Vol 7, №3

Objective. Assessment of epidemiological indicators of drug addiction and the implementation of interdisciplinary measures for the prevention, treatment and reduction of its medical and social consequences in the Republic of Tajikistan.
Materials and Methods. A retrospective descriptive study was conducted using official statistical reporting data from the State Institution “National Center for Monitoring and Prevention of Drug Abuse” of the Ministry of Health and Social Protection of the Republic of Tajikistan, as well as data from other medical and preventive institutions for the period from 2016 to 2025.
Results. Over the past ten years, the number of individuals registered for drug addiction decreased by 43.3% – from 7,067 to 4,004 – while the incidence of drug addiction fell more than fourfold, reaching 0.9 cases per 100,000 population in 2022. The number of people who inject drugs (PWID) declined by 73.6% – from 4,486 to 1,182. The proportion of HIV transmission via non-sterile equipment among PWID dropped from 68.0% in 2017 to 8.0% in 2025; no drug overdose deaths have been recorded since 2023. At the same time, the number of heroin users decreased by 86.6% – from 5,756 to 773 individuals (a 7.4-fold reduction). Conversely, a 4.5-fold increase in poly-drug use was observed – rising from 315 to 1,428 cases (a 353% increase) – driven primarily by the concurrent use of psychostimulants (amphetamine, methamphetamine, etc.) and psychotropic or potent substances (benzodiazepines, Lyrica, tropicamide, tramadol).
Conclusion. Over the years of the country’s independence, the implementation of evidence-based anti-drug policies and harm reduction programs has ensured sustainable stabilization of the drug situation.

Objective. Analysis of the Trends in Standardized and Age-Specific Incidence and Mortality Rates of Cervical Cancer in the Republic of Tajikistan from 2014 to 2025.
Materials and Methods. A retrospective study of aggregated statistical data on the incidence of and mortality from cervical cancer in the Republic of Tajikistan for the period 2014–2025 was conducted.
Results. The mean age-standardized incidence rate (ASIR) was 11.68 per 100,000 female population, while the mean age-standardized mortality rate (ASMR) was 6.80 per 100,000. The crude rates were lower than the standardized rates, at 7.02 and 4.09 per 100,000, respectively. No statistically significant monotonic trend was observed in the ASIR over the study period, with an average annual percent change (AAPC) of 0.76% (95% confidence interval [CI]: −2.95% to 4.61%; p=0.662). For the ASMR, the AAPC was −1.00% (95%CI: −3.86% to 1.94%; p=0.461). The highest mean age-specific incidence rates were observed among women aged 55–64 years (32.16 per 100,000) and 45–54 years (29.10 per 100,000). In the ≥65 years age group, the incidence rate increased from 19.06 per 100,000 in 2014 to 45.95 per 100,000 in 2025, corresponding to a linear increase of 1.46 cases per 100,000 per year (p=0.035).
Conclusion. Between 2014 and 2025, age-standardized incidence and mortality rates for cervical cancer were characterized by significant annual fluctuations. The greatest epidemiological burden was among women aged 45 years and older, with the most pronounced increase in incidence occurring in the ≥65 years age group. These findings highlight the need for an age-targeted approach to the planning and implementation of cervical cancer prevention, screening, and treatment strategies.

Objective. To demonstrate the potential applications of optical magnification and precision techniques for the correction of Apert syndrome in preschool-aged children.
Materials and Methods. Between 2000 and 2026, 18 children aged 4 to 7 years underwent various types of reconstructive surgery for Apert syndrome at the Department of Reconstructive and Plastic Microsurgery of the Republican Scientific Center for Cardiovascular Surgery. The patient group consisted of 11 boys and 7 girls.
Results. Indications for various surgical procedures were established for all children over the age of four. Each child presented with complex syndactyly of both hands; the severity of the condition was determined through objective assessment. No circulatory impairment in the separated digits was detected in the immediate postoperative period; marginal necrosis of the skin flap tips was observed in four cases. During long-term follow-up, recurrence of syndactyly was recorded in five patients.
Conclusion. Apert syndrome is a complex congenital craniofacial syndrome characterized by severe hand deformities and complex syndactyly. Selecting the appropriate surgical methods and treatment sequence helps improve hand function and the children’s quality of life. The use of optical magnification and precision techniques enhances the accuracy of surgical maneuvers and facilitates good functional and aesthetic outcomes.

Objective. To evaluate gender differences in the angiographic profile, frequency, and immediate outcomes of percutaneous coronary interventions in men and women with acute myocardial infarction (AMI).
Materials and Methods. The study included 193 patients with a confirmed diagnosis of acute myocardial infarction who were treated at the Cardiology Department of the Istiklol Health Complex between 2023 and 2025. Coronary angiography was performed on 99 (51.3%) patients (64 men and 35 women).
Results. Women were older than men (68.7 ± 8.4 vs. 63.9 ± 9.9 years; p < 0.001). The frequency of coronary angiography in STEMI and NSTEMI did not differ significantly between the sexes. In STEMI cases, there was a trend toward a longer time from admission to catheterization in women (6.5 vs. 4.8 hours; p = 0.08). Men more frequently presented with multivessel disease (54.7% vs. 28.6%; p = 0.001), complex B2/C stenoses (68.7% vs. 54.3%; p = 0.028), and a higher SYNTAX score (22 vs. 18; p = 0.02). The technical success rate of percutaneous coronary interventions was comparable (91.4% vs. 86.2%; p = 0.257); however, men experienced higher rates of vascular complications (8.6% vs. 3.4%), significant bleeding (12.1% vs. 6.9%), and contrast-induced nephropathy (8.6% vs. 3.4%).
Conclusion. Men with acute myocardial infarction were found to have more extensive and hemodynamically significant coronary artery disease. At the same time, women exhibited a higher risk profile for in-hospital complications and were less likely to receive the full scope of secondary prevention measures. These findings underscore the need for a personalized approach to the management of patients with acute myocardial infarction that takes sex-based differences into account.

Objective. To study the nature of immune and metabolic disturbances in young children with community-acquired and hospital-acquired pneumonia, to evaluate the prognostic significance of available laboratory markers, and to determine the efficacy of their correction within the framework of comprehensive therapy that includes low-intensity laser treatment.
Materials and Methods. The study included 156 children aged 1 month to 3 years suffering from community-acquired (n=91) or hospital-acquired (n=65) pneumonia. Immunological assessments were performed on 80 patients (51.3% of the total) during the acute phase of the disease and prior to discharge. These assessments included the determination of lymphocyte subpopulations (CD3⁺, CD4⁺, CD8⁺, CD16⁺, CD72⁺), the immunoregulatory index, and the concentrations of immunoglobulins of classes A, M, and G.
Results. During the acute period, suppression of the T-cell compartment was observed: CD3⁺ levels were 30.21±2.2% in CAP and 34.18±2.48% in HAP, while the immunoregulatory index was 1.2±0.02 and 1.16±0.06, respectively. In CAP, IgA and IgG levels were reduced by 2.4-fold and 1.7-fold, respectively, with preserved IgM levels. The level of malondialdehyde was 9.1 nmol/mL in the VP group compared to 4.9 nmol/mL in the GP group, against a background of reduced catalase activity. The De Ritis ratio decreased from 1.6 to 1.0 in CAP and from 1.9 to 1.2 in HAP. Lactate levels increased from 2.5±0.55 to 4.9±0.64 mmol/L, while uric acid increased from 116±4.5 to 189±6.5 μmol/L with increasing disease severity. The use of laser cavitation contributed to the normalization of parameters by day 7, a 21% reduction in the duration of hospitalization, and a 30% decrease in destructive complications.
Conclusion. Pneumonia in young children is accompanied by immune and oxidative disturbances, and lactate, uric acid, malondialdehyde, and the De Ritis ratio can serve as markers of severity and treatment efficacy. The combined use of immunomodulatory and antioxidant agents alongside low-intensity laser cavitation improves disease outcomes.

Objective. To assess homocysteine (Hcy) levels in patients with a history of myocardial infarction (MI), determine their associations with the main clinical and functional parameters, and identify factors associated with the development of hyperhomocysteinemia (HHcy).
Materials and Methods. An observational comparative case-control study was conducted, involving 75 participants: 45 patients with post-infarction cardiosclerosis (PICS) and 30 apparently healthy individuals who formed the control group. The mean age was 64.56±5.53 years for the PICS patients and 62.70±2.44 years for the control group.
Results. In patients with post-infarction cardiosclerosis (PICS), Hcy levels were significantly higher than in the control group: 28.11±12.04 µmol/L versus 7.91±1.42 µmol/L (p<0.001). Elevated Hcy levels (≥15 µmol/L) were observed in 93.3% of patients, while concentrations ≥20 µmol/L were found in 73.3%. Patients with Hcy levels ≥20 µmol/L had a longer disease duration: 10.73±3.64 years versus 7.83±4.04 years (p=0.043). Multivariate analysis demonstrated that disease duration is an independent predictor of severe hyperhomocysteinemia (OR=1.41; 95% CI: 1.04–1.91; p=0.026).
Conclusion. A significant increase in homocysteine levels and a high prevalence of hyperhomocysteinemia were observed in patients with post-infarction cardiosclerosis. An independent association was established between the duration of the disease and marked hyperhomocysteinemia. These findings suggest that homocysteine levels may serve as a potential metabolic marker of the chronic post-infarction period.

Objective. To study the distribution patterns of ABO blood groups, Rhesus status, erythrocyte antigen phenotypes (Cc, Dd, Ee), and the Kell system among blood donors in the Republic of Tajikistan.
Materials and Methods. This study involved a retrospective analysis of immunohematological typing data from 67,217 blood donations. The research was conducted at the Republican Scientific Blood Center and its branches (in the cities of Bokhtar, Khujand, Kulob, and Khorog) between 2021 and 2024.
Results. Among blood donors in the Republic of Tajikistan, blood group A(II) predominates (32.4%), followed by O(I) (30.8%), B(III) (26.1%), and AB(IV) (10.7%) (p<0.001). Rhesus-positive status was identified in an average of 86–89% of donors, and Rhesus-negative status in 11–14%. However, the proportion of Rhesus-negative individuals varies significantly across regions: from 11.8% at the Khujand branch to 16.8% at the Khorog branch. Among Rhesus system phenotypes, CcDee is the most common (35.7%), followed by CcDEe (21.4%) and CCDee (20.6%); these three phenotypes collectively account for over 77% of all typed donors. The Kell antigen was detected in 3.9% of donors (branch range: 2.1–5.5%), indicating that this donor group poses a potential risk for Kell alloimmunization during repeated transfusions.
Conclusion. A predominance of blood group A(II) and the CcDee phenotype was established. Furthermore, statistically significant interregional differences were identified in the distribution of the Rhesus factor and the Kell antigen. The data obtained can be used to improve donor registries, plan the collection of rare phenotypes, and prevent post-transfusion complications and alloimmunization.

Objective. To evaluate the clinical efficacy and safety of augmentation urethroplasty using a perineal fasciocutaneous flap in patients with extended strictures of the bulbous urethra.
Materials and Methods. A retrospective analysis was conducted of the surgical treatment outcomes for 48 patients with long-segment strictures of the bulbar urethra between 2018 and 2025. Patient age ranged from 22 to 72 years (median 42 years). All patients underwent augmentation urethroplasty using a vascularized perineal fasciocutaneous flap. Preoperative examination included retrograde and voiding urethrography, urethroscopy, urinary tract ultrasound, and uroflowmetry. Outcomes were assessed at 3 and 6 months postoperatively and then annually.
Results. Successful treatment outcomes were achieved in 44 of 48 patients (91.7%). The mean maximum urinary flow rate (Qmax) increased from 4.65±0.84 to 21.4±3.2 ml/s (p<0.001). Residual urine volume decreased from 120 (50–250) ml to 18 (0–45) ml (p<0.001). The IPSS symptom score decreased from 23.4±3.2 to 6.1±1.8 points (p<0.001). Stricture recurrence was observed in 4 patients (8.3%). In three cases, restenosis was successfully corrected with internal optical urethrotomy. One patient developed a urethral fistula, requiring repeat surgery.
Conclusion. Augmentation urethroplasty using a perineal fasciocutaneous flap provides a high level of clinical efficacy and satisfactory functional results in the treatment of extended strictures of the bulbar urethra. This technique can be considered a reliable alternative to traditional urethral reconstruction methods in patients with complex forms of stricture disease.

Objective. To evaluate local blood flow parameters in the area of keloid scars in children.
Materials and Methods. A total of 107 patients aged 7 to 18 years with keloid scars were examined: 64 patients with “true” scars and 43 patients with “false” scars. Clinical assessment of the scars was performed using the modified Vancouver Scar Scale. Microcirculation was evaluated using laser Doppler flowmetry.
Results. Studies demonstrate an age-dependent worsening of microcirculatory disturbances: no significant changes in parameters were observed in the 7–11 age group, whereas the 12–14 age group showed a decrease in the amplitude of myogenic blood flow oscillations (ALF) by 6.16 units (95% CI: −11.13; −1.19; p = 0.020), a decrease in the amplitude of respiratory blood flow oscillations (AHF) by 6.08–7.08 units, a reduction in the microcirculation efficiency index (MEI) by 0.10 units (p ≤ 0.003), and an increase in the amplitude of cardiac blood flow oscillations (ACF) by 8.78–9.83 units (p < 0.001). The most pronounced abnormalities were observed in adolescents aged 15–18 years, particularly in cases of “true” keloids; these were accompanied by reduced tissue perfusion and diminished microcirculatory reserve capacity. ALF and AHF values for “true” keloids were lower by 12.86 and 11.18 units, respectively, whereas the ACF value was higher by 15.31 units (p<0.001) compared to “false” keloids. The microcirculation efficiency index (MEI) for both scar types was 0.10 units lower than in the control group (p<0.001). Pathological microcirculation patterns were identified in 80.4% of the children; spastic and congestive-stasis abnormalities predominated in cases of “true” keloids.
Conclusion. Analysis of the obtained data demonstrates that, in cases of “true” keloids, local blood flow disturbances are more pronounced and tend to progress with age. This confirms the necessity of incorporating the correction of microcirculatory abnormalities into the comprehensive treatment of patients with this condition.

Objective. To assess and compare the trends and structure of the detection of transfusion-transmissible infections (TTIs) – including hepatitis B, hepatitis C, syphilis, and HIV – among blood donors in the Republic of Tajikistan, broken down by age group and social characteristics.
Materials and Methods. A retrospective comparative analysis was conducted on the results of laboratory screening of donor blood across two observation periods. The first stage covered 2017–2020 and comprised 47,844 donations, representing the initial operational phase prior to the implementation of comprehensive measures to promote blood donation. The second stage covered 2021–2024 and comprised 67,217 donations, performed following the implementation of programs to popularize donation, expand the donor registry, and lower the average age of the donor population.
Results. The overall detection rate of transfusion-transmissible infections decreased from 3.9% (1,875 out of 47,844 donations) in 2017–2020 to 2.7% (1,818 out of 67,217) in 2021–2024 (p<0.001). This was primarily driven by a reduction in the prevalence of hepatitis B (from 1.8% to 1.2%) and hepatitis C (from 0.9% to 0.7%). Detection rates for syphilis (1.1% and 0.9%) and HIV (0.04% and 0.02%) remained consistently low. The age profile shifted: in 2017–2020, these infections were most frequently detected in donors aged 18–27 (6.5%), whereas in 2021–2024, the highest rates were observed in individuals over 48 (4.4%). Among students, the rate dropped from 2.83% to 0.19%. Conversely, among the unemployed and the self-employed, the rate remained high – 6.01% and 4.15%, respectively.
Conclusion. Between 2021 and 2024, the detection rate of transfusion-transmissible infections among blood donors decreased by nearly one-third. However, the risk shifted from young donors to older and socially vulnerable individuals. These findings underscore the need to recruit more young donors and those from organized groups, as well as to strengthen monitoring within high-risk groups.

Objective. To identify and substantiate the main directions for improving the system of pharmaceutical provision for citizens eligible for state social support in the Republic of Tajikistan.
Materials and Methods. An analysis of the subsidized pharmaceutical supply system (including issues of financing, procurement management, and access to medicines in rural areas) was conducted based on national data, recommendations from the World Health Organization (WHO) and the World Bank, and international and regional experience (including the practices of Central Asian countries).
Results. The analysis identified key issues: insufficient funding, high public spending on medicines, limited coverage of subsidized programs, and organizational and regulatory shortcomings. These factors have resulted in a significant portion of vulnerable population groups being deprived of access to timely and comprehensive medical care. This threatens the realization of the constitutional right to healthcare and exacerbates social inequality. To improve the system, the following priority areas are proposed: reforming pharmaceutical procurement and strengthening market competition; introducing pharmacoeconomic approaches into decision-making; expanding access to medicines for rural populations and socially vulnerable groups; developing the institutional framework through the involvement of non-governmental organizations and the private sector; and enhancing transparency, quality assurance, and monitoring mechanisms.
Conclusion. The system for providing medicines to citizens entitled to state guarantees in the Republic of Tajikistan requires comprehensive reforms to enhance its efficiency and ensure equity and operational sustainability. Incorporating measures to improve the supply of medicines – such as developing an insurance system and establishing monitoring mechanisms – into the strategy elevates the reforms to the status of a state policy priority and ensures their alignment with key objectives, including achieving universal health coverage and realizing the Sustainable Development Goals.

Objective. To develop the composition and production technology of a herbal syrup based on the dry extract of Inula macrophylla roots and shoots, and to evaluate its key physicochemical and pharmacotechnological parameters.
Materials and Methods. The study materials consisted of a dry extract of Inula macrophylla roots and shoots and experimental syrup samples prepared from it. The solubility of the dry extract in various solvents was investigated to select an optimal solvent system for the dosage form, and the effect of the dry extract concentration on the syrup’s key technological and physicochemical properties was evaluated. To this end, experimental syrup samples were prepared with a dry extract content ranging from 1.1 to 3.1 g per 100 g of the finished product.
Results. A technology for producing a herbal syrup has been developed, comprising the preparation of the syrup base, incorporation of the extract and excipients, homogenization, filtration, filling, and packaging. A dry extract content of 1.8 g/100 g was determined to be optimal. The concentrations of excipients were substantiated: sorbitol – 40%, propylene glycol – 5%, citric acid – 0.1%, Nipagin – 0.075%, and Nipazol – 0.025%. Rational processing conditions for incorporating the dry extract into the syrup base at a temperature of 50±2°C were established.
Conclusion. The composition and production technology of the herbal syrup “Inulanto” – manufactured using a dry extract of Inula macrophylla roots and rhizomes – have been scientifically substantiated. The results obtained can be used for its further standardization and stability studies.

Objective. To examine the key issues surrounding the formation of the pharmaceutical market, the specific characteristics of entrepreneurial activity in this sector, and the challenge of ensuring a supply of qualified pharmaceutical personnel, as well as to analyze the regional management structure for pharmaceutical activities in the Republic of Tajikistan.
Materials and Methods. This article examines the organizational and economic aspects and management issues regarding pharmaceutical care in the Republic of Tajikistan. The study analyzes the regulatory, organizational, and economic components of the pharmaceutical market’s operation and explores the specifics of entrepreneurial activity in the circulation of medicines and the provision of pharmaceutical services. Furthermore, the study assesses the accessibility of pharmaceutical services for the population and analyzes the level and quality of internal and external controls over pharmaceutical products within the pharmacy network.
Results. Key trends in the development of the pharmaceutical market in the Republic of Tajikistan have been identified. Existing organizational and socio-economic issues affecting the accessibility and quality of pharmaceutical care have been determined. It has been established that the further development of the pharmaceutical sector requires improving state regulatory mechanisms, enhancing the efficiency of the drug quality control system, strengthening workforce capacity, and refining organizational approaches to managing pharmaceutical activities at the regional level. The importance of professional associations in developing the pharmaceutical community, enhancing the professional competencies of specialists, and shaping modern approaches to pharmaceutical services for the population has been defined.
Conclusion. The analysis indicates that the sustainable development of the pharmaceutical market in the Republic of Tajikistan and improved public access to quality pharmaceutical care are directly contingent upon enhancing the system of state and professional self-regulation within the sector. Implementing the proposed measures will help boost the efficiency of the pharmaceutical market, improve the quality of pharmaceutical services, and ensure the population is adequately supplied with essential medicines.

Objective. To conduct a comparative assessment of the hepatoprotective properties of Cholelithol and laurel essential oil in healthy rats and in rats with toxic hepatitis (induced by carbon tetrachloride – CCl₄).
Materials and Methods. In the study investigating the hepatoprotective properties of the preparations, 98 rats of both sexes weighing 180–210 g were used.
Results. A comparative analysis of the hepatoprotective properties of Cholelitol (composed primarily of fennel and bay laurel essential oils) at a dose of 0.02 g/kg of body weight reveals an improvement in liver secretory function and bile chemical composition. This is confirmed by a statistically significant (p≤0.001) improvement in the liver’s bile-excreting function and changes in bile chemical composition in both healthy rats and animals with subacute CCl₄ intoxication. During the course of administering the test agents against a background of subacute carbon tetrachloride intoxication, a decrease was observed compared to control animals: total lipids by 14.0% and 16.9%, total bilirubin by 42.1% and 40.36%, and β-lipoprotein concentration by 44.05%, 42.5%, 42.5%, and 40.0%.
Conclusion. It should be noted that Cholelitol and bay laurel essential oil, at the specified dosage, facilitated the restoration of glycogen and sialic acid levels that had been disrupted by the toxic effects of the hepatotoxin. Moreover, based on a number of parameters, Cholelitol demonstrated significantly higher efficacy compared to the reference drugs – Zhirozital and Carsil – which are used as hepatoprotective and hypolipidemic agents.

Objective. Analysis of the efficacy of various surgical treatment methods for rectovaginal fistulas (RVFs), identification of risk factors for recurrence, and assessment of the impact of this condition on patients’ quality of life.
Materials and Methods. To prepare this review, scientific publications from the PubMed/MEDLINE, Scopus, eLibrary.ru, CyberLeninka, and Google Scholar databases were analyzed. The following keywords were used: “rectovaginal fistula,” “recurrent rectovaginal fistula,” “surgical treatment,” and “quality of life.” Studies published between 2010 and 2026 were examined.
Results. A review of the literature indicates that the problem of RVFs has not been sufficiently studied. This condition is classified as rare, accounting for approximately 5% of all rectal fistulas. However, data regarding the incidence of RVFs and the efficacy of their treatment vary significantly. Among genital fistulas, those of an intestinal-genital nature account for 49.3%, with rectovaginal fistulas representing 59.1% of this subgroup. Recurrent fistulas constitute approximately 2.6–2.7% of all proctological diseases. The annual incidence of RVFs is approximately 0.1 cases per 10,000 population, while the prevalence is no more than 0.5 cases per 100,000 population. To date, no unified algorithm for preventing recurrence or a differentiated approach to the surgical treatment of RVFs has been developed. Furthermore, data regarding the quality of life of women with recurrent RVFs are limited in the literature, despite the fact that this condition predominantly affects women of working and reproductive age.
Conclusion. Recurrent rectovaginal fistulas remain a challenging clinical problem, despite a wide range of surgical treatment methods. Promising areas of development include the creation of new materials and the standardization of treatment strategies aimed at reducing recurrence rates and improving patients’ quality of life.

Objective. To systematize current data on the pathogenetic role of systemic inflammation and hemodynamic overload in resistant arterial hypertension, evaluate the prognostic significance of relevant biomarkers, and justify their use in clinical practice for cardiovascular risk stratification and the personalization of therapy.
Materials and Methods. A literature search was conducted in the PubMed, Scopus, eLibrary, and Cochrane Library databases covering the period from 2015 to 2025. The analysis included randomized controlled trials, meta-analyses, systematic reviews, and current clinical guidelines.
Results. An analysis of the literature indicates that resistant hypertension is one of the most complex forms of hypertensive disease and is associated with a two- to threefold higher risk of adverse outcomes. Traditional risk assessment scales do not adequately account for specific factors associated with resistant hypertension, including left ventricular hypertrophy, hypervolemia, activation of neurohumoral systems, and chronic inflammation. It has been established that patients with resistant arterial hypertension exhibit significantly higher levels of interleukin-6 and high-sensitivity C-reactive protein compared to those with controlled arterial hypertension, confirming the role of systemic inflammation in disease severity and treatment resistance. NT-proBNP is an important marker of myocardial hemodynamic overload; its concentration correlates with left ventricular hypertrophy, diastolic dysfunction, and subclinical hypervolemia.
Conclusion. The incorporation of inflammatory biomarkers – such as high-sensitivity C-reactive protein and interleukin-6 – and the hemodynamic overload marker NT-proBNP into clinical practice represents a promising approach. This will enable more accurate risk stratification and the identification of phenotypes of resistant arterial hypertension. Such an approach facilitates personalized therapy, improves blood pressure control, and reduces the incidence of cardiovascular complications in this patient population.

Objective. To summarize current data on the role of endothelial dysfunction in the progression of chronic kidney disease (CKD) and the development of associated cardiovascular and cerebrovascular complications, as well as to identify and systematize the key pathogenetic mechanisms underlying the development of endothelial dysfunction in CKD.
Materials and Methods. The information base for the study comprises original research papers, systematic reviews, and review articles, as well as clinical guidelines published in domestic and international scientific journals between 2020 and 2025.
Results. An analysis of the literature has shown that the progression of chronic CKD is accompanied by a decline in the glomerular filtration rate and the development of renal failure, as well as a significant increase in cardiovascular and cerebrovascular risk. Endothelial dysfunction serves as a key pathogenetic mechanism linking renal, cardiac, and vascular damage. Endothelial dysfunction in CKD is multifactorial in nature and progresses as renal function declines. Key mechanisms include reduced nitric oxide bioavailability, elevated endothelin-1 levels, activation of the renin-angiotensin-aldosterone and sympathetic nervous systems, oxidative stress, and chronic inflammation. Uremic toxins, disturbances in calcium-phosphorus metabolism, dyslipidemia, and hyperhomocysteinemia contribute significantly to vascular injury. Alterations in von Willebrand factor activity reflect endothelial activation and damage, potentially increasing the risk of thrombosis. The interplay of these mechanisms creates a vicious cycle in which renal dysfunction exacerbates vascular injury, while endothelial dysfunction drives the further progression of CKD.
Conclusion. Endothelial dysfunction is a key pathogenetic factor in the progression of chronic kidney disease and the development of cardiovascular complications. A comprehensive assessment of endothelial dysfunction markers, combined with an analysis of metabolic and inflammatory factors, may be crucial for the early stratification of vascular risk and the improvement of complication prevention strategies in patients with CKD.

Objective. To conduct a comprehensive analysis of complications associated with pancreatic and peripancreatic fluid collections in patients with acute pancreatitis.
Materials and Methods. A systematic review of the literature was conducted for the period from 2017 to 2024, including international clinical guidelines, randomized controlled trials, meta-analyses, and cohort studies. The review focused on the pathophysiology, classification, and multidisciplinary approach to the treatment of complicated pancreatic and peripancreatic fluid collections.
Results. The analysis revealed that the primary life-threatening complications are infection of necrotic tissue, erosive bleeding, and fistula formation. The minimally invasive step-up approach, beginning with percutaneous or endoscopic drainage, has been confirmed to be highly effective. This method has demonstrated a significant reduction in mortality and serious complication rates compared to primary open necrosequestrectomy. Treatment success directly depends on the timely formation of a multidisciplinary team.
Conclusion. The modern strategy for treating complicated pancreatic and peripancreatic fluid collections requires a multidisciplinary approach, the use of modern imaging techniques for accurate diagnosis, and strict adherence to the principles of staged treatment. Future directions include the refinement of minimally invasive techniques and the development of personalized treatment algorithms.

Objective. To summarize current data on occupational risks, working conditions, and the health status of medical professionals across various specialties in the hot climate of the Republic of Tajikistan.
Materials and Methods. An analytical review was conducted of domestic and foreign publications from 2013 to 2025 addressing the hygienic characterization of working conditions for medical professionals across various specialties, the assessment of occupational risk factors, and the analysis of morbidity levels.
Results. It has been established that the physical and mental well-being of healthcare workers is significantly adversely affected by the following factors: work organization issues (including prolonged time spent in “red zones” and isolation units), the extended use of personal protective equipment, poor indoor air circulation, a high frequency of contact with infectious patients, and excessive or irrationally distributed workloads. Particular attention is paid to professionals working in hot climates and socially tense urban environments – specifically in the city of Dushanbe. The study outlines the primary risks associated with exposure to adverse factors, including the development of functional disorders (such as hypercapnia, heat stress, and dermatitis), reduced work capacity, increased fatigue, and a rise in the incidence of chronic diseases.
Conclusion. Protecting the health of medical professionals working in contact with infectious disease patients requires a comprehensive approach that includes optimizing the work environment from a hygiene perspective, rationally organizing work processes, ensuring the ergonomic design of personal protective equipment, and implementing systematic medical monitoring.

Objective. To assess the primary sanitary-epidemiological risks to the quality of drinking water from open sources associated with the impact of heavy rains and mudflows.
Materials and Methods. An analysis of issues related to the deterioration of drinking water quality from open sources was conducted based on scientific publications and studies from the international databases Scopus, Web of Science, and PubMed.
Results. The primary causes of water quality deterioration are emergency situations involving the discharge of sewage and wastewater into water bodies, soil erosion, the washing away of animal enclosures, the destruction of sanitary facilities, and the death of animals and plants. Consequently, the microbiological, chemical, physical, and organoleptic characteristics of the water significantly worsen. The republic continues to face a shortage of centralized water supply coverage for the rural population; approximately 52% of rural residents have access to such systems. Meanwhile, about 60% of the population relies on open water sources for household needs. This situation increases the risk of waterborne infectious diseases, including acute intestinal infections, viral hepatitis A, parasitic diseases, typhoid fever, paratyphoid fever, leptospirosis, and infections caused by Escherichia coli bacteria.
Conclusion. The dynamics of drinking water quality indicators from open sources during pre- and post-emergency periods remain insufficiently studied. This highlights the need to scientifically substantiate the patterns of water quality changes in relation to the intensification of acute intestinal infection outbreaks during sanitary-epidemiological emergencies, as well as to develop effective measures for protecting open water sources.