#2 (2021)

The main goal of this study was to demonstrate the advantages of enzyme immunoassay for testing patients with
COVID-19. Serologic testing is one of the most accurate and highly efficient methods of screening for pathogenic
microorganisms. The enzyme-linked immunosorbent assay (ELISA) is used to detect specific antibodies in individuals at the early stages of COVID-19 infection, during the first 10 days of the disease. The advantage of DIA®-
SARS-CoV-2-Ag-R test system developed by our group in comparison with competing testing methods is that it
allows the most accurate detection of asymptomatic infected and contact individuals. We explored this property
of our test system in a prospective study, and also performed a quantitative comparison of the competing test systems
available in the market with DIA®-SARS-CoV-2-Ag-R. The safety of testing was ensured by the utilization
of the VLM-DIA transport medium, which has viralizing properties and allows to preserve protein structures for
analysis. The affordability of DIA®-SARS-CoV-2-Ag-R compared to competing testing methods allows to detect
SARS-CoV-2 in a bigger number of infected people. A positive result obtained with the DIA®-SARS-CoV-2-Ag-
R test system does not require confirmation by other methods such as polymerase chain reaction (PCR). The
analysis can be performed using both standard equipment for ELISA, and automatic open-type immunoassay analyzers
utilizing a validated analysis protocol. It is the presence of an "open" testing system with the availability
of a relatively simple sample processing technology that makes it possible to perform the analysis in healthcare
facilities of almost any level. In the present study we evaluated the sensitivity of DIA®-SARS-CoV-2-Ag-R in
comparison with competing test systems, analyzed the data obtained and revealed significant advantages of this
method for testing patients with COVID-19.

ABSTRACT
The analysis of the legal regulation of social protection and medical care for senior citizens of the Kyrgyz Republic
has been carried out. The content of these documents requires a uniform correct formulation, a clear definition in
order to unify, eliminate inconsistencies and contradictions of some provisions and terms used in the social sphere,
etc. To a certain extent, the complex of socio-economic measures of the state requires higher costs for medical care,
social and pension provision for disabled citizens of the country, with consideration of international practice. Today,
for older people, in conditions when their discrimination and stigmatization is a very common phenomenon, the country
lacks specialized gerontological services within the health care and social development system to improve their
quality of life.

The article presents data on the analysis of the incidence of foodborne botulism in the Kyrgyz Republic and Osh
region involving 230 people. The epidemiological features of the disease as a result of the use of homemade canned
compotes, jam, vegetable salads, cucumbers and tomatoes are shown.
There were 87 males (37.8%) and 143 females (62.2%), grading age groups: 20 (8.7%) under 14, 25 (10.9%) 15-19,
67 (29.1%) 20-29, 42 (18.3%) 30-39, 35 (15.2%) 40-49, 24 (10.4%) 50-59, and 17 (7.4%) 60 and over. The mortality
rate in foodborne botulism averaged 5.30.9% with fluctuations from 0 to 13.8%. Mortality rates do not correlate
with the highest incidence rates, which is confirmed by statistical data: the correlation coefficient (r) is -0.6

Due to their high prevalence and non-reducing frequency, postpartum purulent-septic diseases are one of the most
urgent problems of modern obstetrics. Over the past 10 years, they steadily ranked the fourth among causes of maternal
mortality in the world [1, 2]. Currently, the nature of the pathogens that cause postpartum complications has changed
significantly. The proportion of microbial associations has increased, which significantly aggravates the course of
postoperative purulent-septic complications and their therapy. [6,7]. This article demonstrates the etiological structure
of pathogens and the level of antibiotic resistance in patients with postpartum endometritis. The aim of the study is
to improve the results of treatment for women with purulent-septic complications after childbirth by optimizing antibacterial therapy based on the results of bacteriological studies. An analysis was carried out among 167 women admitted to the Department of Purulent-Septic Gynecology of the National Surgical Center under the Ministry of Health
and Social Development of the Kyrgyz Republic from 01.01.2019 to 25.12.2020, with the results of bacteriological
culture separated from the uterine cavity, the types of pathogens identified, sensitivity and resistance to antibiotics
were shown. The analysis of the etiological structure of the isolated strains revealed the prevailing role of gram-positive microflora in 43.7% of cases. Gram-negative microflora was found in 25.7% of patients. The most common
causative agents of postpartum endometritis were Esherichia coli 33.3%, Enteroccocus spp. 23.5%, Streptococcus
spp. 10.6%, Staphylococcus epidermidis 9.1%, Staphylococcus haemolyticus 6.1%. When studying the antibioticogram, the highest sensitivity of gram-negative microorganisms was revealed to meropenem in 90%, tobramycin
in 85%, amikacin in 80% of cases, and gram-positive flora to carbapenems up to 85% and vancomycin 95%. The
highest resistance of gram (+) and gram (-) microorganisms was found to b-lactam antibiotics, fluoroquinolones of
2-3 generations, aminoglycosides of 1-2 generations. In order to curb the growth of microorganisms’resistance, it is
necessary to introduce a number of measures, including educational activities among doctors on the rules for the collection and transportation of biomaterials obtained from patients as well as on the rational use of antimicrobial drugs,
to revise the prescribing regimens of some drugs in cases of empirical therapy in order to improve the results of treatment, and to ensure bacteriological laboratories with the necessary equipment and consumables

Research results of physical growth and development of children of primary schools in the Kyrgyz Republic are presented in order to form current understanding of the prevalence of overweight and obesity of this population group
as well as to characterize environmental conditions on the family, school, and community level that influence children’s physical and mental development

Treatment of surgical diseases against the background of diabetes mellitus is one of the important problems of modern
surgery. Its relevance is due to an increase in the number of patients with diabetes mellitus, and, consequently, an in crease in surgical patients suffering from this disease. Despite the advances in abdominal surgery in the treatment of
many abdominal organ pathologies, the incidence of inflammatory complications, especially wound complications,
remains at a high level and occupies one of the first places of complications. The aim of the work is to improve the
treatment results of surgical diseases against the background of diabetes mellitus by preventing inflammatory complications. There were174 patients under observation who had undergone surgery for abdominal cavity diseases suffering from diabetes mellitus. 101 (58.1%) of them were women and 73 (41.9%) - men. To assess the effectiveness
of preventive measures, two groups had been distinguished, which were equal by the main clinical parameters (sex,
age, duration of the disease, type of diabetes mellitus, the nature of abdominal pathology), differences were only in
the preventive measures. The first, control group (71 people), had traditional treatment and prophylaxis measures,
and the second, main group (103 people), in which we used the developed prophylaxis measures. Analysis of the results of treatment showed that traditional treatment caused 26,8% of complications (19 of 71 people), the lethality
rate was 4,2%, and when using preventive measures, the complication 9,9% (10 of 103 people) of the operated patients,
there were no lethal outcomes.

The results of the application of sodium hypochlorite solution in 35 patients with acute destructive cholecystitis
and appendicitis are presented. In order to prevent complications and treat endotoxicosis, 0.06% sodium hypochlorite solution was used in the subclavian vein in an amount of 200 ml daily. The course of treatment is 4-5 injections.
Analysis of the results of the use of sodium hypochlorite showed that there is a decrease in the blood sugar level,
the number of leukocytes and the normalization of the leukocyte index of intoxication.

One of the acute problems of treating extensive purulent-necrotic wounds of various localizations is postoperative
treatment until complete healing. Local wound therapy is also used as the basis of the integrated approach along with
surgical methods - the use of agents with a differentiated effect on the wound process, taking into account the phase
of the wound process and the characteristics of the course of the disease. Inadequate postoperative wound management
can cause poor surgical outcomes, which is especially important in phase I of the wound process. Proteolytic enzymes
are a priority for wound purification in the inflammation phase. The article presents the results of the study of the
comparative effectiveness of proteolytic enzymes in surgical patients based on the use of Enzilite in the I phase of
the wound process.
It was shown that the use of the complex of proteolytic enzymes "Enzilite" in patients with purulent-necrotic wounds
of various localizations allows improving treatment results by 6.1% and reducing the risk of repeated surgical interventions by 19.6%.

Introduction. Cardiovascular disease (CVD) is one of the leading causes of death worldwide. A special place in the
structure of CVD is occupied by arterial hypertension (AH), which is the leading factor in the mortality of cardiac
patients. In the Kyrgyz Republic the prevalence of hypertension in recent decades has increased by 40-50%, and according to the epidemiological studies INTEREPID and STEPS is 44-46%. Mortality from CVD(including hypertension) according to reports from the Center for Electronic Health KR (CEZ) in 2019 accounted for 51% of total
mortality.
Aim of the study: development of indicators for assessing the effectiveness of control of arterial hypertension at the
primary healthcare level in the Kyrgyz Republic. Material and Methods. The outpatient cards data processing for 2019 of all assigned patients of the Pervomaisky
district of Bishkek, approved by the Ministry of Health of the Kyrgyz Republic (CIF outpatient, form No. 025/y),
was carried out. The indicators were analyzed using the SPSS Syntax software adapted for e-health. The p<0.05 value
was taken as the threshold level of statistical significance.
Results. The detection rate of arterial hypertension was 2,69% in relation to the entire assigned population, of which
men –1,78% and women –3,45% (p <0,001). Patients with hypertension under the age of 40 were 1,9-3,3%. The proportion of hypertensive patients whose blood pressure was measured 2 or more times a year was more than 90% for
all FMCs; in FMCs № 3, 7, 14 and 16, the proportion of patients with hypertension who assessed the total cardiovascular risk was 56,5%, 94,7%, 98,3% and 89,3%, respectively. Drug therapy for hypertension was prescribed in 73,6%
of patients, and the effectiveness of hypertension control among patients was 45%.
Conclusion. To assess the effectiveness of hypertension control at the PHC level, it is proposed to use 2 main indicators: an indicator that allows assessing the effectiveness of hypertension control at the healthcare facility level, that
is, the number of patients with hypertension who have reached target BP values in relation to all patients with hypertension who visited this facility during the calendar years, and an indicator of the effectiveness of hypertension control
at the subnational level, i.e. indicator of detectability of AG.2

The thoracic department of the National Center for Oncology and Hematology of the Ministry of Health and Social
Development of the Kyrgyz Republic conducted a comparative analysis of the effectiveness of combined and complex
methods of treating metastatic pleurisy in 90 patients, who were in hospital treatment from 2005 to 2018. During the
study, we found that that the rate of one-year, two-year and three-year survival in the control group was 66,6 ± 6.8%,
40 ± 5.7% and 20 ± 4.2% compared to the main group, where the one-year, two-three-year survival rate was 57.7 ±
6.5%, 33.3 ± 5.3% and 15.5 ± 3.7%, respectively

Introduction. An analysis of 12 cases of acute viral hepatitis of unspecified etiology is presented. In patients, negative
markers of viral hepatitis were obtained twice, the autoimmune nature was excluded by the absence of autoimmune
antibodies. Antibodies (IgG) to HSV (11 patients), EBV (9 patients) and CMV (7 patients) were detected. In patients
with recent infection with HSV (low avidity index), the clinic of acute hepatitis developed in young people against
a background of high immunocompetence, which led to recovery in a short time. Whereas, in the group of patients
with high avidity, the disease developed among the older age group with a longer course.
The aim of study. To study the clinical and laboratory characteristics of viral hepatitis of unspecified etiology.
Material and methods. Clinical and laboratory characteristics of hepatitis of unspecified etiology were studied in 12
patients. All patients underwent a standard general clinical examination, which included an assessment of complaints
and physical examination data, biochemical blood tests, general clinical blood and urine tests, determination of viral
hepatitis markers by ELISA, and ultrasound of the abdominal organs. Antibodies to HSV, CMV, EBV were determined
by ELISA, as well as the avidity of IgG to HSV.
Results and its discussion. According to the RCIB for the period 2014 - 2020 the proportion of hepatitis of unspecified etiology ranged from 2.3% to 7.1%, averaging 4.39 ± 0.58. The observed patients had persistent symptoms of
yellowness of the skin and sclera, weakness, abdominal pain and loss of appetite. The study of biochemical parameters
showed a significant increase in "liver tests" in all examined patients. According to the ultrasound data from the liver,
all patients showed signs corresponding to changes in acute hepatitis. The diagnosis of viral hepatitis was excluded
after repeated negative tests for markers, which served as the basis for further search for an etiological factor and the
patients were examined for viruses of the herpes group (HSV, CMV, EBV), taking into account their hepatotropicity,
as well as for the presence of AMA and ANA to exclude an autoimmune nature. The results of examination for herpes
viruses showed the presence of IgG antibodies to HSV in 11 patients, EBV - in 9 and CMV - in 7 patients. Antibodies
to all three HSV, EBV and CMV viruses were found in 6 patients, to two HSV and EBV viruses - in 3 patients, one
patient had antibodies only in CMV. The hepatotropicity of herpes viruses (CMV, EBV, HSV) was confirmed by the
detection of their antigens in the hepatocytes of the examined patients.
Conclusions: In the etiological structure of viral hepatitis, a certain place can be occupied by viral hepatitis
caused by the herpes simplex virus, cytomegalovirus, Epstein-Barr virus, etc., the clinical picture of viral hepatitis
is similar in form, severity, course and outcomes;in case of laboratory exclusion of viral hepatitis A, B, C, D, E, it
is necessary to continue laboratory studies to confirm the etiology of other viral hepatitis.

At the thoracic Department of the National Center of Oncology of the comparative analysis of the effectiveness of
best practices in the treatment of metastatic pleuritis with 46 of breast cancer patients from 2004 to 2018.

The article examines the state of the measles epidemiological situation in dynamics, in the period from 2014 to 2020.
The collection of data with long-term indicators of incidence and prevalence of measles was carried out with an assessment of the epidemic process in the Kyrgyz Republic. Comparison of the results obtained in different regions
made it possible to identify the most probable reasons for the increase in the incidence, namely, incomplete immunization coverage of the population in recent years.

Oncological diseases are one of the main causes of high mortality and disability of the population. More than 12 million new cases and 7 million deaths are reported annually [1]. Object of study: indicators of morbidity and mortality
from cancer. Purpose: Estimation of long-term dynamics of cancer morbidity and mortality using autoregressive
models and integrated moving average. Methods and approaches. The method of autoregression and the integrated
moving average (ARIMA) was used. The research materials were data of the Statistics Agency of the Republic of
Kazakhstan regarding morbidity and mortality from cancer for the period 2005-2014 (120 months). Statistical analysis
was carried out using SPSS, version 20.0. Results. In the framework of the Program on Development of Oncologic
Care in the Republic of Kazakhstan for 2012-2016, there was a plan for the introduction of screening programs for
early detection of cancer in Kazakhstan in the period from 2011 to 2016 [2]. An assessment of the impact of the Program on cancer morbidity and mortality revealed the following. According to the ARIMAmodel, after the introduction
of the Program, a monthly increase in the incidence rate, equal to 0.57 cases per month, was observed. Obviously,
this is due to improved detection of cancer. For mortality rates, a monthly decrease equal to 0.25 cases per month
was observed. The decrease in mortality proves that the incidence rate increased due to the detection of cases of
disease in the early stages, which led to timely medical examination and treatment of patients.

The article presents the organizational structure of the pediatric cardiac surgery service and the results of a detailed
analysis of indicators of infant morbidity and mortality from congenital heart defects at the Center of Perinatology
and Pediatric Cardiac Surgery for 9 months of 2019.
The cardiac surgery unit consists of two structural units - the department of anesthesiology, resuscitation, intensive
care for pediatric cardiac surgery (total 6 beds) and the department of pediatric cardiac surgery (total 21 beds).
Equipped with high-tech equipment, modern effective perinatal technologies have been introduced, optimal conditions
have been created for nursing sick newborns and premature babies with congenital heart defects. At the same time,
the article reflects the key problems, the solution of which can help to reduce the morbidity and mortality of children
from congenital malformations. Late prenatal diagnosis of congenital malformations occurred in 17.5%. The quality
of prenatal screening suffers in some regions and in private health centers. To improve the mortality situation in children with congenital heart disease, it is necessary to monitor prenatal screening in the regions, with the subsequent
solution of the issue of delivery in the CP and DKH. These measures will make it possible to bring the transportation
of the newborn closer to the level 3-4 cardiac surgery centers in order to provide timely cardiac surgery and increase
the survival rate of these patients.

The article highlights the basic principles of organizing obstetric services in the context of the COVID-19 pandemic,
taking into account international experience. A schematic organization of the work of an infectious-provisional hospital
operating in June-August 2020 at the Center for Perinatology and Pediatric Cardiac Surgery is presented. Measures
are described to ensure the safety of medical personnel - compliance with the current disinfection regime, provision
of personal protective equipment, pulse oximeters, means for remote temperature measurement, and the organization
of remote consultation. A filter has been organized for patients with suspected ARVI and COVID-19 with a separate
entrance from the street, a ward for accommodating patients and a complete set of equipment and consumables for
any clinical case, up to surgical intervention. During the operation of the infectious-provisional department, 118 patients with COVID-19 received treatment, 48 deliveries were received, of which 20 were delivered by caesarean section (41%).

Introduction. In the 21st century, the provision of health care, medical science and industry with new medical technologies, medicines, medical devices, instruments and equipment should have a significant impact on the latest indicators of public health: mortality, morbidity and disability. Many countries are increasing spending on health care
from year to year, but there is no return on investment. Problems of achieving public health is one of the main tasks
of the state. As part of the demographic transition to a modern mode of population growth, pathology is being restructured: resource-intensive nosological forms (primarily chronic diseases) are growing, the share of pathology is
declining, and their treatment and prevention require significantly lower costs.
The purpose of the study is to analyze the features of modernization in health care.
Materials and methods. Statistical, mathematical, observational, analytical, and comparative methods were used in
writing the study.
The practical significance of the work is that it develops the main directions of modernization of health care, which
will allow medical institutions to provide quality medical services to the population and thus increase the duration of
health of the population, as well as the quality of life of citizens.
Results. Thus, health care is a branch of government activity, the purpose of which is to provide affordable medical
care to the population, to protect and improve their health.
The result. Basic legislation strengthens the human right to protection and promotion of health. Optimization of the
health care system is the most important part of the state's socio-economic policy. Health care as a public system is
considered in terms of unity of purpose, interaction and continuity of services (therapeutic and preventive), universal
access to qualified medical care and a truly humanistic direction.

Introduction. Quality Continuing Medical Education (CME) for healthcare professionals is instrumental for the successful Emergency Medical Services (EMF) healthcare system development. Development and implementation of
innovative and effective training programs, based on the principles of evidence-based medicine and the needs of
practical healthcare are of great importance.
Purpose of the study: analysis of the content and effectiveness of the developed comprehensive training programs
for CME on EMF.
Materials and methods. The study describes main approaches to the development of new curricula and different
types of programs, depending on the specialists’category. A comprehensive retrospective analysis of preclinical and
clinical training (monitoring and evaluation) on the progress of participants depending on the level of EMF provision
(primary and secondary level of healthcare organization), received courses, specialties was carried out. The results
of theoretical knowledge were assessed in the form of pre- and post-tests (paper form) and assessment of practical
skills at the preclinical level using various level manikins.
Study results: The development team (international experts, Kyrgyz State Medical Institute of Post-graduate training
and continuous education, teachers and doctors) developed and prepared training programs for EMS specialists,
which corresponded to the needs of practical health care. After intensive and innovative training, the knowledge
growth rate of all medical workers significantly increased compared to the data before training (pre-testing), depending
on the category of participants and the content of the training course. On average, the knowledge growth rate ranged
from 55,8% to 115,7%, depending on the category of specialists (the difference between the indicators is statistically
reliable, p<0.001). The results of the practical exam indicate that simulation based training contributed to the increase
in the level of mastering practical skills and abilities among Emergency Medical Service medical workers.
Conclusions.The use of newly developed and implemented training programs for EMF medical workers, based on
the principles of clinical modeling and problem-oriented training, contributed to the creation of a flexible system of
various complex standardized conditions for emergency conditions and allowed trainees to take an active part in
practicing EMF skills. As a result of the effective implementation of training programs, the level of knowledge, practical skills and abilities of medical workers have significantly improved.

The Asian Medical Institute named after Tentishev (AzMI) is located on the territory of Kant. The Institute provides
educational services to students of the Kyrgyz Republic, near and far abroad. Training is conducted in two languages, Russian and English. Most of the students come from India and Pakistan. The institute also offers residency
and postgraduate studies. The institute plays an important role in the economic life of the Chui region, creating
jobs, providing foreign students with housing, the teaching staff is provided with decent salaries, one of the highest
in the field of education. The testing center of the Ministry of Education tested all medical educational institutions
of the country for the quality of education and AzMI took first place in the republic, this fact suggests that this is
an indicator of the purity of education in AzMI. All structures of the institute are dynamically developing giving
priority to the quality of education. The quality of education lies in qualified teachers, a well-equipped academic
building, and an extensive library fund. Every year the institute develops and fulfills its mission in the field of education, the mission of AzMI is to implement educational programs that meet international standards through highquality training of competitive specialists, by integrating the best world practice in education, science and clinics,
based on the principles of evidence-based medicine. Thus, through professionalism, enthusiasm and long-term endurance, one of the most advanced vocational education institutions in the Kyrgyz Republic was formed in the
Chui region. The founder of AzMI is Erkin Satkynbaevich Tentishev

When looked at the latest news for 2021, we can see that tens of millions of people have contracted the coronavirus.
More than a million people have died or are facing long-term health effects from the virus. The review article is devoted to the study of the biochemical specificities of changing the algorithm of hyaluronic acid in the alveoli of the
lungs with Covid-19. An analysis of the literature covering the problem to date is carried out. On computed tomograms, which do each patient with suspected coronavirus, lucent areas are noted - “ground glass” syndrome, that
contain liquid. So, the analysis of the literature showed that the coronavirus damages the membrane (membranes) of
the alveoli, which causes the outpouring of hyaluronic acid from them. A group of scientists assume that hyaluronic
acid is the leading cause of death in severe Covid-19 lung infections. The study showed that COVID-19 demonstrates
a high level of proinflammatory of cytokines in the affected alveoles and in endothelial cells of blood vessels, in addition to increasing neutrophil extracellular traps that activate hemostatic factors. Consequently, thrombosis in the
pulmonary microcirculation leads to an increase in respiratory failure. The article further describes the role of
hyaluronic acid and the concept of “bradykinin storm” in the development of respiratory failure and the therapeutic
effects of COVID-19 heparin. Scientists have found that in addition to the anticoagulant effect, heparin can bind to
the “spike” protein of the SARS-CoV-2 virus and function as a competitive inhibitor for the entry of viruses, thereby
reducing the infectivity of the process [1].

This article is devoted to the historical facts of the development of medical education and science in the Kyrgyz Republic. The article examines the historical aspects of the formation of the state system of training medical personnel
in the Kyrgyz Republic in the late 19th - early 20th centuries.