Vol. 2 No. 2 (2023): VESTNIK of KSMA

Human hematopoietic organs belong to the main structures of the body that perform the function of forming new blood cells. Evaluation of the features of bone marrow myelogram in newborn children in different regions of Kyrgyzstan. The histology of the red bone marrow, taken by puncture biopsy in 42 newborn children who died in the regions of Kyrgyzstan, was studied. The number of myelocaryocytes and reticulocytes is calculated on the preparations, and myelograms are counted on smears. It is established that residents of Bishkek, Cholpon-Ata and Naryn (the real count of cellular elements per 500 cells) is a sternal punctate cellular, all the sprouts of hematopoiesis are preserved. Residents of the city of Kara-Вalta noted that the indicators of blasts are 0%, promyelocytes are 1.2%, lymphocytes are 21.6%, erythroid germ is 16.9% and the red blood maturation index is 0.7%. In those who lived in Cholpon-Ata, compared with those who lived in Bishkek, lymphocytes were slightly increased by 12.9%, and the erythroid germ was slightly reduced by 17.4%. Indicators of myelogram in residents of Naryn compared with the data of Bishkek erythroid germ increased by 2.2%. Megakaryocytes are in sufficient quantity, there are few mature platelets. Living in the city of Kara-Вalta, located near the uranium tailings dump, is accompanied by a violation of the hematopoietic function of the bone marrow, the structure of bone tissue and the state of the stroma, a change in the ratio of hematopoietic and adipose tissue, the cellular composition is characterized by a different degree of pathological processes, as indicated by the indicators of myelograms in Kara-Balta compared with indicators of other regions of the Kyrgyz Republic.

The problem of adaptation of the body to extreme influences, including oxygen starvation, will always be in the focus of attention of researchers of various profiles, since oxygen deficiency in one form or another accompanies a person throughout the entire life cycle.
Equally important is the problem of using adaptation to hypoxia for the prevention and treatment of diseases, as well as increasing the body's resistance to various adverse environmental factors.
Currently, there is no doubt that the immune system also plays a certain role in the complex response of the human body and animals to the effect of hypoxia. A study of the histology of the thymus in 60 1-year-old rats living in various ecological and climatic conditions of Kyrgyzstan was carried out. Morphofunctional structures of the thymus gland in 1 - year - old rats were studied.
Research methods: 1. Anatomical methods (preparation). 2. Histological methods (hemotoxylin-eosin staining, according to Van Gieson). As a result of a study of rats in Bishkek (770 m above sea level) in low-altitude conditions, all indicators of the control group are within normal limits. Indicators in
the Too -Ashu in high-altitude conditions (3200 m above sea level), a noticeable change in cells, for example, the number of indicators of lymphoblasts increased. In the conditions of the Cholpon-Ata midlands (1660 m above sea level), cell counts decreased slightly. Indicators of this study of 1-year- old rats in the conditions of the highlands of Naryn (2000 m above sea level), the dynamics of cell populations in a unit of the conditional area of the cortical substance of the thymus lobule in 1-year- old rats revealed slightly decreased cell indicators compared to the middle mountains of Cholpon- Ata. Thus, Bishkek in conditions of low mountains, i.e. 770 m above sea level, all indicators of the control group are within normal limits. In high-altitude conditions (3200 m above sea level), a noticeable change in cells, for example, the number of lymphoblast indicators increased by 70.1%, small lymphocytes by 7.5%, аpoptotic bodies 9.5%. Indicators of macrophages increased by 31.0%. Stereometric characteristics the cortical substance of the thymus of 1-year-old rats is 60.6% more. The medulla parts of thymus increased by 46.5%.

Goal of the research: optimizing of management and evacuation, management and tactical methods in organizing and caring victims with combined injuries of the brain and ENT organs and prevention of complications as well. Material and methods. The results of management in 374 patients with combined injuries of the brain and ENT organs were investigated. Clinical and statistical characteristics of victims with combined injuries of the brain and ENT organs were studied, results of diagnosis and treatment and outcome as well. Results. A new classification of combined injuries of the brain and ENT organs elaborated; medical care volume standards in combined injuries of the brain and ENT organs elaborated; antibacterial “carbolen-ointment” for the prevention and treatment of wounds and wound complications in combined injuries of the brain and ENT organs elaborated; a new method of nasal bones fractures reposition and fusion invented.

Objective. Searching new tactical and technical decisions which significantly increase an efficacy of management sufferers with combined brain and visual organs injuries in stages of medical evacuation during extreme situations.
Material and methods. An analysis of diagnostics and management in 441 sufferers with combined brain and visual organs injuries was done.
Clinical and statistical characteristics of sufferers with combined injuries of the brain and visual organs, results of diagnosis and treatment and outcome were investigated.
Results. A new classification of combined injuries of the brain and visual organs elaborated; scientifically sound peculiarities of management and tactical methods in medical care for sufferers with combined injuries of the brain and visual organs have been identified; combined brain and visual organs injuries severity evaluation algorithm was defined; medical care volume standards in combined injuries of the brain and visual organs elaborated.

The purpose of this review article was to analyze and present up-to-date data on the epidemic situation in the world and Kyrgyzstan, as well as an overview of current risk factors and the main etiopathogenetic variants of hemorrhagic stroke. The incidence in the world is 29.9 per 100,000 people per year. At the international level, the incidence of hemorrhagic stroke is significantly higher in low- and middle-income countries (to which Kyrgyzstan belongs) compared to high-income countries. In the Kyrgyz Republic, the incidence of hemorrhagic stroke is 0.54 per 1000 population. Compared with ischemic stroke, the percentage of mortality from hemorrhagic stroke is always higher and in our country it is 54.4%. Hemorrhagic stroke is a devastating event that carries a very high morbidity and mortality. Arterial hypertension and age-related amyloid angiopathy are the strongest risk factors for intracerebral hemorrhage, but smoking, anticoagulant therapy with warfarin, excessive alcohol consumption and cocaine also increase hemorrhagic risk. Hemorrhagic stroke includes epidural hematoma, subdural hematoma, subarachnoid hemorrhage (SAC), intraventricular hemorrhage (IVF), hemorrhagic transformation of ischemic stroke (AI), venous bleeding from the cortical vein or sinus thrombosis and intracerebral hemorrhage (IUD).

Aplastic anemia is a rare and life-threatening bone marrow insufficiency that leads to peripheral blood cytopenia and decreased proliferation of hematopoietic bone marrow cells. The symptoms are similar to myelofibrosis, myelodysplastic syndromes and acute myeloid leukemia, which makes it difficult to diagnose this disease. The pathogenesis of aplastic anemia is complex, and its mechanism needs to be deciphered on an individual basis. This review summarizes several contributions made in recent years in an attempt to understand the pathogenesis of aplastic anemia, which may be useful for the development of personalized treatments for this disease

Anemia is a clinical condition whose frequency increases with age. This is a serious risk factor with adverse outcomes, including hospitalization and mortality. In population studies, the incidence of anemia in the elderly was 16.8% in women and 17.5% in men, but 30.7% in men aged 85 years and older. The aim of the study was to identify the most important pathophysiological aspects responsible for the incidence of anemia in the elderly and their treatment. Pubmed was used, and we searched for the most important studies conducted over the past 10 years on anemia in the elderly. After a comprehensive and standardized assessment, only studies that accurately determined the pathophysiology and treatment of anemia in the elderly were taken into account. A proper understanding of pathophysiology allows doctors to apply the best therapeutic strategies.

Tuberculosis of the female genital organs (FGTB) is caused by the bacillus Mycobacteria tuberculosis and is usually secondary to pulmonary tuberculosis. The prevalence of tuberculosis of the female genital organs is not accurate, since in most cases it is not diagnosed in time. In different countries, the incidence of FGTB varies from 1% to 30%. During the primary infection with M. tuberculosis, spread occurs by hematogenous and/or lymphogenous routes and is deposited in various organs in the form of latent forms. In 5-15% of infected patients, latent forms of mycobacteria are reactivated under the influence of various factors, causing a secondary disease. Tuberculosis of the female genital organs, especially in underdeveloped countries, continues to be the main cause of menstrual irregularities and infertility. The most common manifestation of FGTB is infertility due to damaged fallopian tubes, very low endometrial receptivity, or ovarian damage with low ovarian reserve and volume. The diagnosis of FGTB requires confirmation by a combination of tests. Gynecologists may start by obtaining information through the patient's medical history, general physical examination, abdominal examination, and gynecological examination. Chest x-ray may show active pulmonary or old healed lesions of previous tuberculosis, leading to suspicion of genital involvement. Conventional methods for diagnosing FGTB include various imaging, bacteriological, molecular, and pathological methods, which are positive in only a small percentage of patients, leaving the condition undetected in many cases. As with pulmonary tuberculosis, treatment for FBM lasts a total of six months. Surgery is not recommended in SVT due to multiple risks, and oral anti-tuberculosis therapy is recommended. Of great importance is informing patients with pulmonary tuberculosis about the need to comply with infectious measures, as well as compliance with the recommended therapy regimen.

A parastomal hernia is a sac-like protrusion of the abdominal organs around the stoma due to weakness of the muscular layer of the anterior abdominal wall at the site of stoma formation. Despite significant advances in surgery in recent years, including new materials for prosthetics and the development of laparoscopy, the treatment of parastomal hernias remains one of the most difficult tasks in surgery. This is mainly due to the high recurrence rate in the postoperative period.
This article provides an overview of current knowledge about this disease. We considered works searched in the relevant databases Web of Science, PubMed, RSCI, using the keywords "parastomal hernia" and "stoma-related complications" in Russian and English. The emphasis is on modern approaches to effective treatment and reducing the incidence of this complication in groups of people operated on the intestines for various indications, when one of the stages of the surgical intervention was the imposition of entero- and colostomy. The most modern methods of surgical treatment of parastomal hernias include the laparoscopic Sugarbaker operation, the Pauli robotic operation, which are promising areas in surgery for complications of primary intestinal stoma.

Objective: evaluation of the effectiveness of endoscopic treatment of inguinal hernias.
Materials and methods. A clinical study was conducted in 71 patients with rectal and oblique inguinal hernia, of whom 24 patients underwent laparoscopic transabdominal hernioplasty (TAPP) using a mesh endoprosthesis and its fixation with a herniostepler and 47 patients underwent open hernioplasty with hernial gate plasty. Results. The average duration of surgery (TAPP) was 29.5±1.0 min, and open hernioplasty was 80.2±1.1 min. Patients were hospitalized for an average of 2.5±0.5 days after surgery (TAPP) and 6.6±0.2 days after open hernioplasty. When assessing postoperative complications, 4.1% of cases occurred during (TAPP), which was 3 times less than during open hernioplasty. Conclusions: the use of laparoscopic interventions for inguinal hernias allows reducing the number of complications by 3 times, reducing the length of hospital stay and accelerating the duration of surgery.

The objective of the paper is to analyze the state and assess the effectiveness of the introduction and use of innovative treatment technologies in the surgical unit of a multifield hospital. The data of the Medical Center Hospital of the President’s Affairs Administration of the Republic of Kazakhstan, for 2019-2021 on the introduction of new innovative treatment technologies in the practice of the surgical unit of the Hospital was used as the materials. The research methods studied the number and structure of surgeries performed in the hybrid operating room with biplane angiographic system, robotic surgery center for clinical profiles, Heart Center using differentiated multidisciplinary approach and cardiac surgical interventions in the X-ray Surgery Department. The clinical effectiveness of all innovative treatment technologies used in the surgical unit was assessed. The data obtained showed that the introduction of innovative treatment technologies in the surgical unit allowed expanding the volume and improving the quality of medical care. The main areas of innovative development were hybrid OR, laparoscopic and minimally invasive robot-assisted surgery, methods used in the practice of Heart and X- ray surgery centers. The implemented innovative treatment technologies showed high clinical efficiency in all cases.

In recent years, laparoscopic cholecystectomy has become the "gold standard" for the surgical treatment of gallbladder pathologies due to its advantages, such as low trauma, low pain, cosmetics and quick recovery. The aim was to improve the results of treatment of patients with cholelithiasis by introducing a single-port method of laparoscopic cholecystectomy. Materials and methods: the paper presents a prospective analysis of 11 patients operated on for cholelithiasis by single-port laparoscopic cholecystectomy. There were 4 men and 7 women. At the age of 25 to 52 years. Results and discussions: no complications were observed and there was no need for conversion, there were no lethal cases. Laparoscopic cholecystectomy from one port in the presence of specialized instruments is not inferior to the traditional three- and four-port ones in terms of ease of execution, despite the fact that the cosmetic result is much higher, since only 1 incision is made above the navel with a size of 2.5 cm.

Results of laparoscopic left-sided hemicolectomy in 92 patients. With a diagnosis of dolichosigma, diverticulosis of the left half of the colon. The main indications for surgery are given, the features of the surgical technique of left-sided hemicolectomy are determined. The main attention is paid to postoperative complications, length of stay in the hospital, and the duration of the operation.
The purpose of the study: to evaluate the effectiveness of laparoscopic technology in the surgical treatment of patients with non-tumor pathology of the colorectal zone.
Materials and methods: a clinical study was conducted on the basis of the educational, medical and scientific medical center of the KSMA, and the city clinical hospital No. 1. The study included 92 patients with dolichosigma and diverticulosis of the left half of the colon. 34 patients were performed by laparoscopic method, 58 patients by laparotomic method.
Results. The average duration of operations was 92 minutes. in the main group, and in the control group 118 min. Analysis of postoperative complications revealed 3 (8.2%) complications in the main group, and 8 (13.7%) cases in the control group. The average time spent in the hospital of the main group was 4.14 ± 1.67, in the control group 10.35 ± 2.47.
Conclusion: the use of laparoscopic technologies in colorectal surgery contributes to the early activation of patients, reduces the postoperative bed-day, and also reduces the number of early postoperative complications.

Results of laparoscopic appendectomy using non-immersed method in 24 patients. The main indications for surgery are given, the features of the surgical technique of laparoscopic appendectomy are determined with an analysis of possible options. The main attention is paid to the processing of the stump of the appendix during the surgical period. The diagnosis was confirmed by laboratory and instrumental methods of examination. The immediate results, terms of surgery and inpatient treatment are presented. When using endovideosurgical interventions.

Purpose of research. Evaluation of efficacy of laparotomy and laparoscopic methods of treatment of hepatic echinococcosis. Materials and methods of research. The results of laparotomy and laparoscopic methods of treatment of hepatic echinococcosis of the surgical department of City Clinical Hospital №1 (CCH №1) of Bishkek were used as the research material based on the retrospective analysis. The patients were excluded from the treatment of echinococcosis of the liver in the surgical department of City Clinical Hospital No.1 in Bishkek and the Educational and Scientific Medical Center of the Kyrgyz Academy of Medical Sciences (USSMC) in Bishkek. The exclusion criteria were patients with complicated liver echinococcosis. 123 patients were operated on: 70 patients were operated on using laparotomy method, 53 patients were operated on using laparoscopic method to treat hepatic echinococcosis. The study materials included general clinical tests, Katsoni's reaction, ultrasound, computed tomography. Results. The number of complications in the main group was 3 (5,7%), duration of the operation was 68,4±5,6 minutes, time of hospitalization - 5,14±0,67 days. Conclusion. The results of the study showed that the use of laparoscopic interventions can reduce the number of complications by 2 times, shorten the length of hospital stay and accelerate their rehabilitation. Discussions. According to the world statistics, the results of this study correlate with the results of other authors, nowadays minimally invasive interventions have shown their effectiveness, where postoperative complications occurred on the average in 4,8% of cases, and the hospital stay was 5,8±1,4 days. The role of laparoscopic surgery, as some authors believe, may be exaggerated, due to the lack of a clear intervention algorithm, which dictates the need for further research.

The question of choosing a method for terminating an undeveloped pregnancy in the second trimester of pregnancy in women with a uterine scar after cesarean section remains debatable. Target. To assess the efficacy and safety of medical abortion in patients with antenatal fetal death at 27-28 weeks of gestation and a uterine scar after a previous caesarean section. Materials and methods. An unblinded prospective cohort study was conducted (pregnant women and physicians were aware of the method of abortion). We included 15 patients with antenatal fetal death at 27-28 weeks of gestation and a uterine scar after caesarean section. A combination of mifepristone and misoprostol was used for medical termination of pregnancy. A clinical and statistical evaluation of the obtained data was carried out. Results. With medical abortion, the average duration of labor was 8.5 (95% CI 7.346–9.168) hours. The volume of postpartum hemorrhage was within 280.0 (95% CI 250.0–400.0) ml. Positive effect was achieved in 100% of cases. Pathology associated with separation of the placenta was detected in 2 (13.3%) cases, in these cases, manual separation of the placenta and removal of the afterbirth were performed. Conclusion. Medical abortion in patients with one uterine scar and antenatal fetal death at 27-28 weeks of gestation should be performed in all cases, provided there are no contraindications for vaginal delivery.

Despite the pregnancy complications associated with home births, 30% of births still remain at home as the main place of birth in the Islamic Republic of Pakistan.
Purpose of the study. To study the factors that determine the choice of place of birth in theBalochistan, a province of the Islamic Republic of Pakistan.
Materials and methods. At the first stage of the work, a questionnaire was developed - a basic set of questions that allows assessing the obstetric anamnesis and parity of childbirth of the respondents, the place of birth (maternity hospital/ home), the cause of birth at home, methods of preventing postpartum hemorrhage (PPH) in case of home birth, complications of the postpartum period. At the second stage, within 2 days, on January 6 and 7, 2023, at the same time, by the method of continuous survey using Google forms, a survey was conducted of 144 women of reproductive age (15-49 years old) permanently residing in the Balochistan, a province of the Islamic Republic of Pakistan. The data obtained were statistically processed using MS Excel, and r-Pearson correlation analysis was carried out.
Results. 25% of those living in Balochistan gave birth at home. More than half of the respondents (55.6%) cited the high cost of delivering in a maternity hospital as the reason they gave birth at home. 33.3% of respondents did not consider it necessary to give birth in a medical institution, due to socio-cultural beliefs, despite the possibility to pay for childbirth in medical institutions. 44.5% of the respondents indicated the remoteness of the location of the medical institution and the lack of transport. The frequency of postpartum hemorrhage during home birth was 8%. Only 63.8% of the respondents had access to misoprostol in the postpartum period.
Conclusion. The percentage of women who have access to a birth in a health facility in the Islamic Republic of Pakistan, especially in geographically remote and poor provinces, is still low. Antenatal distribution of misoprostol to pregnant women remains one of the reserves for reducing the incidence of postpartum hemorrhage during home births.

This article discusses the goals, problems, tasks of cognitive linguistics – how the processes of perception, categorization, classification and understanding of the world are implemented, how knowledge is grouped, which systems provide various types of information activities. The nature of linguistic knowledge, its assimilation and application are given.
The solution of mental problems is directly related to the use of language, since language has turned out to be the most powerful semiotics of all communication systems. It is a cognitive mechanism that provides virtually unlimited production and understanding of meanings in speech activity. Language not only mediates the transmission and reception of information, knowledge and messages, but also processes information received by a person from the outside, that is, builds a specific language framework. This, language creates opportunities for organizing and systematizing a large amount of knowledge in memory, for creating a linguistic picture of the world characteristic of each ethno-cultural community.
Therefore, the approach to language learning today is so complex that it can be qualified as an interdisciplinary cognitive science combining the efforts of linguists, philosophers, psychologists, neurophysiologists, cultural scientists, specialists in the field of artificial intelligence and others.