Health care of Kyrgyzstan
Zdravoohraneniye Kyrgyzstana
ISSN 1694-8068 (Print)
ISSN 1694-805X (Online)

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REVIEWS AND LECTURES
Pages: 61-64
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REVIEWS AND LECTURES
Pages: 99-100
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REVIEWS AND LECTURES
Authors: Isupova A.A., Yakubov A.S., Isupov R.V., Lang M.Yu.
Pages: 149-157
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REVIEWS AND LECTURES
- IMPACT OF HIGH-MOUNTAIN CLIMATE ON WOUND PROCESS
Pages: 128-132
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REVIEWS AND LECTURES
- LATENT TUBERCULOSIS INFECTION
Pages: 133-141
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CLINICAL MEDICINE
A case of chronic disorders of the cerebrospinal circulation in patient with combined (vascular and spondylogenic) pathology
Authors: Mamytova E.M., Janybek u. Bekjan, , Nurbekova U.A.
Pages: 55-59
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This article presents a clinical case of chronic impairment of the cerebrospinal circulation in patient with combined
pathology. A detailed neurological examination, as well as an analysis of additional laboratory and instrumental investigations
made it possible to identify the leading etiopathogenetic mechanism of damage to nerve structures that underlies
the development of motor deficit in a patient with chronic somatic pathology.
CLINICAL MEDICINE
A modern view on the problems of early and differential diagnostics of intra-brain non-traumatic hematomas
Authors: Mamytova E.M., , Zholdoshev E.K.
Pages: 73-79
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The article presents a literature review of the current state of the problem of diagnosing intracerebral nontraumatic
hematomas, including diagnostic value, informativeness and sensitivity of clinical, routine laboratory and instrumental
and neuroimaging research methods. Also presented are literature data on controversial issues of the diagnostic efficiency
of MRI in the acute and acute periods of hemorrhagic stroke.
PREVENTIVE MEDICINE
A simple analysis of the measles surveillance system in the Kyrgyz Republic, 2019
Authors: Malysheva M.A., Kasabekova L.K., Dadanova G.S.
Pages: 83-88
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Introduction. Measles is an extremely contagious severe disease of viral origin. Before the introduction of the
measles vaccine in 1963 and the widespread vaccination, major measles epidemics occurred every 2-3 years, there were
2.6 million deaths from measles annually.
Research objectives. The objectives of this assessment are to describe the EPID surveillance system for measles and to
assess its properties, such as usefulness, timeliness, importance, simplicity.
Materials and methods of research. The assessment was carried out according to the instructions of the US Centers for
Disease Control and Prevention (CDC). To assess the epidemiological surveillance of measles, an epidemiological method
was used: the study of morbidity by territory among various population groups, in time and place.
Results. A sensitive, flexible and useful system of epidemiological surveillance of measles has been created and is functioning
in the Kyrgyz Republic, as it determines the trend of the epidemiological situation in the incidence of measles,
determines the outbreak. The evaluation by the criterion of importance showed that vaccination is 29 times more profitable
than the cost of treatment in terms of financial costs.
Conclusions. The analysis revealed problems in vaccination against measles. A detailed assessment of the root problems
of the 2019 measles outbreak should be carried out.
PREVENTIVE MEDICINE
A simple assessment of the HIV surveillance system in the Kyrgyz Republic for 2018-2021.
Authors: Kemelbek k.N., Karagulova A.S., Mergenova G.A.
Pages: 97-101
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Introduction. IV infection causes progressive insufficiency of the immune system with an asymptomatic course,
subsequently leading to the development of secondary infections, various immunological disorders, as well as an increased
risk of developing various types of cancer, with the development of the terminal stage of AIDS. In 1996, the first registration
of HIV infection in a citizen of the Kyrgyz Republic took place. In the regions of the country, the registration of
HIV infection began in 1998. From September to December 2021, according to the instructions of the Centers for Disease
Control and Prevention of the USA, a simple epid assessment was carried out.supervision of HIV infection in the Kyrgyz
Republic. This article presents the results of the evaluation of the HIV surveillance system for 2018-2021, its strengths
and weaknesses. Based on the results of the evaluation, recommendations for improving the system are given.
The purpose of the study is to describe and evaluate the surveillance system for HIV infection in the Kyrgyz Republic,
using the properties of epidsuch as simplicity, sensitivity, flexibility.
Materials and methods. The data sources for the assessment were the documents of the AIDS centers. The analysis of all
reports, regulatory documents, clinical protocols, electronic tracking of HIV cases was carried out.
Results. The system is complex, there are many duplicate reporting forms, the sensitivity of the system is high, which
was 94.8%, the positive prognostic value was 47%, the system is timely, which can be assessed by the example of an increase
in adherence to ART by 15%.
Conclusions. The system is complicated by the number of reporting forms, of which there are 9, which can be circumvented
by entering the necessary reporting data immediately into an electronic database. The system showed high sensitivity
(94.8%), which is a very good indicator for surveillance, with early detection of an outbreak. Reports in the HIV
surveillance system in the Kyrgyz Republic are provided in a timely manner. The detection of new cases of HIV infection
is monitored daily, EPID is carried out at all levels of AIDS centers supervision.
Кыргызстандын Кемельбек к.Н., Карагулова А.Ш., Мергенова Г.А. саламаттык сактоо.
REVIEWS AND LECTURES
ACHIEVEMENTS OF MOLECULAR BIOLOGY IN IMPROVING DIAGNOSTICS AND TREATMENT OF STOMACH CANCER
Pages: 94-98
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REVIEWS AND LECTURES
ACTUAL QUESTIONS OF TOXOPLASMOSI
Pages: 80-83
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CLINICAL MEDICINE
Acute complicated pyelonephritis in the Kyrgyz Republic
Authors: Imankulova A.S., Kabaev B.A., Kozhomkulova K.A., Ryskulbekov N.R. , Sadyrbekov N.J.
Pages: 71-78
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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.
REVIEWS AND LECTURES
ACUTE DISORDERS OF CEREBRAL VENO
Pages: 19-22
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CLINICAL MEDICINE
Adverse events to drugs in the treatment of tuberculosis in Kyrgyz Republic
Authors: Osmonbekov M.D., Sagyndykova S.O., Kushubakov D.A., Tunkatarova J.K., Sulaimanova M.I.
Pages: 97-102
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Adverse reactions to drugs are a serious public health problem, which entails economic consequences: lengthening
the length of the patient's stay in the hospital, the need to individualize treatment regimens with the inclusion of
expensive reserve drugs, additional drugs and drugs to stop adverse reactions. The most problematic issue in the treatment
of tuberculosis is inadequate adherence to treatment, due to its duration, complexity and associated adverse events, leads
to the choice of a much more difficult and expensive treatment for multidrug-resistant tuberculosis. Inadequate treatment
adherence occurs despite extensive global efforts by the World Health Organization, ministries of health and others to
implement a highly labor-intensive TB treatment program that includes direct observation of treatment by public health
workers.
Treatment of tuberculosis involves the simultaneous and long-term use of four to eight drugs, each of which has a wide
range of possible adverse effects. Most anti-TB drugs are well known and have been studied in clinical trials. However,
individual signs and symptoms of adverse events, such as skin rashes, abdominal pain, jaundice, shock, visual impairment,
hearing impairment, can cause severe consequences for patients stopping taking drugs, reducing the quality of life and
complicating daily activities. The frequency of occurrence of adverse reactions to drugs in patients with tuberculosis was
studied on the basis of received message cards / yellow cards for 2020-2021. in the Kyrgyz Republic.
ORIGINAL RESEARCH
Analysis of the antibiotic resistance among women with purulent-septic complications after childbirth
Authors: Orozalieva B.K, Imankulova A.S., Аkmatov Т.А. , Subanova N. A. , Khegay E.V.
Pages: 31-39
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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
CLINICAL MEDICINE
Antigen-specific proliferative activity of b-lymphocytes in reactive arthritis of the rogenital form
Authors: Irisov A.P.
Pages: 92-97
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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.
CLINICAL MEDICINE
Antiviral therapy of liver cirrhosis in the outcome of chronic viral hepatitis C
Authors: Tashpolotova A.Sh., , Murzakulova A.B. , Tashov K.E. , Jumagulova A.Sh. , Ergeshova A.B., Kochkorbekova S.K., , Abdybachaeva M.M.
Pages: 79-88
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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.
CLINICAL MEDICINE
Antiviral therapy of liver cirrhosis in the outcome of chronic viral hepatitis C
Authors: Tashpolotova A.Sh., , Murzakulova A.B. , Abdikerimova M.M., , Sholpanbai Uulu M., Fesenko N.V., Sarkina A.K.
Pages: 89-97
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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.
REVIEWS AND LECTURES
APOPTOSIS OF CELLS. BIOLOGICAL S
Pages: 9-12
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REVIEWS AND LECTURES
APOPTOSIS OF CELLS. THE BIOLOGICAL SIGNIFICANCE AND ITS
Pages: 5-7
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PUBLIC HEALTH AND HEALTH
Aspects of the organization of cardiac surgery for newborn children at the Center for Perinatology and Pediatric Cardiac Surgery
Authors: Bodykov G.Z., Bozhbanbaeva N.S., Sepbayeva A.D., Yesenova S.A.
Pages: 113-120
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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.
PUBLIC HEALTH AND HEALTH
Assessment of long-term dynamics of cancer morbidity and mortality in long-term Kazakhstan using autoregressive models and an integrated moving average
Authors: Baiyzbekova D.A., Erembaeva A.A. , Ismailova A.D.
Pages: 106-112
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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.
REVIEWS AND LECTURES
Assessment of risk factors for coronavirus disease (COVID-19) in healthcare workers: a case-control study, Bishkek, Kyrgyzstan, 2020
Authors: Alymkulova V.A., Zikriarova S. M., Otorbaeva D.S.
Pages: 137-142
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Introduction. Despite coronavirus disease (COVID-19) mitigation measures implemented in Kyrgyzstan hospitals,
3,173 healthcare workers (HCW) had been diagnosed with COVID-19 by September 2020, amounting to 17% of
all COVID-19 cases. We aimed to identify risks for COVID-19 among HCW exposed to COVID-19 patients in Bishkek.
Methods. We conducted a nested case-control study of HCW in six hospitals with high COVID-19 incidence among
HCW using incidence-density sampling. HCW in the national COVID-19 registry with SARS-CoV-2 PCR-positive and
SARS-CoV-2 IgG-negative results June 2020-May 2021 were recruited as cases if exposed to COVID-19 patients <14
days. Controls were randomly selected among HCW concurrently working at the same hospitals with SARS-CoV-2 PCRand
IgG-negative results. We collected sociodemographic, work, clinical, and laboratory information, and used logistic
regression to identify factors significantly (p<0.05) associated with COVID-19.
Results. A total of 511 people were included in the study, of which 128 cases and 383 controls. Out of 511 participants:
454 (89%) women and 383 (75%) participants under the age of 50. Of the participants, 118 (92%) cases and 348 (91%)
controls lived in a hostel (not at home) during the shift. Comorbidities were noted in 44 (34%) cases and 56 (15%)controls. According to the results of the analysis, testing for the tightness of the respirator, sharing a hostel for shift work
with other medical workers and the presence of comorbidities served as risk factors for the disease.
Conclusions. Results suggest need for increased quality assurance of and training in correct fitting and donning of personal
protective equipment, especially respirators, and improved communication for HCW promoting personal responsibility
in protecting staff, patients, and themselves.
CLINICAL MEDICINE
Assessment of the effectiveness of arterial hypertension control at the primary healthcare level in the Kyrgyz Republic
Authors: Amelin E.Yu. , Tolebaeva A.A., Duishenalieva M.T., Arykova A.T., Usubaliev A.O., Altymysheva A.T., Polupanov A.G.
Pages: 73-84
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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
REVIEWS AND LECTURES
ASSOCIATED OSTEONEURAL ABNORMALI
Pages: 52-56
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REVIEWS AND LECTURES
Biochemical justification of the Covid-19 impact on the state of hyaluronic acid in the alveoli of the lungs
Authors: Uspeeva A.E., Makhmudova Z.A., Taalaibekova M.T., Baatyrova N.J.
Pages: 152-159
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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].
REVIEWS AND LECTURES
BIOCHEMICAL PARAMETERS IN ANIMALS WITH URANIUM REFUELING ON THE BACKGROUND OF HERPES INFECTION
Pages: 110-115
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REVIEWS AND LECTURES
Birth defects prevention
Pages: 83-85
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REVIEWS AND LECTURES
BRAIN ABSCESSES: EPIDEMIOLOGY, E
Pages: 8-10
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ORIGINAL RESEARCH
Brief epidemiological characteristics of food botulism in the Kyrgyz Republic fnd Osh region at the present stag
Authors: Salieva S. T.
Pages: 96-103
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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
REVIEWS AND LECTURES
BRONCHOECTASIS IN CHILDREN
Pages: 84-87
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ORIGINAL RESEARCH
Cardiospecific enzymes as markerCardiospecific enzymes as markers of the course of cardiac necrosis in high altitude conditions and during readaptation to low altitude with the use of mildronate
Authors: Makhmudova Z.A., Taalaibekova M.T.
Pages: 125-132
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This article is devoted to the study of the effect of mildronate on the course of myocardial necrosis during the adaptation
of experimental animals to high altitude conditions and readaptation to low altitude conditions on the 30th day. We
found that after treatment with mildronate during 10 days, the content of creatine phosphokinase - MB (CPK-MB), troponin
T (TrT), aspartate aminotransferase (AST), the cardiac form of the protein binding fatty acids (PBFA) in the blood
serum of animals with simulated cardionecrosis on the 30th day of adaptation and readaptation were significantly reduced.
CLINICAL MEDICINE
Causes of decompensation of chronic heart failure in a specialized city hospital
Pages: 29-40
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.
CLINICAL MEDICINE
Causes of melаsma
Authors: Kurbanova D.Ch.
Pages: 47-53
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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.
CLINICAL MEDICINE
Causes of pseudo-resystance of patients with epilepsy in
Authors: Molchanova O. А.
Pages: 60-65
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The main causes of epilepsy resistance in general as diseases and factors contributing to the development of «noncurable
» epilepsy in low- and middle-income countries are listed. The analysis of a group of patients with epilepsy
and their dynamic observation highlights the most common causes of pseudo-resistance.
CLINICAL MEDICINE
Change in the structure of hospitalization of patients with acute vascular diseases
Pages: 21-24
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.
CLINICAL MEDICINE
Choice of diagnostic parameters for differential diagnostics of outputs in the pleural cavity at multispiral computed tomography
Pages: 50-57
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
CLINICAL MEDICINE
Chronic brain ischemia: from risk factors to cerebrovascular complications
Authors: Yusupov F.A., Nurmatov Sh.Zh., Amanbayeva G.T., Abdykalykova N.S., Yuldashev A.A., Abdykadyrov M. Sh.
Pages: 80-89
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The most important task of modern neurology is to develop and implement highly specific and sensitive biomarkers of
damage to the nervous system. Specific biomarkers of acute cerebral circulatory disorders, chronic cerebral ischemia,
neurodegenerative diseases (diseases: Alzheimer's; Parkinson's; Huntington's, etc.), demyelinating diseases of the central
nervous system (deviolithic de Devika, myelitis, multiple sclerosis), traumatic brain injuries are discussed
PREVENTIVE MEDICINE
Clinical and epidemiologic characteristics of hepatitis A in children complicated with ascites
Authors: Alisherova A.Sh., Anarbayeva A.A., Sadybakasova G.K., Suranbaeva G.S.
Pages: 105-110
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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.
CLINICAL MEDICINE
Clinical and epidemiological features of secretory diarrheas in children of early age
Authors: Bedelbaev M.K., Dzholbunova Z.K., Khalupko E.A., Imankulova A.S.
Pages: 59-64
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The paper gives the clinical and epidemiological characteristics of secretory diarrhea in 242 young children
who received treatment at the Republican Clinical Infectious Diseases Hospital in Bishkek for the period 2016-2019. As
a result of the study, it was found that more often (64.0%) secretory diarrhea is observed in children of the first year of
life, less often (36.0%) in children older than 1 year. In almost every 2nd child, secretory diarrhea is caused by rotaviruses
(47.1%) and Escherichia (27.7%), less often (25.2%) other pathogens (norovirus, astrovirus, adenovirus, enterovirus,
proteus, klebsiella, etc.). The disease proceeded mainly (76.4%) in a severe form, especially in children of the first year
of life, with an unfavorable outcome in 1.2% of cases. The peak incidence of secretory diarrhea was noted in the winter
period, which is more typical for a viral infection. For the etiological interpretation of viral secretory diarrhea, an immunochromatographic
express test (57.7%) was used, and a study of feces for fecal calprotectin and lactoferrin was
carried out in order to exclude invasive intestinal infection. Determining the level of blood procalcitonin in secretory diarrhea
in young children shows the presence of a viral or bacterial infection in the patient. The use of these methods for
diagnosing secretory diarrhea will increase the level of etiological interpretation, differential diagnosis of diseases and
will help reduce the unreasonable use of antibacterial drugs, and prevent antibiotic-associated diarrhea.
CLINICAL MEDICINE
Clinical and laboratory aspects in newborns and children under 3 months from the City Children's Clinical Hospital of Emergency Medical Care, 2018-2019, Bishkek
Authors: Sadybakasova G.K., Sabodakha M.A., Mustafina F.S., Bestuzheva G.R.
Pages: 151-157
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The work is devoted to the study of the spread of сytomegalovirus infection in newborns and children from one to 3
months old from the City Children's Clinical Hospital of Emergency Medical Care in Bishkek in the years 2018-2019
using ELISA. Diagnosis of CMV infection was carried out by determining specific CMV IgG antibodies (AB) in blood
sera using an indirect enzyme-linked immunosorbent assay (ELISA). ELISA is based on the immune reaction of antigen
with antibody. In serodiagnosis, the substance to be determined is the specific immunoglobulin (Ig) of the patient. In
the diagnosis of сytomegalovirus infections, the method according to the instructions is usually used. For the study by
the ELISA method, blood from the lactic vein, obtained on an empty stomach, is used. The advantages of ELISA include
high sensitivity, specificity, reproducibility, uniformity and suitability for mass examinations. The age structure of the
examined children was comprised of 407 sick newborns and children under 3 months of age in 2018-2019, of whom
163 (40.1%) were girls and 244 were boys (59.9%). Among the 407 children examined for сytomegalovirus IgG antibody
high titers were found (1:400 and 1:800) in 87 (46.0%), an average antibody titer of 1:200 in 124 (30,5%), indeterminate
result 1:100 – in 64 (15.6%), and seronegative result only in 32 (7.9%) children
CLINICAL MEDICINE
Clinical and laboratory characteristics of patients with COVID-19in Osh region of Kyrgyzstan
Authors: Esenalieva J.A., Brimkulov N.N., Sulaimanov Sh.A.
Pages: 39-45
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The aim of the work is to study the clinical manifestations, results of laboratory and instrumental methods of
diagnosis in patients of Osh region of Kyrgyzstan infected with SARS-CoV-2, depending on the severity of the disease.
Research material and methods. A retrospective study was conducted among 71 patients who were tested positive(RTPCR)
according to The United Clinical Hospital of Osh, The City Hospital of Osh, Ministry of Health of the Kyrgyzstan.
Duration: April - December,2020.Demographics, clinical data, co-morbidity, laboratory results and chest CT interpretations
were analysed.
Results. Patients, infected with SARS-CoV-2,most likely to have thrombocytopenia (p<0.001), lymphopenia (p<0.001),
leukocytosis (p<0.01),high levels of D-dimer (p<0.01), elevated fibrinogen (p<0.05), high AST and ALT levels
(p<0.001)as the severity of the disease increases. In severe cases, the volume of lung tissue injury exceeds 50%, corresponding
to KT3 (n=11) and KT4 (n=14).The risk of severe SARS-CoV-2 infection increases in the older age group
(p<0.001), related to the presence of associated diseases: Essential Hypertension (51.6%), Coronary Artery disease
(35.3%), obesity (20.5%).Patients were treated in accordance with the Ministry of Health Clinical PractiseGuidelines .
Conclusion.The clinical and laboratory characteristics of COVID-19 patients in the Osh region of Kyrgyzstan have fluctuated
regularly depending on the severity of the disease.All of the patients that we had examined, including the patients
with severe features, improved during the treatment and were discharged.
CLINICAL MEDICINE
Clinical and laboratory characteristics of viral hepatitis of unspecified etiology
Authors: manbaeva L.A.
Pages: 48-54
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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.
ORIGINAL RESEARCH
Clinical and neuroimaging parallels in herniated lumbar intervertebral discs
Authors: Yrysov K.B. , Kelieva L.Kh., Kanyev A.A., Karimov W.A.
Pages: 39-46
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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
REVIEWS AND LECTURES
CLINICAL FEATURES OF MENINGIOMAS
Pages: 36-40
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ORIGINAL RESEARCH
Clinical significance of laboratory studies and neuroimaging methods in the diagnosis of concussion
Authors: Yrysov K.B. , Fayzullaeva G.A. , Mashrapov Sh.J.
Pages: 30-38
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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
REVIEWS AND LECTURES
CLINICAL-GENETIC CHARACTERISTICS
Pages: 30-32
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REVIEWS AND LECTURES
COGNITIVE FEATURES IN SCHOOL-AGE
Pages: 77-79
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ORIGINAL RESEARCH
Common immunoglobulin Е level in multi-resistant tuberculosis patients with drug allergy
Authors: Dudenko E.V., Sydykova S., Mukanbaev K.M.
Pages: 52-57
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A high level of common immunoglobulin E (IgE) indicates a high likelihood of an allergic reaction.The aim
of the study: was to identify drug allergy (DA) by quantitative determination of common IgE in patients with multi-resistant
tuberculosis (MDR TB). Materials and methods. The object of the study was 80 MDR-TB patients with clinical
signs of DA. In the group of the standard treatment regimen (SR): 50/62.5% of patients (23/46.0% women and 27/54.0%
men, 34.9±2.8 years). In the group with an individual regime (IR): 20/25.0% of people (6/30.0% of men and 14/70.0%
of women, 36.0±3.5 years). In the short-term regimen group (SR): 10/12.5% of patients (2/20.0% men and 8/80.0%
women, 31.0±5.2 years). The study material is blood serum. The research method is solid-phase enzyme immunoassay.
Design: a prospective and retrospective study. For statistical processing, the SPSS16.0 software package was used.
Results of the study. The presence of DA at a high level of IgE was determined in 39/48.8% of MDR-TB patients. With
SR treatment, the highest level of IgE (423.2±62.7IU/ml) was noted in comparison with IR and SR. The concentration
of IgE in MDR-TB patients with DA is significantly higher (p<0.05) compared with the level of IgE in MDR-TB patients
without DA. The concentration of IgE in MDR-TB patients with DA is significantly higher (p<0.05) compared with the
level of IgE in pulmonary tuberculosis patients with drug sensitivity of mycobacteria with DA. Conclusion. The quantitative
determination of the concentration of common nonspecific IgE can be used in the detection of DA in MDR-TB patients.
ORIGINAL RESEARCH
Comparative analysis of legal regulation of medical and social assistance to the elderly population of the Kyrgyz Republic
Authors: Kasiev N.K., Suleimanova G.T., Akmatov I.M., Kasymova R.O.
Pages: 16-23
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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.
CLINICAL MEDICINE
Comparative analysis of modern methods of treatment of metastatic pleurisy in oncology
Authors: Beishembaev M.I. , Moldomusaev T.S., Lyagazov R.I.
Pages: 85-91
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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
CLINICAL MEDICINE
Comparative assessment of perioperative analgesia methods in retroperitoneoscopic adrenalectomy for aldosteronoma
Pages: 41-49
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.
PREVENTIVE MEDICINE
Comparative assessment of prevalence of parenteral viral hepatitis among people with HIV and conditionally healthy in the Kyrgyz Republic
Authors: Sattarova G. Zh., Nurmatov Z.Sh.
Pages: 98-104
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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).
CLINICAL MEDICINE
Comparative evaluation of the effectiveness of postoperative pain relief in urological and surgical practice
Authors: Imankulova A.S., Chyngyshova J.A., Kabaev B.A., Tolbashieva G.U., Kozhomkulova K.A.
Pages: 54- 60
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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.
CLINICAL MEDICINE
Complex treatment of epididymal cyst
Authors: Usupbaev A.Ch., Kutbolsun uulu U., Kuzebaev R.E.
Pages: 46-52
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Introduction. In the scientific work, the analysis of the results of the examination of 55 men who applied to
the Republican Scientific center of urology at the National hospital of the Ministry of Health of the Kyrgyz republic for
epididymal cyst. The circulation period falls on 2017-2021.
Purpose of the study. To evaluate the effectiveness of surgical treatment of patients with epididymal cyst using dissolving
preparations in the form of a solution of longidase (hyaluronidase) and sclerosant.
Materials and methods. The basis of this study included patients of reproductive age from 16 to 45 years, with a clinical
diagnosis of an epididymal cyst. The middle age of the examined patients was 33 ± 3 years. Complaints of patients upon
admission were taken into account. All men were examined by ultrasound. Ultrasound examination was performed using
the WED 9608 apparatus with a high-frequency probe and Doppler sonography. Testicular size, volume, shape, echogenicity,
and blood flow were assessed. Examined t a semen analysis. For all patients were performed surgical treatment according
to the author's method: "Method of combined treatment of cystic diseases of the epididymis", patent No. 2204.
Results of the study. The data on the condition of patients with an epididymal cyst before and after surgical treatment are
substantiated. A persistent positive trend was noted in the form of a decrease in pain symptoms in the postoperative
period, improvement of spermogram parameters in the form of quantitative and qualitative indicators as well as the absence
of infectious and inflammatory complications.
Conclusion. Thus, the analysis of the study showed that this method of surgical treatment is highly effective, which positively
affects the outcome of the disease and the quality of life of the patient.
REVIEWS AND LECTURES
COMPLEX TREATMENT OF UNCOMPLICATED DORSOPATHY WITH CHONDROPROTECTIVE DRUGS
Pages: 71-74
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CLINICAL MEDICINE
Complex treatment of urethral strictures caused by scleroatrophic lichen
Authors: Usupbaev A.Ch., Kurbanaliev R.M., Kolesnichenko I.V., Akylbek S.
Pages: 54-61
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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.
PROBLEMS IN EDUCATION OR MEDICAL PHARMACEUTICAL EDUCATION
Continuing Medical Education on Emergency Medical Services Curriculum
Authors: Omukeeva G.K., Chubakov T.Ch. , Kurmanov R.A., Dushimbekova K.A.
Pages: 134-145
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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.
ORIGINAL RESEARCH
Covid 19 associated ischemic stroke. Literature review and clinical case
Authors: Tairov B.M., Maanaev T.I., Narbekov I.M., Toktomametova A.U.
Pages: 25-30
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The authors conducted an analytical review of literature sources devoted to the pathogenesis and clinical manifestations of brain strokes against the background of coronovirus infection. The predominant pathogenetic mechanism of brain
strokes in SARS-CoV and MERS-CoV was noted. The article presents a clinical case of a patient with a brain stroke,
which appeared in a young woman without risk factors for acute cerebrovascular accident on the background of an infectious process. In addition, many studies have found a decrease in the frequency of ischemic stroke in individuals with risk factors for brain disasters.
CLINICAL MEDICINE
Criteria for assessing local recurrence of prostate cancer after HIFU-therapy
Pages: 64-69
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.
ORIGINAL RESEARCH
Determinants of serum 25(OH)D indicators of Kyrgyzstan
Authors: Isupova A.A., Isupov R.V.
Pages: 34-39
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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).
PROBLEMS IN EDUCATION OR MEDICAL PHARMACEUTICAL EDUCATION
Development prospects S. Tentishev Asian Medical Institute
Authors: Selpiev T.T. , Koshmuratov A.G., Ashymov J.D.
Pages: 146-151
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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
REVIEWS AND LECTURES
Diagnosis and treatment of chronic herpetic stomatitis of the oral cavity (literature review)
Authors: Azimbayev N.M.
Pages: 141-146
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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.
REVIEWS AND LECTURES
DIFFERENT MEDICAL IMAGING METHODS IN THE DIAGNOSIS OF SARCOMAS OF BONE AND SOFT TISSUES
Pages: 20-25
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ORIGINAL RESEARCH
Direct detection of SARS-CoV-2 viral antigen in nasopharyngeal swabs by enzyme immunoassay using DIA®-SARS-CoV-2-Ag-R test system
Authors: Shevchuk A.A., Serdyuk V.G., Gorlov A.Yu., Kiseleva E.K., Golubovskaya O.A., Demchishina I.V., Chernenko L.N., Cousin I.V., , Spivak N.Ya., Favorov M.O.
Pages: 3-15
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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.
REVIEWS AND LECTURES
DIZZINESS (LITERATURE REVIEW)
Pages: 15-19
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REVIEWS AND LECTURES
EARLY DIAGNOSIS OF MENINGIOMAS O
Pages: 40-43
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REVIEWS AND LECTURES
EFFECT OF VASOTAN ON CARDIOINTER
Pages: 33-35
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REVIEWS AND LECTURES
EFFECTIVE USE OF HIGH-DOSE PIRAC
Pages: 74-77
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CLINICAL MEDICINE
Effectiveness of complex treatment of strabismic amblyopia in concomitant strabismus with vision disorder
Authors: Berdibaeva A.I.
Pages: 61-70
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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.
ORIGINAL RESEARCH
Effects of aceclofenac at the level of tumor necrosis factor alpha and interleukin 6 and 4 in a patient with epididymal cyst
Authors: Usupbaev A.Ch., Kutbolsun uulu U., Kuzebaev R.E.
Pages: 16-20
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Introduction. In the scientific work, the analysis of the results of the examination of 116 men who applied to
the Republican Scientific center of urology at the National hospital of the Ministry of Health of the Kyrgyz republic for
epididymal cyst. The circulation period falls on 2017-2021. Purpose of the study. To evaluate the effectiveness of aceclofenac
on the level of tumor necrosis factor alpha, interleukin 6 and 4 in patients with epididymal cyst. Materials and
methods. For the diagnosis, the collection of anamnestic data was used for patients with epididymal cyst . All men were
examined by ultrasound. Ultrasound examination was performed using the WED 9608 apparatus with a high-frequency
probe and Doppler sonography. The levels of interleukin - 6, interleukin - 4 and tumor necrosis factor alpha were determined
in the blood and cystic fluid. The fluid was obtained during surgical excision of cysts, it was examined by immunometric
analysis using mono and polyclonal antibodies. When examining all 116 patients in both groups, both in the
group with spermatocele and epididymocele, there was an increase in the levels of pro- and anti-inflammatory cytokines:
tumor necrosis factor alpha, interleukin-4 and 6. Results of the study. The conducted scientific work is characterized by
a decrease in the level of cytokines, namely, the indicators of tumor necrosis factor alpha, interleukin - 4 and 6 in all examined
patients, after appropriate treatment with an anti-inflammatory drug - aceclofenac. Conclusion. Thus, the analysis
of the study showed that this method of conservative treatment with aceclofenac is highly effective, which positively affects
the outcome of the disease and the quality of life of the patient.
CLINICAL MEDICINE
Efficiency of measures for preventing inflammatory complications of abdominal surgery in patients with diabetes mellitus
Authors: Kultaev U.T.
Pages: 55-61
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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.
CLINICAL MEDICINE
Efficiency of measures for prevention of wound complications in acute appendicitis
Authors: Musaev U.S., Aitnazarov M.S., Kenzhekulov K.K., Baltabaev A.I.
Pages: 74-78
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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.
CLINICAL MEDICINE
Efficiency of measures for prevention of wound complications in acute appendicitis
Authors: Kulbaev U.A., Kultaev U.T. , Musaev A.I., Daniyarova I.A.
Pages: 144-150
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The frequency of the Diabetic Foot Syndrome was studied in 222 patients with diabetes mellitus who were under in-patient
therapy in the endocrinology medical units. The examination covered clinical, laboratory and instrumental methods.
The Diabetic Foot Syndrome was diagnosed in 38 patients among 222 patients and 14 of which had the following complications:
trophic ulcers of small size (no more than 2 cm in diameter) in 5, infected wounds in 4, infected fissures and
roughness in 4 and in one wound after exarticulation of the toe. Preventive measures and treatment were used in two
variants (Diabetic Foot Syndrome group without complications and Diabetic Foot Syndrome group with complications)
to prevent the progression of diabetic foot syndrome. Attention is paid to familiarizing patients with complications of
diabetes mellitus and methods of treatment recommended by an endocrinologist and surgeon. By the time of discharge,
all complications have been cured. After discharge, the patients received preventive courses of treatment under the supervision
of a surgeon. The patients were monitored for 2 years. The disease progression was not identified. The devel oped approach to the prevention of purulent-necrotic complications confirmed its feasibility in clinical practice. The
only joint work (endocrinologist, surgeon) and the patient will reduce any complications incidences.
REVIEWS AND LECTURES
EFFICIENT APPROACHES ТО EXTERNAL
Pages: 11-14
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CLINICAL MEDICINE
Electrophysiological and neuroimaging characteristics of patients with epilepsy
Authors: Mamytova E.M., Zhusupova A.T.
Pages: 66-72
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The analysis of electrophysiological and neuroimaging data of 430 patients with a confirmed diagnosis of epilepsy was
carried out. When analyzing the EEG data, it was found that in a routine interictal EEG study, only 60% of cases show
epileptic activity, and in the remaining almost 40% of cases, EEG did not reveal any pathological activity. For this group
of patients, to clarify the diagnosis and correct treatment, it is necessary to conduct video monitoring with EEG registration.
In addition, despite the fact that MRI is a mandatory method of examination in patients with epilepsy, in 13.2%
of cases, patients did not have the opportunity to undergo an MRI examination of the brain. Therefore, equipping public
hospitals in Kyrgyz Republic with modern MRI and EEG devices should be one of the priority directions in the development
epileptology.
REVIEWS AND LECTURES
EMOTIONAL-VOLUTIONAL IMPAIREMENTS IN PATIENTS WITH ISCHEMIC STROKE
Pages: 89-91
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CLINICAL MEDICINE
Endovascular factors in the progression of ischemic stroke
Authors: Turgumbaev D.D., Murzaliev A. M., Dzhanaliev B. P., Dzhamalbekova А.D.
Pages: 40-46
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The morphometry of the cerebral vascular bed was studied throughout, on the side of ischemic stroke (IS) and on the
opposite side to determine the cause of infarction and its progression in 106 deceased patients with progressive ischemic
stroke (PIS) and for comparison in 63 patients of the same age (control group) who died from other causes. The measurement
results showed that in patients with PIS, there is not only a statistically significant decrease in the internal diameter of the intracranial vessels on the side of the ischemic focus, but even more on the opposite, "healthy" side, compared with the internal diameter of the vessels of patients in the control group.
PREVENTIVE MEDICINE
Epidemiological Situation of Measles Incidence in the Kyrgyz Republic
Authors: Makembayeva Zh. I.
Pages: 99-105
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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.
REVIEWS AND LECTURES
EPIDEMIOLOGY OF CEREBROVASCULAR DISEASES USING RESULTS O STROKE  REGISTER IN CITY BICHKEK
Pages: 101-103
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PREVENTIVE MEDICINE
Epidemiology of stroke in the city of Bishkek according to the register (2017-2018)
Authors: Turgumbaev D.D., Samudinova T.T., Abirova A.B., Kulov B.B.
Pages: 90-95
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An epidemiological study of stroke in Kyrgyzstan (Bishkek) was conducted according to a special program using the
register method in 2017-2018. According to expert estimates of the World Health Organization (WHO), stroke ranks
second in the world among causes of death and second in long-term and severe disability of patients.
In the Kyrgyz Republic, reliable epidemiological data on the prevalence of stroke are lacking. in this regard, the stroke
register is the best method for determining the incidence, mortality, mortality and economic consequences of stroke
In just 2 years, 2589 new cases of stroke were registered (1630 and 1570 cases, respectively). The incidence of stroke
was 2.6-2.67 per 1000 population (mean 2.61). The incidence of strokes in the population increases in each age group
by 2-3 times: at the age of 25 to 40 years - 0.18, from 40 to 49 years - 1.2, from 50 to 59 years - 3.8, from 60 to 69 years
- 10.6, and 70 years and older - 25.4 per 1000 residents of the corresponding age per year.The proportion of people of
working age (25-59 years old) who have suffered a cerebral stroke is 26.3%. The number of people recognized as disabled
for the first time in urban areas was 301 people. It is concluded that a long-term register is needed to obtain data on the
dynamics of the incidence rate and evaluate the effectiveness of reform of medical and social care programs for patients.
ORIGINAL RESEARCH
Evaluation of factors affecting the behavior of target groups in health care-seeking and tuberculosis treatment
Authors: Ibraimova Ch.T., Huffman S. A., Alimakhunov A.K., Ibraimova A.S.
Pages: 70-77
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Kyrgyzstan has one of the highest rates of drug-resistant tuberculosis (TB) in the world. People at risk of TB
are often among the most hard-to-reach populations, which can make it difficult for them to access health care services.
The study identified enabling factors and barriers to testing and completing treatment for TB patients, causes and types
of stigma and discrimination against TB patients and their families, and widespread misinformation about TB among the
population.
CLINICAL MEDICINE
Evaluation of the effectiveness of the introduction of pc in hospitals to provide medical care of various levels
Authors: Boronbaeva E.K., Imankulova A.S., Asheraliev M.E., Matkasymova A.T., Omurkulova G. S.
Pages: 65-71
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This publication presents the results of a programm of the Mandatory Health Insurance Fund and the Ministry
of Health to introduce a new funding mechanism for hospital services provided to children during the first 24 hours of
hospitalisation. As an example, an assessment of the activities of the department of short-term stay of the Osh Interregional
Children's Clinical Hospital for the period 2016-2017 is presented. The opening of a short-stay unit has improved access
to medical care and has more than halved the time between admission and treatment. The introduction of the system of
providing short-term medical services has reduced the total number of unwarranted hospitalisations by 70% among therapeutic
and 50% among surgical patients in the inpatient departments of the Osh Interregional Children's Clinical Hospital,
with savings reaching 2,8005.0 thousand soms in 2017. The provision of 24-hour medical care in a short-stay unit has
increased the satisfaction of parents and carers with the services provided. The opening of a short-stay unit at a children's
hospital is an accessible, high-quality, promising, and cost-effective form of providing highly specialised medical care
to the pediatric population. The application of the practice of a one-day stays of the patient in the hospital had a beneficial
effect on the hospital budget. The activities carried out to indicate the need to increase the coverage of educational work
at the primary level in order to increase the sanitary and educational knowledge of the population.
PREVENTIVE MEDICINE
Evaluation of the surveillance system for parenteral viral hepatitis "B" and "C" in the Kyrgyz Republic, 2020
Authors: Alymkulova V.A., Nabirova D.A. , Otorbaeva D.S.
Pages: 89-96
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About 4 million cases of acute hepatitis B (AHB) are registered annually in the world, 7 million people are diagnosed
with chronic hepatitis B (CHB). More than 85% of those infected with hepatitis C virus (HCV) develop a chronic
form that leads to cirrhosis and primary liver cancer. Treatment at the present stage requires large economic costs and
long-term treatment. Chronic viral hepatitis (CVH) causes significant damage to public health due to its ubiquitous distribution
among various population groups, the variety of clinical forms and outcomes (including liver cirrhosis and primary
liver cancer). According to the data of long-term dynamics of morbidity since 2013, associated with CH in the
Kyrgyz Republic, it was predicted with the preservation of morbidity registration over the next decades. In the 8-year
dynamics (2013-2020), there is a tendency to reduce the incidence rate.Out of 155 cases of acute viral hepatitis, the cause
of infection was established in 79 cases (51%). An epidemiological investigation shows that in most cases the patient
cannot remember the likely routes of infection due to the long incubation period. And this is a problem in ascertaining
risk factors. Also, HBV diagnostics have not been established in healthcare facilities, which is confirmed by the large
number of carriers detected among medical workers (in 2020, carriers of HBV-179 cases, HCV-112 cases, detected for
the first time during a preventive examination), and the incidence among health workers is at a very low level (new detected
cases of HBV-0 and HCV-1 case, while CVH - 5 cases).Since parenteral viral hepatitis is still a common infection,
the incidence is still relevant today. Surveillance data for parenteral hepatitis in the Kyrgyz Republic are useful for monitoring, planning and detecting outbreaks.The article contains data on the evaluation of the existing HBV surveillance in
the Kyrgyz Republic. Recommendations are given describing the strengths and weaknesses of the system.
CLINICAL MEDICINE
Evaluation of the treatment of patients with diabetic foot syndrome complicated by necrotic process
Authors: Kulbaev U.A., Kultaev U.T. , Maksut uulu E.
Pages: 139-143
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Purpose: to present the results of surgical treatment of patients with diabetic foot syndrome (DFS) complicated with
necrotic process. There are given results of treatment of patients with the DFS. The methods of diagnosis and treatment
tactics are presented. Operations in a cases of necrotic process was performed after the treatment complex, aimed at
limiting the process, thus avoiding high amputation of the thigh in a most cases.
PUBLIC HEALTH AND HEALTH
Experience in initiating PPP projects in the sphere of healthcare of the Kyrgyz Republic
Authors: Ismailov M.A., Dolonbaeva Z.A. , Abilov B.A.
Pages: 117-123
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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.
CLINICAL MEDICINE
Experience in treating extensive purulent-necrotic wounds in phase I of the wound process
Authors: Imankulova A.S., Kochorov O.T., Mamatov N.N., Muratov K.K., Zhumabaev A.Zh., Mamyshov A.Zh.
Pages: 66-72
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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%.
CLINICAL MEDICINE
Features of clinical manifestations and course of tuberculous meningitis in adults in modern conditions
Authors: Tynystanova R.I., Azykova A.B., Dushimbekova K.A., Chubakov T.Ch.
Pages: 103-107
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Tuberculous meningitis is one of the most severe forms of extrapulmonary tuberculosis. It often leads to disability
and death of patients.
The work retrospectively studied 95 case histories of patients who were in a specialized department of the National Center
for Phthisiology under the Ministry of Health of the Kyrgyz Republic.
The medical and social characteristics, indicators of clinical and laboratory research methods and the effectiveness of
complex treatment of patients with tuberculous meningitis were studied. Almost all patients showed signs of damage to
the substance of the brain (menigoencephalitis), which indicates a late diagnosis of tuberculosis. The most sensitive
method for detecting the causative agent of tuberculosis in the cerebrospinal fluid turned out to be the molecular genetic
method (GenXpert MTB/RIF). A high mortality rate was established for tuberculous meningitis (55.8%). The main cause
of death of patients was late detection of the disease, generalized forms of the tuberculosis process and severe concomitant
diseases.
REVIEWS AND LECTURES
FEBRILE SEIZURES, MODERN CONCEPT
Pages: 88-90
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HISTORY OF MEDICINE
Formation and development of hygiene within the system of higher medical education of the Kyrgyz Republic
Authors: Bapaliyeva G.O., Atambaeva R.M., Turgumbayeva J.D., Kasymov O.T.
Pages: 158-165
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The creation and development of hygienic science in the system of higher medical education of the country is
connected with the opening of the Kyrgyz Medical Institute in 1939 and the organization of the Department of General
Hygiene. Subsequently, the historiography of hygiene is closely interrelated with the opening in 1953 of the sanitary and
hygienic faculty with specialized departments, forming a comprehensive development of preventive medicine in the
country. The process under consideration of the experience of accumulating the development of science in various areas
of hygiene covers a long road from the 38-40s of the XX century to the present period of the XXI century, the achievements
of scientists-hygienists of Kyrgyzstan. The presented analysis allows us to conclude that the study of various issues
of the development of hygienic disciplines was a kind of center of organizational foundations for conducting scientific
research in the field of hygiene. Today in the modern world, hygiene as a science and practice is undergoing qualitative
changes, which significantly actualizes the study of historiographical aspects of its development in the Kyrgyz Republic.
REVIEWS AND LECTURES
FUNCTIONAL CAPABILITIES OF VEGET
Pages: 50-53
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REVIEWS AND LECTURES
GAUCHER DISEASE
Pages: 76-79
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REVIEWS AND LECTURES
GERONTOLOGY IN SURGERY
Pages: 133-136
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HISTORY OF MEDICINE
Historical aspects of the development of medical education and science in the Kyrgyz Republic
Authors: Bapaliyeva G.O., Kasymov O.T., Turgumbayeva J.D.
Pages: 160-165
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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.
CLINICAL MEDICINE
Immediate and long-term results of surgical treatment of patients with post-traumatic chronic osteomyelitis of tubular bones against the background of the use of traditional technologies
Authors: Aburasulov M.G., Sagymbaev E.M., Bularkieva E.A.
Pages: 62-68
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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.
PREVENTIVE MEDICINE
Impact of COVID-19 on the implementation of activities by the anti-tuberculosis service of the Kyrgyz Republic
Authors: Abdrakhmanova E.D.
Pages: 108-113
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The article presents data on the impact of the COVID-19 pandemic on the implementation of anti-tuberculosis
measures, in particular on the detection of tuberculosis cases in the Kyrgyz Republic. To achieve this goal, the reporting
data of the Department of Informatics and Epidemiology of the National Center of Phthisiology for 2019-2020 were
taken. The analysis included data on the number of reported cases of tuberculosis (TB), morbidity and mortality from
TB in 2019-2021. According to the NCF, epidemiological indicators such as morbidity and mortality from TB in 2020
compared to 2019 decreased significantly: the incidence of tuberculosis by 3.3 times (from 78.9 to 53.5, OR =3.3, 95%
CI 1.8-6.2, χ2 and mortality did not change, remaining at 3.9). A significant decrease in the incidence of tuberculosis (by
32.2%) is associated with a decrease in detection due to the COVID-19 pandemic. The TB service had difficulties in
staffing during the pandemic, which certainly led to a deterioration in the service of TB patients. The incidence of tuberculosis
in 2021 shows an improvement in the diagnosis of tuberculosis and an increase in the number of registered cases
(58.9 cases per 100 thousand population). Over the past 4 years, the highest incidence of tuberculosis in the republic has
been observed in the Chui region (124.2-88.2), then in the regions with a large population – Bishkek (88.8-59.7), Jalal-
Abad (73.3-55.6) and Osh region (75.0-55.9), and the lowest indicator is in Issyk-Kul region (48.9-37.5).
ORIGINAL RESEARCH
Impact of COVID-19 on tuberculosis services in Kyrgyzstan
Authors: Huffman S. A., Kadyralieva A. A., Cholurova R. A., Ibraimova A.S., Abdrakhmanova E.D.
Pages: 78-85
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A Quality of TB Services Assessment was conducted in Kyrgyzstan with a special module designed to assess
the impact of COVID-19 on TB services. Results demonstrate widespread disruption to TB services across all areas, including
reallocation of TB resources to COVID-19, decreased TB case detection and treatment, and impacts on infection
control. Results also show significant uptake of measures implemented to mitigate the impact of COVID-19 on TB services,
including patient-centered services. There is a need to refocus efforts and investment on TB in order to remedy the
impacts on the TB control system.
REVIEWS AND LECTURES
INCIDENCE OF PRIMARY BRAIN TUMOR
Pages: 43-46
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ORIGINAL RESEARCH
Indicators of immune status and results of culture mycobacteria tuberculosis in the process of chemotherapy in patients with lung tuberculosis
Authors: Dudenko E.V.
Pages: 65-69
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The immune status and result of culture Mycobacterium tuberculosis (M. tuberculosis) were compared in
newly diagnosed patients with pulmonary tuberculosis (TBL) during chemotherapy. Upon admission, 51 patients were
examined. Research material for the presence of M. tuberculosis: sputum and blood of patients with TBL using methods:
polymerase chain reaction (PCR) and culture on Levenshtein-Jensen medium. For PCR, amplification was carried out
on a T1 thermal cycler (Biometra). The immune status was studied by the method of indirect immunofluorescence reaction
(RIF) with monoclonal antibodies CD3+, CD4+, CD8+, CD19+ and the ratio of CD4+\CD8+ (immunoregulatory index
- IRI) was calculated. Job design is a prospective study. Statistical processing SPSS16.0 programs using. The value of
the Fisher angular transformation φ was determined and confidence intervals of CI were calculated (M±tm; t=2.0; p<0.05).
Result of study: all patients with TBL had a positive PCR result. A positive result of the culture method (culture+) was
noted in 38/74.5% of 51 examined patients with TBL at admission. After 2 months of chemotherapy PCR+ was in all examined
TBL patients, culture+ was detected in 11/47.8% of 23 patients. The combined use of PCR and culture showed
a reduced detection of M. tuberculosis during chemotherapy (p<0.05). Upon admission, 74.5% of M. tuberculosis using
culture was detected. After 2 months of treatment, 47.8% of M. tuberculosis was detected. In the course of chemotherapy
in the culture-positive group, there was an increase (p<0.05) in most parameters of cellular immunity (CD3+, CD4+,
CD8+). In the culture-negative group, there was an increase (p<0.05) in CD3+ and IRI. Thus, studies have shown the relationship
between cellular immunity and the result culture of M. tuberculosis.
CLINICAL MEDICINE
Indirect electrochemical oxidation of blood in the treatment of patients with surgical diseases of the abdominal organs on the background of diabetes mellitus
Authors: Kultaev U.T. , Zholdoshbekov E.Zh.
Pages: 62-65
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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.
ORIGINAL RESEARCH
Interleukin-4 and interleukin-6 levels in the blood of multi-resistant tuberculosis patients with drug allergy
Authors: Dudenko E.V., Sydykova S., Zhanybekov I. Zh.
Pages: 28-32
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Drug allergy (DA) is one of the main types of adverse events in multidrug-resistant tuberculosis (MDR-TB).
An allergic reaction develops under the influence of cytokines (CT). The aim of the study: the purpose of the study was
the production of interleukins IL-4, IL-6 and cytokine balance (CB) in patients with MDR-TB with DA. Materials and
methods. The object of the study was 80 MDR-TB patients with DA on anti-tuberculosis drugs according to clinical
signs. Treatment regimen: standard (SR) - 50/62.5%, short-term (ST) - 10/12.5% and individual (IR) – 20/25.0% of patients.
The average age is 34.0±3.8 years. The study material is blood serum. The research method is solid-phase enzyme
immunoassay (Sandwich method), «Awareness Technology» equipment and «Vector-Best» reagent kits. Spontaneous
production of IL-4 and IL-6 was studied. Design: a prospective and retrospective study. Statistical processing was carried
out using the SPSS16.0 software package. Results of the study. The concentration of IL-6 exceeded the norm in 38/47.5%,
IL-4 in 2/2.5% of 80 MDR-TB patients (p<0.05). There was a statistical difference between IL-4 and IL-6 (p<0.05) in
terms of SR and IR. The CB made up: SR (18,1±3,0/1,3±0,1=13,9), IR (31,4±5,8/2,7±0,2=11,8) and ST
(15,3±4,5/3,2±0,3=4,8). Consequently, the most active inflammatory allergy reaction was noted in SR (CB=13.9). Conclusion.
The study of the production of IL-4, IL-6 and the IL-6/IL-4 ratio contributes to the assessment of the activity of
the allergy inflammatory response in DA in MDR-TB patients.
CLINICAL MEDICINE
Introduction of BPaL for the treatment of drug-resistant tuberculosis in the Kyrgyz Republic
Authors: Myrzaliev B.B., Toktogonova A.A., Sakmamatov K.M.
Pages: 92-96
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Administration of Bedaquiline, Pretomanide and Linezolid - BPaL is a new fully oral 6-month regimen consisting
of bedaquiline, a new TB drug pretomanide and linezolid approved by WHO to use in operational research conditions
for the patients with drug-resistant tuberculosis (DR-TB).
Review of the situation and estimation of the TB drugs cost for treatment of the one patient according to the BPaL regimen
in comparison with the conventional treatment regimens for DR-TB.
The National Center of Phthisiology (NCF), with the support of KNCV, has started preparing for the use of the BPaL
regime in the Kyrgyz Republic (KR) since 2021. During this period, a guide on the use of BPaL in the Kyrgyz Republic
was prepared, which was signed by the Ministry of Health of the Kyrgyz Republic in early 2021. Training materials
were prepared, according to which all key specialists of the tuberculosis service were trained, with a focus on the central
council and the Republican Tuberculosis Hospital (RPTB) in Kara-Balta, where treatment of all patients on BРaL
was planned. despite the availability of regulatory documents, trainings, availability of drugs and eligible patients the
patient’s enrolment going slowly. Introduction of the BPaL regime over the next 3 years can save the state up to
460,000 US dollars.
The BPaL treatment regime can help the country significantly improve the effectiveness of treatment success rate of
the patients with DR-TB and rational use of the State and the Global Fund budget used for the procurement of the second-
line TB drugs for the Kyrgyz Republic.
ORIGINAL RESEARCH
Is Metformin beneficial in ischemic etiology chronic heart failure patients at the insulin resistant stage?
Authors: Kurmanbekova B.T., Rustambekova A.R., Noruzbaeva A.M.
Pages: 21-32
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Chronic heart failure (CHF) and type 2 diabetes mellitus (DM) often coexist. CHF is currently considered as
a state of insulin resistance (IR) and is associated with a deterioration in the prognosis and quality of life of patients. The
beneficial effect of metformin on the course of cardiovascular diseases, CHF in particular, in patients with type 2 diabetes,
has been established in numerous studies. The aim of this study is to evaluate the effect of metformin on the clinical
course of ischemic etiology CHF in patients at the IR stage. Material and methods. In the course of an open, prospective,
randomized clinical trial of 76 patients with ischemic etiology CHF (mean age 62 (57.5-65) years, men (n=44), mean
left ventricular ejection fraction (LVEF) 44.0 % (34-52.5)), were randomized into 2 groups: with metformin (n=39) and
without (n=37), respectively. All patients were given and explained in detail the principles of lifestyle modification. IR
was diagnosed with HOMA-IR ≥ 2.5. The necessary objective (with a survey about the quality of life of patients with
CHF), laboratory and instrumental methods of research, a 6-minute walking test were tested at baseline and after 12
months of follow-up. Results. Metformin therapy was associated with an improvement in CHF-associated clinical indicators
such as : IR (HOMA-IR), aldosterone levels, functional capacity and quality of life. Also in the metformin group,
there was a significant improvement in renal function (in terms of creatinine and daily proteinuria) and mean LV EF.
Conclusion. The possibility of a favorable effect of metformin on the course of CHF of ischemic etiology in patients
without concomitant type 2 diabetes will optimize the strategy of interventions to improve the quality of life and longterm
prognosis in CHF, as well as reduce the rate of conversion to type 2 diabetes.
REVIEWS AND LECTURES
Knowledge, attitudes, and practice to COVID-19 prevention among the adult population of Bishkek and Naryn, Kyrgyz Republic, 2021
Authors: Malysheva M.A., Zikriarova S. M., Nabirova D.A.
Pages: 130-136
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Introduction. The coronavirus pandemic (COVID-19) originated in China and affected almost the entire world
in early 2020. To understand and inform about effective public health measures, we conducted a survey of knowledge,
attitudes and practices among the adult population of the cities of Bishkek and Naryn, the Kyrgyz Republic.
Research methods. In August 2021, a cross-sectional study was conducted with a survey of the adult population of the
cities of Bishkek and Naryn, the Kyrgyz Republic. A simple two-stage cluster sampling method was used to recruit study
participants. The analysis was carried out using the statistical software Epi Info 7. The variables were summarized as
frequency and percentage.
Results. The survey was conducted among the adult population of Bishkek 1,390 (86%) and Naryn 234 (14%). A total of
1,624 questionnaires were analyzed, the response rate was 95%, of which 918 (57%) were men and 706 (43%) were
women. The average age of the study participants was 35 years, the standard deviation was 14.9. 1490 (92%) of respondents
knew that COVID-19 can spread from person to person when people are in close contact, 1371 (84%) knew that a
person infected with COVID-19 can transmit the virus to others, not even symptoms. 1446 (89) noted that it is important
to wear a mask, but only 1255 (77) respondents wear a mask, 1440 (89) noted that it is important to observe physical distance
indoors, however, only 955 (59) of the respondents surveyed observe it, 1556 (96) said that it is important to wash
their hands after visiting public places.
CLINICAL MEDICINE
Laparoscopic method of treatment of combined liver and greater oil echinococcosis. Clinical case
Authors: Toktogaziev B.T., Omorov K.R ., Hamidjonov Y.H., Mikukhin D.S.
Pages: 72-76
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The problem of echinococcosis is urgent, because the disease is quite common, at the same time the frequency
of diagnostic errors, complications and mortality in multiple echinococcosis is high. The aim of this work was to estimate
the clinical and epidemiological peculiarities of the liver and greater omentum echinococcosis, diagnostics of the disease
and results of treatment in the present conditions. A clinical case is presented, the patient R. 1976 patient was diagnosed
with hepatic echinococcosis and greater omentum, which was revealed spontaneously. On admission she was examined
additionally. Laparoscopic echinococcosisectomy of the liver and greater omentum was carried out. Intraoperatively the
diagnosis was confirmed. The patient was discharged home on the 5th day.
REVIEWS AND LECTURES
LOWER URINARY TRACT DYSFUNCTION IN OLDER WOMEN (FORMS, PREVALENCE, ETIOLOGICAL FACTORS)
Pages: 63-69
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ORIGINAL RESEARCH
Magnetic resonance imaging measures of brain atrophy in multiple sclerosis
Authors: Dzhaparalieva N.T., Altymysheva N.A. , Dikanbaeva K.E., Tairov B.M.
Pages: 16-24
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Introduction. The severity of neurological disorders in patients with multiple sclerosis (MS) is more closely related to
the general atrophy of the brain, which is manifested by the expansion of the ventricles and subarachnoid spaces and a
decrease in the volume of the parenchyma of the brain.
The aim of the study is to evaluate the morphometric parameters in patients with multiple sclerosis depending on the
type of course, duration of the disease and degree of disability.
Subjects and methods of research. MRI-morphometric study was performed in 25 patients with remitting and secondary
progressive types of MS.
Results. The MRI-morphometric study with MS allowed to assess the degree of brain atrophy depending on the clinical
and neurological features.
Сonclusions in summary. To assess atrophic changes in MS, it is convenient to use linear methods of measurement
(measuring the width of the ventricles, the thickness of the parenchyma of the brain, the area of the calloused body),
which do not require the presence of special equipment, computer programs and personnel training.
ORIGINAL RESEARCH
Mathematical modelling of COVID-19 vaccination strategies in Kyrgyzstan and mortality
Authors: Moldokmatova A.O., Dooronbekova A.Z., Zhumalieva C.K, Mukambetov A.S., Kubatova A.K., Usenbaev N.T., Osmonov A.J., Ibragimov S.M., Abdyldaev T.O., Kutmanova A.Z., Luzia Freitas, Lisa Jane White
Pages: 24-33
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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).
ORIGINAL RESEARCH
Mathematical modelling of COVID-19 vaccination strategies in Kyrgyzstan and the burden on the health system
Authors: Moldokmatova A.O., Dooronbekova A.Z., Zhumalieva C.K, Mukambetov A.S., Kubatova A.K., Usenbaev N.T., Osmonov A.J., Ibragimov S.M., Abdyldaev T.O., Kutmanova A.Z., Luzia Freitas, Lisa Jane White
Pages: 14-23
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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.
PUBLIC HEALTH AND HEALTH
Medical and social aspects of the elderly age in the conditions of the city Bishkek
Authors: Suleimanova G.T., Kurmanova A.R., Kasiev N.K., Kasymova R.O.
Pages: 114-122
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The aging of the population is one of the most important demographic processes in the modern world, it is a
complex, multifactorial, medical and social problem. The trends of rapid aging of the population are mostly characteristic
of the whole planet, especially for low- and middle-income countries, where a threefold increase in the proportion of
people over 60 years of age is expected – 46 million (2015) to 147 million (2050). The manifestation of such patterns
can be predicted for the Kyrgyz Republic, where people over 50 increased from 12.0% in 1999 to 16% in 2019. The
highest proportion of elderly people goes to the citizens of the capital from 14.7% to 17.9%, respectively. Moreover, all
these processes are accompanied by a significant increase in the life expectancy of Kyrgyzstanis, averaging from 67.0 to
71.5 years in the country and from 68.4 to 74.6 years in Bishkek, respectively. Against this background, practically in the
modern system of healthcare and social welfare of the Kyrgyz state there is no personnel potential and organizations to
provide gerontological care to the population. Consequently, in order to respond more effectively to the aging of the population,
the public health system needs an approach that will prevent and reverse the decline in the functional ability and
their dependency on outside help in old age. It is necessary to implement such an approach as soon as possible for the
country's state institutions to create favorable conditions for the elderly with an improved mechanism for monitoring the
demographic situation and its forecasting for the next three decades.
ORIGINAL RESEARCH
Metabolic role of nitric oxide precursors in atherosclerosis from the biochemistry point of view
Authors: Akynbekova N.B., Makhmudova Z.A., Taalaibekova M.T., Mamyshov A.Zh.
Pages: 33-38
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Atherosclerosis is currently considered one of the main problems of our century. It is predicted that by 2025,
the prevalence of cardiovascular diseases will reach 30% of the world's population [1]. Cardiovascular diseases are one
of the main causes of death. Every year, more than 17.5 million people die from cardiovascular pathology, in Kyrgyzstan
this figure reaches more than 18 thousand people. Due to the wide prevalence, high level of complications and mortality
rates, the prevention of cardiovascular diseases is becoming an increasingly priority area of medicine. Recently, the metabolic
direction has been intensively developed in medicine, the purpose of which is to analyze disorders of cellular metabolism
in cardiovascular pathologies. Impairment of function, which can lead to an increase in the permeability of
plasma components, especially low density lipoproteins and their deposition in the subendothelial space, can be considered
one of the earliest phenomena that occurs in atherosclerosis [2,3]. L-arginine, as a precursor of nitric oxide, has a positive
effect on the regulation of vascular tone and hemodynamics, is a mediator in the regulation of lipid and protein levels.
The effectiveness of the use of nitric oxide precursors during the development of a number of pathological conditions
(for example, endothelial dysfunction) has been proven. The study of the literature data of domestic and foreign authors
has shown that, to date, no experimental studies have been conducted in the Kyrgyz Republic to study the features of the
action of L-arginine in high altitude conditions, where special attention should be paid to the effectiveness of this amino
acid in such clinically extremely severe conditions as injuries, burns, hunger, stress.
ORIGINAL RESEARCH
Methodological and organizational approaches to implementing a quality management system in a multidisciplinary clinic
Authors: Zhunusova M.M.
Pages: 22-29
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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.
ORIGINAL RESEARCH
Microbial composition and geneti
Authors: A.A.RACHKOV
Pages: 3-8
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Introduction. Infectious and inflammatory diseases of the maxillofacial area, such as radicular cyst jaws are
polymicrobial. Determination of the qualitative composition of the microbial flora and its genetic resistance to
antibacterial drugs in the area of the bone defect may be important in the choice of tactics for treating patients.
The aim of the study to determine the qualitative and quantitative composition of the microbial flora in patients
with relapses of radicular cysts with an assessment of the genetic resistance of pathogens to various groups of
antibacterial drugs. Material and methods. We observed 40 patients with recurrent radicular cysts jaws who underwent cystectomy
reoperation. In order to obtain data on the composition of the microbial flora in the area of the bone defect at the
time of the operation and in the postoperative period, additional molecular biological studies were carried out.
Results. According to the results of molecular biological research, anaerobic microflora of the oral cavity was
revealed, which included two main groups of periodontopathogenic and stabilizing microorganisms. The results
of PCR studies for the presence of genetic resistance of pathogens showed the following. In all samples (n = 40),
the resistance of microorganisms to β-lactams and tetracyclines was determined. Resistance to macrolides and
fluoroquinolones was detected in 50% (n = 20) of the samples. Metronidazole resistance has not been determined
in any sample.
Conclusion. The study made it possible to establish the presence of 3 or more periodontopathogenic pathogens
in the cavities of cysts at a concentration of 103 GE / ml and higher, which indicates the association of these microorganisms and their primary role in the occurrence of the disease
ORIGINAL RESEARCH
Modelling of the potential effects of lockdown release interventions on the COVID-19 epidemic curve in Kyrgyzstan
Authors: Moldokmatova A.O., Dooronbekova A.Z., Zhumalieva C.K, Mukambetov A.S., Kubatova A.K., Lisa Jane White, Kasymov O.T., Kukeshova M.N. , Estebesova A.M., , Dzhangaziyev B.I., , Zhoroyev A.A., Abdykerimov S.T.
Pages: 3-13
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.
REVIEWS AND LECTURES
MODERATE CONGICTIVE DISORDERS IN
Pages: 56-60
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PROBLEMS IN EDUCATION OR MEDICAL PHARMACEUTICAL EDUCATION
Modern approaches to continuous education in emergency medicine
Authors: Omukeeva G.K., Chubakov T.Ch. , Turgunbaev T.E.
Pages: 121-129
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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.
REVIEWS AND LECTURES
MODERN METHODS OF TREATING PATIENTS WITH CALCULOUS  CHOLECYSTITIS AND ITS COMPLICATIONS OF CHOLEDOCHOLITHIASIS
Pages: 137-144
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ORIGINAL RESEARCH
Molecular epidemiology of tuberculosis in the Kyrgyz Republic
Authors: Kalmanbetova G.I., Kadyrov A.S., Sydykova M.M., Moidunova N.K.
Pages: 86-91
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Introduction. According to the World Health Organization, the Kyrgyz Republic is among the 18 countries
with a high prevalence of multidrug-resistant tuberculosis. The molecular epidemiology of tuberculosis infection, including
genetic diversity, markers of molecular drug resistance, and transmission routes of Mycobacterium tuberculosis complex
strains in the Kyrgyz Republic, remain poorly understood. Whole genome sequencing (WGS) has been used to
determine the molecular genetic structure of the strains circulating in the country. Purpose of the study. The purpose of
the study was to describe the molecular genetic characteristics of strains of the Mycobacterium tuberculosis complex
based on the whole genome sequensing. Materials and methods.Whole genome sequencing was carried out at the National
Reference Laboratory of the National Center for Phthysiology under the supervision of the SNRL, Borstel, Germany.
475 MTBС isolates were tested in 2018 and 2019. Sequencing was performed according to the manufacturer's instructions
on the MySeq platform, Illumina, USA. The MTBSeq protocol was used for comparative genomic analysis and the online
tools “EvolView and PhyResSe” to perform graphical representation and screen for mutations mediating resistance to
antituberculous drugs. Stata/IC version 16.1 was used for statistical analysis.Results. Using WGS, showed that the MTBC population structure in the Kyrgyz Republic mainly consists of three phylogenetic
lineages (L). These lines are L2 (Beijing), L3 (Delhi/CAS) and L4 (Euro-American) as classified by Coll, Mc-
Nerney and Niemann, Merker. The L2 strains were predominant (74.1%, 352/475), while the L3 and L4 strains accounted
for 0.8% (4/475) and 25.1% (119/475), respectively. Next, we classified the L2 and L4 strains into several MTBC sublineages.
The Beijing Central Asia (n=225), Beijing Central Asia outbreak (n=75) and Beijing Europe/Russian W148
Outbreak (n=28) subline strains are the most common strains compared to the other L2 subline strains and the L4 subline
strains. Conclusions. Using WGS, have shown that pulmonary tuberculosis in the Kyrgyz Republic is mainly caused by
L2 (Beijing) strains. Drug resistance is also associated with L2 strains, highlighting the important role of L2 strains in
the epidemiology of tuberculosis in the country. Overall, our results provide a better understanding of the molecular epidemiology
of tuberculosis in the Kyrgyz Republic and require additional molecular epidemiological studies to elucidate
the dynamics of tuberculosis in the country and, therefore, control it.
CLINICAL MEDICINE
Monitoring of antibioticresistance of some topical causative agents of pyoinflammatory diseases in the Kyrgyz Republic
Authors: Kubanichbekov М.K., Adambekov D.A., Aldjambaeva I.S., Tsoi Andrei Rudolphovich
Pages: 40-46
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ORIGINAL RESEARCH
Monitoring of lipid metabolism in persons with diabetes mellitus registered in family medicine centers in Bishkek
Authors: Sultanalieva R.B., Abylova N.K.
Pages: 10-15
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Our study demonstrates the data of total cholesterol (TC) level in the blood of persons with diabetes who are
registered in the Family Medicine Centers (FMC) of Bishkek. The main cause of CVD in DM is atherosclerosis. Insulin
resistance and associated hyperinsulinemia, which has a direct atherogenic effect on the vascular wall, play a significant
role in the pathogenesis of DM2. Therefore, the strategy of CVD prevention in patients with DM, along with achieving
the targets glycemia (which are fundamental for the prevention of microvascular complications), should be based on correction
of risk factors for microvascular diseases, as primarily dyslipidemia. According to all international recommendations,
the control of blood lipids is no less important than the control of glycemia and blood pressure.
During the year, the TC was examined in 2,182 (49.1%) persons with diabetes, its average indicators were within the
target values. However, this indicator was examined unevenly in FMC, 50.9% of patients with DM were left without
control of lipid profile. Primary care doctors did not always prescribe blood cholesterol determination to patients, although
this examination is available free of charge in all PHC laboratories in Kyrgyzstan.
In 33% of patients with DM in CSM, who were included in the group, the frequency of cholesterol determination during
the year reached 5-10 times, which is economically impractical and wasteful.
CLINICAL MEDICINE
Monitoring of urogenital infections in men with chronic urethroprostatites
Pages: 58-63
. 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.
REVIEWS AND LECTURES
MORPHOFUNCTIONAL TRANSFORMATIONS
Pages: 23-27
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REVIEWS AND LECTURES
MUSCULAR DUCHENNE DYSTROPHY IN C
Pages: 82-84
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REVIEWS AND LECTURES
Neuroendocrine tumors of the pancreas. Literature review
Authors: Rakhimova F.S., Bebezov K.S., Bebezov B.K.
Pages: 158-169
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The article shows that a significant proportion of neuroendocrine tumors of the pancreas are non-functional, i.e., not secreting
into the blood a variety of gastrointestinal hormones and polypeptides and as a result, not accompanied by typical
clinical manifestations. Unfortunately, often the scan search starts in the detection of distant metastases of neuroendocrine
tumors. Currently, the only radical method of treatment of hormonally functioning tumors of the pancreas is surgical. It
is indicated that symptomatic therapy can be considered as a stage of preoperative preparation of the patient. The article
examines the rational and integrated use of modern Arsenal of surgical and therapeutic methods, which enable significantly
prolong life, improve its quality in patients with metastatic forms of neuroendocrine tumors of the pancreas.
REVIEWS AND LECTURES
Neurogenic аcraturesiss for patients with the diseases of cerebrum. (Literature review)
Authors: Kaskeev D.M., Kulov B.B., Shamenova A.Ya., Erbotoeva Sh.T.
Pages: 104-108
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Freguency of met of neurogenic acraturesiss is examined in this article, factors resulting in urology complications at a
stroke. The forms of symptoms of lower urinary ways are described. Conservative and operative methods over of
treatment of neurogenic acraturesiss are brought.
REVIEWS AND LECTURES
NEUROLOGICAL AND MAGNETIC RESONA
Pages: 64-67
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REVIEWS AND LECTURES
ON POSSIBILITIES AND FEATURES OF MODERN IT TECHNOLOGIES IN DENTAL IMPLANTOLOGY. COMMUNICATION 2
Pages: 41-51
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REVIEWS AND LECTURES
ON POSSIBILITIES AND FEATURES OF MODERN IT TECHNOLOGIES IN DENTAL IMPLANTOLOGY. COMMUNICATION 3
Pages: 52-63
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REVIEWS AND LECTURES
On the role of vitamin D deficiency in the development of age-related comorbid conditions
Authors: Isupova A.A., Isupov R.V.
Pages: 123-129
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A wide variety of diseases associated with low vitamin D levels are being supported by a growing body of research.
Data are now available on the endocrine, autocrine, and paracrine activities of vitamin D and on the major determinants
of vitamin D decline in humans. Vitamin D deficiency leads to comorbidity, impaired functioning of the human
body, which has its own characteristics depending on age.
CLINICAL MEDICINE
Optimization methods for the treatment of metastatic pleuritis in breast cancer patients
Authors: Beishembaev M.I. , Lyagazov R.I. , Terekaliev B.N.
Pages: 92-98
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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.
REVIEWS AND LECTURES
OPTIMIZATION OF PREOPERATIVE PREPARATION AND STAGES OF SURGICAL CORRECTION OF SCOLIOSIS IN CHILDREN
Pages: 97-98
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CLINICAL MEDICINE
Optimization of surgical treatment methods for patients with cryptorchidism
Authors: Omurbekov T.O., Elgondiev A.А., Porozhay V.N., Esenbaev B.I., Maksut uulu E.
Pages: 53-58
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Cryptorchidism is the cause of impaired spermatogenic and hormonal function [2,5], leading to infertility in
60% of men with unilateral, and 80% to 100% with a bilateral form of cryptorchidism [1,4]. The characteristics of patient
groups and the analysis of the effectiveness of the types of surgical interventions performed in 987 children with cryptorchidism
from 6 months to 16 years for the period from 2016 to 2021 are presented. The prevailing majority (78.4%)
are represented by patients older than 1 year (from 1 to 7 years), which confirms the fact of insufficient early detection
of cryptorchidism in the first year of life and is a contributing factor in the violation of germinative function. The predominance
of unilateral cryptorchidism (93.6%) over bilateral (6.4%), inguinal testicular location (94.4%) over the abdominal
location (5.6%) was noted by localization of the process. The technique of surgical treatment of childhood
cryptorchidism according to Torek-Gertzen is more traumatic and contributes to the development of postoperative infectious
complications 2.7 times more often, and unsatisfactory results are noted 3.5 times more often in comparison with
the Sokolov-Emelianov method. The introduction of laparoscopic methods of treatment is a priority direction of modern
surgery, allowing to improve the results of surgical treatment both in the early and in the long-term period in patients
with cryptorchidism.
PUBLIC HEALTH AND HEALTH
Organization of hemodialysis centers on the terms of public-private partnership in the Kyrgyz Republic
Authors: Ismailov M.A., Dolonbaeva Z.A. , Abilov B.A.
Pages: 110-116
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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.
ORIGINAL RESEARCH
Organization of specialized consultative and diagnostic assistance to the population of Almaty region
Authors: Kargabayev E.Zh.
Pages: 13-21
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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.
PUBLIC HEALTH AND HEALTH
Organization of work of the center of perinatology and pediatric cardiac surgery in the conditions of the COVID-19 pandemic
Authors: Bodykov G.Z., Kurmanova A.M., Bolat K.S., Bakhtiyarova M.A.
Pages: 121-127
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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%).
REVIEWS AND LECTURES
PATHOLOGICAL CHANGES IN THE EYE IN SEVERE CRANIOCEREBRAL  INJURY
Pages: 7-9
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REVIEWS AND LECTURES
Pathophysiological and clinical aspects of ischemic stroke in COVID-19 (literature review)
Authors: Mamytova E.M., Ubariк k. Zh.
Pages: 143-148
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The occurrence of stroke in patients with COVID-19 infection is relatively rare, but COVID-19 is an important
prognostic marker and indicator of severity. This brief review suggests that ischemic stroke may occur early in the disease
and may also affects patients in younger age groups without comorbidities, causing large vessel occlusion and exhibiting
thrombo-inflammatory neuroimaging. The mechanisms underlying the development of stroke in patients with COVID-
19 may be associated both with the usual factors of increased risk of stroke, traditionally found in patients without COVID-
19, and with the development of coagulopathy induced by infection against the background of a systemic inflammatory
reaction characteristic for coronavirus infection.
FRONT LINE
Pathophysiological and Clinical aspects of Nervous System affection in COVID-19
Authors: Mamytova E.M.
Pages: 8-15
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COVID-19 disease is characterized by respiratory ways and other organs and system affection. One of frequent clinical
manifestation is neurological dysfunction. There is presented the most known up-to day COVID-19 associated neurological
disorders in this review. Among the most common neurological manifestations are myalgias, headaches, encephalopathy,
dizziness, dysgeusia and anosmia. Other conditions such as meningitis, encephalitis, encephalomyelitis,
hemorrhagic necrotizing encephapathy and Guillain-Barré syndrome can be attributed to COVID-19 associated complications.
The pathophysiological aspects underlying COVID-19 mediated neuroinvasion, which are based on the high
affinity of binding of SARS-CoV2 to the ACE2 receptor, are presented.
CLINICAL MEDICINE
Peculiarities of the pathogenesis of the perifocal zone in glioblastom of the brain
Authors: Karimov Zh.M.
Pages: 47-54
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In this work, the pathogenesis of the perifocal edema zone in glioblastomas of the brain was studied according to the
data of MRI of the brain, morphological, morphometric, biochemical and histological studies. The zone of perifocal
edema is the main factor of the dislocation syndrome, leading to an increase in clinical symptoms, sometimes to the
death of patients, therefore, the study of the zone of perifocal edema was of interest not only to clinicians, but also to
radiologists, pathologists and pathophysiologists. Timely recognition of both pre and postoperative treatment to resolve
the edema results in successful tumor removal and early recovery of prolapse symptoms. In our work, for the first time,
a more detailed study and a morphological assessment of the zones of perifocal edema are given and are divided into
parts according to the signs of morphological changes. A detailed study of water, lipids and electrolytes in the intercellular
space and cells was carried out. Histological materials have been studied. In this work, histological materials are thoroughly
studied and a more detailed characteristic is given for pronounced changes in the area of perifocal edema with
division into zones, taking into account reversible and irreversible processes and its pre-, intra-, postoperative correction.
REVIEWS AND LECTURES
PECULIARITIES OF WOUND HEALING PROCESS READAPTATION BY HIGHLANDS
Pages: 121-127
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PREVENTIVE MEDICINE
Physical development of primary school children living in the Altai Republic
Pages: 82-87
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
CLINICAL MEDICINE
Placental dysfunction among pregnant women having uterine scar after Cesarean section
Pages: 25-28
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
REVIEWS AND LECTURES
POEMS syndrome, difficulty diagnosis
Authors: Nurbekova U.A., MukanbetovaG.D.-
Pages: 96-103
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POEMS syndrome is a rare multi-system disorder caused by circulating immunoglobulins in the blood due to plasma
cell dyscrasia. POEMS is an acronym that stands for the following symptoms: P –polyneuropathy, O- organomegaly, E
–Endocrinopathy, M- M-protein, S – skin change.
The main clinical feature of this syndrome is a progressive polyneuropathy with predominant motor disturbances. The
disease is potentially fatal, and the quality of the patient's life deteriorates progressive due to neuropathy, massive peripheral
edema, pleural effusion and ascites. Serious complications, such as multiple organ failure, restrictive lung disease
and pulmonary hypertension, lead to an unfavorable prognosis.
CLINICAL MEDICINE
Prevalence of arterial hypertension in persons with diabetes in dispensary accounting at family medicine centers in Bishkek
Authors: Abylova N.K.
Pages: 79-83
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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.
ORIGINAL RESEARCH
Prevalence of various strains of the causative agent of tuberculosis in tuberculosis patients in the Kyrgyz Republic
Authors: Toktogonova A.A., Kulzhabaeva A.A., Myrzaliev B.B.
Pages: 20-27
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This retrospective cohort study included all TB cases reported in 2019-2020 (11908 cases). An analysis of the coverage of the drug sensitivity test was carried out with a study of the prevalence of resistance of various strains of the causative agent of tuberculosis to anti-tuberculosis drugs. Disaggregated data by TB form with drug susceptibility test results were taken from the registration forms.
The COVID-19 pandemic in the country negatively affected the detection of TB, a decrease by 32.2%, in the 2nd quarter of 2020 by 49% (р<0.001, ꭓ²), while in all regions of the republic there was a decrease from 16.3% up to 40%.
DST coverage of all reported TB cases, regardless of COVID-19, is only within 46%. Bacteriological confirmation of TB was only 56.9% and 59.4% in 2019-2020, COVID-19 did not affect this indicator (p>0.05).
The COVID-19 situation negatively affected the confirmation of the diagnosis in extrapulmonary forms of TB (p<0.001, ꭓ², OR=2.9, 95% CI 2.6-3.3), 2.9-3.8 times lower than than among pulmonary forms (60.1% and 61.8% in 2019-2020, p<0.001, ꭓ², OR=3.8, 95% CI 3.2-4.4).
Among TB patients with DST, the vast majority (61.4% and 59.2%) have MBT strains with some resistance, among which 37.6% and 35.0% are with M/XDR. In every 5th patient, strains with multiresistance of the pathogen were found.
PREVENTIVE MEDICINE
Prevention of visual impairment in children, parents' view of the problem
Pages: 75-81
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
REVIEWS AND LECTURES
PROBLEMS OF A COMBINATION OF TUBERCULOSIS AND HIV INFECTION
Pages: 127-132
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REVIEWS AND LECTURES
PROBLEMS OF CLINICAL EXAMINATION
Pages: 80-81
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ORIGINAL RESEARCH
Problems of Surgical treatment of Epilepsy
Authors: Mamytova E.M., Mamytov M.M., Kadyrov R.M.
Pages: 31-39
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The aim of article is surgical treatment patients with epileptic seizures in depend on applied methods of operations.
There is used new algorithm of complex and objective methods of diagnostics which allow to detect epileptogenic focus.
This fact give a chance to plan surgical methods of treatment of pharmacoresistent epilepsy. Results of patients investigation
shown high effectiveness applied methods of treatment in patients with different forms of epilepsy
CLINICAL MEDICINE
Profile of Otorhinolaryngological Disorders in Adults admitted to the Secondary Hospital of Osh Region
Authors: Mamanov M.A., Kasiev N.K.
Pages: 69-73
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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.
REVIEWS AND LECTURES
PROSPECTS FOR THE USE OF MINERAL WATERS AFTER LAPAROSCOPIC CHOLECYSTECTOMY.
Pages: 70-76
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PREVENTIVE MEDICINE
Quality and safety in the context of the COVID-19 pandemic: the impact of training healthcare providers
Authors: Baiyzbekova D.A., Kaliev M.T., Asanalieva L.U.
Pages: 111-120
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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.
REVIEWS AND LECTURES
REHABILITATION: RELEVANCE, TASKS
Pages: 28-29
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ORIGINAL RESEARCH
Risk factors for symptoms of dyspepsia in freshmen
Authors: Bessonov P.P., Bessonova N.G.
Pages: 14-20
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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
REVIEWS AND LECTURES
SIGNIFICANCE OF THE HIGH INTERFIBRAL RESSURE SYNDROME IN SURGERY
Pages: 151-157
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REVIEWS AND LECTURES
SIMULATED ENDOSCOPIC OPERATIONS IN GYNECOLOGY
Pages: 64-69
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REVIEWS AND LECTURES
SIMULATED LAPAROSCOPICAL OPERATIONS IN GYNECOLOGY
Pages: 145-150
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REVIEWS AND LECTURES
Simultaneous endoscopic operations in gynecology modern problems
Authors: Talaybekova A.T. , Kukeshova M.N. , Adylbaeva V.A., Niyazov B.S.
Pages: 134-140
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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.
ORIGINAL RESEARCH
Situation on drug resistance of TB causiator in 2019-2020 in the Kyrgyz Republic
Authors: Toktogonova A.A., Zhanybekov I. Zh.
Pages: 33-40
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The article describes the situation of drug resistance of the causative agent of tuberculosis, provides data on
the effectiveness of anti-tuberculosis therapy in patients with pulmonary tuberculosis with multidrug resistance, as well
as indicators of the success of treatment of RU/MDR TB in short-term and individual regimens. The indicators of treatment
coverage of patients with RU/M/XDR TB, the proportion of pulmonary and extrapulmonary forms, age-sex structure,
categories of previously treated and new cases were studied. Data on a cohort of cases confirmed by various tests for
drug sensitivity are presented. An important place is given to the study of the growth rates of cases with TB and HIV coinfection
in 2019- 2020. The important role of patients' access to antiretroviral therapy due to the limitations associated
with the COVID-19 pandemic was noted. According to the results of the study, an unreliable increase in the proportion
of XDR TB cases was established, the highest level of XDR TB in Jalal-Abad, Osh regions, the State Penitentiary Service
and the city of Osh, among which the share of XDR TB in the Osh region increased by more than 2 times. The analysis
of the results showed the need to increase the coverage of short-term treatment regimens due to the high success rates of
treatment of RU/MDR TB than other regimens. However, in the Kyrgyz Republic, the percentage of coverage of shortterm
innovation regimes in the country does not exceed 12%. High success rates of treatment of RU/MDR TB with shortterm
and individual regimens, including Bdq/Dlm, have been established. The effectiveness of XDR TB treatment in IR
therapy with new drugs is higher than without their inclusion.
PREVENTIVE MEDICINE
Social and hygienic living conditions of the elderly population of the Kyrgyz Republic
Authors: Kasiev N.K., Suleimanova G.T., Akmatov I.M., Kasymova R.O.
Pages: 124-133
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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.
ASSISTANCE TO A PRACTICAL DOCTOR
Some basic legal principles of healthcare organizations
Pages: 93-97
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.
PREVENTIVE MEDICINE
Some issues of quality assurance in laboratory tests of the Kazakhstan epidemiologic expertise
Authors: Bimuratova G.A., Kasymov O.T., Reznik V.L., Dzhemuratov K. A.
Pages: 102-108
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The laboratory service ensuring sanitary and epidemiological well-being in the public health system of the
Republic of Kazakhstan is designated to conduct qualitative various complexity levels research. This article presents the
results of the sanitary and epidemiological expertise organizations laboratory tests quality assurance study. The results
obtained indicate that the quality of laboratory studies performed is achieved by the proper organization of all interrelated
stages of work.
REVIEWS AND LECTURES
SOME OF THE QUESTIONS OF PEDIATR
Pages: 91-92
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CLINICAL MEDICINE
Study of changes in atrial auricles in phylogenesis
Pages: 70-74
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.
REVIEWS AND LECTURES
Suggestibility and diagnosis of
Pages: 90-91
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REVIEWS AND LECTURES
SUICIDE AS THE GLOBAL PROBLEM OF MODERN TIMES
Pages: 54-62
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FRONT LINE
Sustainable development of mountain regions of Kyrgyzstan
Authors: Kasymov O.T., Arabaeva A.Ch., Shatmanova E.K. , Aidaraliev A.A.
Pages: 3-12
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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.
PUBLIC HEALTH AND HEALTH
The characteristic of epidemic process of hepatitis B in Kyrgyz Republic
Authors: Niiazalieva M.S.
Pages: 109-113
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Introduction.Viral hepatitis B in the Kyrgyz Republic continues to be an urgent problem. The introduction of
routine immunization into the national vaccination schedule has undoubtedly made changes to the epidemic process of
viral hepatitis B at the present stage.
The purpose of the study- analysis of the epidemic process of viral hepatitis B at the present stage to assess the epidemiological
situation in the country.
Materials and methods. In the course of the work, epidemiological, statistical and serological research methods were
used.
Results and discussions.According to official statistics, the minimum intensive indicator was 1.5º/0000 in 2020; the maximum
was 38.9º/0000 in 2003. It should be noted that the incidence of hepatitis B tends to decrease. An analysis of the
age structure indicates the undoubted effectiveness of the ongoing immunoprophylaxis of the child population. The carriage
of HBsAg among young people is 7.1%, which indicates its significant spread in the population of our republic.
Conclusions.According to the epidemiological analysis, the incidence of viral hepatitis B in the population of the Kyrgyz
Republic decreased by 24.3 times. The incidence of the adult population has a stable trend with an average level of intensive
indicator of 9,7%.
REVIEWS AND LECTURES
THE COMBINED METHOD OF TREATMENT OF OPTIC NERVE ATROPHY
Pages: 95-96
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CLINICAL MEDICINE
The dependence of the development of hypotrophy in children of the first year of life on pathologies during pregnancy and complications in childbirth of their mothers
Authors: Khakimov Sh.K.
Pages: 98-102
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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.
CLINICAL MEDICINE
The effectiveness of regional lymphostimulation in the prevention of complications after appendectomy with an atypical location of the appendix
Authors: Musaev U.S., Akhmatov S.A., Turatbekova K.T.
Pages: 84-91
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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.
PUBLIC HEALTH AND HEALTH
The importance and importance of present health
Authors: Zhusupova A.B. , Bakhramzhanova N.M.
Pages: 128-133
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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.
ORIGINAL RESEARCH
The informativeness of various types of pathological material samples in the laboratory diagnosis of tuberculosis in children
Authors: Kurmanova N. K., Kalmanbetova G.I., Mataeva G.K., Azykova A.B.
Pages: 58-64
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Tuberculosis (TB) in children is characterized by the frequency of extrapulmonary localization of the process,
the rarity and scarcity of bacterial excretion. WHO recommends that in order to improve the effectiveness of TB diagnosis,
studies of any available diagnostic material should be carried out using all available laboratory methods. The purpose of
this study was to study the informativeness of various types of diagnostic material samples for the detection of M. tuberculosis
in children. Material and methods.A retrospective analysis of the results of microbiological studies on Mycobacterium
tuberculosis in 1,676 children under the age of 15 for the period 2017-2021, performed in the Republican Reference
Laboratory of the National Center of Phthisiology. Results. The most informative samples were biopsies/ resection material,
the contents of fistulas, bronchial flushing water and cerebrospinal fluid. The sensitivity of rapid molecular methods
of TB diagnostics (Xpert MTB/RIF, GenoTypeMDRTB plus) was higher compared to the results of culture (MGIT, LJ)
and microscopy. Conclusion. The cumulative informativeness of various types of diagnostic material samples in the laboratory
diagnosis of TB in children was 11.4%. As an initial diagnostic test, fast molecular methods are recommended to
verify the diagnosis of TB and start its adequate treatment.
ORIGINAL RESEARCH
The overweight and obesity problem among 7-8 years old children in the Kyrgyz Republic: WHO European Childhood Obesity Surveillance Initiative – COSI –round 4
Authors: Kasymova R.O., Subanova N. A. , Khegay E.V. , Usupova Zh.E. , Aitmurzaeva G.T.
Pages: 40-47
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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
ORIGINAL RESEARCH
The prevalence of various resistance profiles of the causative agent of tuberculosis in patients with extrapulmonary forms of tuberculosis
Authors: Kozhomkulov M.D.
Pages: 47-51
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Prevalence of multidrug-resistant (MDR) TB strains in patients with extrapulmonary TB. The aim of the study
was to analyze the prevalence of the resistance profile of the causative agent of multidrug-resistant tuberculosis (MDR)
among patients with extrapulmonary tuberculosis (TB). To study the prevalence of MDR-TB among patients with extrapulmonary
tuberculosis, state reporting forms No. 003/U (case histories of patients with extrapulmonary tuberculosis,
and the electronic database of the National Reference Laboratory of the National Center for Phthisiology) were used.
Among the results of drug resistance tests of drug-resistant forms, the largest share is made up of strains of the causative
agent of TB with MDR-TB in 43 (61.4%) cases. The results of tests with polyresistance were 25 (35.7%) cases. XDR
strain of the causative agent of tuberculosis was detected in two cases - 2.9%. Despite the introduction of the DOTS strategy
and a decrease in TB incidence, prevalence, and mortality among the population, the Kyrgyz Republic has a high
level of MDR-TB among patients with extrapulmonary TB.
ORIGINAL RESEARCH
The results of microbiological, molecular genetics and histological studies of resection and surgical materials obtained from patients with extrapulmonary forms of tuberculosis
Authors: Kozhomkulov M.D., Mukanbaev K.M.
Pages: 41-46
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The relevance of the problem of timely microbiological diagnosis of extrapulmonary tuberculosis using molecular
genetic methods retains its significance. Comparison of the results of testing the sensitivity/resistance of MBT to
anti-tuberculosis drugs by microbiological, molecular genetics and histological methods of resection specimens isolated
from the clinical material of patients with extrapulmonary forms of tuberculosis. For the study, state reporting forms No.
8 “On diseases with active tuberculosis” and No. 089 / y-tube “Notice of a patient with tuberculosis”, registration forms
TB 06 - table 3b were used: “Results of testing drug sensitivity to drugs of the first and second line of patients with extrapulmonary
TB ”, registration forms TB-06 No. 003 / U (case history) of 104 patients with extrapulmonary tuberculosis
who were treated in 2021 at the National Center for Phthisiology. The use of the molecular genetic method of the Hine
test made it possible to obtain a higher percentage of positive results for the detection of MBT in comparison with microscopy
and cultivation methods. When comparing these positive results of the Hine test, highly reliable results were
found. When studying the drug resistance test of MBT strains to first-line drugs, there were no significant differences
between the Hain-test method in relation to both cultural methods in detecting MBT strains with preserved sensitivity to
first-line drugs, with PDR and MDR. When comparing these positive results of the Hine test, highly reliable results were
found. So, in comparison with the cultural Lowenstein-Jensen, there are significantly significant differences.
МААЛЫМАТ ЖАНА ХРОНИКА
The role of special knowledge of a clinical psychologist in forensic psychological examination in the civil process
Pages: 101-104
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.
FRONT LINE
The study of biochemical changes in the body of a manaschi telling the epic "Manas" for 14 hours and 27 minutes
Authors: Makhmudova Z.A., Dusheeva B.M., Baatyrova N.J., Niyazalieva J.K., Taalaibekova M.T.
Pages: 115-124
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This article presents the results studying of biochemical changes in the blood of the manaschi before and after prolonged
telling of epic Manas (on November 12, 2020, manaschi Doolot Sydykov told the epic Manas in 14 hours 27 minutes
without a break and got into the Guinness Book of Records).). This process was viewed as acute psychological and
physical stress. During the study, we studied the main biochemical parameters of the blood that are sensitive to stress,
namely: the indicators of the general blood test and the following biochemical parameters of the blood: troponin I, cortisol, glucose, cholesterol, LDL, VLDL, total protein, lactate. The results of the study showed, that during this process:
cortisol was increased, but at the same time all the indicators of the immune system were increased, which shows that
during the increase in the strength of the immune system, they became synregists; the white blood corpuscles rose,
which proves a powerful mobilization of the immune system; high anaerobic glycolysis, which led to the accumulation
of lactate to a critical level, thabut the buffer systems and defenses of the body protected from negative consequences
for the body; hemoglobin and hematocrit indicators did not go beyond normal values, which was shown by high-quality
erythropoiesis; despite the severe stress of the body, total amount of protein remained normal; the value of platelets did
not exceed the reference values; blood pressure remained normal. All the above indicators prove that the manaschi's
body reacted positively to stressful factors, withstood this test, successfully adapted, since during the telling, he was in
the highest emotional and high spiritual state. This condition saved his body from the negative effects of stressors and
negative consequences.
CLINICAL MEDICINE
The use of natural antioxidants in the treatment of inflammatory periodontal diseases
Authors: Subanova A.A, Belov G.V., Sulaymanov I.B., Smayilkulov D.D.
Pages: 47-53
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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
REVIEWS AND LECTURES
TOPOGRAPHIC-HISTOLOGICAL FEATURE
Pages: 47-50
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PUBLIC HEALTH AND HEALTH
Tuberculosis in the penal system of Kyrgyz Rebublic
Authors: Esentaeva E.A.
Pages: 114-118
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The article presents the situation with tuberculosis in the penitentiary system, the dynamics of incidents and
mortality rates from tuberculosis, in comparison with the civil sector from 2015 to 2020. The data of accounting and reporting
forms of the NTP for the penitentiary system of the Kyrgyz Republic were used. The TB incidence rate in the
penitentiary system in 2015 as a whole was 2240.2 cases per 100,000 population and decreased by 28% over 6 years in
2020, and the TB mortality rate by 14.2%. In the penitentiary system in 2015, there were 3.7 times more new TB cases
than relapses and 8.5 times more than other previously treated cases (p<0.001, χ², OR=3.7, 95% CI 2, 6-5.4 in the first
comparison and p<0.001, χ², OR=8.5, 95% CI 5.7-12.8 in the 2nd). After 5 years, there is a significant increase in the
proportion of new TB cases up to 8 times compared with relapses (p <0.001, χ², OR=8.1, 95% CI 3.5-8.1) and 11 times
compared with previously treated cases (p<0.001, χ², OR=11.4, 95% CI 4.8-27.7). The improvement in the proportion of
new cases is closely related to improved early detection of TB and frequent screening among prisoners (questionnaire,
chest x-ray and rapid diagnostic method). In2015, Xpert-MTB/Rif coverage among reported TB cases were 69.5% and
in 2020 it were 83.8%.
CLINICAL MEDICINE
Volume, ingredient composition and energy value of breast milk in healthy nursing mothers
Authors: Khakimov Sh.K., Huritdinova G.T.
Pages: 103-109
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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.
PROBLEMS IN EDUCATION OR MEDICAL PHARMACEUTICAL EDUCATION
Ways to improve the quality of training of professional pathologists (occupational medicine) in Kazakhstan
Pages: 88-92
: 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.
CLINICAL MEDICINE
Weaning from mechanical ventilation
Authors: Moldotashova A.K., Zhuzumalieva K.S., Kochkonbaev J.A., Imankulova A.S.
Pages: 77-82
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The review is devoted to the problem of weaning from mechanical ventilation (MV). Factors that prevent the
cessation of MV are considered. Criteria of the patient’s readiness for weaning from MV and conducting a spontaneous
breathing trial are given. Forced-auxiliary modes are a combination of forced and auxiliary ventilation. In these modes,
the hardware breaths are synchronized with the patient's attempt to inhale. In everyday clinical practice, the most commonly
used are: SIMV (synchronized intermittent (periodic) forced ventilation), P-SIMV (synchronized intermittent
forced ventilation with controlled pressure). The methods of weaning from MV, options of a spontaneous breathing trial
conduction and exercises to increase the strength and endurance of the respiratory muscles are described.
REVIEWS AND LECTURES
Современные тенденции хирургичес
Pages: 86-89
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CLINICAL MEDICINE
Тhe features of the microbial spectrum of obligate anaerobes in purulent phlegmons of odontogenic nature in maxillofacial pathology
Authors: Kubanichbekov М.K., Aldjambaeva I.S.,
Pages: 133-138
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Relevance. Purulent phlegmon of odontogenic nature is a fairly frequent pathology in maxillofacial surgery, from the
point of view of etiology, many components can be traced, mainly anaerobes or facultative anaerobes. Bacteriological
isolation is not always possible, therefore, alternative diagnostic methods must be used.
Purpose of the work. To study the qualitative and quantitative composition of anaerobic microflora in case of purulent
phlegmons of odontogenic nature in maxillofacial pathology to improve diagnostics.
Material and methods. There are examined 36 patients with purulent odontogenic phlegmons of varying severity - patients
of the Department of Maxillofacial Surgery of the National Hospital of the Ministry of Health and Social Development
of the Kyrgyz Republic. The material used for DNA isolation of microbes by PCR using DNA-express tests
and detection using a DENTOSKRIN kit (NPF Litekh, Russia) in accordance with the instructions. A. P. endodontalis,
P. gingivalis, T. forsythia, P. intermedia, F. nucleatum quantitatively are identified. The concentration of pathogens is
measured in number of copies per ml.
Results. The most common representative of anaerobes is F. nucleatum which found in 70% of the samples. In 67% of
cases, there is a joint isolation of P. gingivalis and T. forsythia. In 30% of cases, four pathogens are isolated from
one sample. The presence of P. endodontalis, P. intermedia is at the level of etiologically significant concentrations.
Conclusions. The quantitative determination of microorganisms, especially with anaerobic type of cultivation, taking
into account the numerous factors of pathogenicity, gives more information about the mutual influence of microbes
and the role of each in the development of the pathological process.
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ISSN 1694-8068 (Print)
ISSN 1694-805X (Online)