioeconomic status and living conditions was associated with higher parity (four or more children).

Conclusion: high-quality indicators of family physician practices were noted, including the early initiation of antenatal care, the prescription of prophylactic iron and iodine, and positive trends in the health status of women with nonobstetric comorbidities (extragenital pathology). These factors contributed to a reduced risk of pregnancy complications. 

Objective: to evaluate the effectiveness of planned relaparotomy with staged peritoneal lavage and small intestinal lavage using electrolyzed isotonic saline in the management of acute hepatic failure in patients with generalized purulent peritonitis.

Materials and methods: the study included 69 patients with generalized purulent peritonitis, divided into an intervention group (n = 35) and a control group (n = 34). After source control, the intervention group underwent planned relaparotomy with staged peritoneal lavage plus small intestinal lavage using electrochemically activated isotonic saline; controls received conventional peritoneal lavage with standard isotonic saline. The following parameters were evaluated: clinical status, characteristics and stage of acute hepatic failure, comorbidities, dynamics of hepatic blood flow (ultrasound with Doppler imaging), biochemical indices of liver and kidney function, inflammatory markers (interleukin-6, procalcitonin, D-dimer), hemostasis parameters, microbial contamination of the abdominal cavity, need for relaparotomy, incidence of recurrent peritonitis and septic complications, duration of mechanical ventilation, clinical recovery and mortality.

Results: use of planned relaparotomy with staged peritoneal lavage plus small intestinal lavage using electrolyzed isotonic saline was associated with faster restoration of portal venous flow and normalization of liver function. Portal vein blood flow velocity in the intervention group increased from 9.8 [8.7–10.9] to 19.2 [17.4–21.0] cm/s by day 15, whereas in the control group it increased from 9.6 [8.3–10.9] to 16.1 [14.5–17.7] cm/s. Total bilirubin decreased from 142 [130–154] to 54 [47–61] μmol/L in the intervention group and from 144 [131–157] to 78 [70–86] μmol/L in the control group. The time to bilirubin normalization was significantly shorter in the intervention group (6.8 [6.3–7.3] vs. 11.4 [10.6–12.2] days; p < 0.01), as was the time to INR normalization (7.2 [6.7–7.9] vs. 12.1 [11.2–13.0] days; p < 0.01). Levels of interleukin 6, procalcitonin and D-dimer decreased more markedly in the intervention group: by day 15, procalcitonin was 0.8 [0.7–0.9] vs. 1.5 [1.2–1.8] ng/mL, and D-dimer was 560 [499–621] vs. 840 [772–908] ng/mL. The total microbial load in the abdominal cavity decreased from 905 [815–995] to 13 [10–16] ×10³ CFU/mL in the intervention group and from 933 [838–1028] to 44 [38–50] ×10³ CFU/mL in the control group. The incidence of recurrent peritonitis was lower in the intervention group (8.6% vs. 26.5%; relative risk [RR] 0.32), as was the rate of septic complications (11.4% vs. 32.4%; RR 0.35; odds ratio [OR] 0.27; 95% confidence interval [CI] 0.08–0.96). Clinical recovery by hospital discharge was achieved in 85.7% of patients in the intervention group and in 61.8% in the control group (RR 1.39; OR 3.71; 95% CI 1.15–12.0). Mortality was 14.3% and 32.4%, respectively (RR 0.44).

Conclusions. Planned relaparotomy with staged peritoneal lavage combined with small intestinal lavage using using electrolyzed isotonic saline provides more effective management of acute hepatic failure in generalized purulent peritonitis, accelerates restoration of hepatic blood flow and normalization of biochemical and coagulation parameters, reduces the severity of systemic inflammation and microbial contamination of the abdominal cavity, and is associated with a lower incidence of septic complications and more than a twofold relative reduction in mortality. 

Objective: to evaluate the clinical efficacy and safety of implementing the Enhanced Recovery After Surgery (ERAS) pathway in the treatment of complicated forms of uterine fibroids to optimize the postoperative period and reduce the incidence of complications.

Material and methods: the study is based on a retrospective comparative analysis of surgical treatment outcomes in 25 (28.7%) women with complicated uterine fibroids operated laparoscopically and 23 (26.4%) women who underwent laparotomic surgery at the Obstetrics and Gynecology Clinic No. 2 of the SEI Institute of Postgraduate Education in Healthcare of the Republic of Tajikistan and the Department of Surgical Diseases No. 1 named after Academician K. M. Kurbonov during 2016 to 2025. Of all the women studied, 16.6% (n = 8, the main group of women - 20.0%, the control group - 13.0%) were younger than 40 years; the remaining 83.4% were 40 years or older.

Results: to implement an ERAS (fast track) pathway, patients in the study group followed a specially developed protocol. A comparative analysis of the procedures performed in women with complicated uterine fibroids showed that supracervical (subtotal) hysterectomy was the most common operation in both groups, performed in 80% of patients in the study group and 91.3% in the comparison group. Mean operative time was significantly shorter in the study group (61.1 ± 10.4 min) than in the control group (79.7 ± 11.3 min). Postoperative complications were almost half as frequent in the ERAS group (7.5% vs 13.3%). Mean length of hospital stay was reduced (4.6 ± 1.5 days vs 11.3 ± 3.7 days). Time to full functional recovery decreased by about 2.5 fold (3.1 ± 0.1 weeks vs 6.9 ± 0.1 weeks).

Conclusion: implementation of ERAS (fast track) principles in the surgical management of complicated uterine leiomyomas appears clinically effective and is associated with earlier mobilization and return of gastrointestinal function, shorter hospitalization, reduced opioid analgesic requirements, and a lower rate of postoperative complications, facilitating faster postoperative rehabilitation. 

Objective: To evaluate the diagnostic value of biomarkers of inflammation, lipid peroxidation, hypoxia and intraabdominal hypertension in gynecological peritonitis.

Material and methods. Forty-four women with gynecologic peritonitis who underwent emergency laparoscopic peritoneal lavage were examined. Biomarkers of inflammation, oxidative stress, hypoxia and intra-abdominal pressure were determined before the operation, their values were compared with intraoperative findings.

Results: Generalized peritonitis was accompanied by severe inflammatory and metabolic disorders. Levels of malondialdehyde (4.35 [4.00; 4.60] vs 3.25 [2.90; 3.50] nmol/ml) and conjugated dienes (2.92 [2.59; 3.18] vs 2.18 [1.93; 2.43] nmol/ml, p < 0.001) were higher, indicating increased lipid peroxidation. Elevated levels of CRP, IL-6, procalcitonin PCT, and lactate (p < 0.001) indicated activation of the inflammatory cascade and hypoxia. Intra-abdominal pressure in generalized peritonitis (22.70 [21.80; 23.68] vs 11.95 [11.40; 12.97] mmHg, p < 0.001) confirmed the risk of intra-abdominal hypertension and organ dysfunction. More severe systemic inflammation and hypoxia were noted in severe intestinal dilation (p < 0.001).

Conclusion. The severity of gynecological peritonitis correlates with changes in biomarkers of inflammation, lipid peroxidation, hypoxia and intra-abdominal pressure, which emphasizes their diagnostic significance. 

Objective: to assess the anatomical features of the nasal cavity and nasopharynx in children with congenital clefts using radiography and computed tomography.

 Material and methods: sixty children aged 3 to 14 years with congenital cleft lip and palate were examined. The patients were divided into two groups: children with a complete cleft and children with an incomplete cleft. Methods included clinical, imaging evaluation (plain radiography of the paranasal sinuses, CT of the nose and nasopharynx), and statistical analysis.

Results: analysis of radiographic and tomographic data revealed pronounced anatomical changes in children with a complete cleft: reduced nasal cavity volume, narrowing of the nasal passages, choanal deformity, and mucosal thickening. In the group with an incomplete cleft, the changes were less pronounced, although local deformities and partial adenoid hypertrophy were observed. The frequency of inflammatory processes, including rhinosinusitis, adenoiditis, and otitis, was significantly higher in children with a complete cleft compared to those with an incomplete cleft. This indicator was 65% versus 40%, indicating a direct relationship between the severity of anatomical defects and the frequency of inflammatory changes. The results confirm that anatomical alterations in the nasal cavity and nasopharynx in children with congenital clefts are a risk factor for chronic inflammatory processes.

Conclusion: based on the findings, the following practical recommendations were developed: ENT examination with radiography and CT when necessary; early diagnosis and treatment of inflammatory processes; prevention of middle ear complications; preoperative preparation with mandatory management of ENT infectious foci; and the use of radiography and CT in dynamics to predict complications and adjust follow-up. 

Objective: to improve the diagnosis and treatment of urethral pathologies in boys through transurethral resection of the urethral valve and urethral cysts with a holmium laser.

Materials and methods: this article describes a clinical case of two boys with rare forms of the urethral valve and urethral cyst, which caused urinary dysfunction and urinary tract infection. One child had an anterior urethral valve accompanied by an anorectal malformation. The latter was managed with proctoplasty.

Results: at 3-month follow-up, all clinical manifestations had resolved and parents reported no complaints. Voiding normalized and signs of urinary tract infection resolved. No evidence of urethral stricture was detected.

Conclusion: an anterior urethral valve variant that divides the urethral lumen into two channels is extremely rare. An anterior urethral cyst that contributes to bladder outlet obstruction is also uncommon Timely diagnosis and endoscopic elimination of the valve and cyst can prevent progression of urinary tract obstruction. These observations support the importance of antenatal ultrasound screening and early postnatal evaluation for congenital lower urinary tract obstruction. 

This article reviews recent data (2020–2025) on the impact of vitamin D deficiency on the quality of life of children and adolescents. Epidemiological studies confirm the high prevalence (up to 50%) of vitamin D deficiency and its adverse effects on children’s physical, psychological, and social well-being. This deficiency is linked to muscle weakness, pain, frequent infections, anxiety, and decreased activity levels. The article emphasizes the importance of addressing vitamin D deficiency to improve physical health and psychosocial functioning. The authors emphasize the importance of preventive measures and a multidisciplinary approach to identifying and treating vitamin D deficiency in older children. The article also discusses the potential of using quality-of-life assessments as an additional tool for monitoring nutritional status. 

Erectile dysfunction (ED) is a significant problem among older men, greatly affecting their quality of life. The risk of developing ED increases with age and is associated with various factors, including age-related changes, reduced testosterone levels, hypertension, diabetes, and metabolic syndrome. Endothelial dysfunction plays a central role in the pathogenesis of ED. Effective treatment of ED in elderly men requires measures aimed at lifestyle modification (weight loss, smoking cessation, physical activity), pharmacotherapy (phosphodiesterase 5 inhibitors), and, when necessary, testosterone replacement therapy. In cases where medication is ineffective, alternative treatments such as vacuum devices or intracavernosal injections may be used. Psychological support also plays an essential role in successful treatment. Early diagnosis and a comprehensive approach to treatment can significantly improve patient outcomes and enhance their quality of life. 

The results of an analysis of recent literature on the clinical features, epidemiology, and etiologic/pathogenetic risk factors for malignant neoplasms of the oral cavity are presented. Trends toward increasing incidence and mortality from oral cancer in most countries worldwide have been identified. Despite the oral cavity being readily accessible to visual examination, most authors report a high frequency of late-stage diagnosis/advanced disease at presentation. The most significant etiological risk factors for oral cancer include smoking, alcohol consumption, chewing various mixtures, chronic ulcers and infections of the oral cavity, and chronic mechanical trauma/irritation of the oral mucosa. Other important factors include cultural and ethnic habits, such as consumption of very hot beverages and the use of smokeless tobacco (nasvai).