Vol. 5 No. 5 (2024): EUROASIAN HEALTH JOURNAL

The purpose of the study: to study the clinical and laboratory features of the course of chronic viral hepatitis B (HVB) in elderly patients in the Kyrgyz Republic. Material and methods. The case histories of 200 patients with HVB were analyzed (95 men (47.5%) and 105 women (52.5%), aged 28 to 75 years (average age – 55 years). All the studied patients with HVB were divided into 2 groups: group 1 (main group) consisted of 100 elderly patients (over 60 years old), group 2 included 100 patients under the age of 60 (control group). In addition to general clinical and standard laboratory examinations, all subjects underwent enzyme immunoassay (ELISA) for markers of viral hepatitis B, C, D, polymerase chain reaction (PCR) (qualitative and quantitative PCR) for markers of viral replication with an assessment of viral load, as well as liver fibroelastometry to verify the stage of fibrosis. Statistical processing of the obtained data was carried out using the STATISTICA 10.0 program. Results. In elderly patients, CHB in most cases occurs due to co-infection with the delta agent (67%). The main route of infection is through surgical interventions (including dental) (47%). There is a high frequency of comorbidity due to the frequency of combination with hypertension (38%) and CKD (16%) with increased levels of creatinine and residual nitrogen. Conclusion: among elderly patients with CHBV, the clinical picture is dominated by dyspeptic icteric and cholestatic syndromes with increased alkaline phosphatase, and advanced stages of liver fibrosis are more often detected.

The evolution of cognitive impairment of vascular origin is becoming an increasingly prominent health threat, especially in this era when hypertension is a leading contributor to the global burden of disease and overall health loss. Hypertension is associated with altered cerebral microcirculation coupled with adverse vascular remodeling, with subsequent slowing of mental processing speed, reduced abstract thinking, loss of language abilities, and deficits in attention and memory. Due to the rapidly increasing burden of hypertension in Kyrgyzstan, we assessed the prevalence and correlates of cognitive impairment among hypertensive patients admitted to the Bishkek Clinical Multidisciplinary Hospital No. 1. The present study highlights that cognitive decline is significantly prevalent among individuals with systemic hypertension. More than two-fifths of the hypertensive participants in this present study had cognitive impairment. There is a wide variability in the prevalence of cognitive impairment (16.5–63.9%) among hypertensive individuals in the literature, but our rate is in the middle. This discrepancy in prevalence may result from differences in population characteristics and variability in the instruments used to assess cognitive function across studies. It is therefore imperative to include cognitive assessment in the routine evaluation of hypertensive patients.

Life expectancy has increased significantly in recent decades. In this scenario, healthcare interventions are needed to improve the prognosis and quality of life of older adults with cardiovascular risk factors and cardiovascular disease. However, the number of older patients included in clinical trials is small, so current clinical practice guidelines do not include specific recommendations. The aim of this document is to review preventive recommendations targeting
patients ≥ 75 years old with high or very high cardiovascular risk regarding goals, medical treatment options, and including physical exercise and its inclusion in cardiac rehabilitation programs. In addition, it is shown why geriatric syndromes such as frailty, dependence, cognitive impairment and nutritional status, as well as comorbidities, should be considered in this population in terms of their important prognostic impact. It is important to assess the most common comorbidities, including anemia, which is often identified in older age, and the mental status of patients, as depression iscommon in this population and may be confused with or overlap with cognitive impairment, increasing complications and cardiovascular morbidity and mortality.

Objective. Maintaining hearing after surgery to remove vestibular schwannoma remains a difficult surgical task. In some patients with preserved inner ear function, hearing improvement is achievable. Since it is currently impossible to determine which patients will have such a result, forecasts should be based on previously published reports. In our clinical case, we describe a patient whose hearing improved from a minor level to a useful one after surgery to remove a vestibular schwannoma.
Methods. The operation was performed by suboccipital retrosigmoid access. The patient underwent a basic audiovisual protocol before and after surgery: audiometry of pure tone and speech, otoacoustic emission, auditory reactions of the brain stem, electronystagmography, as well as a detailed questionnaire. The usefulness of hearing was assessed using international recommendations supplemented by a frequency of 4 kHz.
Results. Hearing was preserved and even improved from a useless level to a useful one. Based on the available literature, the most informative factors predicting such a result seem to be: sudden sensorineural hearing loss before surgery, pronounced otoacoustic emission and damage to the upper vestibular nerve.
Conclusion. There is a limited amount of research on this topic, and it is still impossible to regularly improve hearing in properly selected patients. In addition, the importance of postoperative hearing quality compared to other symptoms and complications remains controversial.

Forty consecutive patients who underwent cranial trepanation for traumatic hematoma after developing bilateral fixed dilated pupils were studied to determine factors affecting the quality of survival and to search for management criteria. Clinical data and computed tomography (CT) data correlated with the outcome 1 year after craniotomy. The functional recovery rate (good result or moderate disability) was 25%, and the mortality rate was 43%. Material and methods. Patients with subdural hematoma had a higher mortality rate (64%) compared to patients with epidural hematoma (18%) (chi-squared criterion, p > 0.05). Other factors associated with markedly increased morbidity and mortality were an increase in age (> 20 years), a long interval (> 3 hours) between loss of pupil reactivity and cranial trepanation, compression of basal cisterns and the presence of subarachnoid hemorrhage on computed tomography. Results. Among the patients who had any of the following symptoms, there were no survivors: surgery 6 hours or more after bilateral loss of pupil reactivity;
age over 65 years; or lack of motor reaction. The results obtained indicate that the presence of an acute subdural hematoma is the single most important predictor of a negative outcome in patients with bilateral unresponsive pupils.

Traumatic brain injury (TBI) is one of the most important causes of death in patients under the age of 25 and is responsible for one third of all injury-related deaths. Therefore, knowledge of the epidemiological picture of this injury in different populations is vital. Thus, the purpose of this study is to study the epidemiological picture of TBI in emergency departments. Methods. In this cross- sectional study, the profiles of 1,000 victims were analyzed. Patients with TBI were selected using a simple random sample. This study looked at variables such as demographic data, time of year, mechanism of injury, concomitant injuries, level of consciousness, duration of hospitalization, computed tomography (CT) results, need for surgery, admission to the intensive care unit, and patient outcome. As a result, independent risk factors for patient death were identified. Results. 1000 patients suffering from (81.8% of men; average age 38.5±21.7 years) were examined. The frequency of their visits to the hospital in the spring (31.4%) was higher (p<0.01). In 45.9% of patients, the level ofconsciousness was below 9 points on the Glasgow Coma Scale (GCS). Subdural (45.9%) and epidural bleeding (23.7%) were the most frequent CT scan results in this study (p<0.001). As a result, 233 (23.3%) patients died. Independent risk factors for death in TBI were age over 60, falls and motorcycle accidents, intracranial hemorrhage accompanied by brain contusion, subdural bleeding, BCC less than 9 and the need for hospitalization in the intensive care unit. Conclusion. Age over 60 years, falls and motorcycle accidents, intracranial hemorrhage accompanied by brain contusion, subdural bleeding, BCC less than 9 and the need forhospitalization in the intensive care unit were independent risk factors for death in patients with TBI. 

Intracerebral hemorrhage (ICH) is the most devastating and disabling type of stroke. Uncontrolled arterial hypertension (AH) is the most common cause of spontaneous ICH. Recent advances in neuroimaging, organized stroke treatment, specialized neuro-intensive care, medication and surgical treatment have improved the management of patients with ICH. Timely respiratory tract protection, control of malignant hypertension, urgent treatment of coagulopathy and surgical intervention can increase the chances of survival in patients with severe ICH. Two recent randomized trials have proven the safety of intensive reduction of systolic blood pressure to <140 mmHg. Platelet transfusion in patients receiving antiplatelet therapy is not indicated unless the patient has planned surgical removal of a hematoma. In patients with a small hematoma without a significant increase in volume, there is no indication for the routine use of mannitol or hypertensive saline solution (HSS). However, for patients with large intracerebral bleeding (volume > 30 cubic centimeters) or symptomatic perihematomic edema, it may be useful to maintain serum sodium levels at 140-150 meq/L for 7-10 days to minimize the expansion of edema and mass effect. Mannitol and HSS can be used in emergency cases with exacerbation of cerebral edema, increased intracranial pressure (ICP) or in the event of a hernia. HSS should be administered through the central channel as a continuous infusion (3%) or bolus (23.4%). Ventriculostomy is indicated in patients with severe intraventricular hemorrhage, hydrocephalus or elevated ICP. Emergency evacuation of a hematoma may be useful for patients with large cerebellar or temporal hematoma.

The state and prospects for the development of medical education in our country remain an important topic for discussion, especially in the context of rapidly developing technologies and innovations in medicine. Modern medical personnel must have not only basic knowledge, but also be able to apply advanced diagnostic and treatment methods, use high-tech equipment, and work effectively in the context of digitalization of healthcare. This requires regular updating of educational programs and competencies, especially at the postgraduate level. Retraining and advanced training of specialists should take into account the latest advances in medicine, as well as the introduction of new educational technologies, such as simulation trainers and online courses. It is important that medical training programmes reflect current healthcare needs, promoting the development of an interdisciplinary approach and improving the quality of medical services in the country. Objective: to analyze the current situation and development opportunities of postgraduate education in the Kyrgyz Republic. Research methods. This article is devoted to a review of the literature on the problems of development at the postgraduate level of education, where the main directions of medical education, the study of foreign experience, based on the analyzed literature are considered. This study describes the state and prospects for the development of medical education in Kyrgyzstan, using a diverse set of methods, including: thematic research methodology and comparative method.

In the Kyrgyz Republic for the entire period as of 12/31/2023, 13 289 people were living with HIV infection. Testing, treatment, and viral load suppression cascades are 70 - 79 - 90. Treatment approaches and low immune status affect the survival rate of PLHIV receiving ART. The purpose of this study is to conduct a survival analysis in HIV-infected patients on ART as well as to evaluate the efficacy of the treatment depending on gender. Data of 13 289 registered cases in the Kyrgyz Republic among patients of 18 years and older on ART was processed. An analysis of viral loads, the level of CD4 and death rates was carried out at different periods of duration of ART. The duration of ART influences survival rates positively, the latter being higher in women. Women achieve virological effectiveness at the start of ART faster than men. Virological and immunological effectiveness among women on ART is higher than among men. Timely initiated ART increases survival rates, especially among women.

Arnold-Chiari syndrome is a rare congenital disease characterized by a decrease in the volume of the cranial cavity and a change in the anatomy of the posterior cranial fossa. Arnold-Chiari syndrome has several types (from 1 to 4), each of which is characterized by a different degree of compression of the brain and hydrocephalus, and its new forms have recently been added (type 0 and 1.5). the quality of life of patients. The disease is most common in children and young people. According to experts, its prevalence ranges from 3.2 to 8.4 cases per 100,000 people worldwide. The incidence and severity of Arnold -  Chiari syndrome have a statistically significant tendency to increase in the female sex. The etiology of Arnold-Chiari syndrome has not yet been fully studied, but it is assumed that genetic factors and effects on the fetus during pregnancy may play a dominant role in its development. Clinically, the syndrome is manifested by headache, vomiting, swallowing disorders, various motor disorders, impaired coordination and long-lasting Babinsky reflex, weakness and numbness in the extremities, sleep problems and other symptoms. Patients may also develop hydrocephalus, which increases the risk of serious complications and requires surgical interventions. The article presents data on the prevalence, clinical manifestations and treatment of Arnold-Chiari syndrome, as well as our own clinical observation of the course of this disease, which is combined with dextrocardia and heterotaxia – the mirror position of internal organs in a 10-year-old patient. Arnold-Chiari syndrome today refers to severe congenital diseases of the nervous system that are difficult to diagnose at an early age, therefore it is important for a pediatrician to understand the mechanism of occurrence of this disease in order to be able not only to eliminate, but also to prevent the undesirable consequences of this disease. 

Epidemiological studies of the prevalence of allergic diseases in children in the Kyrgyz Republic (Bishkek, Jalal-Abad, Balykchy) carried out in accordance with international standards under the program “International Study of Asthma and Allergy in Childhood - ISAAC”, allowed to obtain data comparable with the results of similar studies in the world. However, today these data need to be updated by organizing regular epidemiological studies in accordance with the IV phase of ISAAC. To date, new ISAAC centers in the cities of Naryn, Balykchy, Osh, and Jalal-Abad have undergone international registration in Auckland (New Zealand). Children with a history of atopy living in different climatic, geographical and environmental areas should be actively questioned through the ISAAC program for early detection of allergy symptoms. It is advisable to more widely introduce the ISAAC program questionnaire into the list of mandatory medical documentation of primary health care physicians for the early detection of allergies among children. In order to determine the spectrum of sensitization in allergic diseases in children, we analyze the results of modern molecular allergy testing ALEX. Data on the prevalence of allergic pathology among thechild population of the Kyrgyz Republic allow us to develop a set of measures to improve the organization of allergological care for children and adolescents.

This article presents a clinical case of a congenital developmental disorder in the form of "Ectodermal Dysplasia" in combination with other congenital anomalies. Ectodermal dysplasia is a group of congenital diseases characterized by abnormalities in the development of tissues derived from the ectoderm, such as skin, hair, nails, and teeth. Diagnosing this condition requires genetic analysis and consideration of several criteria based on clinical manifestations and available investigations. The article discusses clinical and anamnesis data, laboratory results, instrumental findings, and social aspects. Special attention is given to a detailed description, including photographs, of a 2-year-old girl diagnosed with ectodermal dysplasia in conjunction with other congenital malformations affecting the central nervous, cardiovascular, musculoskeletal, and urinary systems. The analysis of this case not only helps to systematize existing knowledge about the condition but also provides insights into its interaction with other pathologies. Thus, the article highlights the importance of a comprehensive approach to diagnosing ectodermal dysplasia, emphasizing the need for early detection and individualized care for each patient to ensure effective support.

This article is dedicated to the study of the little-known plant Alfredia nivea, which grows in the Kyrgyz Republic and possesses nootropic properties. The relevance of this topic is determined by the growing problem of diseases manifested by impairments in cognitive and mnemonic functions. In modern conditions, the task of studying and developing effective pharmacotherapy for nervous and mental disorders becomes especially important, as these issues have high social significance. Nootropic drugs play an irreplaceable role in the correction of higher nervous activity disorders associated with a wide range of diseases related to central nervous system damage. Currently, one of the key directions in healthcare is the expansion of the range of medicinal products through the introduction of new drugs based on plant phytosubstances, particularly those with nootropic effects. The aim of the study is to investigate this plant material. The materials of the study included flowers, stems, leaves, and roots with rhizomes of Alfredia nivea, collected during the flowering period. Botanical and geobotanical methods were used for analysis. The study of the distribution and ecology of Alfredia nivea is a promising direction in pharmaceutical research, as its distribution in the Kyrgyz Republic opens opportunities for the creation of new phytosubstances, which can significantly improve approaches to the treatment of cognitive disorders. As a result of prolonged searches, this medicinal plant material was found in the Chui region, in the Kemin district, in the village of Ak-Tyuz. Conclusion: The conducted research successfully established the distribution range of Alfredia nivea and described its ecological characteristics. This study not only expands the understanding of this species but also lays the groundwork for future research related to the effects of its active components with nootropic properties.

Purpose of the work: to develop surgical tactics for prevention of purulent-septic complications in the area of colorectal anastomosis based on the analysis of immediate results of laparoscopic anterior low and ultra-low rectal resections. Material and methods: the results of surgical treatment of 8 patients who underwent laparoscopic anterior rectal resection with low and ultra-low formation of colorectal anastomosis were analyzed. There were 5 mens (62.5%), 3 women (37.5%). The average age of patients was 62 years (37-76 years). Stage III rectal cancer was established in 5 (62.5%) patients, stage II – in 2 (25%) and stage I – in 1 (12.5%). Rectal cancer localization: lower ampullary region – 1 (12.5%), middle ampullary region – 3 (37.5%), upper ampullary region – 2 (25%), rectosigmoid region – 2 (25%). Histomorphological picture of the macropreparation: adenocarcinoma of varying degrees of differentiation. Results and discussion: all patients were discharged from the hospital without fatal outcomes. The average duration of hospitalstay was 12 bed-days (10-17 days). In 3 patients (37.5%), colorectal anastomosis suture failure developed on days 3-5 of the postoperative period. Two patients were re-operated (1 – laparotomy,
colostomy, 1 – laparotomy, extraperitonization and extraperitoneal drainage of the anastomosis area). Conclusions: surgical treatment of operable rectal cancer is preferably performed laparoscopically. The incidence of colorectal anastomosis failure increases with low tumor localization. The methodology of laparoscopic anterior rectal resection suggests performing the following stages of the operation: application of a preventive colostomy, extraperitonization of the colorectal anastomosis by suturing the pelvic peritoneum, drainage of the anastomosis zone with an extraperitoneal drainage in the left iliac region.

Acute appendicitis ranks first among urgent abdominal diseases and accounts for 70% of all operated patients. Diagnostic errors in diagnosing acute appendicitis occur in 12-31% of cases, and at the pre-hospital stage (primary health care) this figure reaches 70%. To improve diagnostics, many research scales have been developed, they are simple and non-invasive. Objective of the study: Improving the diagnostics of acute appendicitis in the elderly using various diagnostic scales.
Materials and methods. During the study, all clinical signs were prospectively determined according to the criteria of the scales used in the diagnosis of acute appendicitis, and laboratory tests were performed in all elderly and senile patients with suspected acute appendicitis. The total number of patients was 252 patients. A retrospective study of the case histories of 82 patients who were diagnosed with acute appendicitis and who underwent surgical treatment was conducted. Results. As a result of the study, the coincidence of the criteria of the scales used in the diagnosis of acute appendicitis is at different levels - from 81.7 to 93.9 percent. Conclusion. The RIPAS scale is a useful indicator for the diagnosis of acute appendicitis in elderly and senile people.

Bariatric and metabolic surgery is one of the most effective methods of treating morbid obesity and associated diseases such as type 2 diabetes, hypertension and dyslipidemia in the modern world. As the number of overweight and obese people continues to grow worldwide, the need for bariatric surgeries also increases. Despite the high efficiency of bariatric surgery in the short term, the problem of postoperative weight regain remains a serious challenge, reducing long-term treatment results and increasing the risk of recurrence of associated diseases. Among the existing methods of preventing weight regain, there is increased malabsorption or increased restriction by using primary bandaging together with the main surgery. As a promising solution, a method of one anastomosis gastric bypass with modified fundoplication (FundoRing) is proposed, which combines the advantages of increased restriction and antireflux effect. This may help prevent weight regain and improve metabolic outcomes, reducing the risk of band-related complications and malabsorption syndrome. However, further randomized studies with long-term follow-up are needed to confirm the efficacy and safety of this technique. Thus, the FundoRing technique represents a promising alternative to traditional methods and may be a significant step in in the struggle against the obesity epidemic and its consequences.