Vol 5, №1

Objective. Analysis of existing prerequisites of the health care system for the introduction of routine vaccination against human papillomavirus (HPV) in the Republic of Tajikistan.

Materials and Methods. Reporting and statistical data from regional cancer centers, reproductive health services, primary health care institutions and the Republican Center for Statistics and Medical Information of the Ministry of Health and Social Protection of the Population of the Republic of Tajikistan were analyzed.

Results. The data of the conducted analyses of primary morbidity over the past 10 years in Tajikistan showed that 2.35-4.35 new cases of cervical cancer (CC) per 100 thousand population are registered annually in the country. The prevalence of this disease in 2022 was 19.8 cases per 100 thousand population. Age-specific rates of precancerous pathology frequency in comparison with CC for 2023 show that women of the following age groups are most susceptible to CIN: from 35 to 44 years old and from 45 to 54 years old, and CC — from 35 to 44 years old, from 45 to 54 years old and from 55 to 64 years old. The age of patients with CIN is approximately 10 years ahead of the development of invasive cervical cancer. The proportion of patients with CC in the advanced stage of the disease is 18-30% among newly diagnosed patients. Over the past two years (2022 and 2023), the number of women diagnosed with cervical cancer for the first time has increased by almost 1.5 times compared to 2010 figures. The following is a suitable HPV vaccination schedule for Tajikistan: the first-choice vaccine is the Merck quadrivalent HPV vaccine (Gardasil®) and the second choice is the GSK bivalent HPV vaccine (Cervarix™); a single-dose vaccination regimen against HPV is acceptable for the country, since according to available data, a single-dose vaccination regimen provides the same effectiveness and immunogenicity as two-dose and three-dose regimens; the most acceptable age for routine immunization against HPV is considered to be girls aged 10 years.

Conclusion. In the Republic of Tajikistan, there is a steady upward trend in the number of women diagnosed with cervical cancer for the first time. Therefore, it is advisable to include routine vaccination against the human papillomavirus in the National Immunization Calendar of Tajikistan, as well as in the National Programs for the Prevention of Cervical Cancer and Other Diseases Caused by HPV.

Objective. Analysis of the incidence rate of drug addiction among the population of the Republic of Tajikistan.

Materials and Methods. An analysis of some indicators was conducted among drug addicts registered in a specialized registry for the period 2017-2022 in the Republic of Tajikistan.

Results. The total number of drug addicts registered in the specialized register for 2022 in the republic (n=4381) decreased by 38.6%, the incidence rate decreased to 43.8 per 100 thousand population, the mortality rate — by 1.8 times and amounted to 0.9 per 100 thousand population. At the same time, a significant number of drug addicts are men (97.7%), the proportion of female drug addicts was 2.3% of the total number of drug addicts (n=101). The process of “aging of drug addiction” is increasing every year. The proportion of people aged 18 to 34 years old decreases in percentage terms in favor of the age category of 35 to 59 years old, which is 21.1% versus 76.2%. In recent years, the number of people using hard drugs like heroin has decreased significantly, respectively by 1.8 times. The significant increase in people using several types of drugs at the same time is alarming, respectively by 2.6 times. Thus, if in 2021 the use of several types of drugs was registered in 282 cases, in 2022 it was 690, respectively, an increase of 2.4 times was noted. In addition, attention should be paid to the growing trend of the spread of psychostimulants among drug addicts, respectively 34 cases.

Conclusion. Despite a significant decrease in the number of drug addicts, and a decrease in the number of deaths, as well as the number of people using hard drugs like heroin, a significant increase in people using several types of narcotic and psychotropic substances (polydrug addiction) is alarming. Cases of using psychostimulants and new synthetic, pharmacy psychotropic and potent substances are recorded. In addition, people who inject drugs are at risk of contracting infections such as viral hepatitis B and C and human immunodeficiency virus.

Objective. A method for assessing the effectiveness of surgical treatment of patients undergoing urethroplasty of the posterior urethra associated with distraction defects of the posterior urethra.

Materials and Methods. A retrospective analysis of the medical history of 48 patients who underwent posterior urethral urethroplasty associated with PFUDD (Pelvic Fracture Urethra Distraction Defect) over the past 10 years was conducted. The patients were followed up at 3, 6, 12 and 24 months after the operation. Forty-six patients underwent bulboprostatic anastomosis with transperitoneal access, and two patients underwent combined suprapubic peritoneal access. Forty-three patients had a history of primary anastomotic urethroplasty, while five patients had undergone repeat anastomotic urethroplasty. The age of the patients ranged from 17 to 65 years (median 34 years).

Results. In 48 cases, all patients (100%) underwent urethroplasty of the bulbar urethra mobilization and splitting of the cavernous bodies, lower pubectomy — in 4 (18.14%), transpubic anastomotic urethroplasty — in 2 patients. The delayed time between injury and urethroplasty ranged from 4 to 48 months with a median follow-up of 14 months. The average length of the distraction defect was 2.7 cm (from 0.5 to 6.0 cm). Anastomotic urethroplasty was successful in 44 (91.67%) of 48 patients. Revision urethroplasty was successful in 4 (80.0%) of 5 patients. All urethroplasty failures occurred within one year after surgery. Four patients required direct visual internal urethrotomy (DVIU) with regular urethral dilation and three patients underwent revision urethroplasty. The average length of hospital stay was 10 days. The average duration of urethral catheterization was 3.2 weeks. Before surgery, 29 patients had erectile dysfunction, and 19 patients had sexual erection, of which 4 patients had persistent erection. 15 subjects had weak erection and were unable to perform sexual intercourse. Of the 29 patients with erectile dysfunction before surgery, 9 had improved erection after urethroplasty. 12 of the 19 patients who had erection in the preoperative period reported a decrease in potency after urethroplasty.

Conclusion. Open delayed anastomotic urethroplasty is a highly effective method for treating posterior urethral stricture. Efficiency depends on the degree of anastomotic tension, the state of retrograde blood supply to the urethra, and adequate excision of the apical scar tissue.

Objective. To evaluate the safety and effectiveness of the use of self-expanding metal stents in patients with esophageal cancer.

Materials and Methods. The object of the study was 8 patients with grades III–IV esophageal cancer referred to the endoscopy department of the Republican Scientific Center for Cardiovascular Surgery in the period from 2018 to 2024. The age of the patients ranged from 48 to 80 years. 5 patients had the third degree of dysphagia, and three had the fourth degree.

Results. In 7 cases, the intervention led to relief of dysphagia symptoms, with a transition from stage III to stage I. In one case, there was a transition from stage III to stage II of dysphagia. Stenting allowed the patient to restore normal nutrition on the day of surgery, minimizing the need for pain relief with narcotic drugs. The period of hospital stay did not exceed three days, on average it was 1.4±0.6 days. In two cases, the stent was localized in the cervical region, and in two more — in the mid-thoracic region of the esophagus. In one patient, the stent was localized in the lower thoracic region, and in three more cases, in the area of the esophagogastric junction.

Conclusion. Endoscopic stenting using metal-coated materials has proven to be an effective and safe method of palliative treatment of patients with inoperable forms of esophageal cancer. Of the eight cases of stent insertion, life-threatening complications were not observed in any case.

Objective. To evaluate the effectiveness of surgical interventions for different degrees of obesity.

Materials and Methods. This study included 458 patients who underwent various surgical procedures for weight loss. Of these, 296 patients underwent combined abdominoplasty with liposuction, in 83 cases liposuction and 71 abdominoplasty. In 8 cases, endoscopic surgery on the stomach was performed.

Results. The study showed the safety of performing endoscopic interventions on the stomach at high degrees of obesity (BMI≥40 kg/m²) and more effective for such indicators than abdominoplasty and liposuction. With liposuction, no statistically significant changes in this direction were noted. All patients in the gastric intervention group experienced significant weight loss, without re-obesity, while patients who underwent liposuction and abdominoplasty had a re-application rate of 42% within a few years.

Conclusion. Bariatric surgery is an effective method of surgical intervention for high degrees of obesity, which has a number of advantages over abdominoplasty and liposuction.

Objective. Analysis of immediate and long-term results of surgical treatment of patients with cervical rib syndrome.

Materials and Methods. The basis of the study was an analysis of the results of surgical treatment of 138 patients aged 16 to 63 years, routinely operated on for cervical rib syndrome (CRS) in the Department of Vascular Surgery of the State Institution “RNCSS” for the period 1990 to 2020. Among them there were 22 men (15.94%) and 116 women (84.6%).

Results. According to the results of X-ray examination and computed tomography (CT), an additional cervical rib was found in 63.76% (n=88), on both sides in 48 and on one side in 40 cases, and a rudimentary cervical rib — in 36.24% (n=50) patients. When analyzing X-ray images (n=138) and CT data (n=24) from the total number of patients, concomitant pathology was revealed: cervicothoracic osteochondrosis — in 52 (36.7%), scoliosis — in 20 (14.5%), thickening of the transverse processes of C6 — in 23 (16.7%) patients. Also, CT revealed anomalies of the anterior scalene muscle in 14 (n=10.1%), osteo-fibrous anomalies — in 10 (n=7.2%) patients, which could remain unnoticed, provoke increased pain symptoms in CRS and influence the results of operations performed.

Conclusion. The task of a comprehensive examination of patients with a cervical rib is a targeted clarification of existing changes, not only to make a diagnosis or differentiate it, but also to select an adequate volume of surgery, in order to achieve positive results and reduce the frequency of relapses.

Objective. To study the antidiabetic, antioxidant and wound-healing effects of decoction of Japanese Sophora fruits (JSDF).

Materials and Methods. The studies were conducted on male and female rats. The experiments involved 100 rats weighing from 180 to 200 grams. The well-known model of diabetes mellitus known as alloxan was reproduced. The antioxidant effect of the decoction (1:10) was determined by the level of malonic dialdehyde. The local regenerative effect was assessed by the dynamics of the wound healing rate, determining the daily contour of the skin defect.

Results. In the experimental group of rats suffering from alloxan diabetes, the blood sugar level significantly decreased due to treatment with the decoction. This decrease was statistically significant (P<0.001) and was observed at all stages of the study. In the experimental animals that received the decoction (in a ratio of 1:10), the blood sugar level on the seventh day was 6.4±0.02 mmol/l (156%), on the fifteenth day — 6.1±0.03 mmol/l (141.8%), and on the thirtieth day — 5.1±0.05 mmol/l (121.4%). In a comparative series, where animals with alloxan diabetes were treated with Arfazetin infusion, the blood sugar level on the seventh day was 8.22±0.04 mmol/l (200%), on the fifteenth day — 7.85±0.01 mmol/l (182.5%) and on the thirtieth day — 7.7±0.03 mmol/l (183.3%). The antioxidant effect of the Arfazetin infusion was less pronounced (by 42.8%) than that of the Japanese pagoda tree fruit decoction. With daily intravenous administration and irrigation, the wound healing time was reduced by an average of 6 days compared to the group receiving the rosehip fruit decoction.

Conclusion. A decoction of Japanese pagoda tree fruits has a strong hypoglycemic, antioxidant and regenerating effect. This allows it to be used both for preventive and therapeutic purposes in diabetes.

Objective. To assess the incidence of complications after rhinoplasty by summarizing the results of relevant meta-analyses.

Materials and Methods. To analyze the scientific literature, the results of modern studies on the incidence of complications during rhinoplasty were used.

Results. Rhinoplasty is one of the most common aesthetic procedures in the field of facial plastic surgery, but it is also considered one of the most complex. Questions regarding reoperation rates, risk factors for various complications, and postoperative patient satisfaction after primary rhinoplasty remain unresolved and are of scientific interest.

Conclusion. Synthesis and analysis of data on complications associated with rhinoplasty will help improve plastic surgeons’ awareness, prevent and/or reduce the incidence of complications in patients, and optimize functional, aesthetic and cosmetic results, as well as patient satisfaction.