Vol 5, № 2

Objective: Analysis of the effectiveness of the opioid substitution therapy program for drug addicts in the Republic of Tajikistan.

Materials and Methods: In 2010, opioid substitution therapy points were opened in the Republic of Tajikistan to prevent HIV/AIDS, hepatitis B/C and other infectious diseases transmitted by blood contact, prevent overdoses and reduce mortality among people who inject drugs. The treatment procedure is defined by the “Clinical Guidelines for Methadone Substitution Therapy for Drug Addiction in the Republic of Tajikistan”.

Results: In recent years, there have been significant changes in the structure of drug consumption among drug addicts. Among persons registered for drug abuse, the proportion of patients with heroin (74.5%) and opium addiction (14.4%) is 88.9%. During the implementation of the Opioid Substitution Therapy Program in the Republic of Tajikistan in 2010, 7,398 drug users were registered. The incidence rate was 99.7 per 100,000 population. As of the end of 2020, their number was 5,099, and the incidence rate was 52.0 per 100,000 population, that is, it decreased by more than 31.0%. In 2020, the primary incidence rate of drug addiction decreased to 3.0 per 100,000 population, and in 2010 – against 10.8 per 100,000 population. In addition, a significant decrease in the share of injection-based HIV transmission among people who inject drugs through non-sterile equipment was recorded. From 67.1% in 2010, before the start of the Program, this figure decreased to 11.1% in 2019, i.e. 6 times.

Conclusion: Over the past decades, existing harm reduction programs have proven their effectiveness in the prevention of blood-borne infections in the Republic of Tajikistan. It is important to ensure subsequent motivation of drug users to detoxify and undergo a full-fledged medical and social rehabilitation program. The implementation of the above strategy requires the development of new regulatory and legal acts and the introduction of comprehensive harm reduction programs taking into account the ethnocultural characteristics of the population of the republic.

The review of literature presents current data on the relationship of stress, anxiety and depression with cardiovascular diseases. It is noted that anxiety-depressive disorders are detected in more than half of patients with arterial hypertension and ischaemic heart disease. Affective disorders in patients with cardiovascular pathology increase the risk of complications of the primary disease and increase the mortality rate. An increase in the prevalence of depression with age has been observed.

The possible association between depression and increased cardiovascular morbidity and mortality is discussed. It is indicated that new generation antidepressants such as selective serotonin reuptake inhibitors (SSRIs) are devoid of side effects typical for tricyclic antidepressants and can be used for treatment of cardiovascular patients with comorbid depression. It is also important that SSRIs, unlike traditional tricyclic antidepressants, are acceptable for the treatment of affective disorders in patients with cardiovascular disease in older age groups.

Objective: Demonstration of a clinical case of successful removal of the chitinous sheath from the arteries of the left lower limb as a result of rupture of a left ventricular echinococcal cyst.

Materials and Methods: We analyze 4 clinical cases of rupture of cardiac echinococcal cyst with embolization of the lower extremities and development of acute ischemia. All patients were admitted between 2020 and 2024.

Results: As a result of urgent intervention by doctors from the Regional Hospital of Kulyab, it was possible not only to save the life of an 11-year-old boy, but also to prevent amputation of the limb. This fact contributed to the improvement of the patient’s quality of life. It was decided to perform emergency surgery on the lower limb. During the operation, remnants of the parasite’s chitinous shell were found in the arterial cavity, which caused the vessel to become blocked. After the embolus was removed, the blood supply to the limb was restored. The patient’s condition improved. Removal of the echinococcal cyst from the heart and other localizations was postponed until the patient’s general condition returned to normal.

Conclusion: The described clinical cases show the need for widespread information among the population and doctors working in endemic regions, where the probability of contracting echinococcosis is higher. With early detection, the possibility of saving patients and preserving limbs increases. However, as our data show, such cases of early detection, especially in severe patient conditions, are extremely rare.

Objective: Evaluation of the diagnostic value of laboratory parameters and ultrasound examination in the complex diagnostics of acute destructive pancreatitis and its complications.

Material and Methods: This study included 85 patients with purulent-septic complications of acute destructive pancreatitis, of which 51 (60.0%) were men and 34 (40.0%) were women. All patients had changes in clinical tests and pathological symptoms during ultrasound examination, which were verified during surgical interventions. All studies were performed upon admission of patients.

Results: Complex studies have shown that the level of the red blood picture changes due to hemorrhagic imbibition, especially in retroperitoneal cellular tissue phlegmon, the level of leukocyte reaction in all complicated forms of acute pancreatitis was characterized by its specificity, the level of total protein, urea, alkaline phosphatase, blood sugar had fairly high numbers, liver function tests in turn indicated the presence of hepatodepression, markers of the inflammatory process indicated the presence of persistent levels of organ destruction and depended on the depth and widespread process, the parameters of the coagulation system had a correlation with the scale and boundaries of organ destruction and their systemic damage, and sonographic examination confirmed the fact of an inflammatory focus, the level and depth of destruction zones and hemocirculation disorders.

Conclusion: Laboratory tests, study of proinflammatory process markers in combination with ultrasound in acute pancreatitis and its local purulent-septic complications provide a complete description of the current phase of the disease, the depth and prevalence of the destructive process zone.

Objective: To study the long-term consequences of balloon dilation of the esophagus in patients with achalasia cardia.

Materials and Methods: As part of this study, 36 patients with achalasia of the cardia who applied to the endoscopic surgery department of the Republican Scientific Center for Cardiovascular Surgery were operated on from 2020 to 2024. The average age of patients was 25.6±1.7 years. There were 25 male patients and 11 female patients. All patients underwent hydrodilation, a course of 5 to 7 procedures, with an interval of several days.

Results: In 29 cases out of 36, a constant decrease in blood pressure was observed in the postoperative period. In 7 cases, a repeated course of hydrodilation was necessary for a continuous decrease in the pressure level. The surgical intervention took place without any serious complications. The patients’ stay in the hospital was short-term, for two days. The technique of performing hydrodilation not only makes it possible to achieve high indicators in patients with achalasia of the cardia, but at the same time is low-traumatic and safe.

Conclusion: Endoscopic balloon hydrodilation is considered an effective and safe method of treating achalasia of the cardia of any stage and type. Moreover, it is the most justified minimally invasive procedure and non-surgical treatment of this pathology, from an economic point of view.

This article presents a review of scientific sources on the results of surgical treatment of patients with liver damage by echinococcosis, as well as the prevalence of postoperative complications of echinococcal liver cysts. The search results show that the most common postoperative complications of echinococcal liver cysts are hydatid cysts, intrabiliary rupture, cyst suppuration, residual biliary fistulas and bile leakage, large cyst cavities or extrahepatic location, peritoneal rupture, wound infections at the site of port installation, etc.

The most effective method for localizing an echinococcal cyst in the liver is considered to be echinococcectomy, which includes open and laparoscopic approaches. The laparoscopic approach helps to reduce the duration of the operation and the average length of stay with a relatively lower number of postoperative complications, relapses, the period of recovery of gastrointestinal functions, the risk of infection after surgery, a decrease in mortality and recovery rates. In addition, there are disagreements, since, according to some researchers, the question arises that performing laparoscopic surgery for an echinococcal cyst in the liver leads to a decrease in mortality, morbidity or relapse compared to open surgery, remains unconvincing due to the lack of significant evidence.

An analysis of the literature shows that the problem of obesity is becoming increasingly important for reconstructive plastic surgeons worldwide. Bariatric surgery and abdominoplasty are often compared with liposuction. However, it is worth noting that with significant BMI values, only gastrectomy can give the desired result. Laparoscopic longitudinal gastrectomy remains a popular procedure that is often used to treat obesity. However, there is an ambiguous opinion about the risk factors that can lead to complications after surgery. Over the past decade, laparoscopic longitudinal gastrectomy has become the most common type of bariatric surgery. One of the most serious complications after surgery is the failure of the mechanical suture that holds the gastric stump together. In this regard, further research is needed to better understand the negative consequences and develop effective preventive measures.