Category Archives: №2

IMPROVEMENT OF CLASSIFICATION OF BILIOUS PERITONITIS

Muminov S., *Kurbonov K.M., Rasulov N.A., *Kayumov A.A.

IMPROVEMENT OF CLASSIFICATION OF BILIOUS PERITONITIS

Department of Surgery of the State Education Establishment “Institute of Postgraduate Education in Health Sphere of Republic of Tajikistan”

*Department of Surgical Diseases №1 of the Tajik Medical State University named after Abuali-ibn- Sino

Aim. Improve and introduce classification of bile peritonitis.

Materials and methods. For a basis of this research the experience of complex diagnosis and surgical treatment of 87 patients with bilious peritonitis was put. Patients treated in the City Clinical Hospital of Emergency Medical Care Dushanbe. Also, evidence to date classification of peritonitis, and in particular, the bilious was analyzed and studied.

Results. The dinical manifestation of bilious peritonitis largely depended from reasons of disease arising and severity of endotoxemia. Based on the study and review of available clinical data the clinical classification of bilious peritonitis was developed. It would greatly optimize the further tactics and thus improve results of treatment.

Conclusion. Conducted operations on the biliary tract are often associated with great technical difficulties which require from surgeon of relevant experience in the field of hepato-biliary surgery. So the given classification would greatly simplify and improve further tactics of selection of operative intervention volume. A significant danger is presented by a septic symptoms which indicate the need for timely selection of treatment of this patients.

MINIMALLY INVASIVE SURGERY OF LIVER ECHINOCOCCOSIS

Gulmuradov T.G, Amonov Sh.Sh, *Prudkov M.I., Sangov D.S.

MINIMALLY INVASIVE SURGERY OF LIVER ECHINOCOCCOSIS

Department of Cardiovascular and Plastic Surgery of the State Education Establishment “Institute of Postgraduate Education in Health Sphere of Republic of Tajikistan”

*State Budgetary Educational Institution of Higher Professional Education Ural State Medical University, Ekaterinburg, Russia

Aim. Improving results of surgical treatment of hepatic echinococcosis by applying minimally invasive technology.

Materials and methods. Under the supervision during the period 2002-2013 there were 149 patients with hepatic echino-coccosis. From them 52 were examined at the Department of Surgical Diseases advanced training faculty and postgraduate training. The remaining 97 patients – in endosurgical department of the Republican Scientific Center for Cardiovascular Surgery in Dushanbe. Among them were men 63 (42,2%) and 86 women (57,8%). In 105 (70,4%) patients echinococcal cysts were located in the right liver lobe (18 – V; 24 – VI; 31 – VII; 28 – VIII), in the left lobe – 44 (29,6%) of 2 – I; 12 – II; 19 – III; 13 – IV segments. According to the size and scope of the cysts distinguish between: medium to 10 cm – 80 patients, large 20 cm – 46 patients and giant than 20 cm – 23 patients. The average size of cyst was 102,77±3,7mm (46-280 mm). From the 149 patients 42 patients underwent echinococcectomy of the traditional approaches, 40 patients underwent laparoscopic echinococcectomy when echinococcus cyst localized to visually accessible segments of the liver S III, IV, V, VI; 67 operations performed minilaparotomiya access using a set of tools “Mini-Assistant”.

Methods of surgical treatment of echinococcal cysts of the liver involves surgical access, puncture and aspiration of the cyst contents, opening the cyst and the revision of its cavity, cyst processing by adsorbed 33% solution of hydrogen peroxide (perhydrol) and the elimination of residual cavity (wide fenestration, in a number of cases a large portion of tamponade gland, external drainage with low vacuum aspiration).

Results. Postoperative complications were observed in 9 (21,4%) of 42 patients operated by conventional methods. Of the 107 patients operated using minimally invasive technology (mini-access and laparoscopically), complications were observed in 14 (13,1%) patients. Especially favorable postoperative course was after the intervention of the small incisions. Case of an expression enteroparesis and systemic were no complications.

Conclusion. Using minimally invasive techniques allow to improve results of surgical treatment of liver echinococcosis. Minimal trauma, high economic efficiency are the main advantages of these methods.

SOME FEATURES OF STI/HIV DISSEMINATION IN THE MODERN SOCIAL AND ECONOMIC CONDITION

Bobohodjaeva M.O., *Ahmedov A., *Kasymova M.K.

SOME FEATURES OF STI/HIV DISSEMINATION IN THE MODERN SOCIAL AND ECONOMIC CONDITION

Department of Obstetrics and Gynecology of the State Education Establishment “Institute of Postgraduate Education in Health Sphere of Republic of Tajikistan”

*Department of Public Health, Economics, Management with a course of medical health statistics of the State Education Establishment “Institute of Postgraduate Education in Health Sphere of Republic of Tajikistan”

Aim.Definition of features STI/HIV transmission in modern social and economic conditions.

Materials and methods.Conducted a sociological survey of 400 workers, providing sexual services (SW) in Dushanbe. The survey was anonymous, voluntary on the basis of an oral informed consent. The questionnaire included questions that reflect the issues of social characteristics, sexual and reproductive behavior and health of the PC and users of their services.

Results. On growth and spread of STI / HIV infection in a certain way affect behavioral factors of SW. In epidemiological process involved not only persons with risky behavior (drivers, businessmen), as well as students of secondary and higher educational institutions, employees of state agencies, including foreign nationals. Foregoing facts explain such fast spread of STI / HIV among the population. During the days of SW had from 2 to 5 sexual partners – 47,8% of respondents; from 6 to 9 – 20,5% SW, 10 and more – 11,7%, 1 sexual partner were 17,3%, 2,7% did not answer. The respondents have taken alcohol at least once a week – 16,0%, several times a week – 12,0%. The proportion of drug users among sex workers was 2,9%. Sex workers who were injecting drug users do not use disposable syringes. 37,0% occasionally use condoms, and only 12,0% – permanently.

Conclusion. Due to the wide spread of STI / HIV, behavior of SW has become one of the most important indicators of risk because it reflects the potential danger of mass infection in the community.

POSITIVE INFLUENCE OF SORBITOL IN PATIENTS WITH CHRONIC RENAL FAILURE

Bobieva N.H., Gadoev S.H., Subhonova Z.I., *Sunatulloev D.S.

POSITIVE INFLUENCE OF SORBITOL IN PATIENTS WITH CHRONIC RENAL FAILURE

Department of Internal Disease № 3 of the Tajik Medical State University named after Abuali-ibn-Sino

*Department of Therapy of the State Education Establishment “Institute of Postgraduate Education in Health Sphere of Republic of Tajikistan”

Aim.To estimate actions of sorbitol in combination with enterosorbents on gastrointestinal tract in the complex treatment of chronic renal failure.

Materials and methods. The study included 40 patients with chronic renal failure. Diagnosis and assessment of severity of uremia was conducted by determination of glomerular filtration rate (the level of urea and creatinine in blood), the A / D profile and the degree of edemas.

Results. In patients on background of reception of sorbitol 10-15 days earlier than in the control group, marked decrease in the level of nitrogenous wastes in the peripheral blood (urea, creatinine), reduction of edemas, reduction of hypertension. Reception of sorbitol accompanied by a decrease symptoms of uremic intoxication and improvement of the patient. Improvement comes after 7-10 days of treatment. This is manifested in decrease of pruritus, nausea and vomiting, headache and decrease in levels of nitrogenous wastes in the peripheral blood. Wellness at reception of sorbitol saved from 1 to 6 or even 12 months.

Conclusion. The use of sorbitol in combination with other enterosorbents significantly complements traditional dialysis therapy, hemodialysis pushing the starting date.

ULTRASOUND SCANNINGAS AN EFFECTIVE METHOD OF DIAGNOSING OF EXUDATIVE PLEURISY IN CHILDREN

Bahodurov J.T., Ibodov H.I., Rofiev R.R., Asadov S.K., Nurov M.S.

ULTRASOUND SCANNINGAS AN EFFECTIVE METHOD OF DIAGNOSING OF EXUDATIVE PLEURISY IN CHILDREN

Department of Pediatric Surgery, Anesthesiology and Reanimatology of the State Education Establishment “Institute of Postgraduate Education in Health Sphere of Republic of Tajikistan”

Aim.Determination of the value of ultrasound scanning in the diagnosis of lung diseases such as exudative pleurisy in children.

Materials and methods. Investigated the clinical and laboratory, radiographical, CT, MRCI and ultrasound scan data of 76 patients with a diagnosis of pleural effusion in age from 1 month to 15 years.

Results. Based on the clinical and laboratory, radiographical, MRCI and ultrasound scan data of 76 patients in 3 diagnosed lung cancer, in 5 specific process, and in rest 68 children set pulmonary-pleural form of bacterial destructive pneumonia. At bacteriological research in 15 patients sown staphilococcus, in 6 – streptococcus, and in 7 – klebsiella. In other 43 cases, microorganism growth is not detected. At ultrasound examination of presumptive defeat zones lung tissue was visualized as a set of cellular structures or destructive changes, and at a depth of 0,5-0,9 cm from pleural sheets started to delaminate planar structures formed vessels and bronchial tubes. At empieme of pleural cavity the presence of echogenic suspensions was revealed, the maximum thickness of the parietal pleura was 5,2±0,3 mm, as opposed to other types of pleuritis. A reliable signs of metastatic pleuritis were: homogeneous pleural contents, the minimum thickness of parietal pleura 3,5±0,3 mm.

Conclusion. Comparison results of ultrasound examination of pleuritis with data morphological research, obtained at puncture biopsy of pleura controlled by ultrasound examination, showed their high correlation in identifying of etiology of pleural effusion. Using of duplex ultrasound scan at complex ultrasound examination allowed to reveal flow in the formations subpleural located in lung parenchyma of tumor etiology, in contrast to formation of inflammatory genesis.

STUDY OF INJURIES STRUCTURE AND IMPROVEMENT OF PREVENTATIVE ACTIVITY OF FAMILY PHYSICIANS IN THE CITY HEALTH CENTER №1 C. DUSHANBE

AshurovZ.Ya., Mirzoeva Z.A., Davlyatova D.D.

STUDY OF INJURIES STRUCTURE AND IMPROVEMENT OF PREVENTATIVE ACTIVITY OF FAMILY PHYSICIANS IN THE CITY HEALTH CENTER №1 C. DUSHANBE

Department of Family Medicine of the State Educational Establishment “Institute of Postgraduate Education in Health Sphere of Republic of Tajikistan”

Aim. Analyze the traumatism in the city health center №1 c. Dushanbe, evaluate its structure, suggest ways of preventing in practice of family doctor.

Materials and methods. For the analysis of traumatism in the city health center №1 c. Dushanbe statistical data of emergency station №3 at city health center №1 c. Dushanbe of 2012 -2013 years were used.

Results. Concerning street traumatism in 2012 1937 persons (40,4%), in 2013 – 1997 (38,4%) appealed. In 2013 decrease of cases of street traumatism on 2% is observe. Concerning home traumatism for medical care 2854 – 59,6% of patients, and in 2013 – 2495 – 47,9% (decrease 11,7%) appealed. 459 pupils received injuries at school (5,2%) in 2012, in 2013 – 241 (4,6%). Sports injuries in 2012 accounted 459 cases (9,5%), in 2013 – 388 (7,4%) (positive dynamics). Over the wound in 2012 1771 children (37,0%), in 2013 – 1440 (27,6%) appealed. Open fractures in 2012 included 8 cases (0,1%), in 2013 – 11 (0,2%) (increase on 0,1%); closed – 1568 (32,7%) in 2012 and 1275 (24,5%) in 2013. Dislocations in 2012 reached 281 case (5,6%), in 2013 – 205 (3,9%). With burns in 2012 18 persons (7,3%), in 2013 – 186 (3,7%), of animals bites 369 patients (7,1%) in 2012 and 320 (6,1%) in 2013 addressed. Conclusion. At the present time, there are serious problems in the prevention of traumatism due to the low level of education of the population, poor public and society awareness.

ANTIDESTRUCTIVE ACTION OF GLUCOCORTICOIDS AT EARLY REUMATOID ARTHRITIS

Ahunova N.T., Holova Z.U., *Niyazov F.I.

ANTIDESTRUCTIVE ACTION OF GLUCOCORTICOIDS AT EARLY REUMATOID ARTHRITIS

Department of Therapy of the State Education Establishment “Institute of Postgraduate Education in Health Sphere of Republic of Tajikistan”

*Department of Internal Disease № 3 of the Tajik Medical State University named after Abuali-ibn-Sino

Aim. Study of antidestructiveactionsofglucocorticosteroids on the background of the basic treatment of early rheumatoid arthritis by methotrexate.

Materials and methods. Present results of treatment of 42 patients (all women) in the age of 32 to 58 years (mean 45 years). Duration of disease from 0,5 to 2 years with a valid RA (ARA criteria, 1987), observed during the year. Exclusion criteria were the presence of stomach ulcer or 12-duodenal ulcer. Patients with IV stage of radiographic disease. All patients were divided into two groups: 1 – 22 persons receiving methotrexate 10 mg per week and glucocorticosteroids7.5mg / day; 2 – 20 patients treated only by methotrexate. Nonsteroidal anti-inflammatory drugs were allowed in both groups. To assess the therapeutic effect was used clinical, laboratory and radiographic performances.

Results. In the 1st group in 8 of 22 patients decline was registered of the index of Larsen. Mainly due to the decrease or disappearance of cystoid enlightenment and of phenomena of periarthric osteoporosis. In the second group decrease of this indicator was observed only in three patients. Reduction of the index of Larsen did not correlate with the expected decrease in erosion, growth of erosions in the two groups was almost the same (2.0 and 2.4 respectively).

Conclusion. In patients with early rheumatoid arthritis reception of corticosteroids in combination with methotrexate helps to reduce osteochondral destruction, estimated by the index of Larsen.

OPTIMIZED APPROACH TO THE TREATMENT OF LIMB FRACTURES IN PATIENTS WITH ORTHOPEDIC TRAUMA

Ahmedov Sh.M., Sirodzhov K.H., Muradov A.M., Holov D.I., Rahimov A.T.

OPTIMIZED APPROACH TO THE TREATMENT OF LIMB FRACTURES IN PATIENTS WITH ORTHOPEDIC TRAUMA

Department of Traumatology and Orthopedics of the State Education Establishment “Institute of Postgraduate Education in Health Sphere of Republic of Tajikistan”

Aim.Optimization of diagnostics and surgical treatment of fractures in patients with multiple injuries.

Materials and methods. The work is based on analyzing results of diagnosis and treatment of 183 patients in the period 2001-2013, which were divided into 2 groups. In the main group osteosynthesis of fractures optimized with the lipid spectrum of blood plasma, in the control group treatment of fractures is traditionally held. The examination program of patients included: clinical examination, beam diagnostics, clinical laboratory tests, the study of the concentration of total lipids, catalase, atherogenic index calculation, the concentration of cholesterol, low density lipoprotein, very low density lipoproteins, determine the extent of fat globulemya.Results. An important criterion of the outcome of treatment of patients with multiple injuries is the number of complications during the acute period of traumatic disease. Organ dysfunction were observed in 3,0 and 4,9% patients respectively in groups, which in 0,9% and 2,4% of cases have led to deaths. Venous insufficiency of limb was observed in 2,0% and 3,7% of patients, kompartmen syndrome – 0,9% and 2,4% of cases, fat embolism syndrome was observed in 1,2% of patients in the control group.

Conclusion.The positive effect of the results of treatment of patients of the main group due to an optimized approach to the treatment of fractures with the use of of lipid spectrum and sparing ways of osteosynthesis. Modified isovolemichemodilution allows to withdraw patient from a state of shock, improves blood oxygen transport minimizes amount of blood loss, the degree of endogenous intoxication, the risk of fat embolism syndrome and other vital violations.