ANNOTATIONS

HEALTH CARE OF TAJIKISTAN

3 (326) 2015

Akhparov N.N.1, Nemilova T.K.2,Kagan A.V.2, Suleimanova S.B.1

EZOFAGOFUNDOPLIKATSIYA OF TAL WHEN GASTROESOPHAGEAL REFLUX DISEASE IN CHILDREN

  • Scientific Center of Pediatrics and Pediatric Surgery MZSR Kazakhstan, 050040, Kazakhstan, Almaty.
  • Pervy St. Petersburg State Medical University. Acad. IP Pavlova, 197022, Russia, St. Petersburg. For correspondence: Suleymanov Saul Bahtyarovna, saule_suleiman@mail.ru.

Congenital and developmental abnormalities of the gastrointestinal tract in children now are probably one of the most difficult sections of pediatric surgery. The big debate among practitioners cause disease, the main symptoms are vomiting. One of the brightest representatives of this group of diseases is gastro esophageal reflux disease (GERD). The high prevalence of GERD, as the availability of its typical symptoms, significantly affects the quality of life of patients and atypical clinical manifestations (bronchial asthmatic syndromes, neurological disorders), make the problem of the treatment of this disease is extremely important. The modern methods of correction of GERD great attention is paid to surgery. The abundance of antireflux surgery showed no methodology that would fully satisfy the surgeons would be safe and would not allow side-effects.

Key words: gastroesophageal reflux, antireflux surgery, children.

 

Botasheva V.S., Barotov F.A.

MORPHOLOGICAL CRITERIA FOR THE DIAGNOSIS OF ACUTE CORONARY SYNDROME

Department of Pathological Anatomy (Head., Ph.D., Professor VS Botasheva) state budgetary educational institution of higher education “Stavropol State Medical University” Ministry of Health of the Russian Federation

Relevance. Acute coronary syndrome (ACS) – a set of pathological reactions that occur during the development of myocardial infarction with ST-segment elevation, myocardial infarction without ST-segment elevation or unstable angina.The term ACS introduced into clinical practice to improve the diagnosis of early symptoms of unstable angina and myocardial infarction, and to expedite the provision of medical care in the prehospital phase.

Objective: to determine the nature of morphological changes in the myocardium in acute coronary syndrome.

Material and methods. Work carried out on autopsy material. A morphological study of the myocardium 136 deaths from acute coronary syndrome. For histological examination took pieces of the left ventricular myocardium and septum. Slices were fixed in 10% neutral formalin, histological sections prepared by an ordinary method. Using H & E stain, pikrofuksinom Van Gison, toluidine blue, Mallory, PAS-reaction was performed to identify glycogen. Immunnogistohimicheskim able to detect expression of myoglobin.

Results and discussion. Acute syndrome occurs predominantly aged 51-60 years (28.6%). By the nature of the pathological process identified unstable angina in 24.2% of cases, which is characterized by degenerative changes in cardiomyocytes breach of contracture, the disappearance of glycogen, localized fragmentation of muscle fibers, a weak expression of myoglobin. In 75.8% of cases diagnosed myocardial infarction, of which 33.1% was transmural infarction (with tooth Q), in 42.7% of cases melkoochagovyj myocardial infarction (non-Q wave). In acute coronary syndrome with the development of myocardial infarction revealed severe destructive changes, necrosis, the destruction of the nuclei, the disintegration of the cytoplasm, the lack of expression of myoglobin.

Conclusion. Thus, in cases of death from acute coronary syndrome with the development of myocardial infarction associated with severe destructive changes in the heart muscle with the development of necrosis, the destruction of the nuclei and cytoplasm of the collapse. In necrosis there is no expression of myoglobin. In cases with unstable angina revealed degenerative changes of cardiomyocytes breach of contracture, the disappearance of glycogen, fragmentation of muscle fibers. Immunohistochemical study observed decrease in the expression of myoglobin.

Key words: myocardium, cardiomyocytes, angina, heart attack, degeneration, myoglobin

 

Bobohodzhaev O.I., Sirojiddinova U.Yu., Dzhumaev R.R., Radzhabov D.M.

CAUSES OF RECURRENCE OF PULMONARY TUBERCULOSIS IN TAJIKISTAN

Department of Phthisiopulmonology, ATSMU

Introduction. Unfavorable epidemiological situation of TB, caused by a decrease of living standards, active internal and external migration, the presence of high levels of drug-resistant forms of the disease, is one of the urgent problems of Health [1]. Despite the considerable efforts done in the fight against TB, to date epidemiological situation of the disease in Tajikistan remains unfavorable [2]. Thus, according to the WHO, a settlement rate of tuberculosis in 2013 was 100.0 on 100 thousand population. Percentage of diagnosed cases of tuberculosis was 68% [3].

Aim. Investigation of the causes of recurrence of pulmonary tuberculosis in different regions of the Republic of Tajikistan.

Methods of investigation. In 2011, at the Regional Centre for Combating Tuberculosis of Kulob region, Khatlon province of the RT were withdrawn from the account and transferred under the supervision of PHC 521 people, who were on the account and were transferred to the dispensary observation during the period of 2009-2011.These patients were observed for three years until 2015. Among the 521 patients taken from the dispensary and transferred under the supervision of primary health care in the period of 2012-2014., 72 (13.8%) patients died, 21 (4.0%) patients dropped out due to relocation abroad. On 1.01.2015y 301 (57.8%) patients who recover from tuberculosis were under the supervision of primary health care, which were included in our group of study.

Results. All patients received standard chemotherapy regimen, including the intensive phase of treatment in tuberculous hospital and supportive therapy – on an outpatient basis. From observed patients at the end of treatment, 191 had outcome – “cured” (63.4%), the remaining 110 patients – “treatment completed” (36.5%). From present sample excluded patients with poor treatment outcome, in violation of the treatment regimen, dead or others. In the present study, we used the following definition of recurrences – outbreak of tuberculosis in persons who were under the supervision of inactive groups of dispensary registration or deregistered for recovery [9].In this study, we allocated recurrence according to the time of their development: early – that arose during clinical supervision (3 years) and late – when the patient was removed from dispensary observation (3 years or more).

Conclusion

  1. Recurrence depends on the presence and extent of residual changes in lungs after treatment.
  2. Patients with absence of residual changes in lung disease recurrence nor early nor late – not observed. However, patients with residual presence of small changes in lung disease recurrence was observed in 6% 0.
  3. Improving social conditions and maintain an adequate chemotherapy reduces the risk of recurrent disease.

Key words. Recurrence, pulmonary tuberculosis, residual changes in the lung

 

Daminova N.M., Gaziev Z.H.,Sa’dulloev D.

OPTIMIZATION OF DIAGNOSTICS AND TREATMENT OF POSTOPERATIVE

Introduction: The use of modern laboratory methods and videolaparoscopy significantly improved the treatment results of postoperative peritonitis.

Aim: to improve the results of surgical treatment of postoperative peritonitis.

Methods of investigation: Results of surgical treatment of 87 patients with PP, who were divided into two groups. At the first group was used minimally invasive technology, at the second – traditional.

Results. Modern technologies allowed to effectively diagnose PP, and in some cases to eliminate the source of peritonitis and thereby to improve the immediate treatment results of patients.

Conclusions.Postlaparotomic laparoscopy can effectively diagnose the PP, its reason, and in some cases to carry out medical aid.

Key words: postoperative peritonitis, postlaparotomic laparoscopy.

 

Ikromov T.Sh., Ibodov Kh. I.

COMPARATIVE ASSESSMENT OF EFFECTIVE METHODS OF POSTOPERATIVE ANALGESIA IN CHILDREN WITH UROLITHIASIS, COMPLICATIONS OF CHRONIC RENAL FAILURE

Institution of postgraduate education in the field of Healthcare of the Republic of Tajikistan (IPE HCRT), Dushanbe

Department of Pediatric Surgery, Anesthesiology and Reanimatology(head. -as.prof. Azizov B. Dzh.)

Introduction.Surgical interventions on the kidney in children are especially traumatic, accompanied by severe pain in the postoperative period, increased at cough and movement. Postoperative pain is a major cause of stagnant complications. Therefore, the struggle against postoperative pain is a component of intensive therapy.

Aim. To study the effectiveness of different methods of postoperative analgesia in children with urolithiasis, complicated by chronic renal failure.

Methods of investigation.We have studied the treatment results of 113 children with bilateral urolithiasis complicated by chronic renal failure in the age aspect from 2 to 15 years.

In order to objectively assess the analgesic effect of different methods of post-operative analgesia in children kidney, respiratory function and cardiovascular system. The intensity of pain was evaluated according to the five- point scale:1 – presence of pain at cough; 2 – Pain by deep inspiration; 3 – slight pain at rest, 4 – severe pain at rest (there is no effect from the analgesia). Patients were divided into 4 groups: I group (33) – postoperative analgesia carried out by intravenous injection of fentanyl and droperidol, II group (31) – carried out by baralgin analgesia. Group III (34) – postoperative regional analgesia through a catheter inserted intraoperatively in perirenal tissue of 1.0% lidocaine, IV group (15) was carried out -combinations of 1.0% lidocaine and Xefocam.

In addition to general clinical and biochemical analyzes were surveyed indicators of cardiovascular and pulmonary system.

Evaluation of the results of studies carried out in accordance with modern principles of evidence-based medicine. Obtained data was processed by the method of variation statistics with the definition of the average value (M), errors (± m) and evaluation criterion of reliability (P>). Accumulation and processing of the data was carried out using the program MSExcel (Ver.5.0).

Results. Depending on the methods of postoperative analgesia in Group 4 analgesic effect was observed in different ways. As drugs taken as analgesics and ways of introduction differ from each other. Effectiveness from medical analgesia by baralgin was minimal, and after fentanyl and droperidol appeared not only cardiodepressive effects, but also reduction in bronchial drainage function. During regional analgesia with lidocaine central hemodynamic parameters, blood gases and kidney function, compared with I – II groups were more effective. In patients of Group IV indicators show the greatest effectiveness, compared with Groups I-III.

Conclusion. Thus, effective analgesia is achieved by blocking parasympathetic and sympathetic nervous systems. This preserves the breathing, cough reflex and the activity of the patients. Improving the function of the operated kidney and blood flow helps to reduce the incidence of postoperative complications.

Key words: postoperative analgesia, pain, children, urolithiasis

 

Eltanazarov M.D., Olimov N.Kh., Sobirova* M.M.

OMACOR IN THE TREATMENT OF VENTRICULAR ARRHYTHMIAS

Republican scientific center of cardio-vascular surgery (dir. PhD Sharipov Z.R.,) MH and SPP, Republic of Tajikistan,

interregional cardiologic center, Penjikent (dir.M.M. Sobirova), Soghd Region, Republic of Tajikistan

Introduction. Ischemic heart disease (IHD), including ventricular arrhythmias have great practical importance in the hospital stage, and can be the reason of death of patients

Aim. Influence of the effectiveness of Omacor (omega -3 polyunsaturated fatty acids) in the incidence of ventricular arrhythmias in patients with ACS.

Materials and methods of investigation. The study included 150 patients with ACS. The estimation of intervals PQ, QT, the segment ST, the width of the complex QRS, investigation of the repolarization phase, as well as measuring the dispersion of the interval QT (d QT = QTmax-Qtmin) to detect ventricular arrhythmias.

Results. Proved that on the background of the basic treatment of patients with ACS, the use of Omacor at the hospital stage by 1000 mg per day is effective treatment for patients with ventricular arrhythmias. Omacor reduces the incidence of ventricular premature beats I and II gradation by 64%, and ventricular extrasystoles III and V of graduation of Lawn Wolf by 51.4%, helping to reduce mortality in these patients.

Conclusion. The study showed that the drug Omacor on the background of the basic treatment of patients with ventricular arrhythmias with ACS reduces the incidence of ventricular premature beats I and II gradation by

64%, ventricular extrasystoles III and V graduation of Lawn Wolf by 51.4%, helping to reduce hospital mortality. Considering the above we recommend to use Omacor in the treatment of patients with ventricular arrhythmias, both in hospital and in outpatient treatment.

Key words: Omacor – acute coronary syndrome – ventricular arrhythmia.

 

Olimov N.Kh., Eltanazarov M.D., Juraev Sh.M., Sobirova M.M.

LIFE THREATENING ARRHYTHMIAS AND RISK OF DEVELOPING MYOCARDIAL REINFARCTION AMONG THE PATIENTS WITH POSTINFACTION CARDIOSCLEROSIS AND SILENT MYOCARDIAL ISCHEMIA

Republican scientific center of cardiovascular surgery (head. PhD Z.R. Sharipov), Ministry of health and Social protection of the population, Republic of Tajikistan,

*Interdistrict Cardiology Center, Panjakent (head. М.М. Sobirova), Sogd district, Republic of Tajikistan

Introduction: Ischemic heart disease (IHD) is increasingly complicated by myocardial infarction and death, the cause of which is life-threatening arrhythmias. However, in the post-MI period ischemia manifests with silent forms of myocardial ischemia, which is not always possible to diagnose and select the appropriate treatment.

Aim: based on the analysis of extracardia heart rate regulation, to identify the risk of arrhythmias and myocardial reinfarction in patients with postinfarctioncardiosclerosis with silent form of myocardial ischemia.

Methods of investugation: The study included 100 patients with postinfarctioncardiosclerosis (with Q-wave myocardial infarction, 86 of them patients with anterior and 14 patients with posterior myocardial damage) with silent form of myocardial ischemia who were on an inpatient treatment. Basic measured parameter was the length of RR interval. The object of analysis is the statistics of the values of R-Ri (i=1…n) and the structure of its fluctuations.

Results: In our observations in these patients prevailed sympathetic activation. Increased tone of the two divisions of the autonomic nervous system, as you know, can lead to changes in the functional state of the heart, increase the heterogeneity of the heart muscles and create prerequisites for the development not only of life-threatening cardiac arrhythmias, but also sudden death.

Conclusion: Investigation of parameters of extracardiac regulation of heart rate in patients with postinfarctioncardiosclerosis with silent form of myocardial ischemia, allow proactively diagnose decrease in stability regulation of cardiac activity and help to identify patients who have a high probability of the risk of instability in the coronary system (myocardial reinfarction, arrhythmias), which turn, allows to choose the adequate effective therapy for these patients.

Key words: postinfarction cardio sclerosis and silent IHD, extra cardiac regulation, arrhythmias and acute MI.

 

Sultanov1 Kh.S, Alimova1 N.A., Sharipova1 Kh.Yo.,

BLOOD PRESSURE VARIABILITY AND ADHERENCE TO TREATMENT OF MIDDLE-AGED MEN WITH ARTERIAL HYPERTENSION ON THE BACKGROUND OF CONTROLLED THERAPY

Department of Propedeutics of Internal Diseases 1 (head- corresponding member of AMS RT professor Shukurova S.M.) and Department of Internal Diseases № 22 (head- assoc. professorKhursanov N.M.) ATSMU.

Introduction. The prevalence of arterial hypertension (AH) in the stipulated population of the Republic of Tajikistan (RT) increases with age, and its incidence in men ranges from 16% to 43.9%, features of the data of middle-aged men particularly stress and depression, factors contributing to the development of arterial hypertension,

inadequate medical and preventive help determine this age range as the most vulnerable period of life and as an optimal base for the development of the pathology of cardiovascular system.

Aim. Assess the dynamics of adherence to treatment and daily variability of blood pressure of middle-aged men with mild and moderate hypertension on the background of traditional and controlled therapy with multi prevention of CV diseases

Methodsofinvestigation. A prospective observation of 117 women with mild and moderate hypertension, treatment of all patients included huge measures to increase adherence to treatment and lifestyle changes, pharmacotherapy with basic antihypertensive drugs. Statistical processing of materials by variation statistics method. Comparison of relative values held by criterion y2, and the absolute values according to t – Student criterion.

Results. During observation for 54 weeks, on the background of traditional therapy, generally, was determined adherence of patients with AH to recommended not medical and medical therapy.

The duration of the hypotensive effect of directly conducted TPT in middle aged men with mild and moderate hypertension persists much longer on the background of controlled therapy than traditional.Overall reduction in the incidence of pathological profiles AE in middle aged men on the background of controlled therapy of arterial hypertension was maintained until the end of observation.

Conclusion.In middle-aged men with mild and moderate AH conducting traditional and controlled therapy at a stationary stage significantly increases compliance and increases the frequency of optimal blood pressure profile.In the dynamics of the gradual reduction of adherence to treatment and increased frequency of abnormal blood pressure profile on the background of traditional therapy contribute to the appearance of significant differences to the end of observation. Controlled treatment of mild and moderate hypertension in middle-aged men is the most effective treatment of this disease.

Keywords: arterial hypertension, traditional and controlled therapy.

 

Tairov U.T., Kudratov A.R..

USE OF A COMBINATION OF SYNTHETIC AND BIOCOMPOSITE OSTEOPLASTIC MATERIAL WITH PLATELET-ENRICHED PLASMA FOR SURGICAL TREATMENT OF ODONTOGENIC JAW CYSTS

Scientific Clinical Institute of Dentistry and Maxillofacial Surgery

Introduction. The cause of the bone defects of the maxillofacial area are various, including in the cystic lesions.

During surgical interventions on the jawbones should be considered features of subsequent reparative process of osteogenesis. Search for all sorts of options to accelerate reparative regeneration both from the use body’s own cells and use of biological and synthetic materials still remains relevant.

Aim. To improve the effectiveness of surgical treatment of odontogenic cysts of the jaws by applying a combination of biocomposite (CollapAn-L) and synthetic (Genesis-BCP) material with a plasma enriched by platelets and fibrin.

Methods of investigation. Results of surgical treatment of 31 patients with radicular cysts of jaws, the size of bone cavities ranged from 0.5 to 3 cm.

Results. During comparative study of patients main and control group was observed that hyperemia and edema of the mucous membrane of the operating area in the main group is significantly lower than in the control group. Disappearance of postoperative edema was marked in the main group on 4-6 day at the same time in the control group on 6-8 day.

Conclusion. Results of surgical treatment of odontogenic cysts of the jaws of 31 patients showed that combined use of osteoplastic biocomposite material CollapAn-L, synthetic drug Genesis-BCP combined with plasma enriched by platelets and fibrin allows to compensate the defect of bone tissue, thereby reducing the severity of inflammation, which favors the processes of reparative regeneration.

Key words. Odontogenic cyst, reparative regeneration, plasma enriched with platelets and fibrin, CollapAn-L, Genesis-BCP.

 

Salimov N.F., Razzokov A.A.

DYNAMICS OF THE INDICATORS OF CHILD INJURY IN TAJIKISTAN

Department of Traumatology, Orthopaedics in Military Field Surgery, ATSMU (head. – Dr., professor A.A. Razzokov)

Introduction. As it is known, high level of injuries is observed among physically active people and children. From the standpoint of medical and social consequences, child injuries takes most significant place.Due to the relatively high proportion of children in the population structure, a significant part of injuries in this age cohort, this problem remains relevant for health care and the government of our Republic.

Aim. To study the dynamics of indicators of child injuries in Tajikistan.

Method sofinvestigation. In this study, we used the data base «Medstat» of the Department of Medical Statistics of the Ministry of Health and Social Protection of the Population of the Republic of Tajikistan, the data of the developed by us form “Maps for exploring the state of trauma and orthopedic services” from all regions of the republic;Statistical analysis of the material was performed using a software package for statistical analysis (intensive and extensive parameters, the average value, etc.). ReliabilitywasdeterminedbyStudent’stest.

Results. Our studies show that in Tajikistan there are serious problems in the registration of injuries, which is caused by a shortage of experts in primary care, unequal access of the population to specialized care. Conducted comprehensive work significantly improved the functioning of the trauma – orthopedic services and eliminated defects. The main element the complex prevention of childhood injuries are multi-sectoral approach involving various ministries and departments, as well as to strengthen prevention work among parents and children. The tendency of reducing of childhood injuries and increasing injury rates among teenagers. Also, there is a decrease in mortality from injuries among children.

Conclusion. Thus, the above stated allows to talk about the prospects for significant implementation in the health care system of integrated child injury prevention within the framework of the National Program. The value of the method for traumatologists and orthopedists determines the necessity for intersectoral approach involving relevant ministries and agencies with the subsequent generalization of the results in the form of manuals.

Keywords: injury prevention, the structure of injuries, childhood injuries, the National Program on injury prevention

 

RazzokovA.A., SalimovN.F., Naimov A.M.

COMPARATIVE ANALYSIS OF THE TREATMENT RESULTS OF TRAUMA AND ORTHOPEDIC PATHOLOGY IN VARIOUS FORMS OF ORGANIZATION OF HOSPITAL CARE

Department of Traumatology, Orthopaedics in Military Field Surgery, ATSMU (head. – Dr., professor A.A. Razzokov)

Introduction. Urbanization, technological and natural disasters, armed conflicts and many other factors are the leading cause of injuries, cause of death of people of working age. Therefore, the problem of injuries in orthopedic pathology is an urgent problem of health authorities and governments all over the world. At the same time was not conducted comprehensive research on the problem of the organization and optimization of hospital care.

Aim. Determination of the optimal methods of the organization of hospital care in trauma and orthopedic care

Methods of investigation.We analysed the data of 28 555 patients with trauma and orthopedic pathology. At the first stage were used traditional regulatory measures to improve the functioning of trauma and orthopedic material processing was performed by formalization and establishment of a database. Reliability was determined by Student’s test.

Results. Comparative analysis of the treatment results of trauma and orthopedic pathology in various forms of organization of medical care, have shown that in the country were used outdated techniques and technologies in the treatment of trauma and orthopedic pathology in specific groups.Based on this were developed and put into practice 35 regulations, including national program and 11 programs, 12 laws, as well as clinical protocols and normative documents on Traumatology and Orthopedics.

Conclusion. Thus, the optimized tactics and new financing mechanisms allow qualitatively improve the treatment results of injuries and orthopedic pathology compared with traditional approaches. The obtained results allowed establishing the structure and the actual amount of specialized medical care for injuries and orthopedic pathologies that should be considered in planning and organizing.

Key words: injuries and orthopedic diseases, modern treatment technology, optimized treatment strategy, co­payments, national program treatment results

 

R.R. Murodov, Kh. Dzh. Rakhmonov, ZokirovSh.F., Devlokhov S.S.

TRANSPEDICULAR FIXATION OF LUMBAR SPINE AT SPONDYLOLISTHESIS

Treatment – diagnostic center «Balkh» (head – Murodov R.R.)

Introduction: Transpedicular fixation (TPF) currently is widely used in surgery of deformations and degenerative disorders of lumbar spine. This allows toincrease the fixation ability and stability of spine-active segment, to reduce the time of hospital treatment and disability, to ensure a qualitatively higher level of rehabilitation.

Aim: The use of transpedicular fixation in patients with spondylolisthesis of the lumbar spine.

Methods of investigation: During 2013 – 2014 years we performed clinical follow-up study of surgical treatment of 12 patients with degenerative and dysplastic spondylolisthesis localized in the lumbar spine in clinical and diagnostic center “Balkh” of the Republic of Tajikistan.

Results: Good results were obtained at9 (75%) patients, at 1(8.3%) – satisfactory, and at 2 (16,7%) not satisfactory. Positive results of surgical treatment allow to widespread implementation of this technique, not only at degenerative pathologies, but also at spinal injuries.

Conclusion: Conducted analysis of surgical treatment of 12 patients with degenerative dysplastic spondylolisthesis of lumbar spine showed the effectiveness of the transpedicular fixation method at patients with this pathology. Selection of surgical treatment tactics requires the usage of highly informative research methods (CT, MRI), intraoperative – IC. Short-term results of surgical treatment showed high efficiency of the method

of symptoms and returning the patient to normal life.

Keywords: Spondylolisthesis, tranpedicular fixation of the lumbar spine.

 

Muminova М., Nozirov Dzh. Kh

DYNAMICS OF CHANGES IN THE QUALITY OF LIFE AT PATIENTS WITH ISCHEMIC HEART DISEASE IN THE SANATORIUM «ZAYRON»

Institution of postgraduate education in the field of Healthcare of the Republic of Tajikistan (IPE HCRT)

Introduction. One of the actual problems of rehabilitation medicine is the development and scientific justification of effective non-drug rehabilitation technologies of treatment and prevention of socially significant diseases. Despite the widespread use of pharmacological agents in clinical practice, drug therapy is not always effective, requires finding ways to improve the efficiency of primary and secondary prevention of coronary heart disease due to the rational use of new non medical methods [3, 4].

Aim. Investigation of the life quality and adherence to treatment of patients with stable coronary heart disease in the conditions of sanatorium and rehabilitation treatment in order to optimize approaches for cardiorehabilitation.

Methods of investigation. In the conditions of a 24-day course of sanatorium and rehabilitation treatment in the sanatorium «Zayron» were examined 60 patients with documented coronary heart disease stable angina of I-II functional class. Among surveyed were 43 (71.7%) men and 17 (28.3%) women. Dynamics of changes in quality of life parameters was investigated in the first and 24 days of stay in the sanatorium. To evaluate the quality of life (QOL) was used the SF-36 questionnaire adapted to patients with cardiovascular disease. Processing of the material was performed by descriptive statistics: calculated the average value (M), standard deviation (о) and standard error (m). The significance of differences between the averages calculated by t-criteria of Styudent. Significant difference of the Results was identified on the level of a=95% (р<0,05).

Results. The results of evaluation of life quality showed that most of the parameters have a marked tendency to increase the total number of points for the 24-day period of stay in the sanatorium. As shown in Table 1 scores reflecting the psychological components of health were more increased (МН) с 46,4±2,5 до 71,3±2,0. The major parameters of improvement psychological component is improvement of vitality (VT) from 37,0 ± 1,5 to 52,0 ± 1,2 points, as well as the psychological component of health (MH) from 58,0 ± 2,5 to 85 5 ± 2,1 points. Dynamics of changes in indicators of physical components (PH – Physical Health) of health also had a reliable trend to improvement.

By the end of rehabilitation treatment the component of physical functioning increased from 34,4±2,0 to 45,5±1,5 points. Results of the study of rehabilitation treatment of patients with coronary heart disease in the conditions of sanatorium «Zayron» showed an improvement of life quality. The main curative factor of the sanatorium «Zayron» is naturally opening onto the surface of the hydrosulphuric-air mixture with temperature while measurement in the borehole over 1000С and the concentration of sulfur and sulfur compounds 66 H K /L.

Conclusion. Sanatorium and rehabilitation treatment in the conditions of sanatorium «Zayron» by using medical, balneological and natural climatic sanatorium factors positively affects the overall health and improves life quality parameters. Among the main parameters determining life quality recorded improvement vital activity, psychological state and intensity of pain that makes it possible to use this sanatorium for cardio rehabilitation.

Key words: coronary heart disease, health and rehabilitation treatment.

 

HEALTH CARE OF TAJIKISTAN

2 (325) 2015

Akhparov N.N.1, Kagan A.V.2, Oinarbayeva E.A.1, Suleimanova S.B.1

STENOSING PEPTIC ESOPHAGITIS IN CHILDREN AS THE COMPLICATION OF GASTROESOPHAGEAL REFLUX DISEASE

1Scientific Center of pediatrics and child surgery of MHSD of RK, 050040,Kazakhstan,Аlmaty.

2 Pavlov First Saint Petersburg State Medical University, 197022, Russia, St. Petersburg.

Introduction. Among all kinds of esophagitis the most common and often required surgical correction is stenosing peptic reflux esophagitis as the complication of gastroesophageal reflux disease (GERD). Nowadays GERD takes one of the key places, due to its high prevalence, frequent exacerbations, significant deterioration of the quality of child’s life. Untimely diagnosis of GERD and the lack of effectiveness of conservative therapy leads to the progression of the disease and the development of serious complications at an early age.

Key words: gastroesophageal reflux, peptic stenosis, esophagitis, children.

 

Ismailov K.I., Mukhammadnabieva F.A.

STATE OF IMMUNOLOGICAL TOLERANCE IN CHILDREN WITH HEMORRHAGIC ANGIITIS

National Medical Center, Department of childhood diseases № 2 Avicenna Tajik State Medical University.

Introduction. Systemic angiitis – group of diseases which are based on general defeat of the vascular wall, mostly of immune etiology, with the development of inflammation and necrosis, leading to disruption of blood flow in organs and tissues.

Aim. To observe of immunological tolerance in children.

Methods of investigation. We observed 50 children with HV. Among them 27 were boys (56%), girls – 23 (46%). Depending on the clinical forms of HV children were divided into 4 groups: Group 1 (n = 14) with skin form; Group 2 (n = 11) – with skin-articular form; Group 3 (n = 13) – abdominal skin form; Group 4 (n = 12) of children – with skin and kidney form. The control group consisted of 30 healthy children of corresponding age and also determination of the immune status in blood by IFA method.

Results. In first group skin manifestations were observed in varying stages of the disease in all children (100%). Among children of the second group skin articular syndrome was observed in all patients. The main clinical manifestation of abdominal syndrome in patients of the third group was cramping abdominal pain of varying intensity and duration. In the fourth group clinically occurred nephritic syndrome as a capillary-toxic nephritis, which was combined with skin rashes (100%) and determination of the immune status in blood by IFA method.

Conclusion. in patients with different clinical forms of HV increased the number of peripheral blood T-lymphocytes with CD4 receptors, and in contrast reduced the amount of receptors CD8 cells with increasing the coefficient CD4 / CD8; Moreover, in the serum of these patients increased the average content of immunoglobulins A and G, combined with increased number of lymphocytes with cyto immunological markers CD20.

Key words: skin syndrome, hemorrhagic vasculitis, articular syndrome, nephritic syndrome, immune status

 

Ismoilov K.I., Yusupova M.A., Mukhitdinova Z.A.

PECULIARITIES OF CLINICAL AND IMMUNOLOGICAL MANIFESTATIONS OF MIXED INTRAUTERINE INFECTIONS AT NEWBORNS

Department of Childhood diseases № 2 Avicenna Tajik State Medical University, (head Ismoilov K.I.)

Introduction. According to the Europeal Regional Office of WHO (1994), at about 10% of newborns can be determined via microbiological, virological and immunological studies the presence of infections during pregnancy or while passing through an infected birth canal of the mother. Widely among the perinatal and neonatal pathology has been a significant increase in the proportion of intrauterine infection with the danger of generalization and sepsis [1-2].

Aim: to study clinical and immunological features of intrauterine manifestations of mixed infections in newborns.

Methods of investigation: Were investigated clinical and immunological manifestations of intrauterine mixed infections of 130 newborns at the base of National Medical Center of the Republic of Tajikistan, in the department of pathology of newborns.

Results. The disease with intrauterine mixed infection in infants in all three groups of study, took place in generalized form of septic process involving all organs and systems, with frequent complications (47%) and lethal outcome (18%). Indicators of immunoglobulin M in the serum of all three groups of patients with intrauterine infection were significantly higher compared with the control group. At the same time the values of IgA and IgG in the serum of all the three groups of patients of newborns were significantly lower than those of the control group. Was stated only the first level of activity of humoral immunity [3-5].

Conclusion. Our reaserch showed that at newborns with intrauterine mixed infection even combination of two infections potentiate cellular immune depression, is its indicator and is characterized by multi-organ lesions. Co­infections are directly proportional to the degree of generalization and correlated with the severity of immunodeficient insolvency. Identified changes indicate that at infants with intrauterine infection often development imbalance of immune system, dictating the need to connect to the causal treatment with drugs of immunocorrecting effect

Key words: Intrauterine infection, cytomegalovirus infection, toxoplasmosis, chlamydia TORCH

 

А.О. Kasymov

IMMUNOLOGICAL DISORDERS IN PATIENTS WITH ALOPECIA AREATA

Department of Dermatovenerology (head – prof. O.I. Kasymov) Institution of postgraduate education in the field of Healthcare of the Republic of Tajikistan

Introduction. In the pathogenesis of alopecia areata importance is given to immunological disorders, but literature data are controversial.

Aim. To study the status of some cellular and humoral immunity in patients with alopecia areata.

Methods of investigation. The study involved 49 patients with alopecia areata (27 men and 22 women) aged 15 to 46 years old.

Results. In the peripheral blood of patients with AA was observed decreasing the number of parameters of cellular immunity and increasing parameters of humoral immunity. Immunological disorders are more pronounced in patients with common form of the disease in an advanced stage and a long process.

Key words: patients with alopecia areata, immunological disorders

 

Kurbonov K.M., Mansurov U.U., Makhmadov F.I., Rasulov N.A.

SURGICAL TREATMENT OF INTRAOPERATIVE INJURIES OF EXTRAHEPATIC BILE DUCTS

Department of Surgical Diseases № 1 (head – academician Kurbonov K.M.) Avicenna Tajik State Medical University

Introduction. At the present stage of hepatobiliary surgery early diagnosis of injuries of the extrahepatic biliary tract is still relevant. With the introduction of laparoscopic cholecystectomy incidence of extrahepatic injuries BT, compared to open variety, increased by 2-2.5 times. The absence of a unified common surgical tactics in identifying EBT injuries, also not a high incidence of complications and errors in the implementation of corrective operations did not reduce the interest to discussed problem, as tell works of recent years.

Aim. Improvement the results of surgical treatment of patients with intraoperative injuries of the extrahepatic bile ducts.

Methods of investigation. The article presents the results of surgical treatment of 38 patients with intraoperative injuries of the extrahepatic biliary tract.

Resilts. Results of the study of patients showed that intraoperative EBT damages most frequently (0.9%) was observed after videolaparoscopic cholecystectomy, slightly less (0.2%) after conventional cholecystectomy and resection of the stomach (0.01%). In the structure of the reasons of EBT damage «human factor» played a leading role, namely technical and tactical errors.

Conclusion. Choice of correction method of yatrogenic damage of EBT depends on the nature and location of injury, development of complications and general condition of patients

Key words: cholelithiasis – cholecystectomy – injuries of extrahepatic biliary tract – postoperative complications

 

  1. Sorbon

HEALTH CONDITION OF FIRST YEARS LIVE INFANTS DEPENDING ON THE NUTRITION KIND IN TAJIKISTAN

M.Sorbon – PhD student of SI Scientific clinical center of Pediatrics and Child surgery, Republic of Tajikistan

Introduction. Worldwide, more than one-third of children aged under 5 years do not get enough and proper nutrition, which is manifested in growth inhibition, weight loss, lack of iodine, vitamin A or iron. Approximately 35% of all infants at the age of 0 to 4 months are exclusively breastfed. Despite the efforts, the prevalence of exclusive breastfeeding during the first six months of life, which provides the full nutrition, protection from infection and harmonious development of the child, remains high.

Aim. To observe the breastfeeding implementation effectiveness in the practice of health facilities.

Methods of investigation. The study was conducted within the period of 1998-2008, 324 children were covered by conducted catamnesis observation during the first two years of life.

Results. Increasing the prevalence of breastfeeding in the period from 1998 to 2008, from 6 to 12 months, from 48.1% to 70.6% did a positive impact on the health of children in the first year of life, which is reflected in the reduction of overall morbidity, hospital morbidity of infants and infant mortality rates. General morbidity decreased by 22.1% and amounted to 1731.1 in 2008, per 1000 children in the first year of life.

Necessary to note that the intestinal infection was found at 6.8% children who were on artificial feeding, and 1.8% of children on breastfeeding, mainly in the group of children older than six months, who received complementary foods and were not registered in the group of children who were exclusively breastfed up to six months. Also, decreased morbidity due to respiratory diseases by 7.5% from 1093.6 to 1016.8 per 1000 chilfdren of first year of life.

Conclusion. Strict adherence to the principles of breastfeeding on the stages health care for children, promotes long and successful breastfeeding, reduction in hospital morbidity and mortality of chilfdren of first year of life.

Key words: breastfeeding, breast milk, children, morbidity of the first year of life

 

Nurmatova М.А., Daminova N.M.

SURGICAL TREATMENT OF RECTAL FOREIGN BODIES

Department of Operative Surgery and Topografic Anatomy (head – associated prof. Dzh.M. Kurbonov) and clinic of General Surgery № 1 Avicenna Tajik State Medical University.

Introduction. Among proctological diseases, foreign bodies (FB) of rectum are quite rare [1,2,3]. The nature and form of FB of the rectum may be different. Despite the fact that the diagnosis of rectal FB is not much difficult but it should be noted that to date there is no modern tactics of treatment of patients with the rectal FB. Precisely because of the tactical and technical errors lethal outcomes still occur [1,4].

Aim. Improvement of surgical treatment results of patients with rectal foreign bodies.

Methods of investigation. For the last 20 years 54 patients with rectal FB were treated in the clinic. Men were 36 (78.2%), women’s -18 (21.8). The age of patients ranged from 19 to 74 years. In the course of the study we have used clinical working classification developed in the clinic (Figure 1). Reasons for entering FB into the rectum were very different. Thus, in 18patients (39.1%) – was anal masturbation, at – 20patients (37.3%) – mental disorders, in 8 (17.3%) – violent introduction of FB into the rectum (hooliganism), 5 patients (10.8%) – iatrogenic (during medical procedures) and at 3 (6.5%) FB rectal were caused by Ascaris (20 and fitobezoras. The nature and properties of the rectal FB material were as follows: 25 patients (54.3%) were non-metallic FB (plastic and wooden), 13 (24.7%) were metal, 16 (29.5%) – hard-elastic.

Results. Conducted study showed that symptoms of rectal FB were characterized by the presence of pain in the anus 68%, 30% in the rectum and 20% of patients in the lower part of the stomach. Typical trituration feeling in the rectum was observed in 20 patients (37.4%). The majority of patients had a variety of disorders of defecation: the utter impossibility of its realization – 15, frequent false urge to defecate at 8, liquid defecation – at 5, defecation mixed with blood – in 4 patients. Bleeding from the anal canal out of the act of defecation is observed in 9 patients. Abdominal distension and carminative occurred in 7patients. After the introduction of large objects into the rectum observed peculiar symptoms such as inability to sit – in 6 patients, changes in gait (walking with legs wide apart) – 11, urination disorders in form of increased frequency evolved – in 6 patients, difficulties – in 3 and full delay in 1 patient.

Conclusion. To diagnose rectal FB nowadays is widely used ultrasound, colonoscopy and sigmoidoscopy along with finger and radiological methods of research. In most cases, rectal FB were removed transrectally except damage to the rectal wall, the presence of large fixed and migrated retrograde FB indicate to open intra-abdominal rectal FB removal and rectal perforation.

Key words: foreign bodies, the rectum

 

Nurov D.I., Sultonov M.Sh

OPTIMIZATION OF MEDICAL AND SOCIAL APPROACH OF THE RENDERING IMPLANTOLOGY HELP IN DENTISTRY PATIENTS

Dentistry clinic «Eurodent» Dushanbe (director – PhD M. Sh. Sultonov)

Introduction. Dental implantation is one of the most progressive directions in modern dentistry. Improvement of appearance favorable is reflected on personality of patient and their social life. In this connection undertaking sociological interview for study of patient’s information about implantology’s dentistry treatment introduces actual.

Aim.Undertaking sociological interview beside patients on questions of the use of dental implants.

Methods of investigation. Organized sociological interview between 500 primary patients adressed for the dentistry help. Interviewing of the patients conducted designed by us special questionnaire. Group of examined patients consisted of 118 men and 382 woman at the age from 20 to 60.

Results. Among the factors that cause failure of the implant treatment of patients on the 1st place – high cost; further there is uncertainty about the final result, and the fear of complications before surgery.

Conclusion. Dental orthopedic treatment using the dental implant is the method of choice and may be practiced with considering motivation of respondents. The level of motivation of patients to dental prosthetics defects dentition structures, fixed on dental implants, it is a determining factor in the development of implant service and improvement of modern forms of prosthetic dental care.

Key words: respondent, dental implant, sociological questioning, motivation, orthopediс design

 

Yu. G. Pogopovich

PHYSICAL DEVELOPMENT OF CHILDREN WITH HIGH CONTENT OF METALS IN THE BIOASSAY

KGP on PHV “Center of Mother and Child” Kazakhstan, Ust-Kamenogorsk Popovich Yulia Georgievna

  • PhD student of Scientific center of pediatrics and child surgery MH RK. Almaty

Introduction. Physical Development (FD) is an important integral indicator of the adequacy of child growth and development in a changing environment. Investigation the effects of heavy metals on children’s FD is an urgent task considering their priorities in environmental pollution.

Aim. Investigation of the physical development of children, depending on the metal content in the bioassays of children from Ust Kamenogorsk.

Methods of investigation. Hair samples of 307 children of Ust-Kamenogorsk were examined on Lead and zinc content. From these children were formed two groups: I group – 35 children with high lead content in the hair samples,

  • group – 30 children with low levels of zinc in hair samples. In addition, was assessed the physical development of children with elevated levels of beryllium in urine samples (III group). FD results of children of III group were


compared with children of IV group with normal levels of Burrill in urine samples. Children of study groups were evaluated on physical development according to “Scheme assessment of physical development of centile tables.” Results. With increasing the age of children of I and II groups stated the increase in the number of children with low FD, the same pattern was determined in children of III and IV groups. Additionally,was determined reduction the number of children with high FD in I and III groups. With increasing the age of girls and boys of Group I and Group III disharmonious FD combined with BMD, while the girls and boys of Group II and Group IV – with BMI. There was an inverse correlation between the FD for girls and lead levels in hair samples.

Conclusion. In FD of children from Ust-Kamenogorsk general trend defineded in all groups as an increasing the number of children with low and disharmonious FD. Furthermore, with increasing the age in girls and boys of Group I and Group III disharmonious FD was combined with BMD, while girls and boys of Group II and Group IV – with BMI. Thus, environmental pollution metals had a negative impact on the FD of children

Key words: children, physical development, lead, zinc, beryllium

 

 

M.Sh. Sultonov

RESULTS OF INCREASED EFFICIENCY OF DENTAL IMPLANTATION WITH THE USE OF BIO COMPOSITE MATERIAL

Dentistry clinic «Eurodent» Dushanbe (director – PhD M. Sh. Sultonov)

Introduction. Methods of the reconstruction of absent teeth with use of dental implants are widely involved in dentistry practice. Though protocols of surgical and orthopedic stages of the treatment are still relevant questions about the influence of the form of the implant and its surface on the osseointegration..

Aim. Evaluation of remote result of orthopedic treatment in patient using dental implants of foreign system «Superline» incombination with biocomposite material.

Methods of investigation. On the base of dentistry clinic of «Eurodent» were examined and received the implantology treatment 64 patients at the age from 25 to 50 in the period of2010-2014 years. Patients were divided into two groups. The patients of 1st group with single defect of the teeth rows (27persons), 2nd – 37 persons with plural defect of the upper and mandible teeth rows of different to localization.

Results. Clinical results of the study within the period of 4 years have shown the good result of dental implants «Superline» systems osseointegration. Use of biocomposite material in process of dental implantation allowed to achieve good results of osseointegration in 100% cases.

Conclusion. Direct, nearest and remote results of dental implantation in patients were considered as «good» in 100% events. Using biocomposite material in process of dental implantation allows to achieve the good results of osseointegration.

Key words: biocomposite material, dental implant, resorbtion, marginal bone, osseointegration

 

R.K. Kuzibaeva

THE LENGTH OF THE CERVIX AS A PREDICTOR OF PREMATURE BIRTH

Department of Obstetrics and Gynecology, Tula State University (head, proff. Volkov V.G.)

The analysis of literature data has shown that the measurement of cervical length by transvaginal ultrasound in patients with no clinical symptoms and high risk is predictive of spontaneous preterm birth. This data is also important in the subgroup of women with preterm delivery in history. Further research may be warranted to assess the use of transvaginal ultrasound in specific subtypes of spontaneous preterm birth (premature rupture of the fetal membranes against spontaneous onset of labour), in women with preterm delivery in history who have received treatment with progesterone, after 24 weeks, in women with preterm delivery in history and those who have been diagnosed anomalies of the uterus, including those who have undergone surgery.

of the cervix, vaginal ultrasound.

Key words: preterm delivery, risk factors, the length

 

Bobokhodzhaeva M.O., Kasymova M.K., Akhmedov A., Mirzoeva F.O

ABORTIONS AMONG SEX WORKERS: FREQUENCY, MOTIVES, MEDICAL ASPECTS

Department of Public Health, Economics and Managment of health with course of medical statistics Institution of postgraduate education in the field of Healthcare of the Republic of Tajikistan, City reproductive health center, Dushanbe.

Introduction. Taking into account that in recent years is distinctly revealed the increase in prevalence of unsafe abortion around the world, including Republic of Tajikistan, and nowadays it becomes more acute problem of the integration of women into commercial sex, the study of prevalence, motivation and medical aspects of abortion in women providing commercial sexual services remains very urgent problem.

Aim. To study some aspects of unsafe abortion among women involved in commercial sex, determining their motives.

Methods of investigation. Conducted sociological research among 400 sex workers (SW), aimed at medical and sociological characteristics and the definition of motivation to abortion as a method of birth control, medical aspects of it.

Results. Our results shows that the experience of sexual services surveyed SW is in direct proportion to their age. However, there is a rejuvenation of the age of sexual services. Revealed the high rate of abortions among workers who provide sexual services in Dushanbe.

Conclusion. Sex workers form a contingent of high medical – social risk of reproductive disorders due to early entry of respondents into sexual commercial relations, the widespread practice of abortion. Serious obstacle of SW to the services in the field of reproductive and sexual health are stigma and discrimination. The results indicate the mandatory involvement of sex workers in programs focused on harm reduction.

Key words: sex workers, abortion, reproductive health, stigma and discrimination

 

Bardele D., Maksimenko E., Sayfudinov S.R.

NATIONAL HEALTH CARE INDICATORS IN THE REPUBLIC OF TAJIKISTAN

Barde Doris, Prof. Dr. of medicine, Chief expert, Project of European Commission: “Technical assistance to support the strengthening of healthcare information system in Tajikistan” (EuropeAid/131670/C/SER/TJ, EPOS)

Thanks to the introduction of health care management information system in Tajikistan became possible transition of on-line routine medical reporting system. This allowed to enter into the electronic health care information system (DHIS2 2) a set of indicators of the health of the RT which consists of 334 coefficients and 314 absolute numbers, that is a good base for their use in the management of health care and decision-making based on evidence. The set of indicators includes in itself data from RCMSI and other departments, such as Agency for Statistics under the President of Tajikistan (population and mortality data), WHO (special studies) and others. To combine multiple sources had to create the structure of a set of indicators, to involve the classification and methods of checking the quality indicators. Examples of analysis of indicators presented.

Key words: set of health indicators, the classification of the indicators, quality of indicators

 

MEDICAL – SOCIAL FACTORS OF WOMEN’S REPRODUCTIVE HEALTH DISORDER OF THE SOGD REGION OF THE REPUBLIC OF TAJIKISTAN

Department of Public Health, Economics and Managment of health with course of medical statistics Institution of postgraduate education in the field of Healthcare of the Republic of Tajikistan

Introduction. Taking into account the presence in modern conditions of a number of factors influencing the formation of reproductive behavior and reproductive health, identifying health social factors of reproductive health of women is a very important issue.

Aim. To study medical and social characteristics of women of fertile age, to identify the main factors affecting the reproductive health of the population.

Methods of investigation. The study is based on social and hygienic data analysis conducted in 2,000 women. The study was conducted selectively on the basis of the regional and district centers of reproductive health for the period from 2009 to 2013. in the following regions of Sogd region of Tajikistan: Khujand (410), Kayrakkum (405), Isfara (393), Aini (396) and Shahristan (396) regions. Sociological survey was conducted according to the questionnaire which we developed.

Results. Socio – hygienic analysis of the respondents indicated that, in general, respondents were women of reproductive age (75.3%). Middle age of the patients was 24.6 years. The social composition of the respondents were represented mainly by housewives (40.5%), further were employees (27.0%) and workers (23.8%). The minimum number of respondents were students (8.7%). The economic situation of the family respondents evaluated as “good” in 73.5%, “satisfactory” in 16.8%, and as a “heavy” 9.7%. Life conditions, in which the respondent lived, evaluated as “good” in 64.0% of cases, “satisfactory” in 23.8%, and “heavy” – 12.2%. At the same time, 65.5% of respondents pointed to poor nutrition in the family, and 57.5% – to the poor nutritional status of children. From the total number of questioning 59.9% said they did not have the funds to buy drugs, and also to pay for medical services.

35.9% of respondents believe that to give birth to their first child should be aged between 15 to 19 years, been wondering about birth outcomes for a woman and for child. Analysis of genital function showed that more than half of the respondents had children – 51.0%, from them 5 children had 23.8%; 3 – 4 children had 49.0%; 2 children had 17.8%; one child 9.4%. However, only 24.6% of respondents comply with birth interval. In the bulk of examined birth interval was up to 2 years – 47.9%, to 1 year and 8 months – 26.6%. The proportion of parous 2 times a year was 0.9%.

Conclusion. Results of the study revealed the influence of age, education, financially – domestic situation on the production of certain reproductive attitudes of the surveyed women contingent. The early onset of sexual relations, small proto – and intergenetic intervals correspondingly early and frequent childbirth, low somatic index define the current status of reproductive health of women of Sogd region.

Key words: reproductive health, intergenetic intervals, reproductive attitudes

 

Nozirov Dzh., Muminova M., Shokirov T.

RESULTS OF SIMULTANEOUS SCREENING TESTS EXERTIONAL ANGINA AMONG UNORGANIZED POPULATION OF TAJIKISTAN

Department of Public Health, Economics and Managment of health with course of medical statistics (head -prof. A.Akhmedov), Department of Cardiology with course of clinical pharmacology (e.head – PhD, A.N. Narzulloeva), Institution of postgraduate education in the field of Healthcare of the Republic of Tajikistan

Introduction. Studies in recent years indicate high morbidity, disability and mortality from coronary heart disease and its complications in the post-Soviet countries. The Republic of Tajikistan is not an exception. Thus, over the last 5 years the population of the Republic of Tajikistan negotiability in hospitals for coronary heart disease increased from 158.5 per 100 thousand population in 2009 to 198.6 per 100 thousand population in 2013. Only during 2011­

  • found growth of disability from CHD from 41.7% in 2011 to 44.8% in 2012. According to the UNDP 2010 male mortality from coronary heart disease aged 25-64 years in Tajikistan in 1994 amounted to 100 thousand men of the same age. Determine the relevance of the above stated problems.

Aim. Through a screening study to determine the real situation of morbidity among populations heart failure among residents of various regions of the Republic of Tatarstan, and in view of the results to develop an appropriate plan for preventive measures

Methods of investigation. Simultaneous screening study carried out among 16,500 of the population aged 15-59 years: 7193 men surveyed (43.6%), 9307 women (56.4%). Population survey carried out in accordance with the adapted questionnaires and WHO guidelines, as well as conducting comprehensive clinical examination with a medical history, anthropometric data measurement, evaluation of laboratory-biochemical and instrumental examinations (electrocardiography, echocardiography, bicycle ergometry and X-Ray examination of chest).

Results. As a result of screening individuals identified with, exertional angina 1290 people. (7.8% of the surveyed) including the 529 men (7,3 ± 0,61%) of the total number of examined persons male and 761 female (8,2 ± 0,56%). Age and sex Analysis of prevalence exertional angina showed its high prevalence in men and women in older age groups (45-54 and 55-59). The analysis showed a relatively high level of coronary heart disease, heart failure among the residents of Tursunzade districtRRS – 10.1%, slightly lower among the population of Vanj, Badakhshan- 9.1%, and even lower among the population of Vakhsh district, Khatlon and Vahdat district RRP: 8.4% and 7.85%, respectively. At the lowest prevalence of coronary heart disease have shown results of screening Ganchi district of Sughd region – 4.2%.

Conclusion. The results from a regional perspective of distribution show that heart failure can serve as starting point for planning targeted prevention programs for the prevention of coronary heart disease.

Key words. Cardiovascular diseases, coronary heart disease, exertional angina, screening

 

HEALTH CARE OF TAJIKISTAN

1 (324) 2015

  1. Bokidzhonov, М.М. Nazarova, M.N. Dzhuraev

CLINICAL VARIANTS OF POLLINOSIS IN NORTHERN TAJIKISTAN

Department of Clinical Allergology and Immunology (head.- Dr. M.N. Dzhuraev) Institution of postgraduate education in the field of Healthcare of the Republic of Tajikistan

Introduction. Features of etiopathogenesis and clinical course of pollinoses, as well as other allergic diseases, are largely determined by the influence of climatic and geographical factors. The highest incidence is recorded in regions with high plant cover, dry and hot climate, and therefore the study of pollinoses becomes especially important due to the increasing scale of greening urban and rural areas, the creation of large areas offorest parks, lawns and boulevards.

Aim. To study the clinical features of pollinoses in the North of Tajikistan.

Methods of investigation. The experience of examination and treatment of 196 patients with pollinosis, of which 86 were males (43.9%), 108 females (56.1%). During clinical investigation of 196 patients with pollinoses, 89 patients were identified in the epidemiological study and 107patients were observed in the City Clinical Hospital

of Khujand. The age of patients ranged from 18 to 55 years.

Results. Revealed that, in the north of Tajikistan the structure of clinical variants of pollinoses is mainly composed of seasonal allergic rhinitis, tracheobronchitis – 30.1%, seasonal rhinitis, asthmatic bronchitis – 25.5%, seasonal rhinitis + conjunctivitis – 15.8%, seasonal rhinitis, asthmatic bronchitis, urticaria – 10.2%, asthma – 7.7% and rare clinical form of hay fever – 10.7%. And also in the structure of the causal factors marked sensitization to pollen of cotton, sycamore and other allergens.

Conclusion. Pollinosis among residents of the north are characterized by early onset and long acute period, primary development of seasonal rhinitis, tracheobronchitis, bronchial asthma, with the leading role in the structure of the causal factors of sensitization to pollen of cotton, sycamore and weeds.

Peculiarities of pollinoses in the North of Tajikistan are: a) the prevalence of severe pollinosis with short periods of remission; b) poly sensibilization in most patients with a predominance of sensitization to household, epidermal and food allergens; c) the variety of clinical symptoms, which are dominated by seasonal rhinitis, and bronchitis.

Key words: pollinosis, clinical variants, features of the course

 

М.G. Igamova, R.A. Rakhmonov, F.I. Odinaev

DYNAMICS AND STRUCTURE OF PRIMARY DISABILITY CAUSED BY STROKE IN DUSHANBE

Department of Neurology and the basics of Medical Genetics (head. – prof. R.A. Rakhmonov) ATSMU;

Department of Internal Diseases №2 (head. – prof. U.R. Rasulov) ATSMU

Introduction. Stroke is an extremely important medical and social problem and one of the most common causes of disability in the adult population. According to WHO, the causes of death among the adult population, stroke ranks third after heart diseases and cancer. According to the National Association for Combating stroke of the Russian Federation, more than 30% of stroke patients are in need of constant care, more than 20% are not able to move independently and only 21% of patients return to the profession.

In Russia, every year more than 450 thousand people had a stroke, with up to 200,000fatal cases, and survived patients of up to 80% are disabled to varying degrees.

Cerebrovascular diseases cause enormous damage to the economy and include the cost of treatment and medical rehabilitation. According to WHO, the aggregate amount of direct and indirect costs per patient of stroke is 55 – 73 thousand US dollars, which makes the problem very relevant.

Aim. To study the dynamics, structure and main risk factors of primary disability caused by stroke. Methods of investigation. The object of the study were 243 patients with stroke, who were examined at the Department of State Service of medical and social expertise in Dushanbe for the period from 2009 to 2012yy. Of the 243 new cases of disability 162 (66.7%) were males and 81 (33.3%) females.

The information of medical institutions on the character, stage and course of stroke, the results of clinical, laboratory and instrumental studies and therapeutic measures was taken into account.

Results. Most of the newly recognized disabled due to stroke, were people of working age, 81% (197 people). Persons of retirement age account for 19% (46 people). Analysis of the dynamics of disability due to stroke, shows that in 2009 the number of new cases of disability consisted of 58 persons (23%), in 2010 – 63 people (19.8%), in 2011 – 73 people (27.3%) and in 2012 – 49 people (30.4%), indicating a sustained high performance. Analysis of the structure of disability depending on the severity showed that people with disabilities of third group made up 26.3% (63 persons), 2nd – 43.7% (106 persons) and group 1 – 30% (73 people). The vast majority of new cases of disability caused by stroke were persons from the 2nd and 1st group of disability.

Conclusion. Among the diseases of the nervous system, stroke in the population of Dushanbe is the most common cause of disability – 24.5%. In the structure of new cases of disability caused by stroke dominated by people of working age, with secondary and higher education, mostly males.

The most common risk factors for stroke are hypertension, hypertension in combination with atherosclerosis, diabetes mellitus and obesity.

Key words: Primary disability, stroke, major risk factors

 

М.А. Kravchenko1, Yu.Ya. Varakin1, Е.V. Gnedovskaya1, О.S. Andreeva1

RISK FACTORS, CEREBROVASCULAR AND CARDIAC PATHOLOGY DETECTED AT SCREENING OF OPEN POPULATION

‘FSBI “Scientific Center of Neurology” RAMS, Moscow

2Institute of Clinical Cardiology named after A.L. Myasnikov of the FSI RCRC, Ministry of Health of RF, Moscow

Introduction. The big problem for primary prevention of diseases blood circulation system (DBCS) is that while doctors can not predict adverse outcomes with high precision in the early stages of the disease. As a result, up to now, the main attention is devoted to prevention, based on risk factors, when the effect is achieved due to the correction of these factors at the largest possible part of the population. However, the need for long-term preventive treatment to reduce the risk of developing DBCS is not evident for most patients. Physicians, in turn, can not substantiate available benefits and safety of this treatment. Other, more effective and specific methods of prevention does not exist, and it once again underlines the need to find them.

Aim. To Assess the prevalence of cerebrovascular and cardiovascular diseases and their risk factors in the population of people of working age.

Methods of investigation. Within the framework of the continuous screening of open population surveyed 415 people aged 40-59 years. Were carried out: biochemical blood tests, electrocardiography, color duplex scanning of brachiocephalic and common femoral arteries, echocardiography.

Results. The prevalence of major risk factors: family history – 19%, smoking – 25% of women and 38% men, 69% overweight, dyslipidemia – 83%, thickening of the intima-media complex in the carotid and / or femoral arteries 34%, atherosclerotic plaques – 49%, left ventricular hypertrophy – 57%, diabetes melitus – 3.8%. Prevalence of DBCS: arterial hypertension – 46%, ischemic heart disease – 6%, arrhythmias – 6%. Cerebrovascular pathology: initial manifestations of insufficient blood supply to the brain – 12%, encephalopathy – 10%, hypertensive cerebral crises – 13%, transient ischemic attack – 4%, stroke – 2.6%.

The study found that two-thirds of those with a majority of the risk factors do not address to the clinic over DBCS. Thus, the probability of timely initiation of treatment and preventive measures among them is extremely small.

Conclusion. Revealed a high prevalence of risk factors DBCS among persons aged 40-59 years. Carrying out preventive and treatment activities only among citizens, independently addressed to the clinic, is not enough, because up to 70% of persons with risk factors do not go to health facilities for preventive screening.

Key words: cerebrovascular diseases, hypertension, cardiovascular diseases, discirculatory encephalopathy, atherosclerosis, prevalence, risk factors, prevention.

 

К.М. Kurbonov., S.S. Satorov

MODERN PROBLEMS OF EPIZOOTOLOGIC SUPERVISION AS EXACERBATING EPIDEMIOLOGIC BRUCELLOSIS SITUATION IN TAJIKISTAN

Tajik Research Institute of Preventive Medicine. Department of Infectious Disease Epidemiology;

Department of Microbiology, Immunology and Virology (head.-prof. S.S. Satorov) ATSMU

Introduction. Over the past decade, Tajikistan has achieved some success in improving the epizootic and epidemiological situation on brucellosis. The incidence decreased from 23/100 thousand population in 2005 to 11/100 thousand population in 2012, but major changes have not yet been reached.Tajikistan is among the seven countries of the former Soviet Union, which are included among the 25 countries with the highest incidence of brucellosis of the population. The urgency of this problem has increased with the entry of the Republic of Tajikistan to the WTO in March 2013.

Aim. Analysis of epizootological situation and the main factors contributing to the persistence and dissemination of brucellosis in animals and humans in the Republic of Tajikistan.

Methods of investigation.Epizootological retrospective analysis was conducted on the basis of the state veterinary supervision services on reporting forms №1-Vet and 1-Vet -A for 12-year period. During the analysis was carried out a review of domestic and foreign articles, reports and newsletters according to subject.

Results. From 2000 on 2013, the prevalence of brucellosis in small cattle ranged from 0.14% to 0.54%, on average 0,30% (± 0,12). The corresponding figures for big cattle was 0.08% – 0.30%, on average 0,14% (± 0,06). In 2013, there has been an increased incidence of brucellosis in farm animals and is for small cattle 0.39% and 1% for big cattle. Median animal vaccination coverage during the period from 2000 to 2012 is 8% for small cattle and 1.3% for big cattle

Conclusion. In Tajikistan, the success of measures for control and prevention of brucellosis depends on the financial capacity and the capacity of the State Veterinary Service of the Republic of Tajikistan supervision. Problems in the comprehensiveness serologically and vaccination of animals to exacerbate epizootological situation of brucellosis in the Republic of Tajikistan. There is a growing incidence of brucellosis in farm animals in 2013.

Key words: brucellosis, prevalence, seroprevalence, animal husbandry, disease, vaccination

 

G.E. Mulodzhanov, А.А. Ismoilov, G.G. Ashurov

ANALYSIS OF THE FACTORS LEADING TO BONE DESTRUCTION OF ALVEOLAR JAWS PROCESSUS IN PATIENTS WITH CONCOMITANT SOMATIC PATHOLOGY

Department of Therapeutic Stomatology (head. – prof. G.G. Ashurov) Institution of postgraduate education in the field of Healthcare of the Republic of Tajikistan

Stomatological clinic Ltd. “Smile” (head – PhDMullodzhanovG.E.)Dushanbe

Introduction. Despite significant progress and scientific advances in dental implantology questions related to factors leading to changes in bone tissue alveolar jaws processus patients with unfavorable somatic background remain relevant. Clinical success of orthopedic treatment of patients with the use of dental implants is possible only if the situational analysis of the factors that provoke destructive changes in jaw bones on a background of intersystem response of the whole organism.

Aim.To carry out structural analysis of the factors that lead to the destruction of bone tissue of alveolar jaws processus at patients with unfavorable somatic background Methods of investigation. Investigations were carried out on the basis of the dental clinic Ltd. “Smile”, Dushanbe. While using the clinico-radiological method were surveyed dental status of 208 patients aged 20 to 60 years who had in the anamnesis diagnosed gastrointestinal (76 pers.), Cardiovascular (53 pers.), Pulmonary (27pers.) endocrine (33 pers.) and genitourinary (19 pers.) pathology. The subject of the study was multivariate analysis of signs of pathology of dental system identified on panoramic radiographs of somatic patients.

Results. The most common causes of bone destruction of alveolar jaws processus in somatic patients are carious complications, poor quality endodontics, early removal of teeth, poor quality of surgical interventions, the lack of rational prosthetics and as consequence of pathological intersystem response, progression of bone destruction of alveolar jaws processus.

Conclusion. Early removal of posterior teeth in somatic patients caused secondary traumatic occlusion, radiological signs which were offset teeth, lack of physiological contacts, and the appearance of diastemata threm, fanlike divergence of teeth and periodontal tissue destruction in congested remaining teeth.

Key words: alveolar process, somatic pathology, the intensity of caries, periodontitis, osteoporosis, endodontics.

 

R.R. Murodov, Kh.Dzh. Rakhmonov, Kh. Mirzoev, S.S. Devlokhov

DIFFERENTIATED APPROACH TO THE TREATMENT OF HERNIAS OFINTERVERTEBRAL LUMBAR DISCS

Medical – Diagnostic Center «Balkh» (Ch. doctor – R.R.Murodov)

Introduction. Surgical removal of the hernias intervertebral disks in degenerative diseases of the spine become very common and accessible operation. At the same time, the number of recurrent pain radicular syndrome after removal of herniated discs in the lumbar level is not reduced and reaches 5-20%. The leading role belongs to the conservative methods of treatment, allowing to achieve lasting remission at the early stages of the disease.

Aim. Differentiated approach to the treatment of disc herniation of the lumbar spine.

Methods of investigation. Studied the results of conservative and surgical treatment at 290 patients with hernias of intervertebral lumbar disc.

Results. The positive results of conservative treatment was observed in 150 (68.2%) patients. In the postoperative period radicular pain remained in 4 (5.7%) patients. Conservative treatments allowed to achieve positive results at an early stage.

Conclusion. Noted high efficiency of complex conservative treatment of patients with compression forms of of lumbar osteochondrosis. While choosing tactics of surgical treatment is an important use of CT and MRI of the spine. Nearest unsatisfactory results of surgical treatment was observed in 5.7% of patients.

Key words: hernia of intervertebral discs, pain syndrome, diagnosis, treatment.

Ы.А. Nurmatova, N^. Daminova, МЖН. Yusupova

DIAGNOSIS AND TREATMENT OF TRAUMA AND FOREIGN BODIES OF RECTUM

Department of Operative Surgery and Topographic Anatomy(head- associated prof. Dzh. М. Kurbonov) ATSMU

Introduction. Trauma and foreign bodies (BD) of the rectum in the structure of coloproctological diseases account for 2-8%. Patients with FB of the colon often come to the clinic late and try to delete it themselves, which lead to the various types of complications such as infection and inflammatory changes, fractures of intestine and peritonitis.

Aim. To Improve outcomes in patients with trauma and foreign bodies of rectum Methods of investigation. Over the past 10 years in the clinic of General Surgery №1 ATSMU 54 patients were hospitalized with injuries and foreign bodies of the rectum, including 35 patients with damage to the rectum and perineum, and 19 patients with rectal FB.

Patients underwent digital examination, anoscopy, ultrasound and X-ray and according to indications videolaparoscopy.

Results. In the first 32 hours entered (59.2%) patients, and in the first 12 hours – only 15 (32.6%). 4 (8.6%) patients were hospitalized after 7 days of self-treatment. The nature of the injuries was different: 38 (70.3%) patients were hospitalized due to mechanical damage of the rectum and perineum of various kinds, 6 (13%) patients with chemical burns. Chemical injury was caused by introduction of enema with concentrated hydrogen peroxide solution (n = 2), white (n = 1), acid (n = 2) and ammonia (n = 1).

In the postoperative period after injury of the rectum died 1 (2.8%) patient from progressing anaerobic phlegmon, suppuration of wounds were observed in 4 (11.4%) cases. In 1 (2.8%) patient was marked sphincter deficiency. Among patients with foreign bodies of the rectum deaths were not observed.

Conclusion. With injuries and foreign bodies of the rectum expedient adheres to individually active surgical tactics that can improve treatment outcomes.

Key words: trauma, foreign bodies, rectum, diagnosis, treatment

 

E.R. Rakhmanov1, Z..К. Mukhiddionv2, R.S. Kimatov1, N..М. Gulyamova1, А.S. Dzhonmurodov2, Kh.Kh.Khabibov1

TREATMENT OF THE AMEBIASIS OF INTESTINE USING METRONIDAZOLE-PECTIN COMPLEX

1Department of infectious diseases (head- prof. Rakhmonov E.R.)ATSMU

2V.I. Nikitin Institute of Chemistry, AS RT

Introduction. Acute intestinal infections, including intestinal amebiasis remain relevant public health problem. In this regard, currently being reviewed approaches to the treatment of acute intestinal infections and, increasinglyas a combination of complex therapy using drugs with previously known prebiotic approved as medications of antidiarrheal action.

Aim. To study the clinical efficacy of metronidazole-pectin complex in the treatment of patients with intestinal amebiasis.

Methods of investigation. The study was conducted during the period of 2011-2013. in City Clinical Infectious Diseases Hospital in Dushanbe. The study included 15 patients with intestinal amebiasis in age from 21 to 30 yearsInvestigations were carried out in 2 groups: group 1 consisted of 15 patients with intestinal amebiasis, whom was appointed as a therapy metronidazole-pectin complex (MPC), group 2 – 18 patients who received metronidazole in the same dosage without pectin.

Results. Treatment of patients with intestinal amebiasis MPC was carried out in a hospital. All patients had good tolerance to the complex. Studies have shown that in group 1 patients treated MPC concentration of metronidazole in the blood persisted until 6 days and averaged 33,2 ± 3,9 mg /1, and patients of group 2 – respectively 5,0 ± 0,4 mg /1.

The concentration of the antibiotic in the feces was also higher in group 1 patients and averaged and 51,9 ± 4,2 mg /1., Which is clearly higher than in patients of the 2 groups receiving monotherapy with metronidazole – 5,0 ± 0,4 mg /1.

Conclusion. The use of metronidazole-pectin complex at intestinal amebiasis helps to maintain a high constant concentration of main drug in the blood and in the feces during the entire course of treatment, which leads to faster clinical recovery patients with extinction the main symptoms of the infection process, resulting a real reduction in the time of hospital stay at 2,8 ± 0,4 days.

metronidazole-pectin complex (MPC), treatment.

Key words: intestinal amebiasis, diarrhea, prebiotic

 

  1. Kakberdiev2, M. Kucher1, A. Tretyakova1, A. Khodzhiev2, B. Bakhovadinov1, G.S. Ashurova

ABOUT SOME IMMUNOLOGICAL ASPECTS OF BLOOD SAFETY

1 Pavlov First Saint Petersburg State Medical University, Raisa Gorbacheva Memorial Research Institute of Children Oncology, Hematology and Transplantation

2Medical-Diagnostic Center “Shifo”, Dushanbe, Tajikistan

Introduction. Transfusion offresh frozen plasma (FFP), erythrocyte mass (EM), a platelet concentrate (PC), cryoprecipitate may initiate the development of transfusion-related acute lung injury (TRALI) during the first 6 hours after starting transfusion.According to the FDA (USA) from 2005 to 2011 in the USA have been registered 155 cases of deaths due to TRALI, which account for 46% of all deaths caused by complications of blood transfusion. Mortality from TRALI ranges from 5% to 10% [6].

Despite the fact that lung edema caused by transfusion of blood or blood components has been described some time ago, TRALI began to be considered as an independent syndrome only in the last decade [28]. Among the post-transfusion deaths according to FDA (Office of Food and Drug Administration USA), with TRALI associated from 10.5 to 14.1% of the cases, i.e. ranks first as the cause of deaths due to post-transfusion complications [5].

Aim.To study the prevalence of transfusion-associated lung injury (TRALI) in patients with surgical, obstetrical and gynecological, oncological pathologies, polytrauma who received transfusions of blood components, mainly connected with disorders of hemostasis.

Methods of investigation.The results of infusion-transfusion therapy were retrospectively analyzed 2000patients, including 1300 pregnant women, puerperas in maternity institutions of the Republic of Tajikistan with massive obstetrichemorrhages associated with disturbances in the hemostatic system, 300 surgical patients with gastrointestinal and esophageal bleeding, 200 gynecological and oncological patients, 200 patients with polytrauma for the period of 1989-2011 yy.

Results. 11 out of 15 recipients had obvious clinical and radiological signs of TRALI. In the remaining 4, due to insufficient amount of diagnostic studies established the presence of “possible TRALI”. The frequency of TRALI and “possible TRALI» amounted to 1664.6 1 transfusion doses of blood transfusions, which is 0.060% at a dose of blood transfusions (0.044% and 0.016%, respectively), which is comparable with data of other authors. In 3 cases, TRALI developed after transfusion of 500-900 ml of FFP and 6-12 doses of cryoprecipitate.

The results of studying the sera of patients and donors for the presence of anti-HLA revealed the presence of antibodies to class I antigens in one patient and two donors, to class II antigens in one patient and two donors. Anti- HLA antibodies to antigens of both classes have been detected in four donors and two patients. In 2 patients (men) and 4 donors (3 men, 1 woman) antibodies were not detected.

Conclusion. The presence among blood donors and blood plasma centers the significant contingent of women with repeated pregnancies and childbirth in the anamnesis is a factor of high risk of TRALI. Installed the frequent use of FFP without clinical and laboratory studies, the presence of the deficit of plasma procoagulants requiring replenishment of FFP. On the absence of alertness of medical personnel of health care facilities concerning possible development of TRALI indicate diagnostic errors. Taken remedial measures were often inadequate due to diagnostic errors that led to the deterioration of the patients.

In order to prevent TRALI to establish investigation of donor blood samples of women on the presence of anti- HLA, anti-HNA antibodies, while detecting antibodies to remove them from donors. In the absence of conditions for such studies women with childbirth and pregnancy in the anamnesis have to be discarded from donors.

In order to prevent TRALI of non-immune genesis requires the use of a red blood cell-containing blood components with a short shelf life, transfusion of washed red cells and defrosted washed red cells suspension. Need to raise awareness of physicians about TRALI through training highly qualified teachers with the presence of clinical and laboratory experience.

Key words: transfusion-associated lung injury, prevalence, prevention

 

М.N. Khotamova, Kh.D. Aminov

SEASONAL VARIATIONS OF HEMOSTASIS OF CHILDREN AFTER HYPOXIC-ISCHEMIC ENCEPHALOPATHY

Department of Pediatric Diseases №1 (head-Dr. Kh.D. Aminov) Avicenna Tajik State Medical University

Introduction. Impairment of the CNS in the perinatal period can contribute to the disruption of all organs and systems adaptation, including the immune homeostasis, in turn it violates the body’s resistance to the effects of internal and external factors of aggression. Hypoxic-ischemic encephalopathy (HIE) at children in Tajikistan are devoted to individual work, which relate to the neonatal period, and hemostatic parameters are not well investigated.

Aim. Establish the nature and extent of violations of the coagulation and fibrinolytic systems in mature newborns that underwent HIE depending on season.

Methods of investigation. In order to identify the nature and severity of hemostasis disorders carried out researches, determining the stage of blood coagulation and fibrinolysis: bleeding time, recalcification time, thrombin time, fibrinogen, prothrombin index, fibrin degradation products, all stages of the fibrinolytic activity of the blood using a modified procedure of microassay, paracoagulation (Ethanol and b-naphthol) tests in mature newborns up to one month of age. To determine the seasonal variations of the studied parameters, investigation of newborn blood of the control and the main group carried out both in summer and winter.

Results. In healthy full-term newborns changes in parameters of coagulation and fibrinolytic systems of blood depending on the season of the year – is insignificant. In full-term neonates with HIE has transferred significant prolongation of bleeding time, thrombin time, decrease of tolerance to heparin of plasma, shortening time of recalcification more pronounced in hottest period of the year (p 0.05).

The study of blood coagulation parameters, indicating the intravascular coagulation of blood (ethanol test, the most sensitive to soluble fibrin monomers, fibrin degradation products, and sample with the B-naphthol) established increasing their content at HIE in mature neonates with HIE (p 0.05) in both period of the year, in comparison with the control group, and more often in the hot season (p 0.05).

Conclusion. At HIE in mature newborns, as during the hot and the cold seasons marked activation of fibrinolysis due to mainly internal mechanisms. The degree of activation of the fibrinolytic process is more pronounced in hottest period of the year that is reliable at the 1st stage, and has the same tendency in the final.

Key words: newborns and young children, hypoxic-ischemic encephalopathy, hemostasis, seasonality

N.М. Khursanov, N.Dzh. Sharifova, KR. Voroneckaya

INFLUENCE OF DEPRESSIVE DISORDERS ON HEART RATE VARIABILITY IN PATIENTS WITH CHRONIC HEART FAILURE

Department of Internal Diseases №2 (head – associated prof. N.M. Khursanov) ATSMU

Introduction. According to the WHO forecasts that by 2020, depressive disorders will take second place in the world among all disease after coronary heart disease (CHD) in terms of mortality, morbidity and disability.

Depression is not only a risk factor for chronic heart failure (CHF), but also greatly aggravates the clinical course of the disease, as well as adversely affects the prognosis of the disease.

Aim. The relationship of depressive disorders with heart rate variability in patients with chronic heart failure (CHF) of elderly.

Methods of investigation. The study involved 90 patients with CHF FC I-IV. Functional class was determined by test of 6-minute walk. Depressive disorders were identified through self testing with scale -Beck Depression Inventory (BDI) and the study of heart rate variability was performed using the Varikard apparatus 1.41.Conducted 5 minute ECG recording in one of the standard leads in the supine position. Patients were divided into 2 groups. The first group included 60 patients with CHF with depression, the second consisted of 30 patients with CHF without depression. The patients did not differ by age and basic clinical and anamnestic parameters.

Results. Frequency of true depression among patients with heart failure was 28.8%, and was more pronounced among patients FC III CHF. The total capacity of spectrum TR in patients was significantly reduced in comparison with a group of patients with CHF without depression. Sympathetic-parasympathetic ratio balance LF \ HF on average in the group shifted to the relative prevalence of low-frequency component LF (1,19 vs. 0.93), indicating an increase in sympathetic tone towards parasympathetic.

Conclusion. In patients with CHF of elderly at the moment of the study showed a decrease of heart rate variability. At presence of chronic heart failure with comorbid depressive disorders these violations more expressed that can be a predictor of sudden cardiac death in this category of patients. This circumstance dictates the need for correction of affective disorders, in the treatment of this disease.

Key words: chronic heart failure, depressive disorders, heart rate variability

 

Z.Kh. Yakubova, KS. Olimova, N.Sh. Abdullaeva

THE ROLE OF THYMOMEGALIA IN THE HEALTH FORMATION OF EARLY AGE CHILDREN

Department of propaedeutics of children’s diseases (head, PhD, docent. L.A. Babaeva) ATSMU

The Republican Scientific Clinical Centre Pediatrics and Pediatric Surgery (head.-prof. Z.N. Nabiev)

Introduction. Thymomegaly detection among young children ranges from 30 to 50% of cases. Despite the high medical and biological importance of the thymus gland, certain aspects of pathology of young children connected with thymomegaly is studied insufficiently and requires further investigation. In this connection, more detailed study of the influence on the performance of the index thymomegaly health of young children is very important.

Aim. To study the health status of young children with thymomegaly including physical, nervous and mental development and physical status.

Methods of investigation. Carried out a comprehensive survey of 50 young children with thymomegaly. The degree of increasing the thymus was confirmed by determining the cardio-thymus-thoracic index (CTTI).

Results. Comprehensive assessment of physical, neuropsychological and somatic status of 50 children with thymomegaly revealed low levels of the health index. Adverse antenatal factors contribute to the formation of early thymomegaly with the breakdown of adaptation mechanisms manifested CNS (70%), the formation of endocrinopathies (30%) and a high frequency of bronchopulmonary diseases with frequent relapses. Average body resistance was observed in 55% of children with thymomegaly, low – 35% and is very low at 10%.

Conclusion. Revealed low levels of the health index allow thymomegaly be regarded as the most unfavorable prognostic marker of state of health of young children.

Key words: children, health index, Thymomegalia, resistance, children

 

F.I. Odinaev

RISK FACTORS FOR COMMUNITY-ACQUIRED PNEUMONIA IN TAJIKISTAN

Department of Internal Diseases №1 (head. – prof. Yu.A. Shokirov) ATSMU

The work analyzes risk factors for community-acquired pneumonia in the Republic of Tajikistan. The main risk factors for community-acquired pneumonia were: hypothermia, meteorological factors, nutritional status, burdened premorbid background, bad habits and thyroid status..

Key words: community-acquired pneumonia, risk factors, meteorological factors, nutritional status, thyroid status, premorbid background

 

R.М. Atambaeva, F..А. Kochkorova, М.К. Esenamatova

FEATURES OF PHYSICAL AND SEXUAL DEVELOPMENT OF FEMALE STUDENTS OF VARIOUS EDUCATIONAL INSTITUTIONS

  1. Akhunbaev Kyrgyz State Medical Academy

Introduction. One of the main indicators of the health of the younger generation is the degree of their physical development. Physical development is closely connected with sexual maturation. An important criterion for evaluating the physical development of adolescent girls is to study the extent of puberty, which reflects the level of morpho- functional development of the organism.

Aim. To study features of physical and sexual development of adolescent girls of various educational institutions.

Methods of investigation. Conducted anthropometric studies of adolescent girls of various educational institutions and assess their sexual maturity in terms of development of secondary sexual characteristics with the use of “gender” formula.

Results. Delayed puberty at girls was observed more vocational schools (up 17.9%) than in schoolgirls and gymnasiums girls (3.5% and 3.2%, respectively).

During study of the health of adolescent girls in the Kyrgyz Republic was determined age of menarche from 12.8 to 13.7 years (3, 4, 2), whereas residents of mountainous regions of the Tien Shan (3200-3600m above sea level) and Pamir (3600-4200m. above sea level) noted later menarche – from 14.1 years to 14.9 years

The duration of menses more than 7 days on average for all the girls – students was observed in 10.3% of cases, but much more was revealed at schoolgirls (13.5%).

Conclusion.

  • Comparative evaluation of physical and sexual development offemale students of various educational institutions identified various frequency of menstrual dysfunction, delayed sexual development, physical development abnormalities and lack of body weight, depending on the conditions of the educational institution, curriculum and school organization.
  • identified especially in adolescent girls should be regarded as a poor prognostic sign for the realization of their reproductive function. Therefore, at this stage necessary to carry out preventive work with adolescents on healthy lifestyles and health saving behavior involving parents, school doctors and adolescent teachers and gynecologists.

Key words: adolescent girls, physical development, sexual maturation, growth retardation, risk factors.

 

A.G.Gaibov, A.Dzh. Shekhov, Z.A.Azizov, I.A. Haknazarov

MEDICAL AND SOCIAL DISABILITIES AND REHABILITATION ASPECTS OF PERSONS WITH DISABILITIES IN TAJIKISTAN

Scientific Research Institute of Medical and Social Expertise and Rehabilitation of Disabled Persons (dir.- prof. A.G. Gaibov) of the Ministry of Health and Social Protection of Population of the Republic of Tajikistan

Introduction. According to the UN data, in the world, there are about 450 million people with mental and physical development impairments, which is one-tenth of the inhabitants of our planet. Disability and Health, quite possibly, will increase the current level of disability measure with the transition of medical and social service expertise to work according to the International Classification of Functioning.

Respectively, the solution of the above mentioned problem could get worse due to the lack of unified legal system in Tajikistan, coordinating the activities of various departments and agencies responsible for the implementation of measures for comprehensive rehabilitation in the absence of reliable, properly organized and identified methods for monitoring and assessing the effectiveness of their programs.

Aim. To raise awareness and responsibility of scientists, employees of the executive authorities, medical and social services, non-governmental organizations and agencies aimed to contribute to the implementation state policies, improving the health of people with disabilities and creating an inclusive society in Tajikistan.

Methods of investigation. We used approved by the World Health Organization (May 2013) World Report on Disability (2011), Human Development Report (2010-2013.), The documents on the presentation of positions 2014­2019 yy. Of the Ministry of Health and Social Protection of the Population of the RT “Best health for disabled in order to create an inclusive society in Tajikistan “, the annual analytical reports of the State Service of medical and social expertise. Basic research methods: system analysis, environmental (aggregated risk), statistical.

Results. According to the State Service of medical-social expertise, on January 1, 2014 in Tajikistan the total number of persons with disabilities amounted 166,589 including 25,325 children, with total disability of the population at 2.2 per 10 000 population.

Thus the organization of basic services supporting adults with disabilities, elderly people and children with disabilities does not conform to generally accepted standards, so that had insignificant influence of methods of social protection to reduce poverty among them.

According to world statistics, the structure of the overall morbidity of non-communicable diseases (NCDs) accounts for 98.4%, and remains the leading cause of disability and mortality. In Tajikistan, they are mainly diseases of cardiovascular and respiratory system, cancer, diabetes, injuries and accidents. The highest percentage in the structure of mortality from NCDs belongs to cardiovascular diseases, whose share is about 55%.

Respectively coronary heart disease (CHD) takes a large proportion of cases, which make up 194,400 men aged 25-64 years. This rate is 2.8 times higher than in the UK, is 3.5 times higher than in Germany and 6.8 times higher than in France.

In the dynamics of primary disability of population in the Republic of Tajikistan since 2011 was outlined a clear tendency – the number of new cases of disability, above the age of 3 years decreased from 12.9 thousand to the changing levels, by the end of this period, did not exceed the 9.4 thousand people.

Conclusion:

  1. The policy priorities of the Republic of Tajikistan is to increase the volume of quality and diversification of social services for the integration of persons with disabilities in society.
  2. Managed Risk Factors of main noncommunicable diseases (arterial hypertension, high cholesterol, smoking, alcohol abuse, overweight, stress, etc.) in 75% of cases are leading in the development of restrictions on health, leading to definition of their disability status.
  3. Social protection of persons with disabilities in Tajikistan is based on a sufficiently high level of developing legislation at not conforming to international standards the quantity and quality of services, depending, inter alia, on the socio-economic development of the country.
  4. The disability problem is associated with inadequate financing of medical and social spheres, including the training of qualified specialists.
  5. Support of people with disabilities should be implemented at the community level, including rural areas of Tajikistan, in the long-term national strategy of disability reduction.

Key words: Disability, medical and social aspects, expertise, rehabilitation, resources, rights awareness.

 

Dzh.Kh. Nozirov, А.A. Аkhmedov, F.I. Odinaev

DYNAMICS OF THE MAJOR CARDIOVASCULAR DISEASES AND THEIR MODIFIABLE RISK FACTORS IN POPULATION OF THE REPUBLIC OF TAJIKISTAN

Department of Public Health, Economics, Management of healthcare with a course of medical statistics (head-prof. A.A.Akhmedov)and Department of Cardiology, with the course of clinical pharmacology (head-PhD A.R.Narzulloeva) Institution of postgraduate education in the field of Healthcare of the Republic of Tajikistan

Introduction. According to the World Health Organization experts in countries with medium (Russian Federation) and low (Tajikistan) level of income, cardiovascular diseases in women goes unrecognized in part due to lack of proper attention to the peculiarities of the emergence and development of clinical symptoms. Aim. To study the dynamics and the relationship between coronary heart disease, hypertension and risk factors among female population unorganized rural residents of Tajikistan.

Methods of investigation. Clinical examination was held on 10,992 women aged 15-59 years: 1625- the first time (2001) and 9307females during the second (2011) screening.

Results. During the observation period despite the decrease in the number of women with a risk factor (down on 8.3%) noted an increase in the number of women with two (up 2.1%), three (up 3.1%) and four (an increase of 3 %) with the greatest risk factor for a combination of 45 years of age or older coincide with periods of exchange- and postmenopausal women.

Conclusion. According to the results of two cross-sectional studies reported the incidence of coronary heart disease growth by 0.25%, among a population of women in Tajikistan, which is associated with an increase in the number of risk factors.

Key words: cardiovascular diseases, risk factors, female population

N.F. Salimov, A.A. Razzoqov

DYNAMICS OF KEY INDICATORS OF INJURY IN TAJIKISTAN

Department of Traumatology, Orthopedics and Military surgery (head. – prof. А.А. Razzoqov) ATSMU

Introduction. The rapid spread of injury, the high proportion of serious consequences, allows us to consider the problem as a man-made epidemic of our time. It is important to emphasize that the most important factors of mortality and disability among people aged 5 to 45 years, are various types of injuries. The lack of complex study of the problem and development the ways of its prevention in Tajikistan shows the relevance of this study.

Aim. To study the dynamics of key indicators of injury in Tajikistan.

Methods of investigation. The study is based on an analysis of the data base «Medstat» Department of Medical Statistics of the Ministry of Health and Social Protection of Population of the Republic of Tajikistan. Examination of key indicators of injury was carried out in two stages. In the first stage of the study (2006-2009) in solving injury prevention and treatment of patients were used traditional approaches. In the second phase of the study (2009­2013) in the prevention of injury was used developed with our participation National Program “Injury prevention and improvement of medical care in injuries and their consequences in the Republic of Tajikistan for the period of 2010-2015 years “, as well as the “Strategy of prevention and control of noncommunicable diseases and injuries in the Republic of Tajikistan for the period of 2013-2023 years.”

Results. In the country for the 2006-2013 years the total number of registered injuries ranged from 149.7 thousand to 182.9 thousand. In the first phase of the study (2006-2009) injury rates tended to significant progression. At the same time the second stage of the study (2010-2013), despite major improvements in the registration of injuries as a result of comprehensive measures tend to stabilize the injury rates. According to the study in the structure of outpatient injuries dominated domestic (63.3%) and street (21.9%) injuries, the total weight of which amounted to 85.2%. The structure of stationary proportion of the total injuries of domestic and street traumatism was 73.5% (55.6%, respectively, and 17.8%). The structure of polytrauma is dominated by traffic accidents (57.2%) and katatrauma (19.4%).

Conclusion

  1. Implementation in practice the developed measures in the second stage of the study allowed to stabilize the dynamics of proportion of traumatism in Tajikistan at 2209,5-2268,4 per 100 thousand population and reduce the share of stationary injuries by 4.5%.
  2. In the structure of outpatient injuries dominated domestic (63.3%) and street (21.9%) injuries. The structure of stationary proportion of domestic traumatism was 55.6%, street – 17.8%, traffic – 7.3% and katatrauma – 8.7%. The structure of polytrauma is dominated by road traffic injuries (57.2%) and katatrauma (19.4%).
  3. In the period of instability in the first years of the post-conflict period, the country experienced a decrease in the proportion of industrial injuries from 35.0% to 4.6%. In recent years, due to the positive trend in the economic developmentof the country there is a stable trend towards increasing this indicator, which should be considered in future planning and conducting preventive works.

Key words: injuries, injuries structure, regional patterns of injury, prevention

 

N.F. Salimov, А.А. Razzoqov

OUTCOMES OF REALISATION OF NATIONAL PROGRAM “INJURY PREVENTION AND IMPROVEMENT OF MEDICAL CARE IN INJURIES AND THEIR CONSEQUENCES IN THE REPUBLIC OF TAJIKISTAN FOR THE PERIOD OF 2010-2015 YEARS”

Department of Traumatology, Orthopedics and Military surgery (head. – prof. А.А. Razzoqov) ATSMU

Introduction. The mortality rate persons of working age from injuries and other external causes are twice as mortality from cardiovascular diseases and combined malignant neoplasms. These prerequisites give reason to consider the problem of injuries and orthopedic pathology as one of the most relevant problems in medical science and public health worldwide

Aim. To investigate the outcomes of realization of national program “Injury prevention and improvement of medical care in injuries and their consequences in the Republic of Tajikistan for the period of 2010-2015 years”.

Methods of investigation. As the material for the study were used the following sources:

  • the database «Medstat» Department of Medical Statistics of the Ministry of Health and Social Protection of Population of the Republic of Tajikistan and the database of the Republican GAI Ministry of Internal Affairs of the Republic of Tajikistan, reflected in the annual collection “Analytical review of road traffic injuries in the Republic of Tajikistan”.
  • “Map to explore the state of trauma and orthopedic services”:
  • The results of treatment of priority injuries and orthopedic pathologies in 28555 patients based on trauma and orthopedic department of the National Medical Center and the National Center of Traumatology and Orthopedics for 2006-2013;
  • Disability trauma and orthopedic pathology based on the National State Administration of medical and social expertise;

Results. Injury rates in the first stage of the study generally had increasing the value and nature of the different directions and ranged from 2067.2 to 2160.5 per 100 thousand of population. At the second stage of the study, by providing more equal accessibility in the provision of medical care, take action to improve the registration of injuries, this indicator has a tendency to stabilize within 2009,5-2265,5 per 100 thousand population.

In other words, in fact adoption of measures on injury prevention, as well as positive changes in the socio­economic sphere led to the relative sterilization of the problem of injuries in Tajikistan.

The adoption of comprehensive measures to organize and optimize the provision of traumatological and orthopedic care, as well as increased outpatient care with the introduction of stationary replacing technologies, strengthening the work of the rehabilitated component due to the qualitative and quantitative increasing rehabilitation centers has led to a decrease in the proportion of hospitalized patients with injuries from 23.7 % in 2009 to 18.5% by the end of the second stage of the study.

Conclusion. As a result of implemented technical and organizational approaches observed intensification of the diagnostic and treatment process, which is manifested by shortening of average duration of stay and bed turnover. Based on these indicators, taking into account the climatic and geographical and other features designed to ensure the optimum parameters of the resource and the optimal scheme to provide specialized medical care in the country. Results of the study also contributed to improve the quality of specialized care for injuries and orthopedic pathology, as evidenced by declines in mortality and disability, as well as data on the study of opinions on various aspects of patient care.

Key words: injury prevention, indicators of trauma and orthopedic services, mortality and disability from injury

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