# 4 (2020)

In light of limited evidence on the nature of COVID-19 epidemic in Kyrgyzstan, the mathematical
modelling has been applied as an additional tool to support the policy makers in the decision process. The model
aimed at accessing the potential effect of two approaches on the further course of the epidemic and its implication
on the specified health system capacity: the full lockdown release and the managed release with various intensity
and duration of interventions. For the analysis we employed the web-based interface of the dynamic SEIR agestructured
model, developed by COVID-19 Modelling (CoMo) Consortium in collaboration with Oxford Modelling
Group of the Global Heath. The model demonstrated that the strict mobility suppression on its own may
not become an effective intervention and must be followed by proper and carefully considered exit strategies.
Contact tracing, shielding of risk groups, including COVID-19 cases and their contacts and physical social distancing
are assumed to be effective in flattening the curve of the epidemic in Kyrgyzstan. However, the existing
health system capacity is predicted to be overwhelmed even in the most favourable scenario, suggesting the necessity
for the better preparation of the system by increasing the availability of surge and ICU beds and ventilators.

Currently, the problem of diseases of the digestive system is one of the main ones in clinical therapy. There is a steady increase in the number of diseases of the digestive system due to young people.
Северо-Восточный федеральный университет им М.К. Аммосова, Медицинский институт,
г. Якутск, Республика Саха (Якутия). Россия
The purpose of the study is to study risk factors for diseases of the digestive system; a survey of 1st year students
of the Medical Institute was conducted.
Materials and methods. Fifty-one students filled out the questionnaire completely, of whom 30 girls (59%), 21
boys (41%), the age range was 17-18 years. This questionnaire included 27 items, nutritional issues, the presence
or absence of complaints about the digestive system and risk factors.
“Кыргызстандын саламаттык сактоо”
илимий-практикалык журналы
№ 4 2020 Бештин айы 15
КЛИНИКАЛЫК МЕДИЦИНА
Results. Symptoms of dyspepsia were detected in 33.6% of people who completed the questionnaire. According
to our data, perhaps, due to workload in studies, the nutrition of freshmen is unbalanced, they often consume fast
food products (hamburger, hot dog, pizza), semi-finished products (Pearson's χ2-13,73, p <0.002), hasty dry food
is noted, violation of the diet, often postpone the main meal in the evening (p <0.001), which is a risk factor for
cardiovascular diseases and digestive organs. The respondents with a symptom of dyspepsia have signs of enzymatic insufficiency, in the form of intolerance to certain foods, as well as concomitant diseases and burdened
heredity.
Conclusions. In most cases, the risk factors for the symptom of dyspepsia are modifiable, which allows planning
preventive measures and conducting health education among students

Venous thromboembolic complications (VTEC), which include deep vein thrombosis (DVT), subcutaneous vein thrombosis (SVT, thrombophlebitis) and pulmonary artery thromboembolia (PATE), remain a critical
clinical problem for many decades, which concerns a patient with any pathology and doctors of all specialties.
The authors consider a change in the hospitalization structure of patients with acute vascular diseases and prove
an increase in arterial embolias and an increase in severity of acute ischemia.

The article presents the results of the study in order to identify complications of pregnancy in women
with a uterine scar after cesarean section: this obstetric operation, being indispensable, is not devoid negative
consequences for subsequent pregnancy. The detected placental disorders cause the importance of determining
the placenta growth factors as markers of placental dysfunction

Research objective. To carry out the analysis of the causes of decompensation of chronic heart failure (CHF)
in patients hospitalized in the therapeutic department within a year.
Materials and methods. Design is a one-time retrospective study. The analysis of the disease histories of patients
admitted to the therapeutic department due to decompensation of CHF was performed. The specially developed
protocol of the study recorded gender and age parameters, risk factors for cardiovascular diseases, clinical data,
diagnosis upon admission, conducted therapy at the outpatient stage before the present hospitalization, data of
laboratory and instrumental methods of study were noted, the index of comorbidity was calculated.
Results. One hospitalization per year with decompensation of CHF was observed in only 13.1% of patients, 2-
3 hospitalizations per year - 62.0%, 4 or more hospitalizations - in 24.9% of patients. At the same time, 47.1%
of patients at the outpatient stage did not follow the doctor's recommendations for medical treatment, 75.1% -
non-drug measures and self-control. 89.9% of patients took blockers of the reninangiotensinaldosterone system,
21.5% - beta-adrenergic blockers, 27.9% - mineralocorticoid receptor antagonists. As the main diagnosis, 92.3%
had hypertensive disease, 58.6% - atrial fibrillation, 33.7% had myocardial infarction, diabetes mellitus was
noted in 31.6%, angina of effort - in 21.5%; chronic kidney disease stage 3 and above was established in 64.6%
of patients; 79.9% had a comorbidity index of five or more. At the time of hospitalization, functional class (FC)
II of CHF was found in 9.4%, FC III - 70.4%, FC IV - 20.2% of patients. Most of the patients had a conserved
release fraction (RF) - 46.1%, intermediate RF - 33.3%, reduced RF - 20.6%. Among hospitalized patients with
decompensation of CHF, male patients constituted 41.4%, women — 58.6%, 90.6% were elderly and senile people. In comparison with men, women were less likely to have smoking (by 66.6%) and alcohol consumption (by
60.0%), sufficient physical activity (by 25.6%), overweight and obesity (by 21.4%).
Conclusion. The analysis will allow planning and development of complex measures aimed at optimizing the
provision of medical care to patients with CHF in the conditions of a large specialized hospital.

Background. Anesthesiological provision for operations on the adrenal glands presents significant difficulties to date. This is due to the fact that the hormones of the cortex and adrenal medulla have a significant
effect on the state of basic vital functions and systems. Often, the complexities of anesthesia are aggravated by
concomitant obesity, steroid diabetes, secondary arterial hypertension, gross water-electrolyte disorders, which
determines the need for careful choice of the tactics of perioperative management.
Research objective. To study the influence of various variants of perioperative analgesia in retroperitoneoscopic
adrenalectomy on the perioperative period.
Materials and methods. A randomized examination of 57 aldosteroma patients who underwent retroperitoneoscopic adrenalectomy was performed. Depending on the method of perioperative analgesia, patients were divided
into two groups. In group 1 (n-30), the operation was performed under the conditions of combined anesthesia
based on low flow inhalation of desflurane, only systemic administration of opioids was used for perioperative
analgesia; in group 2 (n-27), the operation was performed under the conditions of combined anesthesia based on
low flow inhalation of desflurane in combination with blockade of the fascial space of the muscle straightening
spine (ESP erector spinae plane) with 0.35% ropivacaine solution. The indicators of adequacy of anesthesia, central and peripheral hemodynamics were investigated, neuromuscular conductivity was monitored, the effectiveness of postoperative rehabilitation was evaluated, as well as the quality of postoperative analgesia, number of
postoperative critical incidents.
Results. It was revealed that surgical intervention with low flow inhalation anesthesia based on desflurane in
combination with ESP ropivacaine blockade contributes to faster post-narcotic rehabilitation, effective postoperative analgesia and fewer complications in the early postoperative period compared to combined anesthesia
with desflurane and systemic opioid perioperative analgesia. This contributed to significantly lower periods of
hospitalization of patients in group 2 of 96 hours (95% CI 86-103) compared to group 1 of 125 hours (95% CI
115-133) (p=0.036).
Conclusions. ESP blockade is an effective method of anesthesia in the perioperative period, it promotes faster
post-narcotic rehabilitation and shortening the duration of hospitalization after retroperitoneoscopic adrenalectomy for aldosteroma compared to opioid analgesia.

Pleural effusions (PEF) are etiologically heterogeneous manifestations of complications of the patient's
pathology. MSCT was performed in 309 patients with PEF between the ages of 5 and 80. In all patients, diagnoses
were verified by morphological, bacteriological and clinical methods. The digital analysis of scans was carried
out with the help of the Radiologist+ program (Russia). The choice of nosology is the most influenced by parameters: the coefficient of correlation of the average slices of effusion density in the description of parabolic
dependence and the correlation coefficient of the root-mean-square deviation of effusion density in slices whendescribed by parabolic dependence. The parameters that can be excluded from consideration are: the correlation
coefficient of the average effusion density slices in the description of linear dependence and the correlation coefficient of the root-mean-square deviation of the effusion density in slices when described by linear dependence

The comprehensive clinical and laboratory examination of 480 men with suspected chronic urethroprostatitis (CP) was carried out. The collection of history, assessment of clinical symptoms of CP, study of swabs
for urogenital infections, ultrasound examination of PG with Doppler color mapping help assess severity, acuity
of the process, determine the etiology, which allows correct and timely prescribing of appropriate therapy.

A comprehensive examination and treatment of 240 prostate cancer patients was carried out. Ablation
of prostatic gland with high-intensity focused ultrasound (HIFU) was performed, as this method is characterized
by high 5-year recurrence free survival in the treatment of localized forms and the possibility of reapplication.
HIFU-therapy allows achieving PG necrosis with minimal damaging effect on surrounding tissues.

Using material from different groups of animals (frogs, chickens, cats, rabbits, pigs, sheep, cows) of
both sexes (total 150 hearts) and material from corpses of mature people (60 hearts) of both sexes, evolutionary
morphofunctional restructuring of atrial auricles was studied. The identified changes in structures can be seen as
signs of overall progress.

The article highlights the results of a sociological study, the purpose of which was to study the awareness of parents about possible visual disorders in children with an assessment of their readiness to take an active
part in measures to prevent the occurrence of ophthalmic pathology in children. The materials were questionnaires of a sociological survey (422 questionnaires). Methods for conducting the study were sociological survey
and medical and statistical analysis of its results at each stage (calculation of representativeness and reliability).
According to the results of the analysis, insufficient awareness and immature, insufficiently responsible attitude
of parents to the problem of the formation of healthy visual functions in their children were revealed. In turn, it
allows us to conclude that it is relevant to apply a medical and organizational approach to solving issues of timely
diagnosis of visual disorders that have arisen, and the use of preventive measures to prevent its violation, especially among children

The child's physical condition should be regularly monitored within the physical education programme
at school.
Research objective: to assess the physical development of schoolchildren aged 7-13 living in the Altai Republic.
Materials and methods. 1,205 schoolchildren of both sexes aged 7-13 living in the Altai Republic were examined. Anthropometric studies were carried out at the beginning and at the end of the academic year. Non-parametric methods of mathematical statistics were used, the level of significance was p<0.05.
Results. It was revealed that longitudinal body size and weight of children are reliably greater in boys at 7-8
years. In 9-10 years, there are almost no sex differences between the weight and height of schoolchildren. At 11-
13 years, the height and weight are greater in girls. During the academic year, there is an average increase in
body weight by 3 kg, and height - by 4-5 cm.
Conclusions. In all age groups, the Quetelet index was within normal limits and characterized the weight of children as normal

: In the training of a professional pathologist (occupational medicine) with high professional competence, a significant place is occupied by modern interactive teaching methods that allow you to learn a large
amount of material from clinical and preventive medicine. Based on new training technologies, approaches to
the acquisition of knowledge and practical skills for the diagnosis and prevention of early occupational health
disorders are presented.

The article reveals the legal definition of the value of health organizations, their differences by types,
classifications and other bases. The property and legal designation of healthcare organizations as state institutions
is defined. Their rights to property, as well as the income of institutions.

Currently, psychological science is represented by many directions, which allows to distinguish many
subspecialties among psychological specialties, but this causes difficulties in choosing the specialization for psychological examination. The authors determine the role of knowledge of a clinical psychologist and present a
number of advantages of clinical psychology in conducting examinations in the civil practice.