#4 (2021)

In December 2020, an unprecedented vaccination against COVID-19 has started worldwide. As the vaccine
supply is currently not sufficient for most countries to vaccinate their entire eligible populations, the defining of effective vaccination strategies may help with reducing the infection spread and related burden on the health system. The existing evidence suggests that disease severity and mortality differ by age, so that age-dependant vaccination can be considered as an important and priority strategy. Through age-dependant SIERS deterministic model, the paper compares four hypothetical age-dependant vaccination strategies and their impact on the epidemic in Kyrgyzstan. In the short-term horizon (until March 2022), the primary focus on high-risk groups (over 50 years old) with some roll out of the vaccination among high-incidence groups (20-49 years old) may decrease symptomatic cases and COVID-19 attributable deaths. On the other hand, the impact on the overall estimated number of COVID-19 cases with a comparatively small coverage of high-incidence groups (15-25% only based on the current vaccine availability) will not be that substantial. Combination of the vaccination with non-pharmaceutical interventions, such as mask wearing and social distancing, will further decrease the incidence and mortality. Moreover, it may have an indirect impact on the all-cause mortality. Thus, the deaths due to other reasons in this scenario can be reduced from 27,000 to 16,000 over the simulation period (March 2020 – March 2022). The above results and emerging evidence on vaccines suggest that vaccination is more effective in flattening the epidemic and reducing the mortality if supported by non-pharmaceutical interventions. In a short-term horizon, the focus on high-risk groups may reduce the burden on the health system and thus result in fewer deaths. However, the herd effect in delaying another peak may only be achieved by reaching high-incidence groups more broadly.

Since the end of 2020, work has begun around the world to vaccinate people against COVID-19. But due to
the insufficient supply of vaccines in resource-limited countries, data on COVID-19 in the country were analyzed to determine
effective vaccination strategies. Through age-dependant SIERS deterministic model, the paper compares four
hypothetical age-dependant vaccination strategies and their impact on the epidemic in Kyrgyzstan. So, by March 2022, public health can reduce cases of COVID-19 and the resulting mortality, in the case of increased attention
to high-risk groups (over 50 years old) and moderate vaccination of people with a high incidence (20-49 years
old). It should also be noted the importance of combining vaccination with non-pharmaceutical interventions (wearing
masks and distancing), which will lead to a further decrease in morbidity and mortality from COVID-19 and indirectly
reduce mortality from other causes too. Thus, if this scenario is observed, the mortality rate in the country can be reduced
from 27,000 to 16,000 over the simulation period (March 2020 - March 2022). According to the simulation results, vaccination
is an effective measure of protection against COVID-19, but the effect is increased when combined with vaccination
of non-pharmaceutical interventions. When focusing on the high-risk group, morbidity decreases, then mortality.
And thus, the burden on the health care system is reduced. But to achieve the effect of crowd control of the next peak in
morbidity and mortality, it is necessary to increase coverage with high morbidity (20-49 years).

This article describes for the first time the determinants of fluctuations in the mean serum 25 (OH) D levels in
the indigenous population of Kyrgyzstan.
Relevance. Vitamin D is now receiving increasing attention. Deficiency of 25 (OH) D contributes to the development of
both skeletal (rickets, osteopenia, osteoporosis) and non-skeletal pathological effects (dermatoses, hypertension, obesity,
oncological, endocrine, autoimmune and infectious diseases). Serum 25-hydroxyvitamin D levels> 75 nmol / L, or 30 ng
/ mL, are essential for maintaining human health.
Objective of the study- to find out whether gender and seasonal fluctuations in UVR levels are determinants of vitamin
25 (OH) D deficiency among healthy indigenous people of Kyrgyzstan.
Material and methods. A pilot multicenter cross-sectional study of the serum 25 (OH) D level of the indigenous inhabitants
of Kyrgyzstan (41 ° N, 75 ° E; duration of sunshine 1700-2900 h / year) was carried out. The sample consisted of 218
people, of which 99 (45.4%) were men and 119 (54.6%) were women. The average age of the representative sample was
38 ± 1.0 (95% CI 36.0 - 40.1) years.
Results. The mean serum 25 (OH) D3 level in the total sample was 46.9 ± 1.1 nmol / L (95% CI 44.8 - 49.1 nmol / L),
which corresponds to a deficit (<50 nmol / L). At the same time, in men, the average indicator 25 (OH) D3 was 50.0 ±
1.5 nmol / L (95% CI 46.9 - 53.0 nmol / L), in women 44.5 ± 1.5 nmol / L ( 95% CI 41.5 - 47.5 nmol / L), p <0.013.
There were statistically significant (p <0.026) seasonal fluctuations in serum 25 (OH) D3 from 41.7 ± 2.3 (95% CI 37.1
- 46.4) in the spring to 50.0 ± 2.1 (95% CI 45.9 - 54.2) in the fall.
Conclusion. Regardless of statistically significant gender and seasonal fluctuations, as well as the geographic location of
the country (41 ° N, 75 ° E) and the duration of sunshine (1700-2900 hours / year.), The average serum 25 (OH) D3 does
not reach an adequate level (> 75 nmol / L).

Introduction. The relevance of the study of melasma is determined by the location of pathological areas on the
skin of the face, which being a cosmetic defect causes social maladaptation in society, reduces the quality of life. Melasma
is a common disease manifested by the formation of hyperpigmented spots. The development of hyperpigmentation is
associated with various etiological and pathogenetic factors. According to some authors, the causes of melasma may be
hereditary predisposition, increased sensitivity to ultraviolet rays, pregnancy, region of residence, skin phototype, ultraviolet
radiation, taking hormonal drugs and a number of concomitant pathologies. Given the high prevalence of melasma,
it is extremely important to study the causes of melasma development to determine treatment tactics. The aim of the study
is to identify the causes of melasma in patients who applied to the DIVA EFFECT cosmetic clinic with hyperpigmentation
from 2018 to 2020 with melasma, according to a specially developed questionnaire. Materials and methods. 176 patients
with melasma were surveyed. Sociological survey, statistical method of research were used. Results. According to the
study, it was revealed that among patients, cases of melasma with a moderate severity were more often identified. The
main causes were pregnancy and childbirth, exacerbation of chronic diseases and exposure to sunlight. At the same time,
hormonal drugs for more than 3 years were taken by patients with manifestations of moderate and mild melasma. Conclusions.
The identified causes of melasma in patients is the basis for determining treatment tactics that contribute to improving
their quality of life.

In the Republican Scientific Center of Urology from 2015 to 2020, we analyzed the data of 42 men with
urethral strictures caused by scleroatrophic lichen (SAL). The age of the patients ranged from 17 to 77 years. Timely
treatment of this group of patients allowed us to avoid the use of surgical treatment to resolve the infravesical obstruction.
The correctness of the diagnosis and the choice of tactics for the treatment of stricture disease of the urethra contributes
to the restoration of the normal act of self-urination. The effectiveness of complex treatment of urethral strictures was
evaluated in terms from 3 months to 1 year. Objective of the study- to evaluate the effectiveness of the result of an integrated
approach to the treatment of patients with urethral stricture caused by scleroatrophic lichen. Material and methods
of research. In the structural units of urology of the Republican Scientific Center at the National Hospital of the Ministry
of Health of the Kyrgyz Republic, 42 men aged 17 to 77 years suffering from urethral stricture caused by scleroatrophic
lichen were examined. To verify the clinical diagnosis and determine tactical approaches to the treatment of urethral
strictures, monitoring of the details of the violation of the passage of urine from the lower urinary tract with an assessment
of the presence of complications and the effectiveness of the treatment was carried out. Results of the study.The data on
the state of urethral patency in patients with scleroatrophic lichen before and after treatment in the long–term treatment
period up to 1 year are substantiated. When prescribing complex conservative therapy and urethral augmentation with
uncomplicated and unstrained urethral strictures after 3-6-12 months, a persistent positive trend was noted in the form of
a decrease in symptoms of infravesical obstruction and infectious and inflammatory processes in the genitourinary organs. Conclusion. The accuracy in the verification of the diagnosis, the professional skills of the specialist and the correct
choice of the method of treatment of urethral strictures in scleroatrophic lichen positively affects the outcome of the
disease and the quality of life of the patient. After conducting a scientific study of the developed approach to the treatment
of patients with urethral stricture caused by scleroatrophic lichen, we came to the conclusion that its effectiveness is quite
high.

Chronic osteomyelitis is one of the most common purulent inflammatory diseases. The proportion of patients
with chronic post-traumatic osteomyelitis among patients with purulent diseases is 6-10%. Modern research shows that
osteomyelitis after open bone fractures occurs in 10-22% of cases, after surgical treatment of closed fractures - from 2 to
7% and very often in tubular bones [13].
The treatment of a purulent surgical infection to this day remains one of the most important and difficult to solve problems,
which is associated not only with a decrease in the body's immune resistance, the widespread use of antibiotic-resistant
microflora strains that can cause purulent complications, but also with unsatisfactory results of surgical interventions,
the reasons for which are many authors see in the errors of early diagnosis at the prehospital stage, in preoperative preparation,
as well as in the technique of performing the operation [14,15].
The social significance of the problem lies in the fact that purulent diseases and osteomyelitis suffer mainly from the
most efficient part of the population, while more than 90% of patients subsequently become disabled [16]. This is largely
due to the high level of injuries, an increase in the proportion of severe injuries of the musculoskeletal system and an increase
in the number of post-traumatic osteomyelitis, as well as the expansion of indications for surgical methods of
treatment, primarily for various types of submerged metal osteosynthesis.

Diseases of ENT organs, if not treated in a timely, are the cause of reduced quality of life and disability of a
large number of the population. After gaining independence, Kyrgyzstan, as well as many other developing countries,
has faced the problem of access to specialized medical care, especially for the rural population. Primary health care is
not yet well established in the country, there is practically no rehabilitation of ENT patients in the regions, and therefore
most of the burden falls on the secondary and tertiary level hospitals. The aim of the research was to study the profile of
adults seeking inpatient care using the example of the otolaryngological department of the Osh Interregional Clinical
Hospital. Analytical, statistical research methods were used. Out of 4,061 patients, data on 3,423 patients were included
in the development. As a result of the 4-year analysis, it was found that 55.1% of hospitalized patients were men and
44.9% were women. Most patients had compulsory health insurance policy; the load on ENT department increases in
autumn-winter period, hence the consumption of medicines, man-hours, utilities, etc. is higher than in other seasons; average
age of patients was 32±13,8 years. Most often, young people aged 20-24 years were hospitalized. The elderly, aged
60 years and more were less often among all age groups, which may be due to reduced availability of inpatient care for
the elderly; adult patients complained more often of upper respiratory tract diseases (J01-J39), ear diseases (H60-H95),
which is most likely a complication of acute respiratory diseases. The results of the study will improve hospital management,
as well as the focus of preventive measures to reduce complications, at the level of primary health care.

One of the primary problems of abdominal surgery is the prevention of wound complications, especially in
emergency surgery. Purpose of the study- improving the results of treatment of patients with acute appendicitis through
the use of preventive measures, including ozonized solutions and infrared irradiation of the surgical wound. Materials
and methods. The study included 105 patients with destructive forms of appendicitis (phlegmonous forms in 87, gangrenous
9 and phlegmonous complicated by local peritonitis in 9). Clinical, laboratory and instrumental methods of examination
(ultrasound) were used in the examination. In the course of treatment, two groups were identified: The first
group - the main group (51) patients, in addition to antibiotics at the time of the operation and during the suturing of the
abdominal cavity - received irrigation of the abdominal cavity and wounds with an ozonated solution with an ozone concentration
of 8-10 μg / ml and starting from the second day after the operation - irradiation of the surgical wound with
infrared radiation - exposure 10 minutes, for a course of treatment 5-6 sessions. The control group - 54 patients, they received
after the operation antibiotics intramuscularly (gentamicin or ampicillin) and through a microirrigator into the abdominal
cavity with kanamycin 1.0 once a day. In addition, patients in both groups received pain relievers and infusion
therapy. Both groups were equal in terms of the main indicators (gender, age, forms of appendicitis). Results. When comparing
the course of the postoperative period, it was found that in the first main group the pain syndrome disappeared
faster, the temperature returned to normal and a more favorable course of the wound process was noted, and the leukocyte
index of intoxication decreased faster. Complications in the control group were noted in 9 out of 54 (16.79), and in the
main group in 4 out of 51 (7.89). Conclusion. The use of ozonized solution and infrared radiation for the prevention of
wound complications made it possible to reduce the incidence of complications by half, which is the basis for recommending
the use of the method in a broader sense.

The article presents data on the prevalence of arterial hypertension in persons with diabetes mellitus who are
registered in the Central Medical Center of Bishkek. Arterial hypertension (AH) and diabetes mellitus (DM) are widespread
non-communicable diseases worldwide. Despite a significant amount of activities in the field of cardiology and
endocrinology, the epidemiological picture of both hypertension and diabetes is deteriorating every year. The number of
people with hypertension has almost doubled over the past 30 years – from 650 million to 1.28 billion, and the number
of people with diabetes has increased from 171 million to 537 million in 15 years. In the Kyrgyz Republic, in order to
achieve the goals of improving the health of the population, the reform of the health sector is focused on the primary
health care provided by family doctors/general practitioners. Family medicine is the only clinical specialty that treats a
person as a whole, and can provide "multidisciplinary" care to any patient, regardless of his age and gender. The multidimensional
approach of a general practitioner makes it possible to diagnose hypertension in people with diabetes in a
timely manner, since in most cases blood pressure increases asymptomatically, and hypertension is detected only during
an objective examination of the patient. Early diagnosis of hypertension allows for complex therapeutic and preventive
interventions, which potentially reduces the adverse complications of both hypertension and diabetes. After analyzing
the information cards, elevated blood pressure indicators were revealed in 51.3% of people with diabetes. Hypertension
was more common in women and in people over 40 years of age. The combination of hypertension and DM significantly
worsens the prognosis of the disease in patients, they belong to a group with a high risk of complications and need immediate
prescription of drug antihypertensive therapy.

Introduction.Despite the improvement of the technique of surgery and treatment, the frequency of complications
after appendectomy with an atypical location of the appendix varies from 10 to 30%. The aim of the work is to evaluate
the effectiveness of the use of regional lymphostimulation and ozonated solutions in the prevention of complications
after appendectomy with an atypical location of the appendix . Materials and methods. 45 patients with an atypical
location of the appendix were subjected to analysis (a prospective study). 2 groups were identified: the first (comparison
group) included 21 patients who underwent process removal and traditional treatment in the postoperative period. The
second, main group, included 24 patients who had regional lymphostimulation, irrigation of the process bed and the operating
wound with an ozonated sodium chloride solution at the time of surgery. Results. In the comparison group, there
was suppuration of the wound in 4, and infiltration in 2, intestinal paresis in two and early adhesive intestinal obstruction
in one. A relaparotomy was performed. In the main group, one suppuration and infiltration of the postoperative wound
were noted. There were no fatal outcomes. Conclusion. The use of regional lymphostimulation and ozonated solutions
can reduce the frequency of complications and the length of hospital stay in acute appendicitis with an atypical location
of the appendix.

In this work, the significance of antigen-specific proliferative activity of B-lymphocytes (AGPABL) in various
clinical variants of reactive arthritis (ReA) is considered. A positive result of AGPABL was found in 100% of ReA patients,
only in 45.5% of ankilosing spondylitis (AS) patients, only in 19.2% of rheumatoid arthritis (RA) patients and in 14.3%
of osteoarthritis (OA) patients, respectively, and in no case in healthy individuals. The AGPABL index in ReA patients
with II and III degrees of activity was significantly higher compared to the I degree of activity. The level of the AGPABL
index in patients with ReA with a chronic course was significantly higher compared to the protracted and acute course
of the disease. The value of AGPABL in ReA with a minimal degree of activity is significantly higher than in patients
with OA, AS and RA.

Introduction. HIV infection in combination with parenteral viral hepatitis today is a socially significant problem
all over the world. The incidence of HCV infection in HIV-infected people averages 20-40%, and more than 70% of
HIV-infected have serological markers of current or previous HBV infection. The aim of the research is to compare the
prevalence of parenteral viral hepatitis B and C among people living with HIV infection and among the healthy population
of the Kyrgyz Republic. Materials and methods. The materials for this study were the reporting data of Form No. 1
"Report on the movement of infectious and parasitic diseases" of the Department of Disease Prevention and State Sanitary
and Epidemiological Surveillance, personal data (questionnaires) of surveyed persons, blood serum of PLHIV who are
under dispensary observation at the Republican AIDS Center and healthy contingent living in Bishkek. Long-term reporting
forms No. 1 and personal data of the surveyed were studied by generally accepted statistical methods using the
MS Exel computer program. Blood serum samples from PLHIV and healthy contingent were examined for the presence
of markers of the causative agent of viral hepatitis B (HBc-IgG, HBsAg) and C (at-HCV) using a serological method of
research (ELISA). Results. The HBc-IgG marker was found among PLHIV in 50.5% (CI 95: 40.3-60.7), and among the
healthy population in 23.8% (CI 95: 21.2-26.4). The prevalence of markers of current HBV infection (HBsAg) in PLHIV
is high compared to a conventionally healthy population - 7.7% (CI 95: 4.5-10.9) and 3.1 (CI 95: 2.1-4.1) respectively.
And HCV infection is also widespread among PLHIV, it was 40.8% (CI 95: 34.8-46.8), and among the conventionally
healthy population 4.8% (CI 95: 3.5-6.1) statistically significantly different (P <0.01).Conclusions. The research results
show that the prevalence of viral hepatitis B and C among PLHIV is statistically significantly higher than among the
healthy population (P <0.001).

The aim of the study was to study the clinical, laboratory and epidemiological features of hepatitis A (HA) in
children complicated by ascites. Epidemiological, clinical and laboratory, serological and instrumental research methods
were used. 29 children were under observation. The onset of the disease, in all patients, was acute, all periods of the
disease were clearly distinguished. Patients were admitted to the hospital in the jaundice period of the disease with ascites,
which was diagnosed on the basis of ultrasound, was registered in young and older children. HA manifested itself in a
moderate and severe form. Already upon admission to the hospital, the condition of the patients was severe. Jaundice in
all patients was moderate, only in one case it was intense (total bilirubin 204 mmol/L) and was accompanied by skin
itching. The most common symptoms of the jaundice period were nausea, fever, vomiting, sleep disorders and anorexia.
The liver in patients with severe HA increased to 3,0-3,5-3,5 cm, was painful, soft-elastic consistency. Splenomegaly
was observed in 4 patients. Hyperalatemia was observed throughout the entire period of the disease, amounting to 1.25
± 0.1 mkat at the time of hospitalization. The duration of the jaundice period averaged 14.4 ± 3.1 days. In severe forms
of the disease, there were harbingers of an unfavorable course of the disease: sleep disorders, anorexia, nosebleeds.
The severe course of the disease in patients with HA requires hospitalization of patients in hospitals and a differentiated
approach is needed in terms of diagnosis, treatment tactics and patient management.

In order to assess the effectiveness of the implementation of the acquired knowledge and skills at trainings on
topical issues of prevention, diagnosis, treatment and rehabilitation of coronavirus infection COVID-19, monitoring and
evaluation were carried out in healthcare organizations of Naryn, Talas and Batken regions, where training sessions on
COVID-19 were held, according to the Orders of the Ministry of Health of the Kyrgyz Republic No. 893, No. 137 and
No. 370. For this, an assessment sheet was developed and approved (Order of the MoH No. 538). 3 stages of monitoring
and evaluation were carried out using the same evaluation sheet. The assessment was carried out according to 6 criteria.
The overall score in hospitals was higher than with Family Medicine Centers (FMCs). At the FMC level, the assessment
ranged from 18.3 to 65.2%. At the hospital level, according to preliminary M&E, the minimum score was 58.9%, and
the maximum was 97%. According to the results of the mid-term assessment, a significant increase was observed in all
health facilities. For FMCs from 5.8% to 24.7%, for hospitals from 15.4% to 21.9%. In general, in the dynamics from
preliminary to final assessment, there is an increase in the fulfillment of criteria for assessing the assimilation and application
of knowledge on COVID-19 in hospitals and FMCs. With the exception of FMCs in Naryn and Batken, where
there is a decrease due to the fact that, due to the absence of morbidity, the alertness of FMC staff regarding the detection
of COVID-19 among the population has decreased, and, accordingly, control by infection control specialists and heads
of quality control committees has weakened.

Access to high quality continuing professional education (CPE) is essential for healthcare professionals to
maintain and expand their competencies in the ever-evolving global information field. Currently, continuing medical education
(CME) is moving from a traditional passive model to a model of active and independent learning based on the
competencies of specialists. In this regard, there is a need to identify and develop new models and methods of CPE
training courses for emergency medical service (EMS) specialists. This paper reflects the experience of organizing and
conducting CPE for EMS specialists of the Kyrgyz Republic, based on international standards, recommendations, and
global practice, taking into account the needs of practical health care. The main conditions and approaches for the implementation
of the newly developed curricula were: the use of didactic lectures in an interactive mode with the demonstration
of certain skills, seminars, additional information on the board, video materials on the topics and summarizing the
learning outcomes for each topic; simulating practical classes with the help of manikins of different levels, medical equipment,
medical products, medicines; development of handouts, clinical situations on each topic; use of synchronous and
asynchronous training methods; practicing procedural skills based on the repetitive practice method; evaluating each
course at the end of it based on a five-point system questionnaire of a Likert scale to receive the feedback from participants,
allocation of additional time for the rehabilitation exam (retake). As a result of the training, the majority of health care
workers achieved good results in acquiring practical skills and abilities, which were evaluated during their work with patients.
Effective training is critical to prepare highly qualified EMS providers.