Euroasian Health Journal

Currently, a new field of medicine – palliative care – is rapidly developing worldwide. The World Health Organization recommends that governments of all countries ensure palliative care is accessible to every child with a severe, incurable illness. The aim of this article is to propose directions for the development of pediatric palliative care in the Kyrgyz Republic based on a review of existing global practices and the current situation in the country. Materials and Methods. Literature review of scientific publications for the last 30 years in PubMed, as well as on the websites of leading international and national organisations (World Health Organization, European Association for Palliative Care, etc.), regulatory framework of the Kyrgyz Republic was conducted. It has been shown that there is no national-level system for providing pediatric palliative care in the Kyrgyz Republic. However, all the necessary conditions for its establishment and rapid development exist. Prospective directions for ensuring the right of terminally ill children and their families to access pediatric palliative care at the national level have been proposed. These include the development of a long-term state policy for the phased introduction of inpatient and outpatient services, the creation of a continuous medical education system for healthcare workers, and the establishment of a registry of children in need of palliative care to assess their needs and facilitate financial and economic planning for comprehensive multidisciplinary support.

Iron deficiency anaemia is a global public health problem, particularly affecting pregnant women. The association between anaemia and poor maternal, fetal and neonatal outcomes is now well established. Anemia is increasingly recognized as a potentially modifiable risk factor for postpartum haemorrhage, a leading cause of maternal morbidity and mortality. Adverse fetal and neonatal outcomes include preterm birth, growth restriction and increased mortality. Maternal iron deficiency may also be associated with neurocognitive impairment in infants. Iron requirements increase during pregnancy and are influenced by hepcidin, a master regulator of iron homeostasis. Recent advances in our understanding of systemic and placental iron homeostasis may improve therapeutic efficacy by altering the dose and frequency of oral iron supplementation. Future studies should be adequately powered to assess patient-centred outcomes and cost- effectiveness in pregnant women.

The aim of the study: was to investigate the distribution of the concentration of highly sensitive troponin I (hsTnI) in a representative sample of residents of the Chui region of the Kyrgyz Republic, taking into account gender and age.
Material and methods. The material was a representative sample of the population aged 18-65 years in the Kyrgyz Republic (n = 1276, including 529 men and 747 women). An analysis of the distribution of hsTnI levels in the population was carried out taking into account gender and age. The level of hsTnI in blood serum samples was measured by immunochemiluminescent assay with microparticles, using Architect Stat High Sensitive Troponin I reagents (Abbott, USA) on an automated analyzer Architect i2000SR (Abbott, USA). The level of statistical significance was taken to be 0.05.
Results. The median hsTnI concentration in the sample was 1.2 pg/ml, the interquartile range was (0.6; 2.0) pg/ml. The 99th percentile was 19.7 pg/ml. hsTnI levels were significantly higher in men -1.5 (0.8; 2.3) pg/ml, than in women - 1.0 (0.4; 1.8) pg/ml, (p = 0.009). The relationship between hsTnI concentration and age was characteristic of both men (r = 0.13; p = 0.002) and women (r = 0.16; p<0.001). Despite the lower initial values of hsTnI concentration, the rate of its increase with age was higher in women. A detailed comparative analysis of the dynamics of hsTnI concentration in different age groups in men and women was carried out.
Conclusion. The revealed gender differences in the distribution of hsTnI concentration and its age dynamics must be taken into account when determining the threshold levels of this biomarker. 

Cardiovascular diseases are the leading cause of death in the world. Moreover, mortality from them increases annually, and the main portion is caused by atherosclerotic disease. The high prevalence of heart disease in the world is due to the presence of a number of risk factors in patients. In addition to well-known diseases such as high blood pressure, diabetes mellitus, smoking, physical inactivity, and obesity, hyperlipidemia also plays an important role in the development of atherosclerotic disease. Thus, people with elevated levels of low-density lipoprotein cholesterol have a 2-fold higher risk of developing atherosclerotic disease than people with normal levels. Therefore, as preventive measures in the fight against this disease, it is necessary to control not only such diseases as overweight, smoking, alcohol, physical inactivity, hyperglycemia, high blood pressure, but also hypercholesterolemia. As drugs aimed at preventing the development of atherosclerotic disease and related complications, statins are the most studied drugs used in primary and secondary prevention. However, when using statins, approximately 1/3 of patients reach the target cholesterol level. In addition, sometimes side effects may develop (although very rarely), including myopathy and rhabdomyolysis, new cases of diabetes. To increase the frequency of reaching the target level of cholesterol and reduce the risk of side effects, it is recommended to use a combination of lipid-lowering drugs with a synergistic mechanism of action, and prescribe them in the one tablet. Such a combination is statin + ezetimibe, a drug that prevents the reabsorption of cholesterol in the intestine. Rosuvastatin, which has the highest lipid-lowering effect, is recommended as a statin. The combination of rosuvastatin+ezetimibe has shown an advantage over statin monotherapy in terms of lowering low-density lipoprotein cholesterol cholesterol and reducing the development of side effects. 

Aplastic anemia is a rare, life-threatening, and heterogeneous bone marrow blood disorder characterized by peripheral pancytopenia and bone marrow hypocellularity. It results in peripheral cytopenia with trilineage aplasia of the bone marrow. Anemia, bleeding, infection, and several other clinical symptoms are usually the first manifestations of aplastic anemia. In most cases, aplastic anemia is caused by autoimmune mechanisms that target progenitor stem cells, resulting in pancytopenia. Bone marrow transplantation is the definitive treatment for severe aplastic anemia; however, failing this option, combination immunosuppressive therapy with antithymocyte globulin and cyclosporine A is used as first-line therapy. Below, we present a case report highlighting the possible delay in response to an antithymocyte globulin protocol in the treatment of severe aplastic anemia. Regarding antithymocyte globulin, it can have various effects on the immune system, including depletion of T cells in the blood and peripheral tissues, and possibly a direct effect on hematopoietic stem cells.

The etiological and clinical-epidemiological features of foot mycoses and onychomycosis in outpatients were studied. In total, there were 326 patients with onychomycosis and mycosis of the feet treated in the clinic of the RCDV and the Family medicine centersin Bishkek. There were 140 men (42.9%), women – 186 (57.1%). KOH microscopy and culture studies on highly selective Sabouraud media were used for diagnosis. Mycosis of the feet and onychomycosis in almost all cases are caused by dermatomycetes - Tr. rubrum and Tr. mentagrophytes var. interdigitale (93.6%). Tr. rubrum as a monoinfection prevailed 7.8 times over Tr. mentagrophytes var. interdigitale (75.3% vs. 9.7%); combined lesion of Tr. rubrum with mold fungi was registered in 5.3%, with fungi of the genus Candida in 3.1%. Mixed infection Tr. mentagrophytes var. interdigitale + molds in 1.8%. Mold onychomycosis in the form of a monoinfection – in 3.5%, candidiasis of the nails – in 1.3% of patients. Women outnumbered men by 1.3 times (57% and 43%, respectively). Onychomycosis was 1.6 times more common among employees compared to pensioners (43% versus 27.6%). Concomitant diseases were common (66.3%), with the predominant pathology of the gastrointestinal tract and cardiovascular system, angiopathy of various origins. The distal-lateral form of onychomycosis was registered in 53.9%, total-dystrophic – in 31.9% of patients. Skin lesions on the feet were noted in all patients with onychomycosis, with squamous (48.2%), squamous- hyperkeratotic (21.2%) and hidden (14.4%) forms of mycosis prevailing.

Arterial stiffness measurements are currently used more for research purposes than in clinical practice. Increased arterial stiffness values provide direct evidence of target organ damage, with pulse wave velocity considered a biomarker of vascular injury and an important predictor of a patient's global cardiovascular risk, given that classical risk scores, mainly at intermediate risk, are poorly suited to predict cardiovascular outcomes. Traditional risk prediction models such as the Framingham risk score are commonly used to calculate individual risk for primary prevention of cardiovascular disease, but this assessment has limitations such as reduced accuracy in some ethnic groups and lack of inclusion of certain risk factors. Adding arterial stiffness parameters and pulse wave reflection metrics to classical cardiovascular risk stratification may move individuals into a higher risk category, implying changes in treatment aimed at higher cardiovascular protection. The review article presents data on the relationship between cardiovascular risk factors and arterial
stiffness indices and reflected wave parameters.

Increased arterial stiffness and reflected wave parameters are independent risk factors not only for cardiovascular disease but also for the progression of organ damage. Age-related changes and gender of the subjects are among the sources explaining individual differences in arterial stiffness. Increased arterial stiffness is the main cause of increased systolic and pulse blood pressure, as well as decreased diastolic blood pressure with aging. Higher arterial stiffness in women with underlying cardiovascular disease persists even after adjustment for age, body mass index, mean arterial pressure, and heart rate. Given that gender differences play an important role in cardiovascular physiology, including arterial stiffness as an additional variable in diagnostics can serve as a biomarker for monitoring cardiovascular health. This review article presents data from scientific studies devoted to the study of age- and gender-related differences in arterial vascular stiffness and reflected wave parameters.

Anogenital warts are one of the most common infections affecting people of all ages and genders. This disease can lead to serious consequences, including the development of cancer. The purpose of the work is to conduct a literature review on the topic of anogenital warts. Most anogenital warts are caused by human papillomavirus types 6 and 11. Human papillomaviruses are extremely common in nature and the human population, and over time, the issues of therapy for anogenital viral warts caused by papillomaviruses become more and more relevant. In this paper, an analysis of modern scientific articles that describe various aspects of this disease was carried out. Issues such as the causes of anogenital warts, methods of diagnosis and treatment, as well as the prevention and control of the spread of this disease were considered. The results obtained allow us to conclude that anogenital warts are a serious problem for public health and require serious attention from medical science and practice. In conclusion, this work is a useful literature review that can be used as input for further research in the field of anogenital warts, as well as in the development of methods for the prevention and treatment of this disease.

Currently, the mining industry in Kyrgyzstan is reviving and developing. Mainly gold deposits are being developed. Therefore, the problem of silicosis is becoming particularly relevant again.
The purpose: to study the forms of silicosis in the gold mining industry.
Materials and methotds: the article presents an analysis of the results of clinical and radiological examination of 35 patients with silicosis who worked in underground conditions.
The results obtained: the patients were examined in the department of the National Hospital, because changes in the lungs were found during periodic medical examination. The occupational history of all workers was analyzed, as well as a document including the results of hygienic measurements taken at the workplace, conducted by specialists of the Territorial Department of Sanitary and Epidemiological Supervision. The assessment of the clinical presentation of the individuals was carried out. Radiographic abnormalities in the chest provoked by the inhalation of dusts have been studied. Changes in the blood were also analyzed. The study conducted has shown the prevalence of progressive, complicated forms of silicosis in gold mine workers at the present time in Kyrgyzstan.
Conclusion: based on the analysis, the necessity of developing hygienic and medical measures to prevent the development of this disease is justified.

Cardiovascular diseases impose a significant burden on society, including in older adults, in terms of mortality, morbidity, disability, functional decline, and health care costs. In addition, due to the growing elderly population, there is a growing need to improve their health and quality of life, as well as to promote optimal medication use. Increasing age is associated with higher rates of comorbidities, disability (cognitive, intellectual, and functional impairment), and the use of multiple medications. Age-associated changes affect cardiac performance by reducing cardiac elasticity and responsiveness to pressure changes. Involutional changes lead to multiple structural and functional changes in the cardiovascular system that may increase the susceptibility of aging individuals to the development of cardiovascular diseases, which represent the most common pathological conditions in older adults. Pharmacotherapy of cardiovascular diseases in the elderly is complex because age-related changes in body composition, organ function, homeostatic mechanisms, and comorbidities alter the pharmacokinetic and pharmacodynamic properties of many commonly used cardiovascular and non-cardiovascular drugs. Due to multiple chronic diseases and age-related physiological changes that affect the pharmacodynamic and pharmacokinetic properties of drugs, it can be concluded that the prescription of pharmacotherapy in the elderly is a complex and challenging task of the geriatric approach. Polypharmacy, non-adherence, inappropriate prescription of drugs, drug interactions, and drug-related problems are common in elderly patients with cardiovascular diseases. In this regard, the risk of adverse drug reactions is higher in elderly patients. The review article is devoted to the possibilities of prescribing cardiovascular drugs in elderly people, taking into account involutional changes in the body, polypharmacy, as well as problems associated with taking medications. 

The analysis of the results of surgical treatment in 157 patients with liver echinococcosis who were hospitalized in surgical departments of Bishkek City Hospital No. 1 is presented. All patients with liver echinococcosis were divided into 2 groups depending on the nature of the performed operations: main and comparative (control). In the comparative group (94 patients) capitonage according to Delba and invagination of the fibrous capsule were used to eliminate the residual cavity. The second group included 63 patients who underwent abdominization of the fibrous capsule cavity and percystectomy with continuous “P” shaped sutures. During surgical treatment, the number of postoperative complications in the compared groups showed that postoperative complications in the comparison group were observed more than in the main group (29.8% vs. 15.8%, P˂0.001). Recurrence of hydatidosis in distant terms after the operation from 6 months to 5 years was revealed in 3 (3,2%) patients in the first group, and in the second group in 1 (1,6%), which managed to reduce the recurrence of the disease in 2 times (P˂0,001).
Thus, the use of the technique of liquidation of the residual cavity of the fibrous capsule developed by us allows to improve the results of surgical treatment of patients with hepatic echinococcosis.

The article is devoted to the classification of adhesions and diagnostics of acute intestinal obstruction. The main classification of adhesions in surgery is the Zühlke scale, which evaluates adhesions by their morphological features and strength, although it does not reflect the extent of the process. For standardization, a universal system is proposed that allows determining the peritoneal adhesion index, which helps to objectively describe the intra-abdominal condition. Radiographic methods are traditionally used in the diagnostics of acute intestinal obstruction, but their information content is limited due to low sensitivity and specificity. More accurate methods, such as computed tomography and magnetic resonance imaging , have high diagnostic accuracy, but are associated with high cost, radiation exposure and limited availability. Ultrasound examination is becoming increasingly popular due to its high sensitivity (69–98%), non-invasiveness and lack of radiation exposure. This method allows to evaluate the condition of the intestine, identify dilated loops, determine the nature of peristalsis and diagnose complications such as ascites and thickening of the intestinal walls. However, ultrasound depends on the experience of the specialist and can be complicated by obesity or intestinal pneumatosis. Ultrasound is effective as a screening tool and dynamic monitoring of patients with acute intestinal obstruction, especially in conditions of limited access to computed tomography .

Goal. This retrospective study aimed to evaluate the efficacy and safety of three surgical interventions for spontaneous supratentorial intracerebral hemorrhage.
Materials and methods. A total of 63 patients with supratentorial intracerebral hemorrhage were randomly assigned to 3 groups. Group A (n = 21) underwent cranial trepanation, group B (n = 22) underwent perforation, urokinase infusion and catheter drainage, and group C (n = 20) underwent neuroendoscopic surgery. The rate of hematoma removal during surgery was analyzed using 3D Slice software, and the average surgery time, imaging during surgery, decompressive effect, mortality, improvement on the Glasgow Coma Scale, complications such as repeated bleeding, pneumonia, and intracranial infection were also compared between the three groups.
Results. All procedures were successfully completed, and the hematoma removal rate had significant differences between the 3 groups, which were 79.8%, 43.1%, and 89.3%, respectively (P<0.01), with group C being the highest. Group B was the least traumatic and had the shortest surgery time, but due to the lack of hemostasis, she also had more recurrent bleeding (P = 0.03). Despite the fact that the complications were different, there were no significant changes in terms of pneumonia, intracranial infection, improvement in general condition and mortality.
Conclusion. All of these three methods had their advantages and disadvantages, and each approach had its own indications for supratentorial intracerebral hemorrhage. Although due to the minimally invasive neuroendoscopic technique, direct view, effective hematoma removal rate, and relatively optimistic outcome, this approach may be more promising for the treatment of intracerebral hemorrhages.

The purpose of this study was to provide a comprehensive assessment of the reported results of facial nerve preservation after vestibular schwannoma surgery.
Materials and methods. Data on surgical access, tumor size, patient age, and use of intraoperative monitoring were extracted and correlated with facial nerve function after surgery. "Facial nerve preservation" was defined as grade I or II House-Brackman function at the last follow-up visit.
Results. Patients operated by access through the middle cranial fossa tended to have a higher overall level of facial nerve preservation (85%) compared with translabirint access (81%, p = 0.07) and statistically better than retrosigmoid access (78%, p < 0.0001). Patients with an average tumor size < 20 mm had significantly higher rates of facial nerve preservation compared with larger tumors (90% vs. 67%, p < 0.0001). In patients under the age of 65, facial nerve preservation was lower (71% vs. 84%, p < 0.001). Finally, the use of intraoperative monitoring improved the safety of the facial nerve (76% vs. 71%, p < 0.001).
Conclusion. Factors related to the preservation of the facial nerve after microsurgical resection of vestibular schwannoma included tumor size <20 mm, the use of access through the middle cranial fossa, and the use of neuromonitoring during surgery.

Chickenpox remains one of the most common childhood infections, often found in young children. The highest prevalence of chickenpox is observed in countries with low immunization coverage, including Kyrgyzstan. In children with a complicated background: early age, history of other herpes infections, HIV infection, cancer, taking immunosuppressive therapy; genetic characteristics of the body (neurological diseases in the family), as well as in the presence of a viral or bacterial infection simultaneously with chickenpox, there is a high risk of developing such a complication as chickenpox encephalitis. Encephalitis can contribute to the development of epilepsy and disability of the child. Despite the low incidence of chickenpox encephalitis, this complication continues to pose a threat to the health of children and adults, which makes it an important medical problem.
In this article, we present a clinical case of chickenpox complicated by varicella encephalitis in a 12-year-old child who was hospitalized in the specialized department of the Republican Clinical Infectious Diseases Hospital of Bishkek, where he received treatment for 10 days and was discharged with a recommendation for further observation by a neurologist.
In the patient we observed, chickenpox was severe with abundant rashes on the skin and mucous membranes, pronounced symptoms of intoxication and neurological symptoms (unstable in the Romberg pose, tremor of the limbs, scanned speech, unsteadiness of gait). It should be noted that in the presence of symptoms of encephalitis, the magnetic resonance imaging picture was without pathological changes, which is possibly due to early detection and seeking medical help (4th day of illness) and timely treatment.

The article is devoted to the study of the state of adaptive mechanisms of regulation of the cardiovascular system in schoolchildren with different levels of vegetative stability. To identify deviations in the work of regulatory systems, an assessment of the characteristics of physical development and heart rate variability in children was carried out. The study was conducted in a group of 60 schoolchildren aged 7-11 years. To determine the level of vegetative stability, an adapted Czech personal two-factor questionnaire by M. Gavlinova "Society - vegetatics" was used. The functional state of the regulatory systems was determined by conducting functional tests of the cardiovascular system and analyzing the variability of the heart rate using the method of R. M. Baevsky. An assessment was made of the heart rate, blood pressure, weight, height, and a mathematical calculation of the stress index, Kerdo, endurance coefficient, and adaptive potential. According to the results of the study, 50% of children had pronounced vegetative instability, with girls having it 23.6% higher than boys. Physical development indicators in 70-90% of children corresponded to the age norm. However, 20% of girls with vegetative instability had a lag in physical development, while in the group of children with vegetative stability, on the contrary, there was an advancement of physical development more in boys (21%) than in girls (16.7%). According to the parameters of heart rate variability, a normotonic type of regulation of the cardiovascular system was noted in 40-43% of cases. The stress index was in the satisfactory range in 50-60% of cases. Sympathicotonia and uncompensated distress were more often registered in children with vegetative stability, mainly in girls. According to the results of functional tests, detraining of the cardiovascular system was more than 80% of cases. The adaptive capabilities of the body are reduced in children with vegetative stability, more often in girls.

Osteoarthritis is the most widespread disease of the musculoskeletal system, which leads to disability of patients and the need for joint replacement. Until now, the problem of effective local therapy remains a difficult problem in the treatment of osteoarthritis. The purpose of this work was to study the effectiveness of various clinical algorithms for the use of a linear series of biopolymer microheterogenic collagen-containing hydrogel Sphero^®GEL in the treatment of various structural phenotypes of osteoarthritis in real clinical practice. The article presents data on the results of local therapy using bioimplant Sphero^®GEL in 937 patients with various structural phenotypes of osteoarthritis, the effectiveness of therapy was evaluated using standardized indices VAS, WOMAC (pain, stiffness, functionality). The dynamics of structural changes was assessed according to ultrasound examination data. The data obtained indicate the effectiveness and safety of bioimplant Sphero^®GEL in the treatment of various structural phenotypes of osteoarthritis.

This article is dedicated to the description of a clinical case of laparoscopic gastropancreatoduodenal resection for pancreatic head cancer. Pancreatic cancer is one of the most aggressive malignant neoplasms with an unfavorable prognosis. The article discusses the importance of early diagnosis of the disease, which is often detected at advanced stages, making it difficult to apply surgical treatment. The main method of treatment is surgical resection, but only a small portion of patients are candidates for surgery. The article also highlights the significance of minimally invasive methods, such as laparoscopy, in improving surgical outcomes, as this reduces the number of postoperative complications and accelerates patient recovery. In the presented clinical practice, laparoscopic gastropancreatoduodenal resection was performed on a 57-year-old patient with pancreatic head cancer, which became the first such intervention in the Kyrgyz Republic. The surgery was successful, and the patient was prescribed adjuvant chemotherapy. As a result of follow-up in 8 months, repeated examinations showed no signs of tumor progression. The article emphasizes the promising use of laparoscopic surgery in the treatment of pancreatic cancer and the need for further research in this field.

Noninvasive musculoskeletal bladder cancer remains one of the most common diseases in the structure of oncourological diseases, ranking 7th in the world. According to statistics, the number of detected cases is increasing every year. In 75% of cases, according to the literature, this is noninvasive muscular bladder cancer. Timely diagnosis makes it possible to avoid minimally invasive treatment methods, such as transurethral resection or planar resection with mandatory further adjuvant intravesical drug therapy. Currently, the following types are used: Mitomycin C, Doxorubicin, BCG therapy, the most effective of which is BCG therapy, followed by Mitomycin C and Doxorubicin. Also, some authors note the high effectiveness of intravesical chemotherapy in combination with local hyperthermia. Given the acute deficiency of BCG, Mitomycin C, the only available cytostatic agent is Doxorubicin. An alternative is to conduct intravesical chemotherapy with Cisplatin and Gemcitabine, which have long been used for invasive bladder cancer. However, further research is required to confirm the effectiveness of these drugs in non-invasive muscular bladder cancer. Thus, these medicines can serve as an alternative in an era of shortage of recommended drugs.

According to World Health Organization, about 26% of patients do not use complete removable dentures for one reason or another. The article presents results of analysis common mistakes in making complete removable dentures based on questionnaires orthopedic dentists and dental technicians in orthopedic departments of city dental clinics in Bishkek. 75 orthopedic dentists and 81 dental technicians were interviewed. The questionnaire included 8 questions for doctors and 14 questions for dental technicians. Unfortunately, the results of the survey revealed violations committed in the process of making complete removable dentures, both at the clinical and laboratory stages. Non-compliance following the algorithm of actions both doctors and dental technicians in the constructing dentures or ignoring instructions of using materials used in the making dentures leads to low-quality of them. Optimizing the technology of making complete removable dentures by eliminating mistakes at all clinical and technological stages will improve the quality of the dentures and its functional efficiency. Patients will quickly adapt to high-quality prostheses, which will minimize the reasons for refusing to use dentures.

Summary. In chronic periodontitis, the main etiological factors are microorganisms that are found
in plaque scrapings, where they are organized into a biofilm. Gram-negative periodontopathogens,
such as P. gingivalis, A. actinomycetemcomitans, T. denticola, P. intermedia, and T. forsythensis,
have endotoxins in their cell walls, which can cross-react with antigens of joint cartilage and cause
inflammation in the joint.
Pro-inflammatory cytokines: Interleukin-1β, Interleukin-6, Tumor Necrosis Factor alpha, found in periodontal pockets, play a key role in the pathogenesis of rheumatoid arthritis by inducing cellular infiltration of the synovium and an erosive process. To determine the etiological significance of obligate anaerobes, which play a key role in the development of chronic periodontitis and rheumatoid arthritis, molecular genetic methods, specifically real time PCR with the use of the "parodonto-screen" test system, were employed.

Cytokine content in gingival fluid was examined using an enzyme-linked immunosorbent assay (ELISA) with test systems from Vector-Best. PCR analysis showed that the pathological microbial colonization of the periodontium differs from the normal condition. In group 1, where chronic periodontitis and rheumatoid arthritis are present, the frequency of occurrence of pathogens was: P. gingivalis (78%), A. actinomycetemcomitans (58%), P. intermedia (60%), T. forsythensis (100%), T. denticola (75%), Candida albicans (34%). The levels of pro-inflammatory cytokines in group 1 (with periodontitis and rheumatoid arthritis) were as follows: Interleukin-1β 8.23 pg/ml, Interleukin-6 – 2.7 pg/ml, Tumor Necrosis Factor alpha – 4.43 pg/ml, Interleukin-6 in serum –6 pg/ml; while in group 2 (control group), the levels were: Interleukin-1β – 1.8 pg/ml, Interleukin-6 – 0.71 pg/ml, Tumor Necrosis Factor alpha – 1.1 pg/ml, Interleukin-6 in serum – 3 pg/ml. Detection of periodontopathogens and five types of pro- inflammatory cytokines in gingival fluid using real-time polymerase chain reaction Polymerase Chain Reaction and enzyme-linked immunosorbent assay (ELISA) allows for accurate diagnosis of chronic periodontitis and rheumatoid arthritis, which are etiopathogenetically interconnected.

Dental and dental arch prosthetics involve the presence of a foreign body in the oral cavity, which acts as an irritant for the periodontal tissues. The materials used for prosthetics behave differently when immersed in saliva. The connection between the biodegradation of prosthetic materials and the inflammation of periodontal tissues has been proven by many researchers. The release of organometallic compounds due to corrosion of metal alloys, with continuous contact with the mucous membranes of the oral cavity and the periodontium, may lead to an increase in their concentration in saliva and blood, potentially causing allergic reactions and negatively affecting local immunity. Materials prone to rapid degradation cause an inflammatory process with an acute course and affect nearly all stages of the inflammation process. Periodontitis caused by prosthetic constructions, by triggering immune disorders, may influence the concentration of immunoglobulins in mixed saliva.
The protective mechanisms at the level of the oral mucosa are achieved through the development of oral tolerance and the production of immunoglobulins capable of neutralizing the antigen. The concentration of immunoglobulins was determined in mixed saliva using a solid-phase enzyme immunoassay method. The research results indicate that in patients with chronic periodontitis, the concentration of immunoglobulins A and M decreases, which is associated with immune system insufficiency, as well as with their degradation by bacterial proteases or aggregation under conditions of increased exudate formation. The increased level of immunoglobulin G in patients with periodontitis compared to the control group is explained by the rise in the number of anti-inflammatory, antibacterial, and anti-collagen antibodies. 

Population aging due to declining fertility and mortality trends is a major concern worldwide, especially in developing countries. Due to increasing life expectancy, there is a marked increase in the proportion of elderly patients requiring dental care. Dental treatment should be adapted to the age-related changes in the oral mucosa and underlying systemic diseases. Dentists play a key role in the diagnosis of oral manifestations of systemic diseases in the elderly. This review examines the impact of aging on oral tissues and common oral and systemic diseases in geriatrics. The literature review was conducted both electronically and manually. Various scientific journals and web-based search engines were used for the electronic search. The search terms were geriatrics, oral manifestations, systemic diseases, elderly. Dental treatment of patients with systemic diseases such as hypertension, diabetes mellitus, cardiovascular diseases, and neurological disorders was also highlighted. Oral health problems in older adults should be treated with regular professional and personal care and an understanding of the changes that occur with age.

The article presents the incidence of type 1 diabetes mellitus in the context of regions of the Kyrgyz Republic over the past 20 years (2005-2024) according to the data of the State Reporting Form №12.
Comparative analysis showed that a high level of average long-term morbidity was detected in the Issyk-Kul region, amounting to 6 cases per 100,000 population (⁰/₀₀₀₀). The incidence rate was higher than the national average (4.2⁰/₀₀₀₀) in the cities of Osh (5.5⁰/₀₀₀₀), Bishkek (5.3⁰/₀₀₀₀) and Osh region
(4.8⁰/₀₀₀₀). In Chui, Batken, Talas and Jalal-Abad regions, the intensity of the epidemic process was lower than in the above regions (3,8-2.8⁰/₀₀₀₀). A relatively low indicator of the average long-term incidence was in the Naryn region (2.3⁰/₀₀₀₀).
An analysis of the dynamics of the incidence of type 1 diabetes mellitus in the context of regions over the past 20 years shows that in 2005-2006 in a number of regions there was an increase in the incidence (Issyk-Kul, Osh, Chui, Talas regions). In the period 2014-2016, almost all regions recorded rises of varying intensity. During the years of the beginning of the COVID-19 pandemic, an increase in the registration of cases was noted in all regions. In dynamics in recent years, a decrease in the incidence rate has been noted in the Osh, Chui, Batken regions, and an increase in Bishkek, Issyk- Kul, Talas and Naryn regions.

The article presents the results of the epidemiological analysis of the incidence of meningococcal infection in the age aspect in the regions of the Kyrgyz Republic for 2014-2024.
An analysis of the long-term dynamics of the incidence of meningococcal infection over the past 10 years showed that the highest levels were recorded in the period 2014-2016 and 2023. In the republic, during the years of the COVID-19 pandemic, the incidence of meningococcal infection was recorded only in Bishkek and Osh region. The cumulative country rate for the analyzed period was 38 cases per 100,000 population (0/0000); the most susceptible were children under 14 years of age (1600/0000), adolescents were twice as ill (76,50/0000); there was also involvement of persons over 18 years of age (23,10/0000). High morbidity was recorded in the cities of Bishkek (59,00/0000), Osh (38,20/0000) and Chui region (14,90/0000). In such regions as Talas (6,60/0000), Batken (6,50/0000), Naryn (6,30/0000) and Osh (5,80/0000) the initiation rate was almost at the same level. In Issyk-Kul (2,70/0000) and Jalal-Abad (2,70/0000) regions the intensive indicators were relatively low.
Thus, in the Kyrgyz Republic for 2014-2024, cyclical increases in meningococcal infection were observed in the period 2014-2016 and 2023, while the interepidemic period was 8 years. If we take into account the cyclical nature of the increase in meningococcal infection every 8-15 years, then the gradual increase in the incidence rate from 2022 may be the beginning of a new outbreak of meningococcal infection in the republic, which requires strengthening preventive and anti-epidemic measures in the country. The high incidence of the disease in large cities, with the highest incidence among children and adolescents, requires explanatory work with parents through the media to avoid mass events in closed spaces and to recommend vaccination at the expense of the population. 

Nutrition is a key factor in the health and well-being of children, affecting their growth and development. In modern conditions, many children face a deficiency of nutrients, which negatively affects their health. Objective: to provide a hygienic characteristic of the daily food set of school-age children and adolescents living in different regions of the Kyrgyz Republic.
Materials and methods. A study of the daily food set of 4877 schoolchildren aged 7 to 17 years living in different regions of the republic was conducted using hygienic, epidemiological and statistical methods.
Results. Data on food consumption by schoolchildren in different regions of the Kyrgyz Republic show that the consumption of animal products is significantly lower than the recommended norms, with pronounced regional differences. In particular, 52.3% of schoolchildren in the south and 50.4% of the northern regions have a deficiency in meat consumption, and 59.0% of children in the northern regions experience a deficiency of dairy products. In the food sets of schoolchildren, grain products accounted for 38.4% of the total diet. Gender differences in the consumption of the main food groups were established.
Conclusions. Analysis of the daily diet of schoolchildren revealed insufficient consumption of biologically valuable products, which indicates a quantitatively and qualitatively unbalanced diet.

With age, physiological needs of the human body change, especially in terms of nutrition. The growing proportion of elderly people in Kyrgyzstan's population highlights the need to study the specifics of their nutrition. Considering age-related changes in the body and current demographic trends, we aimed to provide a hygienic characterization of the daily diet of elderly individuals residing in a social care institution in Bishkek.
Materials and Methods. To assess the quality of nutrition among the elderly residing in the social institution, an analysis of their daily diet was conducted over the course of a year using hygienic, epidemiological, and statistical methods. A total of 120 menus (30 days in each season) were analyzed using the V.N. Kardashenko methodology.
Results. An analysis of the elderly's diet revealed significant discrepancies between the actual consumption of nutrients and recommended norms. A significant excess of carbohydrate consumption was observed due to bakery products, cereals, and sugar, which can lead to the development of obesity and diabetes. At the same time, there was a deficiency of protein, vitamins, and minerals necessary to maintain the health of the elderly.
Conclusions. The results obtained indicate the need to develop and implement comprehensive measures to improve the quality of nutrition for the elderly in social institutions. It is necessary to optimize the menu by increasing the proportion of vegetables, fruits, low-fat dairy products, and fish. It is also important to conduct regular monitoring of nutrition and carry out health education among the staff and residents of the institutions.

The article presents the age-specific incidence of pertussis in the regions of the KyrgyzRepublic for the period 2014-2024.
Three epidemic outbreaks of pertussis were recorded during the years analyzed (2015-2016, 2018-2019, and 2023-2024), with increasing outbreak intensity over time ((4,7⁰/₀₀₀₀ - 3,2⁰/₀₀₀₀, 9,6⁰/₀₀₀₀ - 6,8⁰/₀₀₀₀ and 27,4⁰/₀₀₀₀ - 46,7⁰/₀₀₀₀, respectively).
While during the first two episodes the epidemic situation differed in different oblasts (in some oblasts there was no registration of the disease, while in others there was an upsurge), in recent years there has been a widespread sharp increase in infection, due to the progressive disease of children and involvement of adolescents and adults. It should be noted that in recent years the incidence of children is progressively increasing in the northern regions of the country, while in Osh and Batken oblasts it is decreasing.
Bishkek city (413,5 per 100 000 population (⁰/₀₀₀₀)) and Chui oblast (207,0⁰/₀₀₀₀) had the highest cumulative incidence rates for 2014-2024. Talas (45,6⁰/₀₀₀₀), Issyk-Kul (28,9⁰/₀₀₀₀), and Naryn (19,4⁰/₀₀₀₀) oblasts occupied the middle of the ranked list, while the southern regions had relative epidemic well-being (Osh city – 10,8⁰/₀₀₀₀; Jalal-Abad – 7,7⁰/₀₀₀₀; Batken – 2,1⁰/₀₀₀₀; Osh oblast –1,3⁰/₀₀₀₀).

Every year, 15 million people worldwide suffer from stroke. Of these, 5 million die, and another 5 million remain disabled for life, which places a heavy burden on families and society. The purpose of the study is an epidemiological analysis of the morbidity and mortality from stroke in the Kyrgyz Republic.
Materials and methods. Statistical indicators for assessing the dynamics of morbidity (newly registered cases) and mortality from stroke for the period 2018-2022 in the republic were calculated according to the annual official statistical collections of morbidity and deaths from stroke.
Results. We have analyzed morbidity and mortality data separately for the administrative- territorial units of the republic for 5 years. The average annual morbidity and mortality rate in the regions of the country has significant differences in different years, while in many areas this indicator exceeds the national level. The diagnosis of "Unspecified strokes, such as hemorrhage or I64 infarction" has a fairly high level in all regions of the republic. A comparative analysis of morbidity and mortality statistics shows that stroke mortality rates significantly exceed morbidity rates both in the republic as a whole and in the regions.
Conclusions. A significant difference in mortality and morbidity rates by region, as well as their excess of national indicators, raises doubts about the reliability of statistical data. For an accurate analysis of the quality and planning of therapeutic and preventive measures for cerebrovascular diseases, it is necessary to streamline stroke statistics.