#1 (2021)

The article presents the results of many years of research on the sustainable development of mountainous regions
of Kyrgyzstan. Based on the analysis of my own results and studies of a number of foreign authors, problems that
hinder sustainable development are identified and promising directions for development are proposed.

Introduction. The problems of organizing and providing specialized consulting and diagnostic assistance to the
population remain one of the most difficult in healthcare. Taking into account unfavorable trends in public health
in almost all regions of the country and the high rate of malignant tumor, it is extremely important to ensure
accessto qualified medical care at the prehospital phase. This is also necessary because about 80% of sick people start and finish treatment in outpatient clinics.
The growth of disease incidents rate is noted in most regions of the country. The increase in the number of primary
cases has influenced the growth of malignant tumors in many regions.
Aim of the study is to improve the organizations of specialized medical care to oncology patients based on the
analysis of screening programs.
Material and methods. The material on the results of the analysis of the level, structure and peculiarities of
morbidity of malignant tumors of the population in the southern region of Almaty region, as well as the scope
and nature of specialized consulting and diagnostic assistance to the population in the implementation of screening
programs depending on the place of residence were used.
Results. The current state of oncological service of health care of rural region according to the data of screening
of cervical cancer, breast cancer, colorectal cancer analysis, and also a complex of actions directed on improvement of specialized medical care with introduction of the developed functional-organizational model of specialized consultative and diagnostic help to rural population has been developed.

The Ministry of Health of the Republic of Kazakhstan has included the Quality Management System into the list
of promising new innovative management technologies that should be implemented in the practice of management
of healthcare organizations.
Solution of these tasks to a great extent depends on the correct setting of goals, quality of strategic management,
implementation of philosophy and principles of quality management system, organization and training of teamwork,
organization of work on elimination of losses and maximum effective management of resources. In our opinion,
the ISO 9001:2015 standards answer the question of what needs to be done to create a basis in the organization for
continuous improvement of activities and satisfaction of consumers needs for high quality medical care.
The work uses the material based on the results of the analysis of the multidisciplinary clinic. During the implementation of the quality management system, it was based on the principles of universal quality management,
which is a management model for the implementation of a systematic approach to process management in order
to meet the requirements and expectations of consumers and all stakeholders.
The developed and implemented quality management system of the multidisciplinary clinic is aimed at reducing
losses and creating conditions that will allow the organization to realize its potential and improve competitiveness,
quality of services, increase customer satisfaction and increase personnel motivation.

Introduction. There is still a lack of complete unity in the views on the essence of brain concussion. In the literature
available to a wide range of specialists in recent years, there is no modern generalized description of concussion
and its diagnostic criteria. To fill this gap is the main task of this study.
The aim of the study - to determine the diagnostic value of protein S-100B level in blood serum at patients with
brain concussion.
Materials and methods. We conducted prospective assessment of protein S100B level in blood serum at 47 patients, received conservative treatment because of brain concussion. All patients underwent clinical-neurological
examination, brain CT and brain MRI, electroencephalography (EEG). The level of protein S100B in blood serum
was determined at once during patients’ admission, and then repeated evaluation - in 24 and 48 hours. The comparative analysis of data, received by clinical-instrumental examination and measurement of protein S100B level
at patients with brain concussion, was carried out.
Results. We revealed the increase of protein S100B level higher than normal value (more than 105 tg/l) at 11
(58%) patients during first 6 hours after trauma. The elevation of protein S100Blevel in blood serum showed that
there was structural damage of brain tissue (brain contusion). Brain CT revealed foci of brain injuries only at 73%
of patients with increased protein S100B level (n=11 patients), while MRI - at 100%. Brain CT and MRI revealed
no pathological areas in brain at patients with normal value of protein S-100B (n=8 patients).
There were no correlations between protein S100Blevel and type of brain injury, localization and volume of pathological focus and presence of cranial bones fractures. In addition, there was no significant correlation between
protein S-100B level and changes in EEG (р > 0.05).
Conclusion. Protein S100B is high-sensitivity biochemical marker of neural tissue damage. The elevation of protein S-100B level in blood serum at patients with mild head injury may be the additional criteria at determining
the diagnosis of brain contusion

Introduction. Recently, there has been a significant trend in the views of researchers and practitioners on the
pathogenesis, course, and biochemical changes in the elements of the spinal cord and ligamentous apparatus that
occur in osteochondrosis. This is due to the new opportunities that have opened up thanks to the advent of computed
tomography (CT) and magnetic resonance imaging (MRI) in the arsenal of diagnostic tools. With the introduction
of CT and MRI, the reliability of information increased to 82-93%.
The aim of the study -to improve the diagnosis and increase the effectiveness of surgical treatment of patients
with disc hernias in the lumbar spine by studying the relationship of clinical manifestations and the results of the
applied research and treatment methods.
Materials and methods. The work includes the results of data analysis of a complex of clinical, diagnostic examinations and surgical treatment of 139 patients with neurological complications of herniated lumbar intervertebral
discs and received inpatient (operative - 116 (83.5%) and conservative – 23 (16.5%) patients) in neurosurgery departments. The age of the patients ranged from 19 to 72 years.
Results. By using a highly informative MRI method, the dependence of the severity of pain syndrome and sensitive
disorders on the number of levels of disc damage, their localization in the diameter of the spinal canal and their
size was determined. The severity of pain and sensory disorders depended on the number of prolapsed discs. Moreover, the greater the number of intervertebral discs affected by the degenerative-dystrophic process, the greater
the likelihood of a pronounced and pronounced pain syndrome.
Conclusion. The most informative method of radiation diagnosis of degenerative-dystrophic processes in the intervertebral discs of the lumbar spine is magnetic resonance imaging, which allows you to identify the number, location and size of herniated protrusions. The optimal algorithm for examining patients before deciding on
neurosurgical intervention for herniated lumbar intervertebral discs includes radiography of the lumbar spine, MRI
of the spinal cord and spinal column, and, if indicated, magnetic resonance myelography

Introduction. In the process of metabolism in the human body, free and peroxide radicals are continuously formed,
the impact of various damaging factors causes their excessive avalanche formation with a cytotoxic effect, which
are the cause of many pathological conditions of the body.
The aim of the study to study of the processes of exposure to free and peroxide radicals in the human body and
their correction by natural antioxidants.
Materials and methods. The study of scientific literature data on the use of natural antioxidants in the treatment
of inflammatory periodontal diseases.
Results. Recommendations for the prevention and treatment of inflammatory periodontal diseases with natural
antioxidants are made.
Conclusions. For additional antioxidant therapy, it is necessary to purposefully recommend a rational diet containing natural antioxidants and the inclusion of dental products from natural natural components in the complex
treatment of periodontal diseases

One of the urgent problems of modern medicine is adequate anesthesia in the postoperative period. Inadequate
analgesia can cause unsatisfactory results of surgical treatment. For the relief of postoperative pain, priority is
given to medicines with maximum analgesic activity. The article presents the results of a study of the comparative
effectiveness of postoperative analgesia in urological and surgical patients based on the use of Nalbuk and Morphine
for the relief of acute postoperative pain of various degrees of severity. The assessment of the intensity of the pain
syndrome was carried out using a visual analog scale (VAS). It is shown that in the postoperative period in surgical
and urological patients, Nalbuk shows high analgesic activity, does not have a sedative effect and does not depress
breathing, which allows achieving better analgesia compared to traditional opiate analgesia with much better tolerability and with a significantly lower frequency of side effects.

The aim of the study- Analysis of the effectiveness of the complex treatment of strabismic amblyopia in concomitant strabismus with binocular vision disorder.
Material and method of treatment. A total of 100 patients (158 eyes) — 54 patients (86 eyes) with concomitant
divergent strabismus and 46 patients (72 eyes) — with convergent strabismus, were subject to treatment. Control
group - 10 people (20 eyes) with emmetropia. The average age up to 3 years is 2.4 ± 0.45 years, from 3 to 7 years
- 4.8 ± 0.07 and over 7 years - 8.3 ± 0.4. Strabismus angle up to 10° - 40 patients (80 eyes); from 11° to 15° - 25
patients (40 eyes), more than 15° - 35 (38 eyes). Hyperopic astigmatism – 69 patients (111 eyes), high-grade hyperopia – 31 patients (47 eyes). Mild amblyopia – 28 patients (40 eyes), moderate – 48 patients (84 eyes) and
severe – 24 patients (26 eyes). The complex therapy was based on a three-stage method: the first stage – the impact
on the pupillary-accommodative system with the determination of the pupil cycle time and (V) the speed of the
pupillary reaction, (color pulse therapy, “Focus”, “Relax” devices, Sidorenko vacuum glasses, home exercises. In
the second stage, the impact on the retinal cones – “Flower”, “Crosses”, “Spider” programs, quantum rays, occlusions and penalization. The third stage – restoration of the bifixation reflex: “Combination”, “Fusion”, “Trainer”
computer programs, nose drops according to the scheme 0.1% Semax solution.
Discussion of results. A decrease in the pupil cycle time from 1400±0.74 m/s to 900±2.08 m/s (P <0.01) was obtained; an increase in the V pupillary response from 1.5±0.17 mm/s to 2.8±0, 05 mm/s (P <0.01); increase in the
volume of absolute accommodation and the reserve of absolute accommodation up to 14.4±0.23D b 5.2±0.27D,
in the strabismus - 14.65±0.8 (P <0.05) increase in distance visual acuity to 0.83±0.12, in 72.2% of cases (68 patients) – the development of binocular vision.
Conclusion. The effectiveness of the complex method of strabismic amblyopia treatment is conditioned by the effect on all parts of the visual system.

The most frequent (11.1%) and serious urological diseases are urinary tract infections [19]. In all age groups
among kidney diseases the most common is pyelonephritis and ranks 2nd in the structure of nosologies among urological diseases [3,19].
This nosology occupies is an important cause of primary disability and death [13], thereby requiring significant
financial costs. More than 100,000 people are hospitalized each year for urinary tract infections, mainly
pyelonephritis [1]. The etiology of acute pyelonephritis is characterized by polyfactory . This article demonstrates
the frequency and structure of complications of acute pyelonephritis, as well as microbiological characteristics
and antibiotic resistance of pathogens.

The work presents the clinical and biochemical characteristics of patients with liver cirrhosis in the outcome of
chronic hepatitis C virus (HCV).
For liver cirrhosis in the outcome of chronic HCV, the early symptom is hepatomegaly with minimal clinical symptoms (Child-Pugh class A). Child-Pugh class B is characterized by asthenovegetative syndrome, splenomegaly,
nosebleeds, and dyspeptic symptoms. Child-Pugh class C is manifested by hepatic encephalopathy, portal hypertension, edematous ascitic syndrome, and bleeding from esophageal varicose veins.
In the functional parameters of the liver, violations of protein-synthetic function, cytolytic activity and mesenchymal-inflammatory syndrome were detected, the severity of changes was observed in class C liver cirrhosis. Hepatocarcinoma screening showed an increase in the frequency of alpha-fetoprotein (AFP) elevation as the pathological
process progressed. The effect of the 1b genotype of HCV on the high frequency of AFP increase (17±2.5%,
p<0.001) was revealed.

The article describes clinical studies and antiviral therapy of patients with cirrhosis of the liver in the outcome of
chronic viral hepatitis C. The safety of the inclusion of direct-acting antiviral drugs (sofosbuvir + daclatasvir +
ribavirin) in the scheme of antiviral therapy of patients in the treatment of cirrhosis of the liver in the outcome of
chronic viral hepatitis C, class A according to Child-Pugh is proved. The use of direct-acting antiviral drugs in patients with cirrhosis of the liver in the outcome of HCV with HCV 1-genotype, indicates a high efficiency and satisfactory tolerability of this treatment regimen. A complete virological response was registered in 96.2% of patients.

To identify regional features of causal risk factors in the development and development of hypotrophy in children
of the first year of life, their dependence on pathologies during pregnancy and complications in childbirth of their
mothers.
The main objective of this study was a comparative study of causal factors, taking into account the clinical and
anamnestic data of healthy and sick children with hypotrophy.
Under our observation were 135 children in the first year of life of patients with malnutrition. The control group
consisted of 126 healthy children of the same age and a description of their anthropometric characteristics depending on the degree of pathology.
The state of health of mothers (pathologies of the pregnancy period and complications in childbirth) can become
causal factors for the development of hypotrophy, children born to such women in the first year of life.

The main goal of this work was to study the nutritional and energy supply of breast milk in healthy nursing mothers.
We carefully studied the health status of nursing mothers. The contingent of healthy (without background and extragenital diseases) women (30 mothers) was selected by random numbers from 259 examined nursing mothers in
ASMI children's clinics. The quantitative (volume of daily and one-time lactations) and qualitative composition
(macro- and microscopy) of mature breast milk were studied after collecting them in sterile dishes.
The content and allocation of food ingredients in the milk breast is not an identical concept, the allocation of nutrients depends on the age of women, the lactation period and the parity of childbirth.
In healthy women, the milk breast contains a sufficient amount of food ingredients necessary for the normal development of children in the first year of life. However, among the healthy population of nursing mothers, there is
a category of women (aged 30 years and older, with a history of 3 or more births) who are found to be deficient in
basic food ingredients, mainly due to protein, fat, and energy, respectively. These data seem to require the close
attention of pediatricians in order to prevent dystrophy among children born to such groups of women.

The Ministry of Health and Social Development of the Kyrgyz Republic, with the support of the International Finance Corporation (IFC), initiated a public-private partnership (PPP) project for the organization of hemodialysis
centers in the cities of Bishkek, Osh and Jalal-Abad (hereinafter - the Project). This project was implemented with
the financial support of the German Development Bank KfW.
The project is intended for the treatment of patients with stage 5 chronic renal failure, based on dialysis centers of
a private partner, who previously received hemodialysis services in six state hemodialysis departments.

The relevance of this study lies in the need to search for new innovative management solutions aimed at improving the quality of the provided hemodialysis services for people suffering from chronic renal diseases of the 5th
stage. The set goal of providing high-quality hemodialysis services to patients in need using the PPP model has
been achieved. Based on the use of the methods, the main results were obtained on optimizing the conditions for
receiving dialysis services, which can be used to form a strategy for improving the current and future models of
the healthcare system.

Comprehensive medico-demographic and socio-hygienic data (2010 - 2019) were obtained on the quality of life
of older people in the Kyrgyz Republic. The above said results will be aimed at the development of further medical-and-preventive and socio-hygienic measures to improve living conditions and promote the health of the population of pre-retirement and retirement age. At the same time, an emphasis is placed on improving the structural
interaction between state institutions themselves to overcome the negative consequences of aging and social adaptation of older persons. All this provides in the short, medium term (2021 - 2030) and long term (2031 - 2050) for
a change in the social policy of the state in the field ageing, the strengthening of state support and joint participation
of non-governmental organizations and civil society.

Tte the review article presents data from domestic and foreign literature regarding the problems of performing simultaneous operations in gynecology, assessing trauma and clinical and economic efficiency, an integrated systematic approach to eliminating simultaneous pathologies, the features of performing combined operations in
gynecological diseases and a combination of other surgical pathologies. Performing simultaneous laparoscopic operation does not lead to an increase in the number of intra- and postoperative complications in comparison
with isolated interventions and is not accompanied by great technical difficulties, but causes a somewhat longer
duration , which, in our opinion, is not critical for anesthesia. Advantages of simultaneous operations are undeniable: two or three surgical diseases are cured simultaneously, progression or serious complication of the
disease is prevented , operative treatmend of wich would be postponed for a later period , the risk of repeated
surgery and anesthesia is eliminated , the time of total stay of the patiend in the hospital and subsequend treatment is reduced , economic efficiency of treatment is increased.

This review of the literature reflects information about the etiopathogenesis of chronic recurrent herpetic lesions
of the oral mucosa and the parotid region. Methods of diagnosis and treatment of chronic herpetic stomatitis by
various authors are described. Algorithms of local and general drug therapy of patients with this pathology are described.