Objective: to assess the association of modified revascularizing osteotrepanation with early in-hospital treatment outcomes in patients with distal neuroischemic diabetic foot syndrome.

Methods: a single-center comparative study included 44 patients followed up until hospital discharge. The main group comprised 22 patients who underwent modified revascularizing osteotrepanation as part of comprehensive treatmentwhen direct revascularization was not feasible. The control group included 22 patients treated without osteotrepanation. Continuous data are presented as Me [Q1-Q3] and categorical data as n (%). Between-group comparisons were performed using the Mann-Whitney U test and Fisher exact test.

Results: time to granulation tissue appearance was shorter in the main group: 9.6 [8.3-12.5] days versus 20.9 [17.3-23.8] days, p<0.001. Length of hospital stay was also shorter: 20.8 [17.1-22.4] days versus 32.7 [29.4-37.9] days, p<0.001. Any amputation was performed in 14 of 22 patients in the main group and in all 22 control patients: 63.6% versus 100.0%, p=0.004; relative risk of amputation was 0.64 (95% CI 0.46-0.87). The proportion of patients discharged alive without amputation was 22.7% versus 0%, p=0.048. Positive wound dynamics was observed in 36.4% and 4.5% of patients, respectively, p=0.021. In-hospital mortality did not differ significantly: 13.6% versus 22.7%, p=0.698.

Conclusion: in patients with distal neuroischemic diabetic foot syndrome, modified revascularizing osteotrepanation was associated with earlier granulation tissue formation, shorter hospital stay, and a lower amputation rate before discharge. These findings should be interpreted with caution given the small sample size, single-center design, and baseline differences in Wagner grade distribution.

Objective: to summarize current clinical, instrumental, and molecular genetic approaches to the diagnosis of hereditary neuromuscular diseases.

Material and methods: a review of recent domestic and international publications on the diagnosis of hereditary neuromuscular diseases was performed, with emphasis on clinical evaluation, electrophysiological methods (electroneuromyography), imaging techniques (muscle magnetic resonance imaging), biochemical markers of muscle damage, and molecular genetic methods, including polymerase chain reaction, MLPA, and next-generation sequencing. A systematic and comparative analysis of literature data published over the last 10 years was conducted.

Results: the review showed isolated use of clinical or instrumental diagnostic methods to be insufficient for accurate verification of most forms of hereditary neuromuscular diseases. The highest diagnostic value was demonstrated by a comprehensive approach integrating clinical phenotype assessment, ENMG findings, and modern molecular genetic technologies. Genetic confirmation of the diagnosis allows to clarifiy the nosological form, identify the inheritance pattern, and predict course of the disease.

Conclusion: modern diagnostic strategies for hereditary neuromuscular diseases should be based on the integration of clinical, instrumental, and molecular genetic methods. A comprehensive diagnostic approach contributes to early detection, reduction of diagnostic errors, and development of personalized patient management algorithms.

Objective: to study and optimize the tactics of surgical treatment of chronic purulent otitis media with intracranial complications.

Material and methods: during the study period from 2010 to 2024, 62,707 patients were hospitalized at the SI NMC “Shifobakhsh,” of whom 11,570 had acute or chronic suppurative middle ear inflammation, accounting for 18.5% of all admissions. Intracranial complications were observed in 95 patients, representing 0.15% of all hospitalized patients and 0.82% of those with inflammatory middle ear disease.

After comprehensive evaluation and confirmation of the final diagnosis, patients underwent source-control surgery on the affected ear. More than 50% of patients with intracranial complications underwent simultaneous procedures, consisting of concurrent source-control surgery of the ear and surgery for the intracranial lesion (brain abscess excision, evacuation of an extradural abscess, etc.). In 42 patients whose intracranial complications presented as meningitis or meningoencephalitis, only ear source-control surgery combined with conservative treatment was performed

Results: the data indicate that chronic suppurative otitis media plays the principal role in the development of intracranial complications; however, acute otitis media, especially post-influenza otitis media, may also contribute substantially to the development of meningitis and sigmoid sinus thrombosis. Among the 95 patients with otogenic intracranial complications, 16 (16.8%) were diagnosed with brain or cerebellar abscess, while 35 (36.8%) had an extradural abscess. Aſter diagnosis, these patients were admitted to the neurosurgical department, where combined simultaneous source-control procedures were performed. These procedures were associated with faster recovery, primary wound healing, a shorter hospital stay, and sustained remission.

Conclusion: computed tomography and magnetic resonance imaging of the mastoid processes and brain play a key role in the diagnosis of otogenic intracranial complications and make it possible to select timely and appropriate treatment strategies. Single-stage combined neurosurgical and otorhinolaryngological procedures for otogenic intracranial abscesses yield favorable outcomes in these life-threatening conditions while minimizing mortality.

Objective: to study the clinical and prognostic features of ischemic stroke in young adults based on a comprehensive assessment of clinical, instrumental, and functional parameters.

Material and methods: the study included young adult patients aged 18–45 years with acute ischemic stroke who were treated in neurological inpatient departments. A comprehensive clinical and instrumental assessment was performed using the National Institutes of Health Stroke Scale (NIHSS), Glasgow Coma Scale, modified Rankin Scale, and Barthel Index. All patients underwent neuroimaging examinations, including computed tomography and/or magnetic resonance imaging of the brain, as well as ultrasound assessment of cerebral hemodynamics. Traditional and non-traditional stroke risk factors, clinical course characteristics, and functional outcomes were analyzed. Statistical analysis was carried out using standard methods of variational statistics.

Results: ischemic stroke in young adults was characterized by clinical heterogeneity and multifactorial pathogenesis.

The leading risk factors included arterial hypertension, cardiogenic disorders, coagulopathies, and behavioral factors. The severity of neurological deficit ranged from mild to severe. More favorable functional outcomes were observed in patients with lower baseline NIHSS scores and earlier initiation of treatment. An association was identified between neuroimaging findings, the severity of cerebral hemodynamic disturbances, and disease prognosis.

Conclusions: ischemic stroke in young adults has a number of clinical and prognostic features that distinguish it from stroke in older patients. A comprehensive assessment of clinical, instrumental, and prognostic parameters can improve prognostic accuracy and optimize management strategies in this patient population.

Objective: to improve diagnostic evaluation and surgical management of congenital hydronephrosis in children.

Material and methods: the results of surgical treatment in 165 patients with congenital hydronephrosis were analyzed. The cohort comprised 102 boys and 63 girls aged 1 to 15 years. Depending on disease stage, the patients were divided into three groups: 20 children with grade I hydronephrosis, 120 with grade II–III hydronephrosis, and 25 with grade III–IV hydronephrosis. All patients underwent comprehensive radiographic evaluation. In children with grade I hydronephrosis, surgery was aimed at relieving urinary tract obstruction caused by adhesions and secondary calculi. In the second group, comprising children with grade II–III hydronephrosis, reconstructive surgery was performed using the Anderson–Hynes pyeloplasty technique; in cases with an aberrant vessel, vascular transposition with pelvic flap reconstruction was used. In patients with so called giant hydronephrosis, surgery was performed in two stages: nephrostomy as the first stage, followed by reconstructive surgery as the second stage.

Results: the study showed that, in children with congenital hydronephrosis, ultrasonography, Doppler assessment of the renal vessels, and contrast-enhanced CT are the imaging modalities of choice for diagnosis. Surgical correction should be individualized and targeted, taking into account the child’s physiological reserve and associated urinary tract anomalies.

Conclusion: the findings indicate that congenital hydronephrosis in children is a serious condition requiring timely diagnosis and surgical correction in order to avoid organ-removing procedures. Surgical treatment is advisable during the first year of life, but not earlier than 4–6 months after birth.

Objective: to assess the effectiveness of combined recombinant interleukin-2 therapy and modified vacuum therapy in patients with chronic non-healing wounds associated with neuropathic diabetic foot syndrome.

Methods: a comparative study included 36 patients with neuropathic diabetic foot syndrome divided into the main and control groups, 18 patients each. After wound debridement, the main group received local recombinant interleukin-2 therapy combined with modified vacuum therapy, whereas the control group received conventional local treatment. Pain intensity on the visual analogue scale, microbial contamination, time to wound cleansing, time to granulation and marginal epithelialization, length of hospital stay, major amputation, and in-hospital mortality were assessed. In addition, IL-2, IL-6, IL-8, and TNF-α were measured before treatment and on days 1, 5, and 10.

Results: the groups were comparable with respect to age, body mass index, diabetes duration, HbA1c, ulcer duration, wound area, and baseline TcPO2. The main group demonstrated lower pain intensity, faster reduction of microbial contamination, and significantly shorter time to wound cleansing, granulation, and marginal epithelialization. By day 10, IL-2, IL-8, and TNF-α levels were lower in the main group. Differences in major amputation and in-hospital mortality favored the main group numerically, but were not statistically convincing.

Conclusion: combined cytokine therapy and modified vacuum therapy were associated with faster wound cleansing, accelerated granulation and epithelialization, lower microbial burden, and a more pronounced decrease in selected pro-inflammatory cytokines by day 10 of treatment.

Objective: to improve the immediate outcomes of treatment in patients undergoing emergency laparoscopic cholecystectomy in the presence of reactive hepatitis and jaundice.

Material and methods: this study analyzed clinical data from 95 patients with acute calculous cholecystitis (ACC) complicated by nonspecific reactive hepatitis and jaundice. To compare diagnostic approaches and treatment strategies, two groups were defined. The main group consisted of 55 (57.9%) patients managed prospectively using contemporary diagnostic methods and clinical algorithms adopted at the study center. The control group comprised 40 (42.1%) patients whose records were analyzed retrospectively; these patients were treated according to standard protocols. Most patients (n = 89; 93.7%) sought specialized medical care more than 24 hours after the onset of biliary colic.

Results: in the main group, the surgical approach depended on the type of inflammatory process. In patients with catarrhal cholecystitis (n = 5), laparoscopic cholecystectomy starting at the gallbladder neck was performed in all cases. In patients with phlegmonous cholecystitis (n = 14), dissection starting at the neck was feasible in 7 cases (50.0%), whereas in 6 patients (42.8%), because of marked inflammatory infiltration in this region, a fundus-first laparoscopic cholecystectomy was required. In 1 patient (7.2%), laparoscopic cholecystectomy using the Pribram technique was performed based on intraoperative findings. Mean operative time was 37.1 ± 2.9 min and 39.3 ± 1.6 min, respectively. In the control group, cholecystectomy starting at the neck was performed in 7 patients (17.5%), while a fundus-first approach was used in 6 patients (15.0%). Postoperative analysis showed that, in the control group, complications after open surgery developed in 9 patients (22.5%), and mortality was 7.5% (3 deaths). In the main group, the complication rate was lower, at 12.7% (7 cases), and mortality was 3.6% (2 deaths).

Conclusion: choosing the laparoscopic cholecystectomy technique according to the pattern of gallbladder wall destruction allows the surgical strategy to be aligned with the severity of the inflammatory-destructive changes and the severity of the associated comorbidity.

Objective: to assess the prognostic applicability of the Peritonitis Index (PI) for risk stratification of postoperative progression in diffuse peritonitis and to describe the association between risk strata and the postoperative management strategies employed.

Material and methods: a retrospective analysis of the clinical data of 188 patients who underwent surgery in 2016-2025 at the Varorud Medical and Diagnostic Center and the State Institution Dushanbe City Emergency Medical Care Center was performed. The patients were aged 15-81 years; 113 (60.1%) were men and 75 (39.9%) were women. The Peritonitis Index (PI) was calculated as the sum of three components: risk factors (F), stage of the process (S), and morphological changes of the peritoneum (V), with a total score ranging from 6 to 30 points. The patients were stratified into three groups: group I, PI ≤12; group II, PI 13-22; and group III, PI >22. The main outcomes were progression of peritonitis, repeat interventions, and death. Statistical analysis was performed in R version 4.5.2. Quantitative data are presented as Me [Q1-Q3], and categorical data as n (%). The chi-square test, Fisher’s exact test, logistic regression, and ROC analysis were used.

Results: progression of peritonitis was identified in 67 of 188 patients (35.6%). The frequency of progression increased with increasing PI: 3/86 (3.5%) in group I, 31/62 (50.0%) in group II, and 33/40 (82.5%) in group III (p < 0.001). In the logistic model, each 1-point increase in PI increased the odds of progression (OR = 1.32; 95% CI 1.23-1.42; p < 0.001). ROC analysis confirmed the high discriminative ability of the PI for progression (AUC = 0.878). Among the 67 patients with progression, repeat interventions were performed in 54 (80.6%): relaparotomy on demand in 42 (62.7%) and scheduled abdominal re-explorations in 12 (17.9%); in 13 cases (19.4%), death occurred without repeat surgery. For mortality among patients with progression, the discriminative ability of the PI was moderate (AUC = 0.656).

Conclusions: PI is a useful tool for risk stratification of diffuse peritonitis progression and may be used as an adjunct for clinical assessment. Prospective studies with calibration assessment and internal/external validation are required before using PI for decision-making.

Objective: to conduct a comparative analysis of clinical, demographic, therapeutic, and prognostic aspects in hospitalized cardiology patients depending on the presence of chronic kidney disease (CKD).

Material and methods: The study included 780 cardiology patients divided into groups with CKD (n = 207) and without CKD (n = 573). A retrospective analysis of medical records was performed to assess demographic, clinical, therapeutic, and laboratory parameters, as well as hospitalization outcomes. Statistical analysis was performed using Student’s t-test, the Mann-Whitney U test, and the χ² test in IBM SPSS Statistics 26.0, with p < 0.05 considered statistically significant.

Results: Patients with CKD were older (71.1 ± 10.9 vs 61.8 ± 15.1 years; p < 0.001) and had a significantly higher prevalence of chronic heart failure (CHF) (77.3% vs 23.9%), diabetes mellitus (DM) (51.7% vs 27.4%), and atrial fibrillation

(AF) (44.0% vs 24.4%; p < 0.001). Decompensated CHF was the leading cause of hospitalization in these patients (58.5% vs 24.1%; p < 0.001). During hospitalization, patients with CKD were less likely to receive angiotensin-converting enzyme inhibitors (ACE inhibitors) or angiotensin II receptor blockers (ARBs) (42.5% vs 88.8%; p < 0.001), but were more likely to receive diuretics, anticoagulants, mineralocorticoid receptor antagonists (MRAs), angiotensin receptor-neprilysin inhibitors (ARNIs), and sodium-glucose cotransporter 2 (SGLT2) inhibitors (p < 0.01). CKD was associated with longer hospitalization (12.5 ± 5.8 vs 8.2 ± 4.1 days; p < 0.001), higher mortality (8.7% vs 3.8%; p = 0.008), and a higher rate of transfer to the intensive care unit (ICU) (21.7% vs 13.6%; p = 0.006).

Conclusions: CKD defines a distinct clinical phenotype of cardiology patients with poorer outcomes. A key issue is “nephrophobia,” manifested in the unjustifiably infrequent use of basic renoprotective therapy (ACEIs/ARBs) during hospitalization, which necessitates changes in the management approaches for this patient category.

Оbjective: to evaluate the dynamics of immune status parameters in patients with alopecia areata undergoing combined therapy.

Material and methods: a total of 61 individuals were examined, including 30 healthy patients in the control group and 31 patients in the main group. Parameters of cellular and humoral immunity, phagocytic activity, and cytokine profile were assessed before and after treatment. Statistical analysis was performed using Student’s t-test. The results are presented as mean ± standard error (M ± m). Differences were considered statistically significant at p <0.05.

Results: before treatment, the patients showed elevated levels of proinflammatory cytokines (TNF-α, IL-1β, IL-6, and IL-8), increased levels of circulating immune complexes, and reduced cellular immunity indices. After treatment, there was a significant decrease in the levels of proinflammatory cytokines (p < 0.01-0.001), a reduction in circulating immune complex levels (p < 0.05), and an increase in IL-10 levels (p < 0.05) and phagocytic activity (p < 0.05).

Conclusions: combined therapy exerts a pronounced immunomodulatory effect aimed at reducing inflammatory activity and restoring immune homeostasis.

Objective: to conduct a comparative analysis of the outcomes of using implant surgical guides in patient with complete edentulism of the maxilla and mandible.

Material and methods: two groups of patients with complete edentulism of both jaws were formed from individuals aged 50-70 years without somatic comorbidities. A total of 26 patients were reported as having been examined. The study group included 18 patients with a mean age of 63.4 ± 2.6 years. Women accounted for 44.4% (8 patients) and men for 55.6% (10 patients). The control group comprised 17 patients with a mean age of 62.9 ± 3.8 years. In this group, men accounted for 64.7% (11 patients) and women for 35.3% (6 patients). In the study group, the surgical stage was performed using guide-assisted navigation based on surgical guides. A key feature of the protocol was implant placement without mucoperiosteal flap elevation, which minimized soft-tissue trauma. In the control group, conventional dental implantation was performed with mucoperiosteal flap elevation, implant placement, and wound closure with sutures.

Results: analysis of the results showed that, in the study group, serous and bloody exudation in the surgical area had completely ceased by the first postoperative day after dental implant placement. In addition, some patients in this group had no clinical signs such as pain (5 patients, 27.8%), swelling (7 patients, 38.9%), or hyperemia of the periimplant mucosa (7 patients, 38.9%). In contrast, in the control group, pathological changes, including pain, swelling, and redness along the suture line, persisted in 15 patients (88.2%) up to the third postoperative day, indicating a longer recovery period with the conventional implantation technique.

Conclusions: surgical access without mucoperiosteal flap elevation is less traumatic than traditional surgical approaches. According to the Hounsfield unit assessment, this minimally invasive method was superior to standard techniques in terms of effectiveness.

Objective: to conduct a comparative evaluation of the functional outcomes of surgical treatment of fractures of the long bones of the lower extremities, using prognostic tests and measures for prevention of infectious complications.

Material and Methods: This study was based on the analysis of the diagnosis and treatment of 110 patients with longbone fractures of the lower extremities. The patients were divided into a study group (n = 51) and a control group (n = 59). Long-term functional outcomes after osteosynthesis for lower-extremity fractures were assessed at 1, 3, and 6 months and at 1 year after surgery using the Lower Extremity Functional Scale (LEFS). Functional outcomes were evaluated by means of a patient questionnaire in which specific functions of the affected limb segment were scored.

Results: The functional results obtained indicate that, in the study group, the proportion of excellent functional outcomes after osteosynthesis increased mainly during the period from 1 to 3 months. By month 6, the rate of increase slowed, but by 12 months a marked positive trend was again observed. In the control group, the number of excellent functional outcomes increased mainly during the period from 3 to 6 months after surgery. The most pronounced increase was observed after 6 months and reached its maximum by 12 months after the operation.

Conclusion: The optimized tactical approach used in the study group contributed to an increase in the proportion of excellent and good functional outcomes after osteosynthesis, whereas in the control group, in which the conventional approach was used, good and satisfactory outcomes predominated in both the early and long-term follow-up periods.

Objective: to develop an algorithm for perioperative management of patients with endometrial and myometrial hyperplastic processes for the prevention of cervical disease.

Material and methods: a cross-sectional comparative study was conducted in 100 women 3–5 years after subtotal hysterectomy. Two groups were formed: Group I (n=50) - patients after supravaginal hysterectomy without oophorectomy; Group II (n=50) - with oophorectomy. The examination protocol included gynecological examination, extended colposcopy, cytological assessment (conventional and liquid-based), microbiological testing, and PCR detection of human papillomavirus (HPV). The findings served as the basis for algorithm development.

Results: in the long-term follow-up period, patients in both groups showed a persistently high rate of complaints of pathological discharge (48–50%) and gynecological conditions such as cervicitis and colpitis. No statistically significant differences in the incidence of cervical stump pathology were found between the group with preserved ovaries and the group after oophorectomy (p>0.05). Liquid-based cytology demonstrated a 1.4-fold higher detection rate of pathological changes compared with the conventional Pap smear. Based on the data obtained, a 4-stage perioperative management algorithm was developed.

Conclusion: the proposed algorithm, based on comprehensive preoperative cervical evaluation and mandatory postoperative surveillance, enables a personalized approach to the selection of hysterectomy extent. It allows safe performance of organ-sparing subtotal hysterectomy in low-risk patients and ensures timely detection of cervical stump pathology in the long-term follow-up period.

The diagnosis of “pituitary adenoma” within the WHO Classification of Endocrine System Tumors is established based on a combination of clinical manifestations, neuroimaging findings (primarily MRI), and histopathological examination with immunohistochemistry. Since 2004, pituitary tumors have been officially classified as endocrine neoplasms, with a distinction introduced between adenomas and carcinomas. The latter designation applies to cases in which the primary pituitary neoplasm is accompanied by distant metastases in cranial, spinal, or other sites. Previously, adenomas were subdivided into typical and atypical forms: an atypical adenoma was diagnosed in the presence of invasive growth, marked cellular atypia, and a Ki-67 proliferation index exceeding 3%, in the absence of metastasis. However, since the 2017 revision, the international classification of pituitary tumors no longer includes the concept of atypical adenoma, thereby simplifying the terminology and shifting the focus toward morphological and clinico-radiological characteristics for diagnostic purposes.

This review systematizes current scientific data on Fritillaria eduardii, an endemic plant of Central Asia widespread in various regions of Tajikistan. This species is ornamental and has significant pharmaceutical potential. Studying its pharmacological properties and biologically active compounds is important for science and the development of new dosage forms. Its bulbs are traditionally used in folk medicine; however, the pharmacognostic characteristics of this species, which grows in Tajikistan, remain insufficiently studied.

The objective of this review is to summarize current data on Fritillaria eduardii, based on publications from the 2020 – 2025 period, including ethnobotanical studies, botanical characteristics, chemical composition, introduction, as well as information on other species of the genus Fritillaria and their comparative chemical analysis with Fritillaria eduardii.

This article focuses on the analysis of the phytochemical composition of F. eduardii, which is dominated by isosteroidalalkaloids and flavonoids with diverse biological activity. Particular attention is given to the issues of identification,standardization of raw materials, and the need to protect this rare species.

This paper presents an analytical review of domestic and international publications on the diagnosis and surgical treatment of lumbar spinal stenosis in elderly and senile patients. Despite a significant number of scientific publications that have studied the pathogenetic mechanisms and clinical presentation of lumbar stenosis in the geriatric population, issues of early diagnosis and optimal surgical approach in this patient category have been addressed insufficiently. In recent years, the adoption of diagnostic modalities such as ultrasonography, CT, and MRI has enabled significant progress in understanding the clinical features and course of lumbar spinal stenosis in elderly and senile patients. The complexity lies in the diverse clinical course and the multifactorial etiology leading to this pathology. Therefore, the development of a systematic approach to both diagnosis and surgical treatment is essential for the appropriate selection of a surgical method based on the underlying etiology.