Vol 6, №1

This paper presents a clinical case, which became the first successful experience of minimally invasive coronary bypass surgery in the Republic of Tajikistan. The operation was performed on a young patient with isolated lesion of the anterior descending artery using the left internal mammary artery, with a good clinical outcome.
The patient was admitted to the Ibni Sino Clinic with symptoms of chronic heart failure, which corresponded to functional class III according to the NYHA classification. It is known from the anamnesis that the patient suffered from decompensated diabetes mellitus, as well as chronic kidney disease, manifested by an increase in the level of urea (14 mmol / l) and creatinine (231 μmol / l). He was also diagnosed with diabetic neuropathy of the lower extremities. In addition, a year ago, the patient suffered from an acute cerebrovascular accident.
Due to the high risk of repeated stenting, it was decided to perform myocardial revascularization surgically. For this purpose, the minimally invasive method of direct coronary artery bypass grafting (MIDCAB) was chosen.
The method of minimally invasive coronary artery bypass grafting through anterior minithoracotomy is a good alternative to standard coronary artery bypass grafting by sternotomy in case of damage to the anterior interventricular artery.
This method can also be used with high efficiency and safety in case of isolated damage to the anterior interventricular artery. At the same time, it provides less trauma, faster rehabilitation and an aesthetic effect.

In the Republic of Tajikistan, the problem of cardiovascular diseases is the most common. In the structure of causes of death, it occupies an overwhelming position, accounting for more than 52%. At the same time, there is a tendency towards atypical clinical manifestations. The high level of cardiovascular catastrophes is largely associated with the psychosocial state of the population.
In this aspect, a clinical picture of angina against the background of unchanged coronary arteries, which in the literature are called “microvascular angina” or cardiac syndrome X, has become a common phenomenon in cardiology in many countries of the world.
Today, cardiac syndrome X remains a complex cardiac syndrome. While most authors agree on the etiologically aggravating factors of cardiac syndrome X, the pathogenetic aspects remain controversial. In any case, syndrome X should be classified as a clinical form of coronary heart disease, since ischemic processes are present, although they can be aggravated by a number of extracardiac pathological conditions associated with an imbalance in the supply of oxygen and blood. With microcirculatory disorders and the formation of coronary heart disease, visualization of the coronary arteries becomes possible only at the level of the epicardial arteries, while the microvascular bed becomes “angiographically invisible”.
According to the literature, the risk of developing cardiac syndrome X in females is much higher than in males, especially during menopause.

A review of current literature was conducted to obtain up-to-date information on the latest advances in the study of the human papillomavirus genome and its relationship with cervical cancer. The study used Medline and Pubmed search engines, where keywords related to the virology and carcinogenesis of the human papillomavirus, as well as the epidemiology of cervical cancer, were found. Primary sources, WHO clinical guidelines, and GLOBOCAN data were used, as well as references to original articles.
Cervical cancer remains a serious public health threat, particularly in low- and middle-income countries. Recent advances in virology and understanding of the processes that lead to the development of cervical cancer have allowed new and more effective diagnostic methods to be introduced into modern medical practice, allowing for the detection of cervical intraepithelial neoplasia at an early stage. Diagnosis and treatment of precancerous cervical lesions based on modern concepts of carcinogenesis are the most effective way to combat this disease at the global level.
There is a steady trend towards an increase in the number of cases of cervical cancer in Tajikistan. In the general statistics of oncological diseases and mortality, this disease ranks second after breast cancer. In 2023, the incidence rate was 4.0 per 100 thousand people, prevalence – 22.2, and mortality – 1.6. In different years (from 2014 to 2023), the mortality to incidence ratio ranged from 43.4% to 84.2%.
Thus, the study of the human papillomavirus genome and modern knowledge about the development of cervical cancer allow us to develop more effective comprehensive measures to combat this disease. A deep understanding of the molecular aspects of carcinogenesis has allowed us to improve diagnostics at early stages of the disease, more accurately assess prognoses, and develop more effective treatment methods.

Objective. To review modern and effective methods for diagnosing cervical intraepithelial neoplasia (CIN).
Materials and Methods. The study examined publications on traditional and innovative methods for post-screening diagnostics of cervical intraepithelial neoplasia (CIN). Based on meta-analyses and individual studies, the main methods of modern diagnostics, molecular, visual (including colposcopy) and cytological tests were analyzed. To assess the effectiveness of tests in diagnostics, we used key terms such as sensitivity and specificity.
Results. Modern innovative technologies, such as HPV DNA testing, advanced colposcopy with spectral photometry, and liquid-based cytology, have significantly expanded access to routine clinical practice in middle- and low-income countries. In many countries, DNA testing is used as an initial screening test, which is then confirmed by colposcopy or cytology. Oncoprotein detection allows us to detect disease progression, which is characterized by the degree of CIN2+ damage. The World Health Organization has developed new algorithms that will help streamline the use of essential diagnostic tests.
Conclusion. The healthcare system in developing countries, including Tajikistan, is awaiting an update of CIN diagnostic protocols. This includes a gradual transition to DNA testing, which will increase the detection of CIN and, as a result, reduce the incidence and mortality rates of cervical cancer.

Objective. To study the structure of morbidity among workers of the Tajikcement cement plant.
Materials and Methods. A retrospective study was conducted in 2024. In accordance with the employment contract concluded between the Republican Center for Occupational Diseases and the Tajikcement cement plant, periodic medical examinations are organized every year for the early detection of occupational diseases. In 2024, a comprehensive medical examination was conducted, which involved 550 workers from the main workshops of the plant and 44 employees of auxiliary departments. Of these, 96.8% (n=575) were men, and only 3.2% (n=19) were women.
Results. The majority of workers are young and able-bodied people from 30 to 60 years old – 452 people (76.1%). The smallest number – 21 people (3.8%) – are among workers over 60 years old who work under an annual contract. Most workers have work experience from 11 to 15 years – 226 people, which is 41.5% of the total. Among the respiratory diseases, the most common are chronic bronchitis, bronchial asthma, chronic pneumonia, allergic rhinitis, pharyngitis, laryngitis, catarrhal angina and chronic tonsillitis. A total of 332 cases of such diseases were identified. Also recorded were pathologies of the digestive organs (100 cases), cardiovascular diseases (67 cases), diseases of the urinary system (90 cases) and other diseases (279 cases). During the medical examination, 42 workers were identified who had been preliminarily diagnosed with bronchial asthma. Of these, 21 workers suffered from the atopic form of the disease, and 13 – from a mixed infectious-allergic form.
Conclusion. Cement production workers are most exposed to adverse factors in the working environment, which lead to serious respiratory diseases. To prevent possible negative consequences for the health of these people, it is necessary to improve the air quality in the main and auxiliary workshops of the cement plant.

Objective. To study the incidence of neural tube defects among the causes of termination of pregnancy for medical reasons, based on prenatal screening data.
Materials and Methods. In the period from 2019 to 2021, 449,252 pregnant women underwent prenatal screening in the Republic of Tajikistan. Of these, 8,502 (1.9%) were diagnosed with fetal abnormalities. During 2019-2022, 6,540 pregnant women were examined and consulted at the Republican Medical Genetic Center.
Results. According to the prenatal screening data, 6,725 (79.0%) pregnant women were able to prevent the birth of children with fatal and severe congenital malformations that cannot be corrected surgically. In particular, the birth of 2,528 children with neural tube defects was prevented, which amounted to an average of 37.5%. Of the 6,540 pregnant women examined, 1,842 were suspected of having congenital malformations of the fetus. In 183 cases (23.3%), previously identified fetal pathologies were confirmed, in 1,059 (57.4%) they were refuted, and in 600 (76.6%) they were diagnosed for the first time. In 783 cases (100%) where fetal malformations were identified, the largest number were congenital malformations of the central nervous system – 342 cases (44%). Among them, 192 (24.5%) were multiple malformations. Gastrointestinal tract defects were detected in 53 cases (6.7%), urinary tract defects in 49 cases (6.2%), musculoskeletal defects in 33 cases (3.3%), defects of the face and palate in 27 cases (3.4%), and defects of the heart in 11 cases (1.4%). Trisomies of chromosomes 13, 18, and 21 were also detected in 52 cases (6.6%), and other abnormalities in 31 cases (3.9%).
Conclusion. Thanks to the work of the Republican Medical and Genetic Center, it became possible to study how often neural tube defects occur, what their structure is, and how important they are for predicting perinatal mortality rates.

Objective. To evaluate the results of one-stage combined urethroplasty for distal hypospadias.
Materials and Methods. In this work, the results of one-stage closure of the urethral defect were studied in nine patients with recurrent hypospadias who had previously undergone only one operation. All patients were male and suffered from the distal form of hypospadias. To eliminate the defect, a combined method was used, which used both local tissues and the oral mucosa.
Results. The immediate and long-term results of the study confirmed the effectiveness of this method. In three cases, partial divergence of the sutures was recorded. To eliminate the divergence at early stages, additional surgical intervention was required. It was necessary to restore the integrity of the transplanted tissues and flaps. After the operation, successful engraftment was noted in all cases. Uroflowmetry was used to assess the condition of the anastomosis in the early stages of the postoperative period in patients. The key criterion for the success of the surgical intervention, according to the results of uroflowmetry, was the stable maintenance of the maximum urinary flow rate at a level of at least 15 milliliters per second.
Conclusion. The obtained results demonstrate the high efficiency of one-stage operations in patients suffering from the consequences of urethral damage. One-stage operation is characterized by lower economic costs and a significant reduction in time costs, which makes it a preferable option for the management of such patients.

Objective. To study the functional features of the skin in patients with vitiligo depending on their phototype.
Materials and Methods. The study involved 200 patients diagnosed with vitiligo. Of these, 92 were male and 108 were female. The average age of the patients was 14.0±2.4 years. All of them were hospitalized in the skin department of the state institution “City Clinical Hospital of Skin Diseases” in the period from 2021 to 2023.
Results. Patients with dark skin phototype were found to have decreased pigmentation levels. In people with dark phototype IV, this indicator was 1.2 times lower than in patients with phototype III (27.3±3.2% versus 23.3±1.2%), and 1.4 times lower than in patients with phototype II (34.3±4.2% versus 23.3±2.2%). Skin dysfunctions were detected in 13 of 22 patients with light phototype, which is 59.1%. In patients with phototype III, such disorders were found in 52 of 79 people, or 65.8%, and in patients with phototype IV – 76 of 99 people, or 76.8%. Thus, in vitiligo patients with dark phototypes, skin dysfunctions are more common than in patients with light phototypes.
Conclusion. Vitiligo occurs as a result of a more significant decrease in the level of pigmentation in patients with a dark skin phototype. In turn, in patients with a light skin phototype, vitiligo is associated with reduced moisture and increased oiliness of the skin.

Objective. To assess the degree of bacterial contamination of the hands of medical personnel working in operating units and dressing rooms. In addition, we wanted to find out how often different types of staphylococci are found and whether there is a possibility of their co-growth.
Materials and methods. In 2022, a retrospective analysis of the results of bacteriological examination of swabs from the hands of medical personnel was conducted. The study was conducted in the bacteriological laboratory of the National Medical Center “Shifobakhsh” (NMC “Shifobakhsh”) with the participation of 39 doctors and 45 nurses from the operating unit, as well as 41 doctors and 48 nurses from the dressing rooms.
Results. The bacteriological study showed that Staphylococcus epidermidis was the most common microorganism among all the studied groups. The study revealed that the percentage of S. saprophyticus among doctors was significantly higher than among nurses. Among doctors, this microorganism was detected in 23.1% of cases in the operating room and in 26.83% of cases in the dressing rooms. At the same time, among nurses, this microorganism was detected in only 22.2% and 6.25% of samples, respectively. Staphylococcus aureus was much less common, especially in combination with other microorganisms, such as Streptococcus pyogenes or Klebsiella. This indicates the likelihood of developing multiple infections and an increased risk of infection.
Conclusions. The results of the study show that, first of all, a system for monitoring hand hygiene compliance should be created or improved. Particular attention should be paid to nurses and doctors working in dressing rooms, where higher rates of contamination were recorded. Conducting regular preventive measures is an important step towards preventing hospital-acquired infections and the spread of antimicrobial resistance.

Objective. To analyze the root extract of Rhodiola heterodonta, which grows in Tajikistan, using ultra-high-performance liquid chromatography equipped with a high-resolution mass spectrometric detector. The main objective is to develop a method for standardizing a medicinal product based on this extract.
Materials and Methods. The object of the study was the rhizomes and roots of Rhodiola heterodentata (R.H.), collected in November 2021 in the mountains of the Baljuvan district of the Khatlon region of the Republic of Tajikistan. A dry extract obtained by the reporcolation method from the rhizomes and roots of Rhodiola was also studied. The phytochemical study was carried out using high-performance liquid chromatography with mass spectrometric detection.
Results. Rosavin was not detected in the ethanol extract of R. heterodonta rhizomes grown in Tajikistan. Therefore, the results of this study focused on salidroside, tyrosol, and heterodontoside, three phytochemicals previously identified in R. heterodonta. In the dry extract of Rhodiola heterodonta rhizome, 13.8 mg of salidroside (p-hydroxyphenethyl-β-D-glucoside), which is the main component of rhodiola, were detected. On average, the tyrosol content in the dry extract was 2.3 mg per gram of dry weight. In our study, using high-performance liquid chromatography and mass spectrometry, the heterodontoside concentration in the dry extract was 0.52 milligrams per gram. This means that the content of salidroside and tyrosol (2.3 milligrams per gram) in R. heterodonta was significantly higher than the concentration of heterodontoside (0.52 milligrams per gram).
Conclusion. These results demonstrate how unique the chemical composition of Rhodiola heterodonta is, making it particularly attractive for future research, especially in the area of its adaptogenic and antioxidant properties. It was proposed to standardize the objects of study – medicinal raw materials and dry extract from the rhizomes and roots of Rhodiola heterodonta – using the HPLC-DMD method. The aim of this study is to quantify the permissible content of salidroside and tyrosol.

This review article details the biochemical and pharmacological properties of the plant called Rhodiola heterodentata. This unique herb is known for its adaptogenic, anticancer, neuroprotective, antiviral and immunomodulatory properties, making it a valuable source for the creation of medicinal products. Scientific research is studying the antiviral properties of plants of the genus Rhodiola, but these properties have not yet been fully studied and described.
Plants of the genus Rhodiola are found in extreme conditions, such as mountainous regions and cold climate zones. They have unique abilities that help them survive in these harsh conditions.
The main active substances of plants of the genus Rhodiola are phenylethanoloids, flavonoids, phenolic acids and essential oils.
Rhodiola has immunomodulatory properties, which helps the body better resist infections and strengthens the immune system. In addition, it has antioxidant activity, normalizes the hormonal system and improves blood circulation and metabolism. One of the ways Rhodiola exerts an adaptogenic effect is by regulating the levels of stress hormones such as cortisol. In addition, it promotes the production of neurotransmitters including serotonin, dopamine and norepinephrine, which helps reduce the effects of stress and improve the psycho-emotional state.
Analysis of literary sources also showed that the chemical composition of Rhodiola variodentata has not been sufficiently studied. This indicates the need for further research. The goal of such research is to deepen knowledge about the pharmacological potential and natural properties of Rhodiola variodentata. This, in turn, will open up new horizons for its use in medicine, pharmaceuticals and other fields.