Avicenna Bulletin

Objective: Studying the possibilities of optimizing criteria of verification metabolic syndrome in children of 10-14 years old with overweight and obesity. Methods: The study included 16 boys and 12 girls who were on rehabilitation at the recreation centre. The middle age was 12.8±1.5 years. The morphofunctional state was studied with the help of anthropometric measurements (height, body weight, waist circumference), bioimpedance study, functional methods of cardiovascular, respiratory and nervous systems, Kerdo index. Results: Changes in the carbohydrate and lipid profiles, which led to the functional disorders in the cardiovascular, respiratory and nervous systems, indicated in the presence of insulin resistance in 35.7% of adolescents, the magnitude of pronouncedness that were calculated in points according to the special Shandler-Biermann scale based on the mass index of a body. Conclusion: Because hypodynamia is the fundamental cause of the development of the metabolic syndrome, the fundamental purpose of the corrective program, which was physical activity since the muscles are the main place for utilizing dextrose.

The authors present a literature review examining the impact of COVID-19 on women's reproductive health. It is noted that menstrual dysfunction creates intense stress in a woman's body. The stress caused by the pandemic could potentially put women at higher risk of endocrine disruption. Furthermore, coronavirus infection adversely affects the course of pregnancy and labour, increasing the number of premature births and the frequency of delivery by caesarean section. The status of the fetus and changes in the uteroplacental complex in SARS-CoV-2, during pregnancy and subsequent pregnancies, have not been sufficiently studied. Researchers agree that timely diagnosis of the sequelae of COVID-19 in women will allow the development of new preventive and therapeutic strategies to restore optimal reproductive health. Keywords: COVID-19, menstrual cycle, reproductive health, pregnancy, stress.

Objective: To assess an implementation study (IS) aimed at improving the epidemiological surveillance of tuberculosis (TB) and drug-resistant TB (DRTB) in Dushanbe during the COVID-19 pandemic. Methods: IS assessment was carried out according to the RE-AIM framework and WHO recommendations for reporting on IS. To assess the effectiveness of the action taken, official statistics and reports from the City Center for Protection of Population from Tuberculosis were used. Results: IS was a qualitative study. The study was supported by the WHO Special Program for Research and Training in Tropical Diseases (TDR). A multidisciplinary team led by the Dushanbe City Health Department has undertaken the following measures: introduction of a system of weekly epidemiological surveillance for TB at the primary health care (PHC) level from the second week of 2021; involvement of students of basic and advanced field epidemiology programs (FETP) in the assessment of the TB epidemiological surveillance system; tracking of registered patients with laboratory confirmation of TB; application of data from the quarterly reports in tracking the diagnostic trends and evaluation of the effectiveness of DR-TB treatment. All materials received were documented and used to train TB doctors and PHC workers. Only 66% of TB doctors were involved in capacity building in Dushanbe PHC: 24.4% of PHC workers were trained in the basics of TB diagnosis and treatment. Stabilization of TB and DR-TB rate was achieved in 2021 compared to 2020 (morbidity growth rates were 2.7% and 11.9%, respectively); effectiveness of treatment of TB with preserved sensitivity of M. tuberculosis (MBT) to anti-TB drugs in the 2020 cohort increased, but efficacy of DR-TB treatment in the 2019 cohort decreased. Conclusion: IS has identified major barriers to achieving the TB elimination goals. Although the data indicate stabilization of TB and DR-TB incidence rates and increased effectiveness of drug-sensitive TB treatment in Dushanbe, further monitoring and achievement of sustainable results are required.

Objective: To analyze the development of the measles outbreak in 2018 among the population of the Kyrgyz Republic to improve the prevention system in the country. Methods: An operational and retrospective epidemiological analysis of official statistics has been carried out. The diagnosis of measles was confirmed with the immunoenzyme analysis (IEA) using the Vector-Best IgM Measles n-905 test system. The genotype of the measles virus was determined in the laboratory of the Moscow Research Epidemiology and Microbiology Institute named after G.N. Gabrichevsky, the material served as nose-swallow scrape and urine. Results: A total of 1,005 cases of measles have been reported in the country (an intensive indicator of 16,10/0000), of which 515 have been laboratoryconfirmed and 490 cases have been clinically and epidemiologically interconnected. The areas of risk were Bishkek with an incidence rate of 57.2% and Chui region – 24.5%. Risk groups were children under the year of life – 45.7% and at the age of 1-4 years – 37.1 %. Risk time is spring-summer and autumn periods. The main proportion of patients were unvaccinated – 92%, of which 45% were children under the year, 21% – due to failures, 11% – with medical recusals and 5% – due to migration of the population. Conclusion: The presence of non-immune stratum among the population, formed by the causes of frequent failures, migration of the population and medical recusals, as well as in the conditions of the emergence of hospital-acquired hotbeds in the infectious and non-infectious hospitals have contributed to the outbreak of measles in Kyrgyzstan among the young children.

Objective: Analysis of the frequency and structure of postoperative infectious and inflammatory complications in the puerperae after abdominal delivery, which were under treatment in the specialized department of the third-level hospital for 2017. Methods: s: Examined and treated of 66 parturient women with infectious complications after cesarean section. The spectrum of nosocomial microflora and resistance to antimicrobial agents determined using an automatic microbiological analyzer based on mass spectrometry. Results: The main recorded nosological form was infection of the area of surgical intervention. In 3% of cases, postoperative metroendometritis complicated by the inconsistency of sutures on the uterus with the development of obstetric peritonitis, and in 7.6% by sepsis. The structure of isolated microflora in postoperative infection was different after planned and emerged delivery, which should be taken into account when developing a local form of perioperative antibiotic prophylaxis and therapy. Conclusion: At present, there is an underestimation of the severity of metroendometritis after cesarean section with premature discharge or a belated transfer from the maternity hospital to the specialized observatory department of the multi-profile hospital. One in five postoperative metroendometritis caused by multidrug-resistant hospital microflora.

In this paper, we wish to present a case report of a 38-year-old woman who underwent abdominoplasty (AP). Patient history obtained during the preoperative phase of care included sleeve gastroplasty, after which she noted a significant weight loss (about 35 kg). As a result, a saggy skin-fat flap of the abdomen in the form of an apron was formed. In addition, she was worried about the pronounced drooping and sagging breasts. Therefore, the patient was offered AP through combined vertical and horizontal incisions. However, due to the patient's refusal of the combined incisions, AP with a transverse incision and vertical mammoplasty were performed. A year later, dissatisfied with the cosmetic result, the patient insisted on AP through a combined incision, which was performed. At this time, the patient indicated her satisfaction with the aesthetic outcomes. Keywords: Saggy abdomen, abdominal dermatochalasis, bariatric surgery, abdominoplasty, mammoplasty.

Objective: To study the role of the implantable port system (IPS) in the treatment of pulmonary tuberculosis with multiple and extensively drug resistance (MDR TB, XDR TB). Methods: Since September 2017, IPS (POLYSITE 4008 ECHO) implanted in seven patients (4 men and 3 women) with MDR and XDR forms of pulmonary tuberculosis in the age of 30 to 60 years. All IPS implanted under the local anesthesia in the operation room. Port system installed with catheterization of the subclavian vein, mainly on the right. All these patients at the time of IPS installation received a short course of chemotherapy with new and before profiled preparations after having passed through a Consultation on drug-resistant tuberculosis. Results: The use of IPS for patients with MDR TB and XDR TB pulmonary tuberculosis demonstrated a high level of commitment to treatment. Only in one case, the infection and suppuration of punction area took place in short-term period. This complication was corrected by secondary surgical treatment and overlay of secondary seams. Conclusion: The preliminary results of the IPS application for seven patients with MDR TB and XDR TB demonstrated high safety and effectiveness of the technique, which allows recommending it, be for further expanded use in the treatment of this patients.

Objective: To segment the pharmaceutical market of non-steroidal anti-inflammatory drugs (NSAIDs) of the derivatives groups of acetic acid in the Kyrgyz Republic. Methods: The database of the State Registry of Medicines registered and approved for Medical use in Kyrgyzstan, the Department of Drugs Security and Medical Engineering of the Ministry of Health of the Kyrgyz Republic is used for analysis. Results: Analysis showed that the leaders of the pharmaceutical market in Kyrgyzstan the number of registered medicines (M) under the trade names are Medical Drugs (MD) with international generic name: diclofenac, ketorolac, indomethacin. It has been established that there are 99 trade names of NSAIDs of the groups of acetic acid derivatives in the Kyrgyz pharmaceutical market. The largest part of the range consists of diclofenac (M01AB05), represented by 62 trade names MD (62.6%), and ketorolac (M01AB15), represented by 20 trade names MD (20.2%). In the pharmaceutical market of Kyrgyzstan are NSAIDs from the groups of acetic acid derivatives from 15 countries, of which 21.1% of MDs are produced by neighboring countries, and 73.3% – in far countries. Conducted studies have revealed that the structure of the range of NSAIDs groups of acetic acid derivatives is dominated by soft medicinal forms, which making up 37.4%. A comparative analysis of the composition of MD by the number of active substances revealed that 92.9% of NSAIDs of the groups of acetic acid derivatives are monodrugs. Based on the analysis of the price segmentation of NSAIDs of the groups of acetic acid derivatives, most of the drugs are in the low-price segment. Conclusion: A sufficient assortment saturation of the pharmaceutical market of Kyrgyzstan NSAIDs groups of acetic acid derivatives has been revealed. The pharmaceutical market of the Kyrgyz Republic is dominated by monocomponent NSAIDs in the form of soft medicinal forms produced in foreign countries. Only 7 MDs from this group are in the high-price range, making the remaining drugs financially available to consumers.

The review summarizes studies related to current issues and concepts of the neuroanatomic basis of the meridian system and acupuncture points. The proponents of their existence have not yet come to any consensus on how they might work or be tested in a scientific context. Kim Bonghan, a professor at Pyongyang Medical University of the Democratic People’s Republic of Korea, discovered the anatomical structure of meridian collaterals, which he called the Bonghan corpuscles (now known as primo nodes) and the the Bonghan ducts (primo vessels), and called it the Bonghan (Kyungrak) system. In 2010, it was renamed into the primo vascular system (PVS), which exists throughout the organism, including blood and lymph vessels. PVS is an anatomical structure being a network of ducts with fluid flowing in them. This system consists of primo-vessels and primo-nodes, corresponding to acupuncture meridians, and acupuncture points, respectively. Thus, the PVS can serve as a morphological substrate for acupuncture points and meridians of traditional Chinese medicine; however, since there is no scientific consensus on the neuroanatomical basis of acupuncture, further morphological, physiological, and clinical studies are needed to promote a broader mutual understanding of this issue in the research community and beyond.

The review article highlights the modern classification of acute pancreatitis, indications for the surgical treatment of severe, first of all, infected pancreonecrosis, development and the contentious issues of this problem. As you know, all surgical interventions in pancreonecrosis are divided into two types: radical and organ-preserving. This article examines the results of both methods with an analysis of the frequency of postoperative complications after each. In addition, two different methods of operations, «closed» and «open» – were evaluated to drain extraperitoneal space, taking into account the area of the necrotic process. Described the prospect of using Embryonal Natural Orifice Transluminal Endoscopic Surgery (ENOTES) in the treatment of severe acute pancreatitis, complicated by abdominal compartment syndrome. The frequency of intraoperative and early complications of «closed» and «open» interventions in severe acute pancreatitis, their recognition, prevention, and the choice is considered a method of surgical or conservative treatment. Keywords: Acute pancreatitis, surgical treatment, complications of acute pancreatitis, pancreonecrosis.

Objective: To assess the derangements in lipid metabolism and the severity of atherosclerotic disease of the coronary arteries in patients with the acute coronary syndrome (ACS) and subclinical hypothyroidism (SHT). Methods: 146 medical records of inpatients of working age with newly developed ACS and various thyroid hormonal statuses were analysed. The lipid profile, high-sensitivity C-reactive protein (hs-CRP), thyroid-stimulating hormone (TSH), and free thyroid hormones (free thyroxine, FT4, and free triiodothyronine, FT3) levels were investigated. Coronary angiography results were used to assess coronary atherosclerotic plaque burden. The study group comprised 67 patients with ACS and SHT (TSH level >4.0 mIU/l with normal thyroid hormone levels), and the control group included 79 ACS patients without thyroid hormonal abnormalities. The groups were matched for the presence of unhealthy habits, gender, age, and severity of arterial hypertension. Before admission to the hospital, patients did not receive preventive therapy for coronary artery disease (CAD) or hormone replacement therapy. Results: In SHT patients, in comparison with the group of patients with normal thyroid function, the proportion of individuals with type IIa hyperlipidemia was higher – 82.0% (n=55) and 46.8% (n=37), respectively (χ2=19.33; p

About 40% of patients with multiple intracranial aneurysms (MIAs) are admitted with poor-grade subarachnoid haemorrhage (Hunt & Hess Grades IVV). Therefore, an approach to identify the most appropriate strategy for an individual patient should be applied to obtain the best functional outcomes. However, there is still no consensus on selecting proper MIAs treatment in patients with acute subarachnoid haemorrhage with localization of all aneurysms in the surgical intervention area. The article presents a case of a 43-year-old patient with MIAs: a ruptured aneurysm of the anterior communicating artery (ACA) and intact right pericallosal and right middle cerebral arteries (MCA). The first stage included clipping the ruptured ACA aneurysm and decompressive craniectomy. After stabilization of the patient's condition, the second stage of treatment was performed: clipping the aneurysms of the right pericallosal and right MCA and autologous cranioplasty. The patient was discharged from the hospital in satisfactory condition. The presented case demonstrates the need for a flexible individual approach to treating patients with MIAs and acute subarachnoid bleeding. Staged surgical treatment and performing as the second stage clipping of intact aneurysms with simultaneous early cranioplasty after compensating the patient's condition allowed for good treatment outcomes. Keywords: Multiple intracranial aneurysms, aneurysm clipping, decompressive craniectomy, staged surgical treatment, cerebral aneurysm rupture.

Objective: Improving the results of treatment of patients with acute strangulated intestinal obstruction (ASIO). Methods: Analyzed the results of complex diagnostics and surgical treatment of 49 patients with ASIO. In 20 (40.8%) observations, the cause of ASIO was the acute adhesive small intestinal obstruction, 12 (24.5%) – intussusception, 10 (20.4%) – nodulation and 7 (14.3%) – volvulus of small intestine. Results: Established that as the syndrome of enteric insufficiency progresses, observed an increase in endotoxemia levels. Thus, with the syndrome of enteric insufficiency of II and III degrees, the leukocyte index of intoxication (LII) was 6.23±1.16 units and 8.62±2.51 units, respectively, medium-mass molecules (MMM) – 0.587±0.25 conv. units and 0.838±0.06 conv. Units, respectively, and blood lactate levels were 2.8±0.04 μmol/l and 3.1±0.06 μmol/l, respectively. At a severe and extremely severe increase in intra-abdominal pressure, the level of MMM reached 0.1104±0.53 conv. units and 0.1274±0.78 conv. units, respectively, blood lactate – 2.5±0.02 μmol/l and 3.1±0.04 μmol/l, respectively, and LII – 6.24±1.18 units, and 8.60±2.53 units, respectively. Performed various kinds of surgery with intubation of the small intestine with subsequent decompression and gut lavage, which effectively reduced endotoxemia and indices of intra-abdominal pressure, and also reduced the incidence of enteroenteroanastomosis insufficiency. Four observations have suppuration of the laparotomic wounds, in 2 patients – subhepatic abscess and in 1 – entero-enteroanastomosis nsufficiency. Two elderly patients died of peritonitis (n=1) and acute myocardial infarction (n=1). Conclusion: Intubation of the small intestine with the implementation of hypothermic sanation allows effective removal of toxic intestinal content and prevents the risk of entero-enteroanastomosis nsufficiency.

In the given literary review are discussed the actual problems of diagnosis and treatment of the syndrome of enteral insufficiency, occurs against the background of acute pancreatitis. In patients suffering from acute pancreatitis, up to 80% of cases, enteral insufficiency syndrome (EIS) occurs, aggravating the processes of endotoxicosis. To date, the timely detection of EIS through the use of modern methods of research of detecting disorders is still considered to be influencing disorders of intestinal function. For full diagnosis of EIS are modern laboratory and instrumental studies, such as radiographic, ultrasound, electrogastroenterography, and also the bacteriological research of feces. Prokinetics (ganaton, metoclopramide derivatives, etc.), early intestinal lavage, and cleansing enemas are more often used to stimulate the intestine. It is considered that such a combined application of treatment methods has a great effect against enteroparesis which contributes to the consolation of the results of the EIS in acute pancreatitis. It should be noted that recently a great interest in scientists cause the issues of early enteral probe feeding. It was determined that the best results were the treatment of patients with the use of enteral probe feeding in combination with selective decontamination of the gastrointestinal tract. Thus, therapeutic measures for EIS are aimed at resolving enteroparesis. However, these therapeutic measures need further research as well as aspects of preventing the development of functional bowel disorders. Keywords: Enteral insufficiency syndrome, acute pancreatitis, diagnosis, treatment.

Objective: To study and provide the clinical and dynamic characteristics of heroin addiction and their impact on the prognosis of the disease and formulate the recommendations to improve the narcological care. Methods: The values of some clinical and dynamic factors in the assessment of the prognosis of heroin addiction in 170 patients were investigated. Results: It has been established that the combination of such clinical and dynamic factors of heroin addiction as the early onset of familiarization the use of narcotic substance in the age of 20 years, the use of heroin as a first sample of the narcotic substance, the duration of the disease more than ten years, a highly progressive rate of the course, the presence of concomitant viral hepatitis or positive HIV status may determine an unfavorable prognosis of the disease. Clinical and dynamic factors of favorable prognosis are: the late start of drug use – over the age of 40 years; the first test drug is different from heroin; duration of drug use up to 5 years; the low-progressive rate of the disease, the absence of concomitant diseases associated with injecting drug use in the form of viral hepatitis and HIV. Conclusion: The highlighted prognostic criteria for heroin addiction and the offered to their base prognostic «risk group» of patients will optimize clinical and organizational approaches in fulfillment of complex measures aimed at the treatment and rehabilitation of patients with heroin addiction. Presented characteristics can be taken into account in the formation of preventive measures, a differentiated approach to dispensary supervision of persons suffering heroin addiction.

Objective: To study and present the socio-demographic characteristics of patients with heroin addicts and its impact on the prognosis of the disease, to develop recommendations for improvement of specialized drug treatment services Methods: The paper presents data on the study of the socio-demographic characteristics of 130 patients with heroin addiction. Such parameters as age, level of education, family, labor and social status were taken into account. Results: The socio-demographic indicators of the studied patients testify to the spread of heroin addiction among the socially significant groups of the population, that is expressed in strengthening specific weight of young people with education and with a preserved social and labor status. It has been established that the largest proportion of patients with heroin addiction is in the age of 31-40 years (40%) with secondary education (73.9%) who do not have a permanent job (86.2%) who have not served in the army (73.9%) and married (64.6%). Conclusion: The totality of socio-demographic indices, the most characteristic and often encountered in the present time in patients of heroin addiction allows to determine the group of risk. It should be based on preventive measures for the timely detection of persons suffering from heroin addiction. In the complex of medical and social measures on prevention of heroin addiction, along with pharmacotherapy, a significant place should occupy in the treatment of patients in the programs implemented in the country psycho-social rehabilitation and group psychotherapy programs.

Objective: To determine the influence of adenotomy on the course of the inflammatory process in the maxillary sinuses in children. Methods: During the three-year period, examined 162 patients with the chronic inflammatory process in the maxillary sinuses. Hypertrophy of the tonsils (nasopharyngeal, palatine), chronic tonsillitis was observed in these patients. All patients underwent general clinical, otorhinolaryngological, and radiological methods of investigation. The effectiveness of the treatment was evaluated clinically immediately after a week and after three months. Results: After surgical treatment, the condition of the children improved, they were discharged in a satisfactory condition. After three months, 87.7% of the patients underwent a full recovery: the suppuration from the nose stopped, nasal breathing was restored, and headaches stopped. In 3.7%, despite the treatment, catarrhal rhinitis periodically occurred, the radiological process in the sinuses was absent. And in 8.6% of the improvement of the condition was not observed either clinically or radiographically, that, apparently, was due to the reduction of the immune forces of the body. After these surgical procedures, puncture and catheterization of the maxillary sinus and daily rinsing were carried out to these patients, which contributed to the subsequent stable remission. Conclusion: Changes in the maxillary cavities in children suffering from adenoid tumours occur quite often. The timely removal of adenoid cavities is of great prophylactic value since it prevents the development of the inflammatory process in the maxillary cavities. If the adenotomy does not give effect, the puncture of a maxillary sinus with the subsequent conservative treatment is necessary. If this does not lead to recovery, then the operation on the maxillary sinus is indicated.

Objective: To assess the level of adherence to medical prescriptions and recommendations by patients with bronchial asthma (BA), in order to achieve control over the symptoms of the disease; to identify the most common factors of low adherence to BA therapy; to suggest strategies for optimizing treatment compliance. Methods: 92 children with a verified diagnosis of BA were examined. All patients underwent a general clinical, laboratory and instrumental examination, as well as an additional screening test with a mixture of respiratory allergens – the ImmunoCapPhadia® 250 method. The control of BA symptoms was assessed using ACT and ACQ tests. Adherence to BA therapy was assessed using a questionnaire. Results: Analysis of gender differences revealed that the proportion of male patients was 58%; female – 42%. The median age was 11 years. The average age of diagnosis of BA in children was 9 years. All patients were hospitalized during the period of exacerbation of the disease, the proportion of children with an attack of moderate BA – 87%; severe – 13%. An intermittent course of BA was observed in 28%; a persistent course in 72%. Analysis of ImmunoCap Phadia®250 data revealed that in 17.2% of cases class V sensitization prevailed, and the average values of allergen-specific IgE antibodies were 69.82 kU/L. Assessment of the level of control over asthma symptoms and the use of AST and ACQ tests revealed that partially controlled the course of BA was noted by 56% and uncontrolled over 46% of children. Analysis of the «Questionnaire of adherence to treatment of bronchial asthma (BA) in children», differences were found in the response to questions: «Do you experience difficulties in using the inhaler?» (χ2=8.952; p=0.003), «Was there any reluctance to take medications?» (χ2=4.715; p=0.03); «Does it happen that you forget to take drugs one/several days?» (χ2=5.093; p=0.025), «Are you satisfied with the prescribed therapy for BA?» (χ2=5.093; p=0.025). Conclusion: In order to achieve success in long-term control of the symptoms of BA in a patient, a comprehensive approach to the treatment and prevention of exacerbation of BA is required with an individual approach to each child, both from the doctor and from an adult who participates in the conduct and adherence to doctors appointments.

Objective: To study the level of compliance in patients with pulmonary tuberculosis and selection of the most optimal questionnaire for routine screening of adherence to treatment, both at the hospital and primary health care level. Methods: The study conducted for 70 patients with an established diagnosis of pulmonary tuberculosis (sensitive form). Two questionnaires were chosen as the methods for the study of compliance: the Morisky-Green scale and the "Compliance level" questionnaire. These patients were interviewed on the above questionnaires, the results of which were compared among themselves. Results: Based on the results of the study, we obtained discordant results: on the Morisky-Green scale, the number of adherents was 18.6%, and according to the questionnaire "Compliance level», 78.6% of patients showed a high level of compliance. Discordant results can be explained by distrust to each other, both from the patient and from the attending physician. So, as in a personal conversation with each patient are directed on the clarification of reasons for the discrepancy of results the overwhelming majority of the respondents have answered that they wanted to wish and make a positive impression on the attending physician. Conclusion: In patients with pulmonary tuberculosis, there is a fear of stigmatization in relation to them from the society that negatively affects the relationship of the attending physician and the patient. Because the selected questionnaires refer to an indirect method of diagnosing compliance and depend on the conscientiousness of the examinee, it is necessary to exert all efforts establish a cooperation between the attending physician and the patient.

Objective: To optimize the diagnostic accuracy of the postoperative adhesion process on the background of undifferentiated connective tissue dysplasia (UCTD) in patients with chronic pelvic pain Methods: The study conducted based on the Regional Clinical Hospital "Regional Clinical Perinatal Center", during which 60 patients diagnosed with tubal and peritoneal infertility. Patients divided into 2 groups based on a modified scoring scale of T. I. Kadurina. A study of genotype-phenotypic predictors carried out by analyzing the expression of UCTD by the method of profiling phenotypic markers, according to a modified scale of T.I. Kadurina. The study of polymorphism of VEGF 634 [rs2010963], IL6-174 [rs1800795] genes, and the evaluation of the adhesion process according to the classification system of the American Fertility Society, the genetic predisposition to the development of the adhesion process by the method of genotyping acetylation and pain intensity on a visual analogue scale. Results: Patients with the grade of UCTD scores equal to 10 or more according to the modified scale of T.I. Kadurina assigned to the high-risk group for pelvic peritoneal adhesions (PPA). Diagnosis of predisposition to adhesions by methods of determining the type of acetylation and ultrasound suggests the presence of adhesions in the small pelvis before surgery in 76.66% and 65% of those examined respectively. The molecular-genetic predictors of UCTD are C/C IL6-174 allele C and C/G VEGFA 634 allele G. The intensity of chronic pelvic pain in the adhesive process depends on the stage of the latter. To predict the risk of development of PPA, the developed mathematical model based on P = 1/(1+еЂ(–z)) and independent predictors should be used: myopia, mitral valve prolapse, IL6-174 [rs1800795], VEGFA 634 [rs2010963] and phenotype of acetylation. Conclusion: Using the method of binary logistic regression on the basis of clinical, anamnestic, experimental and molecular-genetic data makes it possible to determine the probability of development of PPA on the background of UCTD using the formula: P = 1/(1+еЂ(–z)).

A historical and literature review providing insight into the development of adolescent medicine as a discipline in the Kyrgyz Republic was conducted. In addition, the paper presents the scientific research results considering how to solve urgent health problems in children and adolescents. The research was carried out by adolescent medicine specialists and postgraduate students over the years. A fundamental contribution to the field of adolescent medicine was made by Associate Professors B.M. Mamytov and R.A. Nedviga. In the post-world-war II period, the research was focused primarily on studying nurturing and educational environments, as well as assessing the health status of children and adolescents. However, in recent years, scientific work on providing students with proper nutrition in various educational institutions has become particularly relevant. Keywords: Child and adolescent health, science, research, the contribution of scientists.

Objective: Treatment of coarctation of the aorta (CoA) patients remains an unresolved aspect of cardiac surgery. There are two groups of patients with this congenital heart defect (CHD). One group includes newborns who have juvenile CoA and other CHDs. Organs below the CoA area rely on a functioning patent ductus arteriosus for blood supply. Another group of adult patients with an isolated form of CoA primarily consists of teenagers and young males accidentally diagnosed with arterial hypertension. Treatment of patients until the early 1990s was only surgical; now, most undergo endovascular interventions. This case report describes a successful CoA stenting procedure performed on an adult patient at our center.

Objective: Assessing short-term and long-term results of multivisceral resections (MVR) performed for rectal cancer (RC) with invasion into adjacent pelvic organs, as well as the effectiveness of bladder reconstruction with the formation of a urinary reservoir of «low» pressure. Methods: The work was based on the results of surgical treatment of 37 patients with locally advanced or primary multiple RC underwent MVR. Invasion of adjacent small organs was observed in 89.2%, primary multiple malignant tumors (PMMT) – in 10.8% of patients included in the study. Results: According to the preoperative examination of tumor infiltration of one adjacent organ was diagnosed in 20 (54.1%), two or more organs – in 17 (45.9%) observations; more often affected the bladder – in 18 (48.6%) cases. Volumes of performed operations: in 6 (16.2%) cases of complete pelvic organs evisceration, in 10 (27%) cases of MVR with rectal extirpation, in 21 (56.8%) cases of MVR with resection of the rectum and adjacent organs. More often in 27 (72.9%) patients, there was urinary tract resection, of which 11 (29.7%) patients underwent primary bladder repair with the formation of ortho- (n=3) or heterotopic (n=6) urinary reservoir of «low» pressure. Postoperative complications developed in 14 (37.8%) patients, what required re-surgery in 8 (21.6%) observed, of which urological complications occurred in 4 (10.8%) patients. Complications were not observed during the formation of the artificial bladder according to the presented method. Long-term results: RC – overall and disease-free 2-year survival – 78.1% and 65.6% respectively, PMMT – all patients are alive without signs of relapse, the timeline of observation is 24 months. Conclusion: The immediate results of MVR on locally advanced RC can be considered as satisfactory. The level of postoperative complications is primarily due to the prevalence of primary tumors. In case of urinary tract resection, primary plastic surgery is preferred. Long-term results allows to examine such operations as a method of choice in the treatment of RC with invasion in adjacent organs.

Objective: A comparative assessment of the quality of life (QOL) parameters in patients with head and neck cancer (HNC) depending on the methods of reconstruction. Methods: A prospective and retrospective observation and follow-up of 169 patients with HNC aged from 25 to 92 years old was carried out. The main group included 108 (63.9%) patients, who underwent one-stage reconstruction of surgical defects by 132 various pedicle flaps with axial type of vascularization: myocutaneous 65 (49.2%), fasciocutaneous 56 (42.4%) and other 11 (8.2%). The control group consisted of 68 (36.1%) patients to whom the surgery was completed with minimal reconstruction to the defect with local tissues or free skin graft. The performance status and QOL of the patients were assessed with Karnovsky Scale, ECOG-Performance Status Scale and the EORTC QLQ-H&N-35 questionnaire. Results: The baseline performance status of patients in the study and control groups was at the same level – in the range between 40-80 points according to the Karnovsky Scale. After surgery, changes in the general condition of patients in both groups were achieved towards improvement – in the range from 60 to 100 points. Evaluation of the patients` ECOG performance status before and after surgery showed that postoperatively, this status changed from ЕСОG 1-2 to ЕСОG 0 in 63.9% of patients in the main group and 37.7% in the control group. The analysis of the results of the QOL EORTC-QLQ-C30/H&N35 questionnaire revealed significant positive changes in all parameters of the QOL of patients of the main group, and among the patients of the control group after surgery no positive changes were noted. Thus, statistically significant positive results were obtained for the parameters of the QOL in patients of the main group for all three assessment tools. Conclusion: Despite the complexity and versatility of the assessment, and the subjective nature of the QOL parameters, we can conclude that simultaneous reconstructive surgery for locally advanced head and neck cancer with pedicle flaps has a positive effect on the QOL of patients and accelerates their rehabilitation.

Objective: To evaluate the effectiveness of a screening programme for detecting allergic rhinitis (AR) and its risk factors (RFs) based on a 5-year epidemiological analysis among children ages 0 to 17 years in the Odintsovo urban district in Moscow Oblast, Russia. Methods: A retrospective study of polyclinic facilities' performance indicators and an analysis of outpatient records of patients diagnosed with AR between 2017 and 2021 were carried out. The rates of incidence, prevalence, risks and odds ratios for AR were assessed. Results: A database of identified 28 RFs for AR was registered at the Federal Service for Intellectual Property of the Russian Federation (Rospatent) (Certificate of Registration # 2022620939 dated April 13, 2022). All RFs for AR, in terms of modifiability, were divided into three groups: non-modifiable, partially modifiable and modifiable. When assessing the relative risks and risk probability, it was found that the impact of RFs is uneven in different age groups. Therefore, age groups with the highest risk probability for AR were determined. In addition, a screening program has been developed. Conclusion: Epidemiological research and knowledge of modifiable age-related AR RFs will allow the early detection of AR in children's different age groups through cascade screening programmes.

Objective: Examining issues of continuity of the ambulance service (AS) with primary health care, Nursing Care Hospital and other profile services. Methods: An analysis of the activities of the AS station, Nursing Care Hospital, city health centers, large hospitals were carried out. The materials of the Traffic Police Department of Dushanbe were used in the victims of road accidents, as well as the existing normative legal acts and regulating the activities of the Ambulance Medical Care. Results: The need for medical social assistance (hospital stage) increased 4 times. Number of AS calls in the working hours health centers increased by 45.3%. The number of patients, who died in an accident before the arrival of AS, due to the lost "golden hour", was 13.9%. Conclusion: Rational use of the possibilities of the Nursing Care Hospital, Health Centers, the extension of the bed fund for medico-social care, and the adoption of a number of integrated measures a legislatively and organized nature, including measures at reducing fragmentation of health care can significantly reduce the load on the ambulance.

Objective: To assess the results of the treatment of spinal muscular atrophy (SMA) in children using international scales of physical capacity assessment and computer electroneuromyography on different stages of the disease. Methods: 95 children with a genetically confirmed diagnosis of proximal SMA from Donetsk region and other regions of Ukraine, as well as neighboring countries were under observation. All patients, depending on the therapy, were divided into two groups: the main group consisted of 65 children (68.4%), who received treatment based on the method developed by us; the control group comprised 30 children (31.6%) who received general therapy incorporating drugs from the metabolite group in age dosages and symptomatic drugs. Results: An interim evaluation of the effectiveness of therapy was carried out after 2 years, the final assessment – based on 4 years of catamnesis observation by statistical processing of patient’s physical performance assessments. According to the interim and final results, the severity of the clinical condition is reliably higher in patients of the control group with the SMA II and III type. Conclusion: A comprehensive approach to the evaluation of the treatment of SMA, both from a clinical and additional research perspective, effectively promotes differentiated phases selecting therapies aimed at slowing down the pathological process, preventing complications and improving the quality of life.

Objective: To assess the effect of intraoperative neurophysiological monitoring (IONM) on the incidence of life-threatening complications of the surgical treatment of thyroid diseases in the operating room and intensive care unit. Methods: A retrospective analysis of the medical records of 212 patients aged 31 to 72 was carried out. Depending on the treatment modality, they were divided into two groups. In group I (study group, n=96), IONM was used during surgery, and in group II (control group, n=116) – the surgery was performed without IONM. The effectiveness of IONM was assessed based on the number of complications and tracheal reintubation in the postoperative period. Results: IONM contributed to a statistically significant decrease in the number of postoperative complications. Thus, injury to the recurrent laryngeal nerve (RLN) was noted in 1 (1.0%) patient in the study group versus 17 (14.6%) in the control group (p0.05) and the overall treatment time (59.1±1.7 and 121.3±4.8 patient days in the study and the control groups, respectively, p

The article presents a general description of the lymphatic system and detailed characteristics of the structure of the terminal thoracic duct (TD) and lymphovenous junction (LVJ): their clinical and anatomical features, the role of LVJ in regulating lymph flow, and the separating two systems (circulatory and lymphatic). The presented data expand the concept of the structural and functional characteristics of the left central LVJ, its valves, and TD, and also provides information about the anatomical heterogeneity of the studied tissue complex. The morphological and functional characteristics of LVJ will help to better understand the logistics of the lymph flow and the mechanism of the LVJ valves’ work. Keywords: Lymphatic system, thoracic duct, lymphovenous junction, ostial valve.

Objective: To explore the character of androgen-dependent dermopathy (ADD) in women with keloid scars. Methods: 100 girls and women aged 15-28 years were examined, of whom 47 were with «true» and 53 were with «false» keloids. The evaluation of keloid scars was carried out using the Vancouver Scale (Baryza MJ, Baryza GA, 1995), modified Fistal HH (2006). Hyperandrogenic skin conditions were evaluated using the dermatological acne index (DAI), the Ferriman-Galway scale and the trichoscopy method. Results: Acne was detected in 47 (100%) patients with «true» keloids and 40 (75.5%) patients with «false» keloids. Seborrheic dermatitis occurred in 32 (68.1%) cases of «true» and 27 (51.0%) observations of «false» keloids. In both groups of patients, the borderline condition between normal and excess haired, which in 22 (46.8%) patients with «true» keloids amounted to 10,5±1,2. Signs of androgenic alopecia were detected in 35 (74.5%) patients with «true» and 38 (71.7%) patients with «false» keloids. In «true» keloids, the density of hair in the androgen-dependent (parietal) area was lower than in patients with «false» keloid scars (171.3±14.6 vs. 273.2±17.5). The androgen-independent occipital area, the density of hair in patients with «true» scars was lower (191.3±11.2), than in patients with «false» keloids (241.0±18.5). In all patients with «true» keloids observed a combination of scarring with ADD. In 13 (24.5%) patients with «false» keloids correlation with ADD was not observed. Conclusion: The most typical ADD in women with keloid scars are the acne and androgenic alopecia, which occur respectively, in 100% and 74.5% of cases in «true», and in 75.5% and 71.6% with «false» keloids. Consequently, hyperandrogenic skin conditions in women may be risk factors for keloids and indicate a hormonal imbalance in this contingent of patients.

Objective: To determine the impact of anemia on the structural-geometrical condition of the heart in patients with rheumatoid arthritis (RA). Methods: 154 patients with RA were included in the study: 37 patients with anemia (1st group) and 117 – without systemic manifestations of RA (2nd group). All patients underwent echocardiography. Results: Both groups were comparable in age, sex, ratio of seropositive and seronegative patients. A comparative analysis of both groups revealed that in 1st group DAS28 was higher than in 2nd group (p

Modern anesthesia is a very complex process, in which an important role is played not only by a highly qualified specialist, making quick and deliberate decisions in emergency and planned situations, but also a set of ways to solve the problems faced by him. This review provides information on pharmacological drugs – anesthetics, used to perform spinal and epidural anesthesia, which are described in chronological order. The origin of anesthetics is considered; as well as their inventors and promoters, positive and negative effects; indications and contraindications; choices of local anesthetics for various surgical interventions; methods of their application; dose and volume; and physiological effects of neuraxial blocks. In recent years, there have been global changes in the pharmacological arsenal of anesthesiologists. New pain management drugs with significant benefits have emerged. Modern anesthetics provide a longer analgesic effect than their precursors, lack significant toxic effect, do not cause significant hemodynamic changes during surgery, and have a short latency period, which allows them to be recommended for spinal, epidural and spinal-epidural anesthesia. Keywords: Local anesthetics, spinal anesthesia, epidural anesthesia, spinal-epidural anesthesia.

Objective: The paper describes the case of successful diagnosis and surgical treatment of an aneurysm of the internal jugular vein (IJV) in a young patient. Keywords: Aneurysm, internal jugular vein, diagnosis, treatment, results.

Objective: To study the principles of the use of anti-diabetic drugs in the medical system of Avicenna based on the features of the «mizaj» of medicines. Methods: For the analysis the understanding of the Avicenna processes of diabetes genesis, the treatment of diabetes and its prevention, screening of his works was carried out: all the books of the five-volume «Canon of Medicine», medical treatises «Al-Vohiya» («Recipe Code»), «Ash-Shifa» («Book of Healing»), «The Treatise on Medical Care», «The Treatise on Medicines», «The Treatise on Heart Medication», «The Treatise on Pulse». Results: Screening of Avicenna’s works allowed allocating 84 medicines used for diabetes therapy and prevention. Most of the remedies have plant origins, including gums and gum-resins. The list also contains mineral and animal remedies. Most anti-diabetic remedies on Avicenna have «hot nature», i.e. warming and leaching properties. Cooling action with «cold nature» products was aimed at reducing the body’s fluid loss in diabetes. The combination of Avicenna’s various remedies recommended balances their effects on the body and alternating their use will add the correction of the «mizaj» in diabetes. Conclusion: Treatment of diabetes, as a condition of poly-morbidity with numerous metabolic disorders, requires taking into account the relationship between multicomponent phytochemical composition, the versatility of the range of therapeutic actions of natural origin remedies and the features of the «mizaj» of the patient’s body

Objective: To study the state of cytokine status in the dynamics of the disease and find out its role in the course of a whooping cough in children of the first year of life. Methods: Twenty children have surveyed at the age of 1-year-old with a diagnosis of a whooping cough, which formed the main group, as well as 30 practically healthy children of the same age who formed the control group. The concentration of pro-inflammatory cytokines (IL-6, IFN-γ) and the anti-inflammatory cytokine (IL-4) studied by enzyme immunoassay. Results: The analysis of the peculiarities of the cytokine profile in patients with whooping cough showed that the most significant violations concerned the ability of lymphocytes to produce IFN-γ, which was low, starting from the 2nd week, and throughout the disease in all variants of whooping cough. Also paid attention to the active products the of one of the pro-inflammatory cytokines IL-6, which exceeded control value in half and more. The level of antiinflammatory cytokine IL-4 was not significantly different from such of practically healthy children. Conclusion: Multidirectional changes in the level of cytokines in the dynamics of the infectious process and depending on the severity of the pathological process, allowing predicting the current outcome of this infection. Analysis of the obtained data revealed a correlation of different levels between pro-inflammatory and anti-inflammatory cytokines, which play an important role in inflammatory mediators during whooping cough in children.

Objective: To evaluate the spectrum of antibacterial activity of plants growing in the central part of the Republic of Tajikistan. Methods: The antibacterial properties of 18 plant species from the 14 families were studied. The extract samples on dry filter discs were prepared according to the method developed at Rutgers University. Screens-to-Nature (STN) and disc diffusion (DD) methods were used to assess antimicrobial properties of the extracts. The antimicrobial activity of plant extracts was determined against four types of pathogenic standard museum strains of Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae, as well as by using the same types of microorganisms isolated from inpatients (the hospital strains). Results: Ethanol extract from leaves of Artemisia absinthium demonstrated a broad-spectrum high degree of antimicrobial activity against both reference and hospital strains of S. aureus, P. aeruginosa and E. coli. The Morus nigra extract also showed broad-spectrum activity, however overall antibacterial activity was lower than in A. absinthium. In general, tested extracts were less effective against E. coli. None of the 18 tested extracts showed activity against K. pneumoniae. Conclusion: Artemisia absinthium and Morus nigra have a broad-spectrum antimicrobial effect and differ only in the degree of activity. The extracts of Amaranthus tricolor and Arctium tomentosum, Indigofera tinctoria, Punica granatum were characterized by a somewhat narrower spectrum of action. Mentha arvensis and Allium suworowii had approximately the same degree of inhibitory ability.

Objective: To study the features of lipid peroxidation (LPO) and the antioxidant system (AOS) in blood in Takayasu arteritis (NF) with a predominant lesion of brachiocephalic vessels. Methods: Several markers of LPO (malondialdehyde – MDA), AOS (superoxide dismutase – SOD, ascorbic acid – AA) and inflammation (sialic acid – SA) were studied in 16 patients with type I TA, where the inflammatory process was localized mainly in the aortic arch and its branches. Most commonly TA was observed among females (n=14; 87.5%), the average age of patients was 20.8±0.8 years. The study of the above markers was carried out in two stages: upon admission of patients in the stage of exacerbation of inflammation and after targeted anti-inflammatory, immunomodulatory and antioxidant therapy – in the stage of remission of the inflammatory process. Results: The study of LPO and AOS showed that in all patients, upon admission, there was a considerable oxidant-antioxidant imbalance due to an acute inflammatory process. MDA was increased by 2.6 times constituting 3.9±0.1 μmol/l. After pathogenetically targeted therapy, its significant decrease to 2.9±0.1 μmol/l (р˂0.001) was achieved. Activation of LPO was paralleled with a significant decrease of the body's AOS markers. The activity of SOD and concentration of AA during acute inflammatory process was reduced by 1.4 and 1.3 times, and amounted to 13.3±0.1 c.u./l and 57.8±0.3 μmol/l, respectively. After pulse therapy these indicators showed a significant increase compared with the initial data: up to 15.9±0.2 c.u./l and 63.9±0.4 μmol/l, respectively. The content of SA, which is one of the important components of cell membrane glycoproteins and glycolipids, was increased by 2.3 times (6.1±0.1 mmol/l), while after treatment it significantly decreased to 3.4±0.1 mmol/l (p˂0.001). Gender and age did not affect the dynamics of the specified markers, except for SA, which showed higher values in women (p

Objective: : Analysis of literature sources on variant anatomy of arteries arising from aortic arch and branches. Methods: Analysis of cases of the variant anatomy of arteries arising from the aortic arch (AA) and their branches, based on autopsy, surgery, and modern diagnostic techniques. To gather information, we utilized a range of online resources such as https://www.library.ru, https://www.scopus. com, https://femb.ru/, https://www.cochranelibrary.com/, http://www.acponline.com, https://www.sciencedirect.com/, https://www.embase.com, and the Yandex search engine. The primary research methods utilized were bibliographic and comparative in nature. Conclusion: The AA anatomy displays frequent variations in medical practice. To prevent complications and errors, it is imperative to thoroughly evaluate the patient before performing angiography, surgery, or any relevant medical procedures. Keywords: Aortic arch, branches of the aortic arch, brachiocephalic trunk, variant anatomy, variation.

Objective: To evaluate the results of diagnosis and treatment of patients with cerebrovascular diseases (CVD) using modern technologies Methods: The results of the diagnosis and treatment of 105 patients with CVD for the period from January 2018 to May 2022 were evaluated. The age of the patients ranged from 10 to 75 years. The Glasgow Coma (GCS) and Hunt-Hess (HHS) Scales were used to assess the severity of the disease. In patients with arteriovenous malformation (AVM), the Spetzler-Martin grading scale was used to determine the size, location, and drainage into the deep cerebral veins. The Fisher scale was used in all cases of subarachnoid hemorrhage (SAH). Additional research methods included computed tomography (CT), magnetic resonance imaging (MRI), and digital subtraction angiography (DSA). Results: Of the 105 patients, operations were performed in 55, the remaining 50 patients underwent conservative treatment (due to refusal of surgery). The main reasons for the development of non-traumatic intracranial hematomas (NICH) were: hypertension – in 30 (28.5%) cases, arterial aneurysm (AA) – in 12 (11.4%) cases, AVM – in 20 (19.5%) cases and other causes in 8 (7.6%) patients. Out of 38 (69.1%) patients operated on during the acute period, 5 (9.1%) underwent surgery during the first 5 days, while 12 (21.8%) – were operated on within 10-14 days. The following interventions were performed: external ventricular drainage – 10, removal of blood clots from the basal cisterns – 1, clipping of vessels – 7, and decompressive craniotomy – 37. In the group of operated patients, mortality was 9.1% (5 patients); mortality in the conservative treatment group constituted 40% (20 patients). Conclusion: The wider use of modern and highly informative imaging methods resulted in increased detection of asymptomatic AVMs and AA. This, in turn, contributed to the application of adequate treatment techniques in a relatively safe period of the disease, thereby reducing the frequency of deaths and serious complications.

Objective: To study and evaluation of modern approaches to early diagnosis of primary knee osteoarthritis (PKOA), analysis of the frequency of comorbid diseases. Methods: The study included 98 patients with PKOA. In order to early diagnose the disease and determining prevalence and spectrum of the comorbid pathology, all patients were submitted to a comprehensive clinical laboratory and instrumental survey. Results: The most informative symptoms in the early diagnosis of PKOA were typical pain syndrome, sluggish synovitis and specific changes from the soft peri- and intraarticular tissues and bone structures of the knee joint, detected by MRI and arthrosonography (ASG). Comorbid diseases had 80.6% of the patients examined. Most commonly identified: cardiovascular pathology (CVP, 73.4%), metabolic syndrome (MS, 66.3%), gastrointestinal pathology (19.4%), type 2 diabetes mellitus (16.6%) and respiratory system diseases (12.2%). The majority of patients (66.2%) with developed of PKOA (of II and III stages) had two or more comorbid diseases. Conclusion: Early diagnosis of PKOA implies a comprehensive assessment of both subjective and objective symptoms of lesion, as well as MRI and ASG data. The most common and prognostically unfavorable comorbid diseases in patients with PKOA are CVP and MS, which have close associative relationship with the pathogenetic aspects of PKOA.

Objective: Improvement of the results and effectiveness of endoscopic treatment for arachnoid cysts of the middle cranial fossa (AC MCF) in children. Methods: At the Federal Center for Neurosurgery of Tyumen 65 patients with AC MCF were operated from 2012 to 2018 by endoscopic cystocisternostomy (ECCS). Patients age ranged from one month up to 17 years. Children under 3 years old were – 32 (49%). Hypertensive symptoms were in 26 (40%); delayed speech development in 20 (31%); symptomatic epilepsy in 12 (18.5%); pathology of the ocular fundus was in 5 (7.7%). Associated abnormalities were in 19 (29%). All patients underwent CT and/or MRI. In 46 (71%) patients, cysts were located on the right, in 13 (20%) on the left and 6 (9%) bilateral. The displacement of the middle structures was diagnosed in 45 (69%). According to the Galassi classification: type II was in 20 (31%), type III – in 45 (69%) patients. The average volume of AC MCF before the operation was 181±18.6 cm3. All 65 patients underwent ECCS: a miniature neuroendoscope KarlStorz – Endoskop 11576 KF/KG was used in 47 patients, and a standard rigid endoscope LOTTA, «Gaab I scope» or flexible video scope was used in 18 patients. Results: The postoperative observation period ranged from 1 year to 8 years. The volume of cysts after surgery averaged 124.8±17.2 cm3. On average, the volume of cysts decreased by 58.2±13.5 cm3. The total efficiency of ECCS in 65 patients with AC MCF reached 81.5% of cases. Relapse was noted in 14 patients (22%). The period of recurrence ranged from 1 month to 81 month. Recurrence was in 71% of children under the age of 3 years. There was a correlation between repeated interventions and age. Children under 3 years of age have the efficiency of surgical treatment at 68.8% than in children over 3 years old – 93.8% (p≤0.01). The results of surgical treatment, depending on the endoscope used, were statistically unreliable, because when using Karl Storz – Endoskop 11576 KF/KG the total efficiency was 81%, and when using LOTTA, «Gaab I scope» or a flexible video scope – 84%. Complications in the postoperative period occurred in 6 (9%) children. Conclusion: The effectiveness of ECCS in 65 children with AC MCF reached 81.5% of cases. The effectiveness of ECCS in children under 3 years of age was 68.7%, and 93.7% in children older than 3 years.

Objective: To study genetic determinants in patients with atrial fibrillation (AF) on the background of arterial hypertension (AH) in combination with various extracardiac comorbid pathology. Methods: In a prospective cohort study included 167 patients with paroxysmal and persistent forms of AF and stage II hypertension without CAD. The average age of the patients studied was 53.3±7.1 years. DNA isolation from blood leukocytes was carried out by phenol-chloroform extraction. Testing polymorphism rs2200733, polymorphism 174G/C (174G/C (rs1800795) gene IL6), the IL6 gene performed with PCR with RFLP. Testing of statistical hypotheses was carried out at a critical level of significance p=0.05, i.e. the difference was considered statistically significant at p

The presented review of the literature examines the main issues of cognitive function in patients with high blood pressure. More than a quarter of older people have cognitive impairments, and hypertension is seen as a contributing factor to such disorders. An analysis of the effects of some hypotensive drugs on the cognitive functions of patients in this category is given. The findings suggest that effective hypotensive therapy reduces the incidence of cognitive impairment in given patient’s categories. Keywords: Arterial hypertension, cognitive function , old age, hypotensive therapy.

Objective: To study the influence of gender stereotypes of personality (GSP) and family settings (FS) on the course of arterial hypertension (AH) in middle-aged patients. Methods: One hundred sixty patients examined with AH who were under observation for at least two months after in-patient treatment. Patients divided into 2 groups: I group – 80 people (men – 34, women – 46, average age 53.2±0.45 years) with resistant hypertension; Group II – 80 patients (men – 36, women – 44, average age 53.3±0.5 years) with controlled hypertension. In all patients, GSP studied for the index staple (IS) and CS for the family settings (FS) in comparison with adherence to treatment and cardiovascular risk. Results: Frequent GSP with AH was masculine and high-masculine, revealed in 71.3% of patients with resistant and in 52.7% of patients with controlled hypertension. A moderate positive relationship between IS and FS has been established (r=0.593852, p

Objective: To evaluate the effectiveness of ozone therapy in the combination of arterial hypertension (AH) and gastropathy in miners. Methods: Two groups of male miners with AH and gastropathy were analyzed: group I – 43 miners aged 47.4±1.3 years with work experience of 27.9±1.9 years and group II – 42 miners aged 46.9±1.4 years with work experience of 27.1±1.8 years. Group II received drug treatment only, and group I, in addition, received ozone therapy. An ozone-oxygen mixture was administered intravenously in an amount of 200-400 ml with an ozone concentration in a solution of 1-1.5 mg/l five times every other day. To assess the effectiveness of the ozone therapy, the lipid profile was studied, the level of blood pressure was monitored, and fibrogastroduodenoscopy was performed. Patients were examined before the start of the course of ozone therapy, control examinations were carried out on the 12th day from the moment of treatment. Results: In both groups, individuals with grade I AH showed a statistically significant (p

Objective: The article analyzed the possibilities of hybrid and endovascular operations in the treatment of patients with chronic ischemia of the lower limbs. The analysis of the literature shows that at the present stage these interventions are being applied more and more often, often being an alternative to traditional operations. Most researchers have proven that when performing hybrid and endovascular operations, a low incidence of cardiovascular events and infectious complications is noted, and in most cases, it is possible to save the limb. However, the effectiveness of this or that method of treating peripheral artery disease of the lower limbs depends both on the degree of limb ischemia and anatomical level of the lesion where performed revascularization. To date, the literature on this issue does not have a definitive answer regarding the priority in choosing the method of revascularization of the limb. This is primarily due to the type of arterial lesion, the level of occlusion or stenosis, and the presence of severe comorbid status, the experience of the surgeon and the technical equipment of the clinic. Keywords: Atherosclerosis , lower limb ischemia , hybrid operations, angioplasty, stenting , amputation .

Objective: To study and evaluate in a comparative aspect the effectiveness of methotrexate (MT) and leflunomide (LEF) in patients with active rheumatoid arthritis (RA) who have indicators of adverse «Treat to target – T2T» strategy. Methods: Monitoring and comparative evaluation of the effectiveness of therapy of modern basic anti-inflammatory drugs in 104 patients with active RA, which, depending on the character of the therapy was randomized and divided into three groups: I (n=34) – Metoject group (MTJ), II (n=36) – MT group and III (n=34) – LEF group. Results: Against the background of the therapy of MTJ, MT and LEF, the patients surveyed showed a statistically significant decrease in both clinicallaboratory activity indicators of RA and the level of pro-inflammatory cytokines (tumor necrosis factor alpha – TNFα, interleukin-6 – IL-6), the positive results of which were most vividly represented in patients of the MTJ group. By the time the study is completed (after 12 months), most patients have achieved the ultimate goal of therapy – a state of low disease activity/remission – and this figure, for I, II and III groups consisted of 78.2%, 73.1% and 44% respectively. Conclusion: The results of the study show a satisfactory performance/tolerability profile of MTJ, MT and LEF in an intensive mode in conditions of close scrutiny based on T2T strategy.

Methods: The relevance of nonparasitic cysts of the liver (NPCL) is related to their steadily increasing incidence, high recurrence rates, delayed diagnosis, and potential complications. In general, hepatic cysts (HCs) are classified into several types, including simple and complex, false and true. Simple cysts are mainly congenital but also occur in polycystic liver disease. Complex cysts include mucinous neoplasms, echinococcal cysts, hemorrhagic cysts, cystic hepatocellular carcinoma, and other rare lesions. Nonparasitic cystic liver lesions do not usually cause symptoms, and their characteristics are not specific. In 15% of cases, nonspecific signs (flatulence, nausea, dyspepsia) accompany pain. Diagnosis of NPCL is based on data from ultrasound, CT, or MRI of the abdominal organs. There still needs to be a consensus on surgical treatment indications or the effectiveness and feasibility of its various methods. Many surgical interventions for NPCL treatment include puncture drainage, multiple minimally invasive (laparoscopic) surgery options, and open methods. In clinical practice, laparoscopic fenestration, associated with fewer complications and faster recovery, has become widespread. However, significant progress has yet to be achieved in reducing NPCL recurrence rates despite advances in surgical treatment. Therefore, multiple studies are underway to improve treatment options for this medical condition. Keywords: Liver, cyst, nonparasitic cyst, pseudocyst, laparoscopic fenestration.

A review of literature data carried out on the most important aspects of epidemiology, risk factors and pathogenesis of metabolic syndrome (MS). Metabolic syndrome has been found in approximately one quarter of the world’s population, and, despite the large-scale treatment, preventive and health-improving promotion programs on a global scale, the number of persons with MS tends to increase annually, especially among young ablebodied age. There are many risk factors in its genesis, including genetic predisposition, low physical activity, poor diet, smoking, intestinal microbiota, obstructive sleep apnea syndrome and others, the role of most of which needs to be studied in more depth. Many criteria have been proposed for the diagnosis of MS, each of them has its own advantages and disadvantages. With MS, most organs and systems are affected, and with the combined involvement of the cardiovascular, endocrine, urinary, digestive and respiratory systems burdened clinical course of MS. In connection with the above, there is a reason for further scientific research to identify the causes and risk factors for the development of MS, development of preventive ways of prevention, preventive diagnostics and early treatment of MS. Keywords: metabolic syndrome, epidemiology, pathogenesis, diabetes mellitus, insulin resistance, obesity, hypercholesterolemia.

Objective: To study the current epidemiological trends related to PD in children Methods: In 2015-2016, a cross-sectional one-stage study was conducted to examine the PD of children. The body height and weight were determined during the examination program using standardized equipment and accepted methodology. The Body Mass Index (BMI, Quetelet's index) was expressed in kg/m2 , along with SD values (standard deviation) for both height and BMI. We utilized BMI-for-age percentile growth charts. Results: : 9,662 children between the ages of 1 and 17 were assessed, with 49.7% boys and 50.3% girls. The sample was split equally between urban and rural areas, with 50.0% residing in each. The age distribution of the participants was divided into five age groups: 1-2 y/o (14.5%), 3-6 y/o (19.6%), 7-11 y/o (30.7%), 12-14 y/o (19.1%), and 15-17 y/o (16.1%). Of those surveyed, 65.8% had an average height, 19.0% were below average or short, and 15.2% were above average and tall. The height 2SD below and above the mean height for age and gender was found in 3.7% and 2.7% of children, respectively. Most below-average and low height values were found in early and preschool ages. In boys, gender characteristics were associated with more significant variations in heights towards low and high values. Research shows that children residing in urban areas tend to have better physical development than those in rural areas. Conclusion: Data have been gathered on the current PD of children, focusing on age, gender, and geographical factors.