Objective: To compare immediate outcomes of ERAS-associated and traditional postoperative management after pancreatic resection.

Material and Methods: This non-randomized comparative retrospective-prospective study with historical control included 63 patients who underwent pancreatic resection. The ERAS group comprised 25 patients managed with an adapted enhanced recovery protocol, whereas 38 patients received conventional postoperative care. Quantitative data are presented as Me [Q1-Q3] and categorical data as n (%). Methods included the Mann-Whitney U test, Fisher’s exact test, relative risk, odds ratio, and 95% confidence intervals.

Results: Overall postoperative morbidity was 24.0% in the ERAS group versus 60.5% in the control group (p=0.005). ERAS-associated management reduced the relative risk of complications to 0.40 (95% CI 0.19-0.83) and the odds ratio to 0.21 (95% CI 0.07-0.63). In the ERAS group, bowel activity recovered earlier - 2.0 [1.4-2.3] versus 3.5 [2.7-4.0] days (p<0.001), first stool occurred earlier - 2.6 [2.0-3.3] versus 4.2 [3.2-4.9] days (p<0.001), oral intake started earlier - 1.3 [0.8-1.6] versus 3.2 [2.8-3.8] days (p<0.001), ICU stay was shorter - 16 [11-22] versus 24 [14-34] hours (p=0.002), and postoperative hospital stay decreased - 13 [11-15] versus 16 [13-20] days (p=0.001). Pain intensity, opioid use, and nutritional decline were also lower in the ERAS group.

Conclusions: ERAS-associated postoperative management after pancreatic resection was linked to a more favorable early postoperative course, lower overall morbidity, and shorter hospitalization compared with conventional care.

Objective: To assess the functional status of the pulmonary detoxification in patients with polytrauma complicated by sepsis.

Material and Methods: Diagnostic findings (levels of sepsis biomarkers, pro-inflammatory cytokines and the veno-arterial gradient of endogenous intoxication markers in the blood) were analyzed in 50 patients with polytrauma complicated by sepsis (Group 1, the main group). Depending on the severity of the condition, the patients were divided into three subgroups: subgroup 1.1 moderate severity (n = 21); subgroup 1.2 severe degree (n = 20); and subgroup

1.3 extremely severe degree of general condition (n = 9). The data obtained were compared with corresponding data from 30 apparently healthy individuals, who constituted the control group (Group 2, control).

Results: Comparative analysis of the median values of procalcitonin, C-reactive protein, D-dimer, lactate, and interleukins IL-1 and IL-6 in patients across the different subgroups versus the control group revealed a significant elevation of all studied parameters in every subgroup. Specifically, in the subgroup 1.1 these parameters exceeded control values by factors of 556, 88.6, 7.9, 3.9, 65, and 2.7, respectively. In the subgroup 1.2 parameters increased by factor of 1018,

231.6, 19.6, 5.6, 106.4, and 5.5, respectively. In the subgroup 1.3 the values were higher by factors of 2644, 619.8, 28, 7.7, 165.7, and 8.5, respectively. Analysis of MEI parameters showed activation of the pulmonary detoxification function in subgroup 1.1, subcompensation in subgroup 1.2, and decompensation in subgroup 1.3.

Conclusion: In patients with polytrauma complicated by sepsis, ARDS of varying severity develops depending on the degree of organ and systemic dysfunction; against this background, the pulmonary detoxification function becomes impaired in a staged manner: Stage I (compensation) in 42.0% of cases, Stage II (subcompensation) in 40.0%, and Stage III (decompensation) in 18.0%.

Objective: To determine prognostic risk factors for early intra-abdominal postoperative complications after laparoscopic cholecystectomy.

Material and Methods: A retrospective case-control study was conducted based on the records of 9472 patients who underwent laparoscopic cholecystectomy for calculous cholecystitis between 2015-2025. The main group included 297 patients with early intra-abdominal complications, while 9175 patients without complications formed the comparison group. At the first stage, Pearson’s chi-square test and Fisher’s exact test were used; at the second stage, univariate and multivariate logistic regression models with odds ratios and 95% confidence intervals were built. Model discrimination was assessed using the ROC curve.

Results: Early intra-abdominal complications developed in 3.1% of patients. Bile leakage predominated among the complications (60.3%). At the univariate stage, risk factors included perivesical inflammatory infiltrate, perivesical abscess, Mirizzi syndrome, anomalous anatomy of Calot’s triangle elements, liver cirrhosis, insufficient surgeon experience (fewer than 40-50 laparoscopic cholecystectomies), failure to achieve the critical view of safety and failure to perform timely conversion. Multivariate analysis identified perivesical abscess, Mirizzi syndrome, anomalous anatomy of Calot’s triangle elements, liver cirrhosis, insufficient surgeon experience, failure to achieve the critical view of safety and failure to perform timely conversion as independent predictors. The area under the ROC curve was 0.872.

Conclusion: The development of early intra-abdominal complications after laparoscopic cholecystectomy is determined by a combination of severe local inflammatory changes, anatomical complexity of the intervention, and intraoperative surgical tactics.

Objective: To study the clinical features and risk factors of severe nasal decongestant intoxication in children.

Material and Methods: Between 2020 and 2024, 59 children, aged from birth to 14 year, with decongestant intoxication were examined. Most patients (62.3%) were under the age of 3; 64.4% were girls; and 52.5% lived in rural areas. Methods included clinical, laboratory, and instrumental analysis of patients’ conditions, as well as binary logistic regression to identify risk factors for severe intoxication.

Results: Young children predominated (χ²=17.84; p<0.001); girls were hospitalized more often than boys (χ²=4.92; p=0.026). The most significant risk factor was the use of concentrated forms of the medication (p=0.044). Severe forms of intoxication were recorded in 67.8% of children, which statistically exceeded moderate forms (χ²=7.47; p=0.006). Logistic regression showed that age under 3 years (OR=3.12; 95% CI: 1.41–6.89) and the use of concentrated forms (OR=2.48; 95% CI: 1.08–5.71) were associated with severe intoxication.

Conclusions: To minimize the risks, it is necessary to strictly follow the recommended dosages and dosing intervals of nasal decongestants. Pediatricians should inform parents about possible side effects and precautions.

Objective: To evaluate the impact of hyperuricemia (HU) on the clinical and laboratory characteristics and the course of acute myocardial infarction (AMI).

Material and Methods: A prospective study was conducted involving 85 patients with AMI, divided into two groups: AMI with HU (n=39) and AMI without HU (n=46). HU was defined as a serum uric acid level >420 µmol/L in men and >360 µmol/L in women. Methods included assessment of demographic parameters, risk factors, severity of heart failure (HF) according to the Killip classification, left ventricular ejection fraction (LVEF), and the course of pharmacotherapy.

Results: The groups were comparable in terms of age, sex, and frequency of ST-segment elevation. Patients with HU more frequently presented with Killip class > I (56.4% vs. 28.3%; p=0.008), had lower LVEF (45.8±9.27% vs. 49.6±8.1%; p=0.012), higher serum creatinine levels (118.7±59.1 vs. 87.7±17.6 µmol/L; p=0.001), and lower glomerular filtration rate (GFR) (64.2±14.8 vs. 79.6±19.3 mL/min/1.73 m²; p<0.001). The HU group showed more cases of arterial hypertension (89.7% vs. 63.0%; p=0.004), type 2 diabetes mellitus (61.5% vs. 36.9%; p=0.024), obesity (56.4% vs. 32.6%; p=0.031), and chronic kidney disease (38.5% vs. 10.9%; p=0.003). Urate-lowering therapy was prescribed to only 23.1% of patients with HU.

Conclusions: Hyperuricemia in patients with AMI is associated with a more severe course of the disease, pronounced heart failure, impaired renal function, and a high burden of comorbidities. These findings justify the need for active detection and correction of hyperuricemia in the comprehensive management of AMI patients.

Objective: To improve the diagnostic and treatment strategy for infected pulmonary hydatid cysts complicated by rupture into the pleural cavity in pediatric patients.

Material and Methods: A retrospective and prospective cohort study was conducted on 140 children with complicated, infected pulmonary hydatid cysts, where rupture into the pleural cavity was diagnosed in 37 (26.4%) patients. The main group consisted of 24 patients (managed according to the developed algorithm), and the control group consisted of 13 patients (managed according to traditional methods). The study utilized general clinical, laboratory, radiographic, computed tomography (CT), bacteriological, histological, and statistical research methods.

Results: CT verified cyst rupture in 86.4% of cases. The developed algorithm includes comprehensive preoperative management using minor surgical techniques (puncture and thoracentesis for sanitation and decompression). In the main group, reliable stabilization of hematological parameters (decrease in leukocytes to 7.40±0.25 x10⁹/L), relief of endotoxicosis (mean survival time of Paramecium was 39.2±1.0 sec), and attenuation of systemic inflammatory response (LII 1.5±0.1 units) were achieved. Organ-preserving surgeries (echinococcectomy with subtotal pericystectomy) yielded good results in 66.9% of patients and satisfactory results in 33.1%.

Conclusions: Based on the identified clinical and morphological features, a diagnostic and treatment algorithm is proposed that enables early diagnosis, effective resolution of severe toxemia manifestations, and a differentiated approach to surgical intervention, thereby minimizing postoperative complications.

Objective: To study and analyze clinical and epidemiological features of foodborne botulism cases in the city of Tursunzade, Republic of Tajikistan, between 2020 and 2023.

Material and Methods: A retrospective analysis of medical records of patients diagnosed with botulism and admitted to the Infectious Diseases Department of Tursunzade Central Hospital was conducted. The diagnosis of botulism in all cases was based on clinical and epidemiological data and confirmed by laboratory testing.

Results: A total of 14 patients were observed. Of these, 3 were hospitalized in 2020, 7 in 2021, 3 in 2022, and 1 in 2023. Most patients were women: 12 (85.7%), while 2 (14.3%) were men. No cases were recorded among children. Among the patients, 9 (64.3%) were rural residents and 5 (35.7%) were urban residents. In all cases, infection occurred through the consumption of home-canned foods.

Conclusion: Botulism is characterized by a polymorphic clinical manifestation, which requires increased vigilance on the part of ophthalmologists, neurologists, and internists. This can be achieved by incorporating foodborne botulism as a dedicated topic into mandatory continuing medical education courses for physicians of various specialties.

Objective: To evaluate the effectiveness of transpedicular fixation in traumatic deformity of the lower spine based on clinical and instrumental examination methods.

Material and Methods: The study included 37 patients with traumatic deformities of the lower thoracic and lumbar spine, who were treated in the neurosurgical department of the “Shifobakhsh” Medical Center in the Republic of Tajikistan from 2022 to 2025. Among them were 12 women (32.4%) and 25 men (67.6%). Patients’ age ranged from 19 to 54 years. All patients underwent surgical intervention: transpedicular fixation of the damaged spinal segments under radiographic control. Diagnostic evaluation included spinal radiography in two projections, computed tomography (CT) to assess the nature of the fracture and monitor screw position, magnetic resonance imaging (MRI) to visualize the spinal cord and soft tissue structures, pain assessment using the visual analogue scale (VAS), and neurological status assessment using the Frankel scale.

Results: Preoperatively, all patients experienced severe pain, with an average VAS score of 7.2±1.1 points. Postoperatively, the score was 2.8±0.9 points, indicating a significant reduction in pain. 24 patients with partially preserved spinal cord conduction demonstrated positive neurological changes, including movement in the lower extremities and resolution of pelvic disorders.

Conclusion: Transpedicular fixation is a reliable and effective surgical treatment for traumatic deformities of the lower spine. The use of X-ray, CT, and MRI allows for precise determination of the nature of the injury and optimization of screw placement. Patients with preserved spinal cord conduction experience a significant reduction in pain and improvement in neurological status. In cases of severe neurological impairment, surgery is justified from an orthopedic perspective to stabilize the spine. The main technical complication remains malposition of pedicle screws (10.8% of cases), which requires careful intraoperative monitoring.

Objective: To reduce the number of infectious complications after osteosynthesis of long bones by developing and implementing new preventive measures.

Material and Methods: The results of surgical treatment of 110 patients with fractures of long bones of the lower extremities were analyzed. The patients were divided into the main (n=51) and control (n=59) groups. The severity of injury in victims upon admission was assessed using the Injury Severity Score (ISS). In parallel with emergency care, all patients underwent diagnostic procedures in the intensive care unit of the emergency room: general clinical laboratory tests, assessment of comorbid status, monitoring of the functions of vital organs, hemodynamic parameters, level of consciousness, respiratory function, and circulating blood volume.

Results: Stratification of patients by traumatic injury severity revealed a similar distribution in the two groups. Mild injury severity was recorded in 60.8% and 62.7% of patients, respectively, and accounted for the majority of injuries in both cohorts. Severe injuries were recorded at a rate of 17.6% and 13.5%, respectively, while critical conditions on admission were found in 7.8% and 8.5% of cases, respectively. Considering the severity of the injury, a surgical treatment algorithm was developed. Of the 21 (41.2%) injured in the main group, the severity of injuries was assessed as severe in 13 (25.5%) according to the ISS. The surgical was delayed until the normalization of inflammatory markers and vital functions. The remaining patients were operated on at the optimal time, taking into account all indicators.

Conclusion: Prevention of wound infection after osteosynthesis of long bones of the lower extremities requires a multimodal approach, considering a combination of clinical, anamnestic, and intraoperative determinants. The scope of preventive measures is determined by the initial severity of the patient’s condition, the nature and morphology of bone and soft tissue injuries, the patient’s age and premorbid medical history, including comorbidities, the extent of perioperative blood loss, the presence and severity of organ dysfunction, the timing of surgery from the time of injury, and the chosen osteosynthesis method.

Objective: To evaluate the clinical, social, and medical history characteristics of women with premature rupture of membranes (PROM) according to the gestational age at delivery.

Material and Methods: A retrospective analysis of 125 delivery records of women with premature rupture of membranes was conducted. The patients were divided into two groups: women with PROM who delivered at term (61 women), and women with PROM who delivered prematurely (64 women). All women underwent a full clinical, laboratory, and obstetric examination, including taking a medical history, physical examination, measurement of body mass index (BMI), identification of non-obstetric comorbidities, and pregnancy complications. Statistical analysis included parametric and non-parametric methods.

Results: A statistically significant increase in the incidence of fetal growth restriction (FGR) and induced labor was noted in women with PROM who delivered prematurely compared to women with PROM who delivered at term. Perinatal outcomes of preterm delivery in women with PROM were characterized by a high frequency of neonatal asphyxia (31.3% vs. 4.9%, p <0.001). Perinatal mortality was recorded in 5 instances (7.8%) among newborns of mothers with PROM and preterm labor.

Conclusion: Preterm delivery in women with PROM should be considered a condition of high perinatal risk, requiring early prediction, stratification, monitoring, and optimization of pregnancy and labor management.

Objective: To evaluate the efficacy and safety of sinustrabeculectomy (STE) and simultaneous micropulse laser cyclocoagulation (mLCC) in patients with angle-closure glaucoma.

Material and Methods: Data regarding the efficacy and safety of STE (25 eyes) and simultaneous STE and mLCC (25 eyes) in patients with chronic angle-closure glaucoma with a follow-up period of 12 months were analyzed.

Results: After STE, the Intraocular Pressure (IOP) decreased from 28.2±5.8 mmHg to 23.7±7.0 mmHg after 12 months. After STE with simultaneous mLCC the IOP decreased from 30.6±6.7 mmHg to 20.2±3.2 mmHg. After surgery, antihypertensive drugs were prescribed in 7 of 25 (28%) eyes of the main group, and in 12 of 25 eyes (48%) (p<0.05) of the control group. There were no cases of persistent hypotension, postoperative iridocyclitis, ocular hypertension with ostium blockage, or phthisis bulbi.

Conclusions: STE with a simultaneous mLCC is a more effective and safer method of treating angle-closure glaucoma.

Objective: To analyze morphological changes in gingival tissue following autoplasty in the area of dental implants.

Material and Methods: A prospective study with histopathological analysis of gingival mucosa biopsies was conducted in 50 patients (22 men, 28 women; age 37-64 years) who received dental treatment from December 2020 to June 2023. Patients were randomized into two groups: control group (n=22) received treatment with apically repositioned split-thickness mucosal flap; test group (n=28) underwent a combined approach using free gingival graft from the maxillary tuberosity area. Morphological examination was performed using a Leica DMD 108 microscope. Statistical analysis was performed using Statistica 10.

Results: Morphological analysis showed a well-differentiated structure of papillary and reticular layers of the gingiva. The “thick” biotype is characterized by gingival thickness of 1.5-2.0 mm. In the control group after 6 months, peri-implant tissue thickness decreased to 0.9 [0.7; 1.1] mm versus 1.4 [1.2; 1.6] mm in the main group (p<0.001). Mucositis frequency was 68.2% in the control versus 28.6% in the test group (p=0.006). A strong negative correlation was found between gingival thickness and inflammatory complications frequency (rs=-0.72; p<0.001).

Conclusions: Insufficient width of the gingival component compromises the protective barrier of underlying tissues. The use of autografts allows for the maintenance of gingival thickness at “medium” biotype level and reduces the incidence of inflammatory complications by a factor of 2.4.

Objective: To evaluate the efficiency of the autologous platelet-rich plasma (PRP) in the comprehensive treatment of peri-implant mucositis.

Material and Methods: The study included 38 patients (11 men, 27 women) aged 35 to 50 years. Injections of autologous PRP, aimed at macrophage reprogramming, were administered in an outpatient setting using the following protocol: venous blood was drawn from patients in a volume of 450-475 ml into a plastic container. Following centrifugation, the plasma was isolated and administered locally into the mucobuccal fold of the affected area. The number of injections varied from 5 to 10, depending on the severity of the inflammatory process. The volume of plasma administered per procedure was 1.0 ml. Patients were discharged 10 minutes post-injection, provided they felt well and maintained stable blood pressure. Clinical and radiographic examinations were utilized to monitor the status of the peri-implant tissues.

Results: Following the treatment course, which lasted between 5 and 10 days depending on the severity of peri-implant mucositis, the majority of patients showed a complete resolution of clinical symptoms. One patient was an exception, exhibiting residual signs of mucositis, which were successfully resolved following a repeated course of comprehensive therapy. At baseline, the peri-implant probing depth was maximal in the study participants, likely due to inflammatory edema. Upon completion of treatment and during subsequent follow-up, a statistically significant reduction in this parameter was observed.

Conclusion: Macrophage reprogramming was effective in patients with peri-implant mucositis. The high rate of inflammation resolution in the peri-implant tissues (97.4%) demonstrates the clinical efficacy of this oral macrophage reprogramming approach. Furthermore, the rapid elimination of inflammatory symptoms confirms the therapeutic value of these reprogramming interventions in the management of peri-implant mucositis.

Anterior cruciate ligament (ACL) injuries are one of the most common injuries to the knee joint structure, especially among individuals who regularly engage in physical activity. In clinical practice, this pathology is observed mainly in patients who subject their knees to significant stress due to sports and other high-intensity activities. Contemporary surgical approaches offers a wide range of reconstruction techniques, including autografts, allografts, all-inside procedures, and lateral extra-articular augmentations. This review summarizes current strategies in ACL surgical treatment, compares graft types and fixation methods, and analyzes factors influencing clinical outcomes, including revision surgeries and postoperative complications. Special attention is given to biomechanical stabilization, rehabilitation protocols, and prevention of graft failure. The article includes evidence from meta-analyses, systematic reviews, and clinical guidelines published between 2020 and 2024. It is intended for orthopedic surgeons, sports medicine specialists, and clinicians involved in knee joint surgery.

Recurrent myocardial infarction (RMI) remains a critically important problem in cardiology, significantly worsening patient prognosis and contributing to high mortality rates (with a ris of up to 8%, and up to one-third of patients dying within a year after recurrence). It also contributes to the development or progression of heart failure. Patients following acute myocardial infarction (AMI) retain a high risk of recurrent ischemic events. The objective of this review is to systematize current approaches to the diagnosis, prevention, and treatment of RMI, as well as to analyze factors influencing clinical prognosis. A literature search was conducted in MEDLINE, PubMed, Scopus, and ELIBRARY (2015–2024) using the following keywords: “recurrent myocardial infarction,” “acute coronary syndrome,” “risk factors,” “revascularization,” “percutaneous coronary intervention.” Relevant studies, reviews, and clinical guidelines were included.