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Objective: Improve the treatment results of patients with diffuse peritonitis by accurately predicting the progression of persistent peritonitis to septic shock in the postoperative period Methods: The study involved 75 patients with diffuse peritonitis. These patients were split into two groups based on whether their peritonitis persisted after surgery and if they needed further surgery. The study used pre- and intraoperative clinical and laboratory predictors to determine the progression of peritonitis to septic shock Results: The preoperative CT attenuation coefficient of intraperitoneal fluid, measured in Hounsfield units (HU), was significantly higher in the study group compared to the control group (28.35 HU vs. 18.3 HU; p

The causes and development of inflammatory bowel disease (IBD) are not fully understood and can be influenced by various factors such as genetic, environmental, and immune system dysfunction. With chronicity, IBD requires long-term medication use. Therefore, strictly adhering to the prescribed treatment regimen is essential to prevent relapses and achieve remission. This review article evaluates the relationship between treatment adherence (also compliance) and quality of life (QoL) in patients with IBD. We conducted a literature search using databases such as PubMed, Scopus, Web of Science, Embase, and eLibrary to analyze scientific articles published between 2013 and 2023. We included articles that presented the results of assessing quality of life and/or adherence to treatment in patients with IBD. We excluded articles that evaluated patients with other concomitant conditions or provided incomplete data.

Objective: To analyze the results of the first experience of performing simultaneous operations for saphenous varicose veins of the lower extremities and knee osteoarthritis. Methods: The results of simultaneously performed combined phlebectomy and arthroscopic knee surgery in patients with varicose veins (VV) were analyzed. A total of 15 female patients (mean age 52.8±1.9 years) were included in the study. In 5 patients, Clinical Class II, according to the Clinical Etiological Anatomical Pathophysiological (CEAP) classification, published in 1994 for chronic venous disease, was noted, and in 10 – class III. In 13 (86.7%) cases, there was a bilateral dilatation of the saphenous veins; and in 12 patients, there was a combined dilatation of both the Great Saphenous Vein (GSV) and Small Saphenous Vein (SSV). Perforator venous insufficiency was present in 5 patients. Among those examined, in 5 cases, clinical and laboratory findings of the КOA grade II, according to the Kellgren and Lawrence system (1957) for OA classification, were noted, and in 10 patients – grade III. Overweight was observed in 9 patients, and the mean weight was 77.5±3.8 kg. Assessment of the function of the knee joints before and three months after the operation was carried out according to Lequesne's algo-functional index (AFI). Results: The mean diameter of the GSV and SSV was 10.2±0.4 and 6.4±0.4 mm, respectively, and the diameter of insufficient perforating veins was 4.1±0.3 mm. The malleolar circumference before surgical treatment was 37.7±1.5 cm. In all cases, patients had pain and discomfort during the night (n=5 with movement and n=10 without), morning stiffness (n=9), and increased pain when walking a certain distance (n=8) or at the beginning of the movement (n=7). A positive correlation was found between pain and discomfort with age (r=0.53), KOA stage (r=0.70), malleolar circumference (r=0.58) and a negative correlation with body weight (r=-0.55) and recurrence of VV(r=-0.68). All patients complained of walking difficulties, and as a result, their walking distance was reduced. A direct correlation was found between walking distance and body weight (r=0.71), KOA stage (r=0.84), malleolar circumference (r=0.81), pain and discomfort during the night (r=0.66). In addition, in all cases, there was a decrease in daily life activities – the ability to climb one flight of stairs up or down at a moderate effort, squatting or kneeling, and limited ability to walk on uneven ground. The mean operative time of the combined operation's first step (phlebectomy) and arthroscopic knee surgery was 125.5±25.5 and 58.2±10.5 minutes, respectively. The development of postoperative seroma in the wound area was observed in only one case. The average hospital stay was 7.2±1.2 days, and sutures were removed within 10-12 days. A follow-up examination of patients after 1 and 3 months revealed a significant decrease in all the above parameters of Lequesne's AFI and malleolar circumference to 32.0±1.3 cm. Conclusion: Combined phlebectomy with arthroscopic knee surgery in VV comorbid with KOA results in a significant improvement in symptomatic KOA patients with increased walking distance and daily activity with no significant complications.

Objective: To evaluate the role of arthritis of the knee joint in the development and progression of varicose veins of the lower extremities. Methods: An observational cross-sectional cohort study was conducted on 180 patients. There were 56 (31.1%) males and 124 (68.9%) females with VVs of the lower extremities. The VVs' clinical features were studied according to the presence or absence of knee osteoarthritis. The study group (SG) included 88 patients with KOA in combination with VVs. The control group (CG) comprised 92 people suffering from VVs and not having a degenerative joint disease of the knee. Both groups of patients were comparable in terms of basic demographic parameters, disease duration and body mass index. Results: In the SG, oedema and skin trophic changes of the lower limbs (lipodermatosclerosis, eczema) were observed in 39 and 21 cases, respectively. The number amounts to 68.2%, which was 33.4% more compared to the percentage of the CG cases (34.8%, n=32). In the presence of KOA, a varicose transformation of both saphenous veins and their tributaries was more often noted in 36 (40.9%) cases, whereas in CG patients, VVs development occurred only in 6 (6.5%) cases. On the contrary, an isolated varicose transformation of the great saphenous vein (GSV) and its tributaries was more common among CG compared to SG patients, at 93.5% and 55.7%, respectively. Among the examined cohort, the incidence of isolated disease of the small saphenous vein (SSV) and insufficiency of its ostial valve had no significant difference between SG and CG patients and occurred in 3.4% and 6.5% of cases, respectively. In SG patients, concurrent incompetence of the ostial valves of the GSV and SSV (n=39; 44.3%) and insufficiency of leg perforating veins (n=60; 68.2%) were more often noted. In the CG, perforator reflux and incompetence of the communicating veins were present only in 6 (6.5%) and 32 (34.8%) patients, respectively. The mean GSV ostial diameter in SG and CG patients was significantly different and amounted to 12.1±1.4 mm and 8.2±0.9 mm, respectively. Varicose dilatation of the superficial veins of both lower extremities was most often noted in the SG than in CG, 90.9% and 39.1% of the patients, respectively. There was a direct correlation between the KOA stage and such factors as VVs class (r=0.58; p

Objective: To study the features of lipid peroxidation (LPO) and the antioxidant system (AOS) in blood in Takayasu arteritis (NF) with a predominant lesion of brachiocephalic vessels. Methods: Several markers of LPO (malondialdehyde – MDA), AOS (superoxide dismutase – SOD, ascorbic acid – AA) and inflammation (sialic acid – SA) were studied in 16 patients with type I TA, where the inflammatory process was localized mainly in the aortic arch and its branches. Most commonly TA was observed among females (n=14; 87.5%), the average age of patients was 20.8±0.8 years. The study of the above markers was carried out in two stages: upon admission of patients in the stage of exacerbation of inflammation and after targeted anti-inflammatory, immunomodulatory and antioxidant therapy – in the stage of remission of the inflammatory process. Results: The study of LPO and AOS showed that in all patients, upon admission, there was a considerable oxidant-antioxidant imbalance due to an acute inflammatory process. MDA was increased by 2.6 times constituting 3.9±0.1 μmol/l. After pathogenetically targeted therapy, its significant decrease to 2.9±0.1 μmol/l (р˂0.001) was achieved. Activation of LPO was paralleled with a significant decrease of the body's AOS markers. The activity of SOD and concentration of AA during acute inflammatory process was reduced by 1.4 and 1.3 times, and amounted to 13.3±0.1 c.u./l and 57.8±0.3 μmol/l, respectively. After pulse therapy these indicators showed a significant increase compared with the initial data: up to 15.9±0.2 c.u./l and 63.9±0.4 μmol/l, respectively. The content of SA, which is one of the important components of cell membrane glycoproteins and glycolipids, was increased by 2.3 times (6.1±0.1 mmol/l), while after treatment it significantly decreased to 3.4±0.1 mmol/l (p˂0.001). Gender and age did not affect the dynamics of the specified markers, except for SA, which showed higher values in women (p

Objective: Experimental and histological justification of the use of perhydrol to treat the residual cavity (RC) and recurrence prevention after hydatid cystectomy for hepatic echinococcosis (HE) Methods: The results of surgical treatment of 85 patients with HE were evaluated between 2010 and 2019. In all patients after hydatid cystectomy, RCs were treated with 33% perhydrol. The scolicidal activity of 33% perhydrol was tested in vitro when the latter acted on protoscoleces obtained during the operation. In addition, a histological examination of the fibrous capsule (FC) was performed before and after RC treatment with a perhydrol solution. Results: Following exposure to perhydrol, the protoscolices lost their characteristic round or oval shape with the translucence of the parenchymatous tissue and the disappearance of the calcareous corpuscles. Following 1-minute exposure to a perhydrol solution, scolex swelling was observed, followed by a decrease in size due to the "boiling" of the released gas bubbles, as a result of perhydrol decomposition to oxygen and water with release of heat. Following 1.5-minutes of exposure to perhydrol solution, significant destructive changes were observed: delamination and tegument integrity loss, free hooklets, protoscolices dissolution, which indicated the parasite's death. On RC histological tissue preparations, stratification and destruction of FC were noted. In the long-term follow-up period for operated patients, there were no cases of HE recurrence. Conclusion: In vitro studies have shown that the treatment of protoscoleces with perhydrol solution leads to destruction followed by dissolution of the germinal layer. The perhydrol penetration into the FC walls resulting in its stratification and destruction contributes to the disease recurrence prevention.

Immediacy of the problem of acute adhesive small bowel obstruction (AASBO) is due to its high prevalence and presence of certain difficulties in diagnosis, which affect the choice of the treatment method. In addition, the long-term results of treatment cannot be considered satisfactory due to the large number of AASBO recurrences. In 64-93% of cases, adhesions form on the abdominal organs after surgery. It should be noted that their recurrence after open surgery reaches 30% of cases, and after repeated operations this value increases to 78%. Determination of the main etiological factor is of great importance, which makes it possible to assess the feasibility surgery, since it is known that if adhesions do not develop, treatment can be conservative. In this regard, X-ray methods of investigation can be of great help. Surgical intervention is recommended in the presence of intestinal dysfunction symptoms that do not disappear after conservative treatment or when it worsens. Surgical intervention is recommended if symptoms of intestinal dysfunction do not disappear after conservative treatment or if they deteriorate. n recent decades, specialists in the field of abdominal surgery have been striving to expand the indications for laparoscopic interventions in order to reduce the invasiveness of surgery, which will also decrease the risk of adhesions.

Nowadays, telemedicine services are widely used throughout the world. Various types of telemedicine services, such as the storage and transmission of real-time information, remote monitoring or self-control can be applied in the fields of education, health and management, disease screening and disaster risk management worldwide. Telemedicine can play a big role in conducting medical research, as well as in the field of training scientific personnel, allowing remotely collaborate with scientific and clinical institutions and gain access to expensive remote equipment. In this context, it is considered appropriate to develop and apply such innovative ideas as online computing models in telehealth applications; simplified software and hardware interfaces, programs for modelling; portable telepresence systems; artificial intelligence applications that are especially relevant in cases where simulated patients cannot replace real ones; and development of a large number of application simulators.

Objective: To study the sepsis markers informativeness to assess the role of monocytes in the pathogenesis of generalized peritonitis (GP). Methods: The study included 160 patients with GP, who were divided into 3 groups, according to the stages of the disease. To establish the activity of monocytes was made a determination of the level of cytokine TNF-α and presepsin in the blood. Results: Studies showed that the level of TNF-α in patient with septic shock was reliably lower (24.5±13.3 pg/ml) than in patients with endogenous intoxication and abdominal sepsis. The value of TNF-α in deceased patients also was low – 4.8±0.9 pg/ml. This indicates a decrease in the ability of monocytes in GP at the stage of septic shock to exude a sufficient amount of pro-inflammatory cytokines in response to endotoxin aggression. The level of presepsin increased by stages and amounted to 355.6±8.6, 783.4±24.0 and 1587.7±70.5 pg/ml, respectively. This indicates the circulation in the blood of the CD14 receptor, which is able to express on monocytes, converting them into endothelial progenitor cells. Conclusion: Monocytes as endothelial progenitor cells contribute to the regeneration and restoration of endothelial function in its dysfunction that develops in GP and abdominal sepsis. In consequence of developing immunosuppression and suppression of monocyte function in the stage of septic shock, the process of renewal of endothelial cells is weakened, the secretion of pro-inflammatory cytokines, in particular TNF-α, decreases, which can contribute to an increase in mortality in septic shock.

Objective: To assess the predictable role of inflammatory biomarkers in determining the stage of generalized peritonitis. Methods: The study included 160 patients with generalized peritonitis. All patients were assigned to three groups depending on the stages of the peritonitis. Once, on the first day after the patient’s admission to the hospital, investigated the concentration of the main inflammation markers in the blood serum. Results: The maximum levels of biomarkers were found in patients with septic shock (group 3). The lowest average value and minimum concentration were detected in patients with generalized peritonitis in the endogenous intoxication stage. The presepsin test has a high degree of sensitivity (96.2%) and acceptable specificity (90.9%). The test for procalcitonin showed less sensitivity and specificity – 91.9 and 87.9%, respectively. The values of sensitivity and specificity of C-reactive protein and interleukin-6 in our study are slightly lower: 90%, 81.9%, and 90.9%, 84.8%, respectively. A strong correlation between biomarkers and the stage of the disease is noted. In this case, the strongest relationship was found in prespepsin (r=0.9194). Conclusion: A reliable relationship between the severity of the extent of peritonitis and the level of presepsin in the blood was found, which allows for effective use of its value in the diagnosis of abdominal sepsis. The use of the complex of biomarkers has a higher value. The results we have obtained indicate the prospect character of using the presepsin test in combination with other markers of inflammation in surgical practice.

The article provides an overview of literature on the surgical treatment of postoperative ventral hernias (POVH), development trends and controversial questions of the problem. Today, according to many researchers, the frequency of POVH is up to 20-26% of the total number of external hernias of the abdomen, which give way to the primacy only to groin hernias. The recurrence rates of POVH remain high, reaching between 4.5-90% after the use of autoplasty methods and 3-19.5% after alloplasty methods. Incomplete satisfaction with the results of surgical treatment of POVH has helped to find new ways of hernioplasty using prosthetics, which allows increase the effectiveness of surgical treatment and reduces the incidence of complications. Increased intraabdominal pressure is the most common etiological factor in the development of purulent-inflammatory complications, leads to relapse, and increases the numbers of fatalities among patients with large POVH. The great interests among abdominal surgeons are issues of improving the quality of hernioplasty using prosthetic materials and methods of prevention of development inflammatory complications in the area of surgical wound.

Objective: To determine the role of laboratory parameters for the study of early diagnosis of liver echinococcosis (LE) complications. Methods: Carried out the results of a study of 147 patients with complicated LE – suppuration of echinococcal cysts (n=50) and mechanical jaundice (n=97). As a result of a general blood analysis for diagnosing complications of LE were studied biochemical analyzes and indicators of endogenous intoxication. Results: The results of the study showed that in patients with complicated LE – suppuration and mechanical jaundice, noticed an increase content of leukocytes in 67.3%, of eosinophils in 42.9% and accelerated ESR in 57.8% of cases. The leukocyte intoxication index (LII) in patients with suppurative echinococcal liver cysts was 4.3±0.06 units. In patients with mechanical jaundice, an increase in the activity of ASAT and ALAT was observed up to 52.4±0.07 and 64.3±0.05 IU/L, respectively. In addition, patients showed an increase in the level of urea (7.8±0.05 mmol/L) and creatinine (128.4±0.04 μmol/L). In severe cases of jaundice indicators of bilirubin exceeded 190 μmol/L, diene conjugates increased to 1.86±0.074 nmol/L, malondialdehyde to 8.15±0.4 μmol/L, and medium mass molecules to 0.5±0.04 c.u./L, procalcitonin – up to 5.6±0.04 ng/mL, C-reactive protein – up to 175.3±9.8 mg/L. Conclusion: Some indicators of the general and biochemical analysis of blood, as well as indicators of endogenous intoxication, can be very informative for the early diagnosis of complications of liver echinococcosis and determine the functional state of the liver. Laboratory indicators of functional state of the liver and the common state of the patients helps to choose the most rational surgery tactics, and thereby reduce the percentage of postoperative complications and mortality among these severe categories of patients.

The review article highlights the modern classification of acute pancreatitis, indications for the surgical treatment of severe, first of all, infected pancreonecrosis, development and the contentious issues of this problem. As you know, all surgical interventions in pancreonecrosis are divided into two types: radical and organ-preserving. This article examines the results of both methods with an analysis of the frequency of postoperative complications after each. In addition, two different methods of operations, «closed» and «open» – were evaluated to drain extraperitoneal space, taking into account the area of the necrotic process. Described the prospect of using Embryonal Natural Orifice Transluminal Endoscopic Surgery (ENOTES) in the treatment of severe acute pancreatitis, complicated by abdominal compartment syndrome. The frequency of intraoperative and early complications of «closed» and «open» interventions in severe acute pancreatitis, their recognition, prevention, and the choice is considered a method of surgical or conservative treatment.

Objective: Improve the surgical results of interventions for intervertebral hernias using modern technology Methods: The results of endoscopic surgeries performed by 82 patients were analyzed. All patients studied the clinical and neurological status before and after surgery, as well as CT and MRI. The results of the treatment were assessed by the MacNab scale, the severity of the pain syndrome – by the pain audit scale, and the parameter “quality of life” – by the questionnaire SF36 and the duration of the patient’s temporary disability Results: Assessment of remote postoperative MacNab scores was performed 6 months after surgery. At the same time, 69 (84.1%) patients had an excellent result. In 8 (9.8%) cases, a good result was observed (at the time of discharge, there was a significant decrease in pain syndrome); in 3 (3.7%) cases the result was satisfactory, and in 2 (2.4%) observations there was an unsatisfactory result. At the same time, there was no need to perform reoperation interventions on acute spine pains with the redevelopment of intervertebral hernia. Long-term results of surgical endoscopic interventions in 98.8% of observations showed great efficiency and small injuries. Conclusion: Endoscopic treatment of intervertebral disc hernia in comparison with the traditional open method helps to reduce the time of the operation and the terms of stay of the patient in a hospital and also more acceptable with the cosmetic point of view

In the given literary review are discussed the actual problems of diagnosis and treatment of the syndrome of enteral insufficiency, occurs against the background of acute pancreatitis. In patients suffering from acute pancreatitis, up to 80% of cases, enteral insufficiency syndrome (EIS) occurs, aggravating the processes of endotoxicosis. To date, the timely detection of EIS through the use of modern methods of research of detecting disorders is still considered to be influencing disorders of intestinal function. For full diagnosis of EIS are modern laboratory and instrumental studies, such as radiographic, ultrasound, electrogastroenterography, and also the bacteriological research of feces. Prokinetics (ganaton, metoclopramide derivatives, etc.), early intestinal lavage, and cleansing enemas are more often used to stimulate the intestine. It is considered that such a combined application of treatment methods has a great effect against enteroparesis which contributes to the consolation of the results of the EIS in acute pancreatitis. It should be noted that recently a great interest in scientists cause the issues of early enteral probe feeding. It was determined that the best results were the treatment of patients with the use of enteral probe feeding in combination with selective decontamination of the gastrointestinal tract. Thus, therapeutic measures for EIS are aimed at resolving enteroparesis. However, these therapeutic measures need further research as well as aspects of preventing the development of functional bowel disorders.

Objective: The study of the waterway transmission as dominant, with the spread of intestinal infections. Methods: A retrospective analysis of the journals for the registration of infectious diseases, maps of epidemiological checkups of typhoid foci, dysentery, diarrheal diseases, infectious hepatitis A (HAV) for 1980-2015, as well as reports of the Republican and regional CSSES (Center for State Sanitary and Epidemiological Surveillance) on infectious diseases were carried out. Results: The dominance of the water factor under conditions of the specific weight of Flexner shigellosis during the period of under study ranged between 75-85%. Compared with typhoid fever and bacterial dysentery, the incidence of diarrhoea in the country during the analyzed period remains at a high enough level – from 629.0 to 1206.3, and in 2015, it rose sharply and reached 2150 per 100 thousand. The indicators for the Regions of Republican Subordination, Gorno-Badakhshan Autonomous Region and Khatlon Region varied the broad mass of the population. The performed complex of sanitary-epidemiological evaluation paths and transmission factors identified the dominant value of an aqueous (90%) and a minor role contact-domestic (6.2%) and food (3.8%) of acute intestinal infections transmission routes among the population. Conclusion: Typhoid fever, acute intestinal infections, dysentery, hepatitis A in the Republic of Tajikistan are a typical aquatic infection associated with the constant activity of the waterway transmission, which often causes large epidemic outbreaks.

Objective: Conduct an analysis of the clinical-epidemic process of HIV infection amongst the population and convicted individuals, and the development of the preventive measures to persons in the risk groups. Methods: 3000 maps of epidemiological survey of the nidus of HIV-infection viruses among the population were analyzed, including 500 maps of the epidemiological survey amongst convicted for 2007-2012 periods, and 1 342 043 of express-testing of HIV-infection among the population, including 37 417 amongst convicted were conducted. As a result, 752 HIV-positive people were identified, of whom 356 were among those convicted. Results: The epidemic mostly affected people aged 20-39 (83%) of the total number of HIV-infected people registered in 2012 among the civilian population. As of July 1, 2008, the share of the sexually transmitted diseases, according to registration, accounted for 25.1% of cases, in 2012 – 30.1 %, in 2016 – 42.4%. In penitentiary institutions, among injected prisoners in 2012 was 92.3%, and the sexual way – 7.0%, and in 2016 – 91.2% and 7.5% respectively. Conclusion: Comparison data on the incidence of HIV infection among the population of the Republic of Tajikistan with registered data amongst convicted established essential distinctions. Counteraction is the priority of the HIV/AIDS agents and methods of non-specific prevention. Providing the risk group with information on the character of the behavior associated with HIV transmission, its change over time in certain areas improves the prognosis of the spread of HIV infection and allows analyzing the effectiveness of preventive and anti-epidemic measures.