№3 (2024)

Introduction. Analysis of data on the activities of the blood service in recent years indicates positive trends such as an increase in the number of donors, the number of blood donations, plasma donations, the volume of collected blood and its components. The volume of the average single dose has increased, and the number of plasma donors obtained by plasmapheresis haincreased. New technologies such as leukofiltration and virus inactivation
have been introduced. Improved methods of early detection of blood-borne infections (HIV, hepatitis B, hepatitis C, syphilis). An effective method for diagnosing brucellosis in blood donors has been developed and put into practice. Goal: To create a stable, secure donor base to ensure a safe, sufficient and
reliable blood supply nationwide. Material and method. Statistical reporting data - F1zdrav “On the activities of the blood service”. Excel computer programs were used for generalization and processing. Results and discussion. The introduction of new technologies (leukofiltration, viral inactivation, the method of diagnosing brucellosis with Brucella cards - Coombs gel test) allows to increase the level of infectious safety of blood transfusions. Such changes in the field of industrial transfusiology have a beneficial effect on providing healthcare organizations with necessary and safe blood products. The analysis allows us to positively assess the forecast for the further development of industrial and clinical transfusiology in the Kyrgyz Republic.
Conclusions. In comparison with similar data from 2019 to 2022, there was
an increase in the number of donors and the volume of collected blood in 2023. Improving the work of blood service institutions will increase the infectious safety of donor blood and prevent post-transfusion complications. All these achievements indicate that the blood service is one of the key factors for the successful development of clinical areas in medicine, such assurgery, hematology, anesthesiology, resuscitation, clinical toxicology, transplantology, etc.

Introduction. We proposed criteria for the selection of patients with hypertensive stroke hemorrhage for surgical treatment, to select patients according to the following criteria: by the level of consciousness, by the localization
and volume of hematomas, by the dislocation of the midline structures of the brain. The goal of the work is to develop and implement into practice the optimal tactics for surgical treatment of patients with hypertensive hemorrhagic
stroke, depending on the location, volume, degree of dislocation, level of consciousness and time of hemorrhage. Results and discussions. There was also a certain dependence of favorable outcomes on the volume of hematomas, the age of the patients, and the nature of the stroke. The results of surgical treatment showed a significant dependence on the timing of the operation, the severity of the condition, the level of consciousness, the patient’s age, the location and volume of the hematoma, the presence of lateral dislocation, the presence of ventricular hemorrhage, and the
presence of signs of occlusive hydrocephalus.
Conclusions. 1. Prognostic favorable indications for surgical treatment are
stroke hematomas with a volume of less than 60 cm3 and with depression
of the patient’s consciousness of more than 10 points on the GCS with dislocation of the midline structures of the brain up to 2 mm. Mortality during
surgical treatment of comatose patients was 83%. When the level of wakefulness decreases to coma, surgical intervention is inappropriate and ineffective. An exception is the surgical treatment of patients in a coma caused
by a cerebellar hematoma, with compression of the trunk and/or acute occlusive hydrocephalus. 2. The optimal period for surgical treatment of intracerebral hematomas with
subcortical localization with a volume of less than 60 cm3 and with depression of consciousness not lower than stunning (more than 10 points on the GCS) and dislocation of the midline structures of the brain up to 2 mm is
the first 72 hours. The prognostically favorable period for surgical treatment of patients with intracerebral hematomas of medial (basal ganglia) localization with a volume of less than 80 cm3 and with depression of consciousness
below stunning (less than 10 points on the GCS) with a displacement of the median structures of more than 3 mm is 6-7 days after hemorrhage. Surgical treatment of intracerebral hematomas with a breakthrough into the ventricles or supratentorial localization, with a volume of more than 80 cm3 and with depression of consciousness below stunning (less than 10 points on the GCS) with a dislocation of more than 6 mm is 15-20 days after the hemorrhage.

Introduction. One of the main problems in the republic’s blood service is the viral safety of donor blood and its components. Solving this problem will make it possible to protect the recipient from possible infection with
viral infections such as HIV (human immunodeficiency virus), hepatitis B,
hepatitis C, syphilis, etc. This article presents improvements in testing of donor blood, and a comparative analysis of donation indicators and an assessment of donor potential.
One of the main problems in the republic’s blood service is the viral safety of donor blood and its components. Solving this problem will make it possible to protect the recipient from possible infection with viral infections such as HIV (human immunodeficiency virus), hepatitis B, hepatitis C,
syphilis, etc. Material and research methods. The research materials were statistical data
from the Republican Blood Center. A retrospective data analysis was carried
out. Results. All donated blood from the RBC, as well as from two transfusiology
departments of the National Hospital (NH) and the Research Institute of
Heart Surgery and Organ Transplantation (NRIHS&OT) in Bishkek are
tested for blood-borne infections with each blood donation. Since August 2022, two-stage testing of donor blood has been introduced.
Donor blood samples from each donation are examined using two different methods on two different machines. At the 1st stage, the study of donor blood is carried out using the ICLA method, then at the 2nd stage, all negative samples for ICLA are examined using the PCR method. Studies using the ICLA method are carried out on an automatic analyzer “Architect
i2000SR” (USA), and studies using the PCR method are carried out on an automatic analyzer “Cobas 201” (Switzerland). High quality of examination of donor blood is ensured by introducing automated laboratory systems,
using highly sensitive techniques and eliminating the risk of errors due to the human factor. This ultimately guarantees the receipt of reliable research results and the detection of infection in a latent stage when examining donor
blood samples. Conclusions. Daily internal laboratory quality control, participation in External EQA and testing on automatic “closed type” analyzers allows us to draw conclusions about the reliability of the results obtained.

Introduction. Allergic purpura (AP) is one of the most common hemorrhagic diathesis, related to hypersensitive systemic vasculitis. The purpose of the study was to study pro-inflammatory cytokines: interleukin-6, tumor necrosis factor-α and genetic abnormalities of homocysteine
metabolism in patients with AP. Material and methods. The study included 119 patients with AP treated in the hematology department of the National Center of Oncology and Hematology
(NCOiH) of the Ministry of Health of the Kyrgyz Republic. In addition
to basic research methods, we conducted the following special studies:
cytokines, homocysteine, and folate cycle genes, such as MTHFR, MTRR.Results and its discussion. In patients with a high degree of aseptic inflammation activity, an increase in the concentration of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) was observed. It was revealed that hyperhomocysteinemia in patients with AP is associated with genetic abnormalities
of methylenetetrahydrofolate reductase (MTHFR) C677T (41,5%) and methionine synthase reductase (MTRR) A66G (58,4%). In 40% of patients with AP, parallel polymorphism of the MTHFR C677T and MTRR A66G
genes was registered. Conclusion. In the diagnosis of AP, it is advisable to include determination of the level of IL-6, TNFα, homocysteine and the presence of MTHFR
C677T and MTRR A66G mutations. If a polymorphism of the MTHFR C677T and MTRR A66G genes with hyperhomocysteinemia is detected, folic acid supplements should be prescribed.

Introduction. The majority of hepatitis E virus (HEV) infections worldwide are due to contaminated water or food sources. There is also a rising incidence of HEV transmission through blood transfusions from donors. Annually, approximately 20 million cases of HEV infection are reported globally, with symptoms in about 3.3 million individuals and 56,600 fatalities. Given the increasing serological prevalence of hepatitis E, which can lead to serious clinical consequences for patients who most need transfusions, HEV screening is becoming a significant public health issue in both developing and developed countries. The aim of the study was to determine the prevalence of hepatitis E virus and identify risk factors among blood donors in Kazakhstan. The assessment was carried out by testing HEV genetic material in donor plasma and analyzing associated risks. Materials and Methods. Donor blood samples were tested for HEV RNA using PCR on the Cobas 6800 automatic analyzer (Roche Diagnostics Ltd., Istanbul, Turkey), with the combination of 6 samples. Both laboratory tests
and sociological surveys were used in the study to provide a comprehensive understanding of the prevalence of hepatitis E. A questionnaire was developed to assess the socio-demographic characteristics and dietary habits of the donors.
Results. Blood samples from 16,147 donors (6.8% of the total number of donors for the year) were examined. No HEV RNA was detected in donors from blood service institutions in the Southern, Northern, Western, and Eastern regions of Kazakhstan. This finding indicates the effectiveness of screening and safety measures implemented in Kazakhstan's blood institutions. Conclusions. For the first time in Kazakhstan, a screening of blood donors for HEV among healthy individuals was conducted, and their demographic and behavioral characteristics were studied. The results show that HEV is
not currently a significant issue among blood donors in Kazakhstan. However, including HEV markers in the blood donor screening standard enhances the safety of blood components but leads to an increase in the number of blood components discarded as unsuitable for transfusion, which also results in financial losses.

Introduction. This article addresses the topic of the role of leukoreduction
in ensuring the safety of donor blood and its components. Information is
provided on technologies for leukoreduction of donor blood and its components,
the possibilities of assessing its effectiveness and impact on the quality
of transfusion agents. It has been shown that transfusions of
leukocyte-depleted blood components help prevent post-transfusion complications.
New information on the procurement of safe and high-quality
leukofiltered blood components is presented. It has been demonstrated that
leukofilters after leukoreduction can be a source of blood cells for experimental
studies. The information obtained from the article made it possible
to identify unresolved issues and outline prospects for scientific research in
the field of safety and effectiveness of obtaining and using leukoreduced
components of donor blood. Materials and methods of research. The official reporting data of the Republican
Blood Center (RBC) was used as research material. The research
methods were the activities of the blood procurement department of the
RBC.
Results of the study and their discussions. In the Kyrgyz Republic, leukofiltered
blood components are transfused to 70-80% of patients with oncohematological
diseases, and the rest to patients with other pathologies. For the
period from 2019 to 2023, a total of 3143.84 liters of leukofiltered erythrocyte
suspension was prepared and transferred to the finished products department
in the blood procurement department of the Republican Blood
Center. Today, the need of healthcare organizations for filtered blood components
is covered by 80%. Among the population of donors, there is a deficiency
of groups A and AB, therefore, less filtered components of these
particular blood groups are prepared, and therefore the need of the healthcare
organization (HO) for leukofiltered blood is not sufficiently covered. If from all the prepared red blood cell mass in 2022 (6647 l) 8% of leukofiltered
red blood cell suspension and 15% of washed red blood cells were produced,
then in 2023 (6913 l) this amounted to 17% of leukofiltered red blood cell
suspension and 8% of washed red blood cells. This shows that the population’s
need for leukofiltered blood components is increasing.
Conclusions. Leukoreduction of donor blood and its components is an important
element in ensuring the safety of transfusion therapy. It is necessary
to evaluate the effectiveness of the use of leukoreducible blood components
in different categories of patients. It is also necessary to develop and improve
methods for extracting cell solutions from leucofilters for experimental and
clinical studies.

Introduction. Infectious safety of donated blood and its components is one
of the basic principles of blood transfusion, which underlies blood services
around the world and remains a pressing issue to this day. To ensure safe
and effective blood transfusion, one strategy for ensuring safe blood donation
is to obtain blood from voluntary unpaid donors at low risk of infection.
This article provides information on the prevalence of blood-borne infections
among student donors. The purpose of this article is to compare the detection
of blood-borne infections between unpaid student volunteer donors and other
potential donors. Materials - statistical data for 2021-2023. Research methods:
retrospective analysis of reported data.
Research results and discussion. Blood collection was carried out in organized
groups where potential donors work, study or serve: universities and
vocational schools, enterprises, military units and various other organizations.
As the need for blood and its components increases, the number of
free donors increases, mainly due to student donors. 65% of the total number
of donors are student donors. Markers of infection detected in student donors
decreased from 5.5% (2021) to 0.7% (2023). The most frequently detected
infection is brucellosis, but in recent years (2023) there has been a slight decrease,
which is explained by improved methods for testing donated blood
samples. In this regard, the number of unusable blood products tends to decrease
annually: from 6.3% (2021) to 1.6% (2023). Conclusion:
- There is a trend towards a decrease in the number of infectious markers
detected among young donors;
- The low prevalence of blood-borne diseases among donors also reduces
the likelihood of prepared blood being unusable, thereby ensuring efficient
and rational use of resources;
- It is advisable to select voluntary unpaid blood donors from low-risk
groups;
- Students should be considered as the main target audience for free blood
donation, since they are a socially active and healthy part of the population.

Introduction. We conducted a retrospective analysis of 23,788 donor blood
samples for brucellosis and proposed an effective diagnostic method for determining
brucellosis in blood donors. The goal of the work is to develop
and introduce into practice an effective method for diagnosing burcelosis in
blood donors.
Material and methods. The paper presents a retrospective analysis of the results
of a study of donor blood from 23,788 blood samples. The material for
the study was the sera of 23,788 blood donors and two methods for diagnosing
brucellosis were used, the first by the Heddelson reaction and the
second by the Brucella Coombs gel test.
Results and discussions. Donor sera were examined using the Heddelson
plate reaction method, brucellosis diagnosticum was used for the agglutination
reaction, liquid produced by the Almaty Anti-Plague Institute and gel
cards for diagnosing brucellosis - Brucella Coombs gel test.
During the 1st half of 2023, 11,577 donor serum samples were examined
with the Heddelson reaction, of which 302 were positive, which amounted
to 3% of defects, and for the 1st half of 2024, 12,211 donor serum samples
were examined with Coombs gel test cards, of which 12,211 were tested. -
256, which amounted to -2% of defects.
The Heddelson reaction is a rapid diagnostic method for brucellosis. It is
quite simple to carry out, does not take much time, and does not require special
conditions. Can be used from the first days of the disease. The disadvantage
of this method is the high percentage of false positive results.
However, the simplicity and speed of the technique make it possible to identify
people who need to be referred for more thorough research. The maximum
observation period is 8 minutes.
The Brucella Coombs gel test card allows you to quickly and accurately determine
antibodies to Brucella in human serum. It is based on the principle
of a gel molecular sieve combined with the Coombs test method. Simplicity
and speed of operation, possibility of standardization. The result after 30
minutes is significantly better than with traditional methods (18-24 hours
incubation required). Capable of detecting low potency antibodies to prevent
missed detection Simultaneous diagnosis of acute/chronic infection. Simultaneous
determination of IgM/IgG/IgA allows the diagnosis of acute and
chronic infections. The results can be saved for future use.
Conclusions. Thus, the study of donor blood for brucellosis is recommended
to be carried out with the Brucella Coombs gel test card, because the sensitivity
is 98.6%, the specificity is 98%, compared to the Wright reaction in
20 minutes, similar results for Coombs Wright and CAPT. Easy to read the
result, visually. Complete antibody detection blocking ability. No false positive
effect. Screening and titration.

Introduction. During the pandemic, health systems around the world underwent
restructuring due to increased infection control, the need to comply
with certain measures to protect patients and medical personnel. Many hospitals
have been deployed for patients with pneumonia, and medical staff
have been reassigned to fight the new infection. The number of patients with
coronavirus infection increased every day, but this did not affect the frequency
of acute surgical conditions of patients, which increased the complexity
of providing medical care in the current situation.
The purpose of the study. To study the impact of the COVID-19 pandemic
on the provision of emergency surgical care.
Materials and methods. The study was conducted in the department for patients
with COVID-19 and acute surgical pathology, deployed on the basis
of the M.M. Mamakeev National Surgical Center, the only red zone for surgical
patients throughout the Republic. During the pandemic period from
March 18 to May 18, 2020 and on that day.
Results and discussions. During the COVID-19 pandemic, people's fear of
getting sick reduced the number of hospitalizations. A total of 114 patients
underwent urgent surgery during a 2-month period in the pandemic group.
For a 2-month period of the same period in 2019, we determined that this
number was 157. When analyzing the subgroups of operations, there was no
statistical difference in the frequency of patients undergoing surgery for gastrointestinal
bleeding, mesenteric ischemia and gastrointestinal perforation
between the groups.
Conclusion. The results of this study may be useful in identifying patients
who can be treated conservatively or on an outpatient basis in case of an
emergency surgical situation during these and similar periods of the pandemic
or at normal times.

Introduction. The proficiency testing program (PTP) is an important component
of the quality system of services provided by diagnostic laboratories,
aimed at improving laboratory diagnostics and obtaining reliable research
results.
The aim of the study is to develop and implement a PPT in medical laboratories
for the diagnosis of SARS-CoV-2 using the RT-PCR method.
Materials and methods. The development and implementation of the PPT
included two stages: at the first stage, an assessment tool was developed a
panel of control samples, the starting material of which was 400 samples of
positive and negative nasopharyngeal swabs in the viral transport media. At
the second stage, the quality of laboratory diagnostics of SARS-CoV-2 RNA
of program participants was assessed by correctly identifying control panel
samples.
Results.The developed panel of control samples included 4 samples, of which
one was negative and three were positive with high, medium and low levels
of SARS-CoV-2 RNA. The created control panel met the requirements of
ISO 13528, ISO Guide 35 and became a tool for independent assessment of
the quality of SARS-CoV-2 RNA testing in medical laboratories. Over 3
rounds conducted in the period 2022-2023 the proportion of laboratories that
identified without errors was 83.3% (15/18) in the first round and 80.9%
(17/21) each in second and third rounds.
Conclusions.The PPT results demonstrated a relatively low level and lack
of growth in the quality of control testing over three rounds in general for
all laboratories, which dictates the need to take measures to improve quality
both at the level of an individual laboratory and at the country health system
level.

Introduction. TThe Kyrgyz Republic is a country with a high burden of viral
hepatitis: the prevalence of HBV among the population ranges from 3.1%
to 5.6%, and HCV prevalence from 2.6% to 4.7%. In this regard, this article
provides information on the assessment of the prevalence and incidence of
blood-borne infections among donors in the Kyrgyz Republic.
Purpose of the study: To assess the prevalence of blood-borne infections
among donors in the Kyrgyz Republic.
Materials and methods. The material for the study was laboratory data from
studies of donor blood for blood-borne infections from the Republican
Blood Center and regional blood centers for the period from 2021 to 2023
and statistical data on the incidence of blood-borne infections from the Department
of Disease Prevention and State Sanitary and Epidemiological Surveillance
of the Ministry of Health among population of the Kyrgyz
Republic.
A comparative epidemiological analysis of the prevalence of blood-borne
infections among donors in the Kyrgyz Republic was carried out for the periods
from 2013-2015 and 2021-2023. Results and discussion. An important link in ensuring viral safety is the quality
and organization of the donor selection process . It is generally accepted
that voluntary unpaid donors who regularly donate blood are the safest compared
to family or paid donors. In the structure of blood donors in the Kyrgyz
Republic, 77.2% are family donors, a small share of 19.7% are unpaid
donors and 3.1% are paid donors. The increasing prevalence of blood-borne
(HIV, HBV, HCV, syphilis, brucellosis) infections among the population, as
well as the high proportion of primary donors today create a certain problem
in ensuring the safety of donor blood. Quantity donations increased over the
analyzed periods of time in 1.2 times (from 37463 to 50457). In the dynamics
of blood-borne infections among donors, there is a tendency to reduce
the incidence of HIV infection by 2 times, HBV by 2.4 times, HCV by 5
times, syphilis by 1.8 times and brucellosis by 5.4 times. The frequency of
detection of markers of the causative agent of HIV infection from 2013 to
2023 decreased from 0.4% to 0.2%. The number of donors with detected
hepatitis B virus surface antigen decreased (from 4.4 to 1.8%). The number
of donors with antibodies to the hepatitis C virus in 2023 decreased by 706
people compared to 2013 (from 2.5 to 0.5%). The number of donors with
markers of the causative agent of syphilis in 2023 decreased by 177 people
compared to 2013 (from 1.5 to 0.8%). The number of donors with a positive
result for brucellosis in 2023 compared to 2013 decreased from 6.5% to
1.2%. In 2023, the incidence of viral hepatitis B and brucellosis was the
highest among all blood-borne infections, amounting to 1.8% and 1.2%, respectively. Conclusions. Due to the correct formation of the contingent of blood donors,
a decrease in the frequency of detection of markers of hemotransmissible
infections among donors is noted. For the first time, the prevalence and incidence
of hemotransmissible infections in repeat blood donors of the country
have been determined.

Introduction. Donation and safety of blood components are of great importance
Due to the growth of bloodborne infections (TTIs) - viral hepatitis B,
C, D and HIV infections, it is necessary to strengthen control over the infectious
safety of blood components and provide a strategic supply of blood
components in case of a pandemic and emergencies (ES), emergencies (PE).
These circumstances require a new assessment of the current situation with
blood donation in the Kyrgyz Republic, to study the prevalence of markers
of blood transfusion infections and some socio-demographic characteristics
of blood donors, to monitor donor activity and analyze the reasons for medical
rejections.
Goal of work: Increasing free blood donation and increasing strategic reserves
of blood components and increasing the safety of blood components,
minimizing the risks of transmission of TTIs through blood components,
early detection of TTIs in donors. Uninterrupted provision of health care organizations
in the Jalal-Abad region with donor blood, its components and
drugs for use in emergencies, disasters, and pandemics. Materials and methods of research. A collection and analysis of available
available materials was carried out from 27,947 donors in the Jalal-Abad
region for 2019-10 months of 2023. The study included 27,947 blood samples
from donors who came for donation between January 2019 and October
2023. The age of the donors ranged from 18 to 60 years. The gender distribution
was as follows: men - 17,346 people, women - 10,601 people, donors
aged 18-25 years were 2,211 people, from 25-50 years old were 16,153 people,
from 50-60 years old were 9,583 people from the total number. Results
and discussions. Our research shows an increase in primary donors in the
Jalal-Abad region and low rates of repeat donation. And low rates of donation
among young people from 18-25 years old - 2211 people out of all
27947 donors, which is 8%
And a relatively high increase in gratuitous donations from 20% to 74%
over the past 4 years.
Conclusion. The main motivational factor for donation among various
groups of the population of the Jalal-Abad region is relative donors. With
the enthusiasm of donor relatives, there is an increase in GTI among donors
and the reason for blood defects in this group is associated with GTI and
the reason for medical withdrawals is lack of awareness of the donor’s
preparation before donation. TTIs are more often detected in primary donors,
there is an increase in TTIs in primary donors of relatives and a decrease in
TTIs in primary donors in the Jalal-Abad region due to an increase in gratuitous
donations among primary donors. More often, markers of HBsAg
infection are detected in blood donors in the Jalal-Abad region, as there are
low rates of donation among young people who have been vaccinated
against hepatitis B since 2000. The growth of gratuitous donations in the
Jalal-Abad region from 20% to 74%. Social media marketing of blood donation
using media networks are effective ways to have a long-term and positive
impact on the development of blood donation in the Jalal-Abad region.

Introduction. Prevention of posttransfusion complications (PTR) is an urgent
task of transfusion medicine. To date, modern technologies have been introduced
in the Republic of Uzbekistan to prevent the development of febrile
non-hemolytic reactions, graft-versus-host disease and reduce the risk of
transmission of infectious and bacterial infections to patients receiving blood
transfusion. The aim of the study. Conducting an analysis of the causes of post-transfusion
complications over a 5-year period, as well as developing recommendations
for the introduction of modern technologies into blood processing
processes and reducing the risk of post-transfusion complications.
Materials and methods. We have analyzed 12 cases of serious posttransfusion
complications that have developed in medical institutions of the republic
over the past 5 years. The production processes of the Blood Service of
the Republic of Kazakhstan on the introduction of new methods of screening
and processing of donated blood, including a two-stage method of testing
for markers of hemotransmissive infections, leukofiltration, irradiation (irradiation)
of blood components, were analyzed.
Results. According to the materials of the Republican Commission for the
Analysis and Prevention of post-transfusion complications of the Ministry
of Health of the Republic of Uzbekistan, we have identified 12 cases of serious
post-transfusion complications, of which 6 were fatal in medical institutions
of the republic.
Conclusions. The introduction of modern technologies into the practice of
the blood service, strict compliance with the rules of blood transfusion and
increasing the knowledge of practitioners on blood transfusion can significantly
reduce the risk of post-transfusion complications and ensure the quality
and safety of transfusion therapy in medical institutions of the republic.

Introduction. Vaccination against COVID-19 is recognized globally as a
critical factor in ending the pandemic, leading to expedited development
and clinical trials of vaccines. However, the success of any mass immunization
program is directly influenced by the public's willingness to be vaccinated.
Key factors affecting vaccination rates include the availability of
vaccines and the healthcare system's ability to organize vaccination campaigns.
Nonetheless, vaccine hesitancy among certain population groups remains
a significant issue for healthcare systems in many countries. The
concept of "vaccine hesitancy" is considered by the WHO as one of the top
ten threats to global health. This highlights the urgent need to investigate
factors influencing motivation for COVID-19 vaccination.
The aim of this study is to assess the awareness and commitment to COVID-
19 vaccination among breastfeeding mothers with children under the age of
two, and to evaluate the impact of informational interventions on the population,
comparing pre- and post-intervention data, in order to further enhance
the vaccination awareness campaign for these groups.
Materials and Methods. This study employed a cross-sectional research
method. A validated questionnaire was utilized. Descriptive statistics and
analyses were performed at various stages of the study, with statistical data
analyzed using Epi Info and Excel.
Results and Discussion. In the first stage of the survey, 586 breastfeeding
women aged 18 to 44 years participated, with an average age of 29.5 years
and a median age of 29 years. In the second stage, 627 breastfeeding women
aged 18 to 49 years participated, with an average age of 30 years and a median
age of 29 years. In both stages, the majority of participants with children
under the age of two were women aged 24-29 years (34%) and 30-34 years (29%). Analysis revealed that 63.2% of breastfeeding mothers believe
it is necessary to receive all vaccinations according to the schedule. Up to
9% of respondents are strongly opposed to vaccination. In the second stage,
there was a notable shift in attitudes toward COVID-19 vaccination, with
an increase in those considering it beneficial (from 68% to 72%) and a 5%
rise in those planning to get vaccinated soon. Trust in vaccines improved as
well: the proportion of those who distrust all vaccines decreased by 4%, and
those without any opinion about vaccines decreased by 3%. Over half of
the respondents rely on the opinions of doctors and specialists when forming
their views on COVID-19 vaccination. However, about 17% are influenced
by information from social media. Trust in vaccination information presented
by the media remains balanced, with neither complete trust nor complete
distrust being predominant. The vast majority of respondents trust their
family doctors and other healthcare professionals regarding vaccination issues.
Some breastfeeding women believe that pregnant and breastfeeding
women should not receive vaccines. The informational campaign on vaccination
has led to increased trust in vaccines and reduced concerns about
their negative effects. However, the belief in the superiority of natural immunity
persists, indicating a need for continued educational efforts.
Conclusions. Among nursing mothers, 63.2% believe it is necessary to receive
all vaccinations according to the schedule. Up to 9% of respondents
are categorically against vaccination. The level of trust in vaccines has improved.
The vast majority of respondents trust their family doctors and other
health professionals in matters of vaccination. The information campaign
about vaccination has led to increased trust in vaccines and reduced concerns
about their negative consequences. However, the belief in the advantage of
natural immunity remains, which requires further educational efforts.

Introduction. The reform of the blood service in the Republic of Uzbekistan
has significantly improved the provision to health care facilities the highquality
and safe blood components, introduced modern technologies into
production, reduced the losses associated with the discard of blood components
due to hemotransmissive infections.
The aim of the study- To study the main performance indicators of the blood
service over the past decade, as well as the impact of centralization and reform
of the blood service on ensuring the quality and safety of blood components.
Materials and methods. We conducted a comparative analysis of the main
production indicators of the Republic's Blood Service institutions, studied
the volume of donor blood procurement, the percentage of rejection of blood
components for hemotransmissive infections, indicators of red blood cell
mass write-off after expiration date, and also developed a scientific justification
for approaches to managing the blood service in peacetime and emergency
situations.
Results. Due to centralization of blood service over the past decade, an increase
in the main indicators of blood donation has been revealed in Uzbekistan,
so in 2012 the total number of donations was 111759, and in 2023
-266400, the production of erythrocyte-containing components, plasma and
thromboconcentrate increased almost 2 times. Utilization of blood components
for hemotransmissive infections (HIV, hepatitis B, C, syphilis, Brucellosis,
ALT) in 2012 amounted to 13%, in 2023 – 6.0%, in absolute figures
for the republic in 2023 amounted to 8,073.07 liters. The decrease in absolute rates of TTI markers positive blood became possible due to the introduction
of a set of measures for the selection and questioning of donors,
carefully medical examination and reconciliation with the database of persons
excluded from donation, as well as conducting a two-stage method of
screening donors for markers of hemotransmissive infections and PCR studies
of a pool of negative samples significantly affected the quality and safety
of blood components.
Conclusions. The centralization and reform of the blood service had a positive
impact on the performance of the blood service, ensured the availability,
safety and quality of blood components and significantly reduced
economic losses in the blood service.

Introduction. This article analyzes the results of implemented measures for
the infection control system in the blood service. The implemented measures
for the infection control system made it possible to improve the monitoring
and evaluation rate from 84% to 95.5%, which significantly increases the
safety of infection control. The cost of operating the infection control system
increases, and this increases the overall percentage of fulfillment of all infection
control criteria.
The goal of the M&E was to improve the safety and quality of medical care
in the structural units of the blood service.
Materials and methods. Monitoring and evaluation of the infection control
system in blood services is carried out twice a year. All monitoring and evaluation
were carried out in two directions – qualitative and quantitative assessments.
Materials for collecting information included: monitoring and
evaluation assessment sheets and direct observation of existing infection
control (IC) practices, including demonstration at the request of the researcher.
A retrospective analysis of the M&E Scorecards for 2017-2018
was carried out.
Results and discussion. During the 2 M&E conducted at the RBC, certain
achievements in the development of the infection control system were identified.
In particular, it was revealed that the center has an IC specialist -
100%, there is a Quality Committee (with IC functions) and plans for IC,
the organization is provided with a full package of regulatory documents on
IC, and there is a good supply of the center with disposable medical products.
As a result of the M& E, it was found that the overall percentage of
compliance with the IC requirements in the Central Clinical Hospital in 2017
was - 89%, which indicates a high level of organization of the infection control
system. The fulfillment rate increased by 94% in 2018, thanks to the
“Laundry” block. The Laundry block at M&E was assessed at 33.3% in
2017. In 2018, repair work was carried out and recommendations were implemented,
and those criteria that were marked as not fulfilled were fulfilled.
Conclusion. Subsequently, from 2019 to 2024, the Republican Center for
Infection Control and regional blood services did not conduct a single monitoring and evaluation of the state of the infection control system in connection
with the pandemic. But during this period, the main documents in the
infection control system were updated and revised: on infection control and
on the management of medical waste and many other regulatory documents.

More than 220 years have passed since the first description of Henoch-
Schönlein purpura (HS-H). The disease belongs to the group of systemic
vasculitis, where it occupies one of the leading places in terms of frequency
of occurrence. Currently, the immunocomplex nature of HS-H has been
proven, in which “aseptic inflammation” develops in microvessels with destruction
of microvascular walls with thrombosis and the appearance of purpura
of various localizations due to the damaging effect of circulating
immune complexes (CIC) and activated components of the complement system
(C). The cause of the disease is not fully understood; among the provoking
factors of development, hyperhomocysteinemia deserves special
attention in recent years. The purpose of the study was to conduct a literature
review on Henoch-Schönlein purpura (HS-H) and hyperhomocysteinemia.
The main causes of homocysteine metabolism disorders are indicated, including
genetic abnormalities in the development of hyperhomocysteinemia.
A classification of hyperhomocysteinemia is presented depending on the
level of homocysteine in the blood serum. This review article suggests that
hyperhomocysteinemia has a triggering role in the mechanism of development
of PS-H.

Introduction. According to population registers, the prevalence of stroke
reaches 257.9 per 100,000 population per year, and the proportion of ischemic
stroke is 80-92%. This is due to the multifactorial nature of the disease.
In mountain climates, the main risk factors are an increase in
hematocrit, blood viscosity, arterial hypertension and atherosclerosis are
more often diagnosed. The immune and autonomic nervous systems are involved
in the regulation of these processes. It becomes interesting to study
their adaptation possibilities at different levels and severity of brain ischemia
The aim of the study: To investigate the dependencies of immunologic and
vegetative parameters in patients with primary ischemic stroke in the acute
and acute periods in low mountain conditions. To clarify the pathogenesis
and severity of the disease.
Materials and methods. A cohort study of 52 patients with primary ischemic
stroke and 59 patients with dyscirculatory encephalopathy was performed.
The groups were distinguished: Group 1 - patients with ischemic stroke in
the middle cerebral artery basin on the left (18 patients); Group 2 - patients
with ischemic stroke in the middle cerebral artery basin on the right (11 patients),
Group 3 - patients with ischemic stroke in the vertebrobasilar basin
(15 patients) and comparison group - patients with stage I-II dyscirculatory
encephalopathy (59 patients). Eight patients with fatal outcome were described
separately (Fig.1). Stroke severity was assessed using the Gusev and
Skvortsova scale. Cardiointervalography and immunological study in patients
with stroke was performed on the 1st and 10th days of the disease,
and in patients with dyscirculatory encephalopathy on the first day of hospitalization.

Introduction. Atypical variants of acute appendicitis occur in 20-30% of patients.
The uncharacteristic clinical picture is explained by the variety of options
for the location of the vermiform process in the abdomen. The article
presents the features of the clinical manifestations of acute appendicitis.
Special attention is paid to uncharacteristic clinical manifestations depending
on the localization of the vermiform process in the abdominal cavity.
The purpose of the study. To describe the features of the course of atypical
forms of acute appendicitis on the example of clinical cases.
Materials and methods. The study was conducted in the Department of Intestinal
Surgery of the National Surgical Center named after M.M. Mamakeev.
Three clinical cases of atypical forms of acute appendicitis have been
described.Key words: acute appendicitis, appendectomy, differential diagnosis,
localization of the appendix.
Results and discussion. One of the main errors in the diagnosis of acute appendicitis,
as well as one of the causes of various perceptions, is the unusual
location of the appendix, which together accounts for 10 to 35 percent of
cases of acute appendicitis According to statistics, acute appendicitis was detected in 3.1% of cases, the patient was not hospitalized, and in 1.6% of
those hospitalized, the operation time was delayed.
Conclusion. Considering the above, the only reasons for the late diagnosis
of acute appendicitis are the unusual location of the appendix and the uncharacteristic
course of acute appendicitis. There are no decent methods that
can confidently diagnose acute appendicitis in less time. The diagnosis of
acute appendicitis is easy to treat, but the disease is very difficult to diagnose.