Vol. 4 No. 4 (2022): VESTNIK of KSMA

Abstract. To reduce the threat of antibiotic resistance, the World Health Organization (WHO) introduced the Access, Watch, Reserve (AWaRe) classification system in 2017, which is an important tool for collecting data on global consumption of antibiotics based on their resistance potential. The purpose is to conduct a comparative assessment of the use of antibiotics in the Kyrgyz Republic according to the AWaRe classification. Materials and research methods. To assess the use of antibiotics according to the AWaRe classification system, the WHO database for 2019 and the approved List of Essential Medicines of the Kyrgyz Republic (2018) were used, with an emphasis on physical availability in the pharmaceutical market and registration in the Kyrgyz Republic. Results. According to the AWaRe classification, the category of general access (Access) includes 48 antibiotics, 20 of which are included in the WHO List of Essential Medicines, while 18 are included in the List of Essential Medicines of the Kyrgyz Republic, while 16 antibiotics are registered in the country.Of the 110antibiotics in the Watch group, only 33 (30.3%) are registered in the Kyrgyz Republic, of which 11 comply with the WHO List of Essential Medicines. The List of Essential Medicines of the Kyrgyz Republic includes 18 antibiotics, but only 10 of them comply with the WHO List of Essential Medicines. The Reserve group includes 22 antibiotics, of which 7 are included in the WHO List of Essential Medicines. Only 3 antibiotics are registered in the Kyrgyz Republic, 1 is included in the "List of vital medicines of the Kyrgyz Republic". Discussion. The issues of rational use of antibacterial drugs are relevant at the cross-country level. Without changes in national policy, the WHO target of at least 60% of total antibiotic consumption in the access category by 2023 will not be met. Conclusions. The AWaRe system is an important indicator of efforts to combat antibiotic resistance and ensure equal access to effective antibiotics across countries. In the Kyrgyz Republic, in the context of a global increase in antibiotic resistance, it is necessary to introduce the AWaRe system to determine the purchase and use of antibacterial drugs. Revision of the List of Essential Medicines and registration of antibacterial drugs in the Kyrgyz Republic should be carried out on the basis of the AWaRe (WHO) classification. 

Abstract. Improving the quality of antibiotic use in hospitals is one of the main goals of the World Health Organization (WHO) global action plan to combat antibiotic resistance. Drug use analysis provides insight into clinical use, comparisons across countries, regions and health system settings, and changes in drug use over time. The purpose: was to analyze the consumption of antibiotics using DDD analysis in a multidisciplinary hospital in Bishkek, the Kyrgyz Republic for the period 2016-2019. Materials and research methods. To assess the level of consumption of antibiotics, the WHO-recommended system of “conditional daily doses” (Defined Daily Dose, DDDs) and DDDs per 100 bed-days (DDDh) were used. Results. Consumption and purchases are 8 groups of antibiotics - penicillins, cephalosporins, macrolides, fluoroquinolones, nitroimidazoles, aminoglycosides, carbapenems and glycopeptides. Discussion. During the study period, there is a trend of increased consumption of cephalosporins I, IV generations, penicillins, fluoroquinolones, aminoglycosides, carbapenems and glycopeptides. There is a decrease in the consumption of cephalosporins II, III generations, macrolides, aminoglycosides, nitroimidazoles. The use of the lincosamide group, nitrofurantoin, tetracyclines were limited only in 2017 or 2018. Conclusions. The structure of consumption in a multidisciplinary hospital was dominated by IV generation cephalosporins, fluoroquinolones, carbapenems, glycopeptides, aminoglycosides (mainly amikacin), the widespread use of which can contribute to the formation of microorganisms with multiple resistance. In 2016-2019 there is a positive trend in the consumption of the group of penicillins, cephalosporins of the first generation, nitroimidazoles, nitrofurantoin. An increase in the consumption of levofloxacin by 5.6 times and moxifloxacin by 10 times requires an assessment of their rational use. Revealed positive changes in the consumption of macrolides, which have limited indications for use at the hospital stage.

Summary. The article presents the results of scientific research on the study of physical development, as the main indicator of the state of health, 8670 urban children and adolescents of school age (7-17 years old), living in high-mountainous regions- 5694 (Naryn city-altitude over 2500 m above sea level) and 2976 schoolchildren in the lowlands (Bishkek city -altitude less than 1500 m above sea level). Anthropometric indicators (by gender and age) of body length and weight, as well as the structure of general morbidity of schoolchildren’s of this regions were studied. Arithmetic mean indicators of length and body weight of schoolchildren in Bishkek are significantly higher in all age groups in comparison with schoolchildren in Naryn. The studied data of anthropometric indicators were used in the development of the Standards for the physical development of schoolchildren (7-17 years old) in the high-mountain region of the Kyrgyz Republic. Diseases of the respiratory organs (30.6%) and digestive organs (28.8%) occupy the leading place in the structure of morbidity in schoolchildren of low mountains, and diseases of the eyes and its appendages (24%) and respiratory organs (14%) in children of high mountains. 

Summary. Disinfection and elimination of anthrax soil foci that interfere with the long-term development of the state is one of the urgent problems for many countries of the world. In the course of the work, experimental studies were carried out on the possibility of disinfection of the surface and deep layers of animal burial grounds using the method of drilling and moistening the soil with a solution. For the study, three experimental sites were prepared, measuring 1.0 x 1.0 m, on which the cultivated soil was naturally occurring of a gray-earth type. Each test site included 4 pits at a distance of 1.0 m, 80.0 cm and 50.0 cm from each other, respectively. After filling the wells and completely moistening the surface, a plastic film was additionally placed on top of each pad to prevent liquid evaporation. To control the moistening of the entire volume of soil for 3 days, control drilling of control wells was carried out daily at each experimental site: in the center between four pits; between two adjacent wells; and also away from the extreme pit at various distances. Experiments have shown that for complete tillage, i.e. for the entire depth of the soil hearth, the most optimal distance between the pits is 50 cm. At the same time, the volume of solution required to fill one well is from 35.0 to 38.0 liters of solution, with a hole diameter of 15 cm and a drilling depth of 3.0 m. In addition, for a complete one-time moistening of the surface of the treated area, the size of 1.0 x 1.0 m requires from 35.0 to 37.0 liters of solution. In general, for complete and high-quality humidification, it is necessary to fill each pit three times with an interval of 24 hours and also moisten the surface of the entire experimental site three times.

Summary. This article analyzes the epidemiological features of ischemic stroke in Bishkek over a 15-year period. In addition, risk factors identified in patients with ischemic stroke were analyzed, depending on their age and gender characteristics.

Summary. The data of 198 patients with isolated traumatic brain injury were analyzed. For the study, patients with acute and subacute isolated traumatic intracranial hematomas (epidural, subdural, intracerebral) or their various combinations were selected by the continuous sampling method. There were 130 (65.7%) men and 68 (34.31%) women in the study. The average age of the patients was 48.2±4.3 years, ranging from 15 years to 81 years. It is proved that the optimal timing and methods of surgical interventions and conservative treatment are based on the location of traumatic intracranial hemorrhages, the volume and level of compensation of neurological functions of the patient.

Annotation. Peptic ulcer disease and its complications have been studied by various scientists from all over our planet, but the influence of mountain conditions on the course of bleeding of ulcerative genesis has not been studied before. Objective of the research: To determine features of clinical and laboratory indexes in patients with peptic ulcer of the stomach and duodenum complicated by bleeding, in persons living in mountainous conditions of the Kyrgyz Republic. In order to realize the aim 316 patients with gastroduodenal bleedings of peptic ulcer etiology were examined. Results: the study found that in high-altitude conditions the higher values of hemoglobin (by 8.2%), red blood cells (by 6.5%), platelets (by 17.6%), thrombocrit (by 28%). So it should be noted that the clinical course of gastroduodenal bleeding highland patients characterized by good adaptive capacity of the organism and is expressed by the easier tolerance of blood loss and a large number of patients who came with the final hemostasis in comparison with the patients of the lowlands (by
6,8%).

Summary. The age of patients with spinal cord injury ranged from 17 to 82 years. Among the examined patients there were 76 men (74.5%) and 26 women (25.5%) (p<0.05). The average age of the patients was 47.3±8.4 years. As can be seen from Table 1, the largest age group consisted of patients aged 21-60 years (86.3%), that is, the most able-bodied age. Much less often, spinal cord injury was noted at the age of 20 years (5 patients - 4.9%) and older than 61 years (9 cases – 8.8%).

Summary. In the work the peculiarities of clinical neurological displays of spinal cord injury have been studied, comparative analysis of various diagnostic methods efficacy was done, the structure and ways of prevention for postoperative complications have been investigated.

Summary. Neurodegenerative diseases represent a wide range of diseases of different nature, caused by the gradual death of individual groups of nerve cells and characterized by steadily progressive neurological deficits, including motor disorders, psychoemotional and cognitive (up to dementia) disorders and epileptic seizures. The most common neurodegenerative pathology in children is neuronal ceroid lipofuscinosis. The article describes data on the prevalence, features of the therapy of this pathology, and also presents a clinical case with the onset of the disease in a child aged 2 years 11 months. The clinical case demonstrates the difficulties of diagnosing this pathology due to the rarity of this pathology, a wide range of differential diagnostics, the duration and high cost of molecular genetic studies. An early examination would make it possible to explain the nature of epilepsy, to choose a rational therapy for this disease in a timely manner.

Resume. The article is devoted to the problem of treatment of neurogenic bladder dysfunction. The paper proposes a list of necessary non-invasive methods for examining patients to assess functional disorders of the bladder dysfunction and enuresis in children, depending on the form of dysfunction. Complex phased multidirectional therapy, which allows to influence all links of the pathological chain, improved the results of treatment and gave a long-term positive effect in the observed patients.

Summary. The aim of the study was to develop a simple and universal questionnaire to assess the quality of cataract phacoemulsification. Under observation were 69 patients aged 48 to 85 years with age-related cataract. All of them underwent cataract phacoemulsification with implantation of toric intraocular lenses. The quality of the performed operation was assessed by the patients themselves, as well as by specialists using questionnaires developed by the authors. After the operation, the average visual acuity on the first day was 0.85±0.18, and 1 month after the operation it was 0.93±0.11.
In most cases (94.3% and 94.2%, respectively), the patients themselves rated the operation performed at 4 and 5 points. Cataract phacoemulsification with implantation of toric intraocular lenses was rated by independent experts on average, also at 5 points, 72.5% and 68.1%, respectively. The survey showed that the developed questionnaires are easy to use and easy to use.

Summary. The article is devoted to the assessment of morphometric indicators in 4 groups (group 1 pregnant myopes with ophthalmological treatment, group 2 pregnant myopes without ophthalmological treatment, group 3 and 4, respectively, emmetropes and hypermetropes without ophthalmological treatment) in the third trimester of pregnancy before delivery and in the postpartum period. It was revealed that in pregnant myopia, against the background of systemic circulatory disorders due to utero-placental circulation, the reserve of relative accommodation decreases, as a result of which uncorrected visual acuity decreases, it was revealed that in the group of myopia with the III trimester of pregnancy, recommended instillations of 2.5% irifrin
1 drop per night for 10 days with obturation lacrimal points, helps to increase the reserve of relative accommodation and increase uncorrected visual acuity, which contributes to faster rehabilitation of myopic eyes in the postpartum period.

Summary. In the literature review have been considered the anatomo-morphological structure and pathological changes of the lacrimal puncta in the adult population, one of the most common pathology of which is the lacrimal puncta stenosis. There were also presented the causes, mechanisms of occurrence and various classifications of the puncta stenosis, as well as modern methods for their diagnosis. Such a pathology can occur as a result of using topical or systemic drugs, various infections, abnormal position of the eyelids because of involutonal changes, traumatic injuries and neoplasms. Despite the lacrimal puncta stenosis being one of the most common pathology of the proximal lacrimal apparatus, it remains understudied.

Summary: Based on the content (comparative-analytical) analysis of the forensic rules and the severity of injury and the deviations of the spinal cord in different parts of its regions, the provisions of the points of rules, according to which the blast mouse's mouth with violation of its functions are considered to be harmful to health for the victim, creating a threat to life, contradict the clinical data on possible outcomes of the spinal cord moss. The presence of significant internal contradictions between the 7.13 and 19 rules and points 6 and 7, tables of the percentage of the loss of total disabilities leading to a wide range of severity of harm to health in the spinning brain.

Summary. The article presents an extremely rare case of forensic sexuality with Swyer syndrome in which a chromosomal abnormality in the form of a mutation in the SRY gene can lead to the formation of a female organism with the XY genotype (Swyer syndrome or gonadal dysgenesis). The body of a person with Swyer's syndrome has a chromosome set characteristic of a male body, but it has female genitalia, a female reproductive system, but the sex glands do not produce hormones. During puberty, the development of secondary sexual characteristics does not occur and amenorrhea is observed. Sexual identity was established on the basis of karyotyping, ultrasound (presence of prostate) and anthroposcopic data.

Abstract. This article examines the issues of working with a dictionary on Russian language lessons. The article is about the essence of dictionary work in forming communication competence of a medical student. While working with dictionaries, a word should be viewed simultaneously from four perspectives: orthoepic, lexical, orthographic and in the context with other words. Proper organization of dictionary work during Russian language classes helps to consciously and practically learn the Russian language and successfully develop professional language competency.

Resume. Compression allows to improve the skills of reading, understanding, analyzing scientific texts and writing abstract, research papers, reviews. This
article is devoted to teaching medical students compression at the level of words and word combinations. Types and graphical registration of word compression, as well as abbreviations, that students encounter in every medical text, and their pronunciation have been considered.

Abstract. The article analyzes the fundamental differences between fundamental and traditional Islam. The features of the worldview of fundamental and traditional Islam in the conditions of Kyrgyzstan, as well as the influence of other religions and civilizations in the Muslim environment through heterodox Sufism are considered.

Summary. The article summarizes the experience of preparing and conducting an objective structured clinical examination. The requirements for the preparation of a standardized patient are given, a scale for assessing the skills and abilities for the examinee is recommended. Examples of clinical and diagnostic stations are considered.