Vol 6, №3

Objective: To study patterns of consumption and use of antimicrobials in Tajikistan, with a focus on identifying key drivers of antimicrobial resistance and exploring potential strategies to strengthen antimicrobial stewardship interventions.

Materials and Methods: A retrospective analysis of the use of antimicrobial drugs in Tajikistan from 2011 to 2023 was conducted. Data on drug registration and certification were examined.

Results: The total consumption of antibacterial drugs for systemic use in Tajikistan has been steadily decreasing from 2011 to 2023. The most widely consumed antibiotics were penicillins (drugs of the pharmacological group ATC J01C) from 49.0% in 2011 to 29.1% in 2023, cephalosporins (group ATC J01D) from 18.2% in 2011 to 14.5% in 2023 and quinolone derivatives (group ATC J01M) from 10.9% in 2011 to 19.3% in 2023. At the same time, there was a sharp increase in the consumption of macrolides (group ATC J01F) from 2.3% in 2011 to 17.1% in 2023. The increasing reliance on last-line antibiotics suggests that more common first-line antimicrobials are losing their effectiveness. This could make it increasingly difficult for health workers to fight serious and deadly infections.

Conclusion: There is an urgent need to address the factors that lead to overuse and misuse of antimicrobials in Tajikistan, including aggressive marketing tactics, easy access to antibiotics without a prescription, and lack of awareness among health workers and the public about the appropriate use of these drugs.

Objective: To study the frequency of iron deficiency conditions in women of reproductive age, pregnant women and children, as well as to evaluate the effectiveness of treatment of iron deficiency anemia using various approaches to therapy based on new links in pathogenesis.

Materials and Methods: Over a period of 20 years, 558 women of reproductive age, 342 pregnant women, and 439 children in their first year of life were examined. Biochemical examination of 37 women with grade I-II iron deficiency anemia, 53 with latent iron deficiency, and 45 without iron deficiency was conducted.

Results: In 2024-2025, in Ukraine, compared to previous years, there is a significant increase in the incidence of latent iron deficiency and iron deficiency anemia among women of reproductive age, pregnant women and children. Meanwhile, in Tajikistan, every third pregnant woman suffers from anemia (from 32.0% to 39.4%). A comparative analysis of the prevalence of anemia among pregnant women living in Ukraine and Tajikistan shows that in the Tajik cohort the level of iron deficiency in 2024 was 1.6 times higher.

Conclusion: An increase in the incidence of latent iron deficiency and iron deficiency anemia in women of reproductive age, pregnant women and children has been established. The results obtained show that the use of a vitamin-mineral complexes “Feruza FL” with iron is more effective in improving the clinical picture and homeostasis in patients with iron deficiency anemia, compared to other iron preparations.

Objective: To analyze the impact of diabetes mellitus on chronic rectal diseases such as hemorrhoids, chronic anal fissure, pilonidal disease and anal fistula.

Materials and Methods: The literature review presents data on the pathophysiological mechanisms of the influence of diabetes mellitus on the course of chronic surgical diseases in the rectum.

Results: Diabetes mellitus alters the course and outcomes of chronic rectal surgical diseases, leading to an increased risk of infection, delayed healing, and a higher risk of recurrence. The main practical conclusion is that preoperative blood glucose levels should be optimized, treatment methods should be individually tailored to the degree of diabetes control, and a multidisciplinary approach should be applied to patient management. For patients with diabetes, minimally invasive treatments for pilonidal disease and hemorrhoids can be effective when carefully selected, but in complex cases, such as those with severe infection or complex fistulas, more radical interventions are necessary. Standardized prospective studies are needed to evaluate the impact of glycemic control on specific outcomes of proctological surgery.

Conclusion: Diabetes mellitus is a significant risk factor for rectal disease recurrence and significantly impacts the course and outcomes of anorectal surgery due to micro- and macrovascular disorders, neuropathy, and immune dysfunction, requiring an individualized approach to surgical planning and follow-up.

Objective: To evaluate the short-term and long-term outcomes of endovascular embolization of labial arteriovenous malformations.

Materials and Methods: From 2009 to 2023, six patients with labial malformations were admitted to the Vascular Surgery Department of the Republican Scientific Center for Cardiovascular Surgery. The patients’ ages ranged from 2 months to 76 years. There were two men and four women.

Results: No significant complications were observed in the immediate postoperative period in all 6 patients. Pain was successfully controlled with ibuprofen, and in cases of severe pain, analgin injections were used. No discomfort was experienced during the postoperative period. The average hospital stay was 2.1±1.1 days. Positive results were achieved in 4 patients, and the results were satisfactory in 2 patients. In both cases, satisfactory results were observed in patients over 40 years of age. Ultrasound data revealed only two patients with weak blood flow in the area of the lesion. This condition gradually diminished and completely resolved after three months.

Conclusion: Endovascular embolization is an effective and safe treatment for arteriovenous malformations in children. In the six cases reviewed, sustained regression of the lesion was achieved, with no subsequent growth or restoration of blood flow. The rapid results and absence of complications make embolization a promising approach to the treatment of arteriovenous malformations.

Objective: To analyze intra- and postoperative complications that may arise during traditional and videoendoscopic nephrectomies in patients with various kidney pathologies.

Materials and Methods: In this study, a retrospective and prospective analysis of 803 medical records of patients with various kidney pathologies who underwent traditional and videoendoscopic nephrectomy was conducted.

Results: Intraoperative complications were detected in 88 patients (23.91%) with traditional access, in 37 (13.76%) with laparoscopic access, and in 16 (9.63%) with retroperitoneoscopic access. Statistical analysis revealed significant differences between the traditional and retroperitoneoscopic access groups (p=0.0002), as well as between the laparoscopic and retroperitoneoscopic access groups (p=0.0407). Postoperative complications according to the Clavien-Dindo classification were observed in 76 patients (28.25%) after laparoscopic access, in 37 (22.29%) after retroperitoneoscopic access, and in 162 (44.02%) after traditional access (p=0.006).

Conclusion: When performing nephrectomy, the complication rate after the traditional method is high, despite the low complication rate after multiport laparoscopic surgery. The risk of damage to the abdominal organs remains in both cases. With retroperitoneoscopic nephrectomy, complications are rare and do not affect the abdominal organs. In most cases, these problems disappear on their own or are treated without reoperation.

Objective: To conduct an updated analysis of the epidemiological situation related to the burden of cervical cancer in Tajikistan to justify the need for vaccination against human papillomavirus as an effective method of preventing morbidity and mortality from this disease.

Materials and Methods: Over the past 11 years (from 2014 to 2024), data on morbidity and mortality were collected. The source of information was the unified form 07 of statistical reporting provided by the Republican Center for Statistics and Medical Information.

Results: About 400 cases of cervical cancer are registered in Tajikistan annually. Of these, about a third of women seek medical care at the late stages of the disease. This leads to the fact that mortality from this disease ranges from 160 to 230 women per year. Only 20% of women diagnosed with cervical cancer survive for more than five years. The main reason for such low survival is untimely seeking of medical care. The number of women dying from cervical cancer is 3-3.5 times higher than the maternal mortality rate. Tajikistan has become the 53rd country in the WHO European Region to introduce human papillomavirus (HPV) vaccination into the national immunization program. The Government of the Republic of Tajikistan announced the start of this campaign in October 2025. In May-June 2025, the first batch of HPV vaccines produced by Merck & Co (USA) arrived in the country in the amount of 496 thousand doses. The Ministry of Education and Science will take part in this campaign. It will be carried out in schools. Immunization will affect girls aged 10 years and those who have not been vaccinated before, aged 11-14 years. Over 30 years, the vaccine has been used by more than 270 million women worldwide. It has proven its safety and effectiveness, which exceeds 95%.

Conclusion: Vaccination against human papillomavirus is included in the national immunization calendar of the Republic of Tajikistan, which is an effective measure towards eliminating cervical cancer in the future. The data obtained will be used to develop and implement measures for the prevention and control of this disease.

Objective: To study the state of the main and indirect markers of endothelial function (desquamated endothelial cells, von Willebrand factor, fibrinogen, homocysteine, vascular-platelet and plasma hemostasis indicators) at different stages of chronic kidney disease.

Materials and Methods: The study involved 60 patients with chronic kidney disease at different stages (20 people at each stage). All had impaired nitrogen-excreting function of the kidneys. Among them, there were 44 men (73.3%) and 16 women (26.7%). The average age of the patients was 64.8±1.5 years. On average, they had been ill for 4.8±0.5 years.

Results: Chronic kidney disease is associated with pronounced disturbances of endothelial function, manifested by an increase in desquamated endothelial cells, elevated von Willebrand factor, and altered blood rheological properties toward hypercoagulation. The most pronounced disturbances are recorded in the terminal stages (chronic kidney disease C5) and are expressed in an increase in desquamated epithelial cells to 18.7±0.3×10⁴/l; an increase in von Willebrand factor from 123.6±2.2% at stage C3A to 132.5±1.0% and 135.0±2.5% at stages C4 and C5. Fibrinogen and platelet levels were significantly and consistently increased. Indicators of endothelial dysfunction showed a strong positive correlation with disease duration and the presence of comorbidities.

Conclusion: Endothelial dysfunction develops at preclinical stages of chronic kidney disease and progresses with advancing disease. Assessment of endothelial dysfunction markers should be initiated at the early stages, allowing timely intervention and correction.

Objective: To estimate the prevalence of arterial hypertension among the adult population of the Republic of Tajikistan.

Materials and Methods: Research work to analyze the prevalence of arterial hypertension was conducted among the population of the Republic of Tajikistan for the period from 2020 to 2024.

Results: The overall prevalence of arterial hypertension in the republic in 2020 (40,204 cases) was significantly higher than in 2024 (35,199 cases), which is associated with the COVID-19 coronavirus pandemic and complications from the cardiovascular system and kidney diseases. The incidence rate varies depending on the region: in the Sughd region in 2020, 21,333 (53.1%) patients were registered, and in 2024 – 17,647 (50.1%), in the Khatlon region in 2020 – 10,804 (26.9%), in 2024 – 9,158 (26.0%). The lowest rate is observed in GBAO (3.2%). In men, the incidence rate increases with age: from 3.1% (n=437) at the age of 25–34 years to 38.5% (n=5369) at the age of 55–64 years, a 12.4-fold increase, respectively. Among women, the incidence rate at the age of 25 to 34 years (5.1%, n=1152) is significantly lower than that of individuals aged 55–64 years (35.3%, n=8062), which is 7 times higher.

Conclusion: The study’s findings indicate that the prevalence of hypertension in the Republic of Tajikistan has regional variations. Age plays a significant role in the development of hypertension, but is not the primary risk factor. Hypertension becomes more common with age among both men and women.

Objective: To assess the significance of modern approaches to the treatment and prevention of vertebrobasilar insufficiency.

Methodology: A literature review and systematic analysis of modern scientific research in the field of conservative and surgical treatment, as well as prevention of vertebrobasilar insufficiency, was conducted.

Results: The presented review of world literature data shows that vertebrobasilar insufficiency is a complex and multifaceted problem of modern angioneurology. Modern approaches to treatment include optimal drug therapy to correct risk factors and prevent stroke. Open surgeries remain an important method of treating vertebrobasilar insufficiency. This is especially relevant for complex, extended or occluded lesions, as well as for tortuosity of arteries, when endovascular methods are ineffective or technically impossible.

Conclusion: Acute vertebrobasilar insufficiency (transient ischemic attacks and stroke) requires urgent treatment. In some cases, thrombolytic therapy or mechanical thrombectomy may be necessary. Primary and secondary prevention measures play a key role. They include lifestyle changes and control of vascular risk factors, and comprehensive rehabilitation programs are also important.

Objective: To study the prevalence of intestinal helminthiasis in children in the Republic of Tajikistan.

Materials and Methods: A study of the prevalence of helminthiasis among children in urban and rural areas of the Republic of Tajikistan was conducted in the laboratories of parasitology and immunology of the Tajik Research Institute of Preventive Medicine during 2019-2023.

Results: Among children in urban areas of the Republic of Tajikistan, the incidence of ascariasis remains at a very high level, with a downward trend of at least 1.2 times, with a five-year trend of -17.6%. Analysis of the dynamics of ascariasis incidence in rural areas for the period from 2019 to 2023 shows that there is a downward trend of -19.6%. The incidence of enterobiasis in 2019 was 228.3 (8066 children), increasing by 1.4 times over five years and amounting to 158.4 per 100 thousand children in 2023. The total number of patients decreased by 2268 cases over five years, while the incidence rate in urban areas was -23.1%, and in rural areas -30.6%. A downward trend in the incidence of hymenolepiasis has been noted: in rural areas the incidence rate has decreased to 34.2%, in urban areas – to 39.1%. In general, the analysis of the incidence of ascariasis, enterobiasis and hymenolepiasis among residents of urban and rural areas of the Republic of Tajikistan revealed similar dynamics of indicators. For all three forms of helminthiasis, there is a decrease in the incidence rate (per 100 thousand children) and the number of patients from 2019 to 2023.

Conclusion: The incidence of intestinal helminthiasis (ascariasis, enterobiasis and hymenolepiasis) among children – residents of urban and rural regions of the Republic of Tajikistan, despite the fact that it remains at a very high level, nevertheless, over the five-year study period, there is a tendency towards a significant decrease.

Objective: To study the degree of antibacterial property of the skin of the hands of children – students in general educational institutions, and to establish the degree of resistance of microorganisms to antibiotics.

Materials and Methods: In the course of the work, the microbial landscape of the skin of primary schoolchildren in Dushanbe was studied, in the structure of which both gram-positive and gram-negative microorganisms are observed. A comparative analysis of antibiotic sensitivity of the isolated strains from the skin was carried out.

Results: The most effective antibiotics against Klebsiellae are amikacin and ciprofloxacin, which are effective in 85.7% and 71.4% of cases, respectively. Less effective are the antibiotics ceftriaxone and gentamicin (57.1% and 42.9%). With respect to St. Aureus isolated from schoolchildren, the most effective activity was shown by the antibiotic ciprofloxacin – in 78.6% of cases and erythromycin (71.4%). St. Hemoliticus was less resistant to the antibiotic amikacin, which was manifested in 90.9% of cases and cefazolin (81.8%) of cases.

Conclusion: Based on the obtained results, the antibiotics of choice for infections in children caused by opportunistic normal skin microflora Klebsielae can be considered ciprofloxacin and amikacin. For purulent-inflammatory skin diseases in children caused by the skin flora Staphylococcus aureus, the following antibiotics can be recommended: ciprofloxacin, erythromycin and in case of allergic reactions to these antibiotics, amoxiclav can be recommended. The antibiotics of choice for infections caused by Staphylococcus aureus in children were amikacin and cefazolin.

Objective: An experimental study of the effect of the choleretic properties of tagetol on the secretory function of the liver and the chemical composition of bile in healthy rats and rats poisoned with CC14, as well as guinea pigs.

Materials and Methods: The study is devoted to the study of the properties of tagetol, which is obtained from the essential oil of Tagetes L. To substantiate the choleretic effect of tagetol, 56 white rats of both sexes weighing 200-220 g, as well as 30 guinea pigs weighing 350-500 grams were used in the experiments.

Results: According to the obtained data, the volume of secreted bile in intact animals averaged 2.76 – 2.8 mg/min per 100 g of weight. The amount of secreted bile for 3 hours with the introduction of tagetol in doses of 0.01, 0.02, 0.04 g/kg of weight compared to the control groups increased by 19.3%, 35.0%, 30.1%, respectively. Tagetol, along with its choleretic properties, actively affects the chemical composition of bile, as a result of which, in the indicated doses, the concentration of cholesterol decreases, compared to the control animals by 10.5%, 21.0% and 13.2%, respectively. Tagetol at a dose of 0.02 g/kg body weight during 2-month intoxication with CC14 also had a pronounced hepatoprotective effect and in terms of effectiveness not only surpassed similar properties of comparative agents, but also other doses of tagetol.

Conclusion: Tagetol, improving the choleretic function of the liver, simultaneously improves the chemistry and lithogenicity of bile, as evidenced by the normalization of the secretory, cholecystokinetic function of the liver under the action of tagetol in tetrachloromethane hepatitis.

Objective: To conduct a comprehensive, systematic analysis of current scientific data on the influence of the urobiome and gut microbiota on the pathogenesis, prevention, and personalized treatment of urolithiasis.

Materials and Methods: The literature review focused on studies using modern molecular genetic methods, such as 16S rRNA gene sequencing and metagenomic shotgun analysis, to study the microbiota of the urinary tract, intestine, and urinary stones. Data on the microbial composition of various types of urolithiasis, including calcium oxalate, struvite, and urate stones, were analyzed.

Results: It was revealed that urobiome dysbiosis, manifested by a decrease in overall microbiota diversity and an imbalance in microbial communities, is an important pathogenetic factor contributing to the development of urolithiasis.

Conclusion: Integrating the concepts of the urobiome and the gut-kidney axis into our understanding of urolithiasis pathogenesis opens new perspectives for diagnosis, prevention, and treatment. Dysbiosis is recognized as a causal factor in the stone formation process, rather than a consequence. A promising direction is the development of comprehensive microbiota modulation methods, such as probiotics, prebiotics, and fecal microbiota transplantation. These approaches aim to restore protective microbial networks rather than targeting individual microbiota. Large-scale randomized trials that ensure the objectivity and reliability of results are needed to implement these strategies into clinical practice.