Medical science of Uzbekistan

CHARACTERISTICS OF ADRENAL GLAND PATHOMORPHOLOGY IN MATERNAL DEATH

Khumoyunmirzo Shokirov — 2025-06-28

The relevance of the problem. Maternal mortality is a pressing problem in the world, and although what is being done has a certain result, it is observed at a high level. The purpose of the study was to investigate specific aspects of the pathomorphology of the adrenal gland in maternal mortality, observed during pregnancy and in the first week of the postpartum period. Research method and material. The study investigated the specific aspects of the pathomorphology of the adrenal gland in the archival materials of autopsy in maternal deaths, observed during 75 pregnancies and in the first week of the postpartum period in Uzbekistan during 2015-2024. Study result. The accumulation of lipid infusions instead of basophilic inclusions in adrenocorticocytes in the buttockular area of the coarse layer showed important diagnostic value in morphological investigation of processes associated with preeclampsia. Conclusion. One of the pathomorphological features of the adrenal gland in maternal mortality is a violation of connectivity in the sympathoadrenal system, which continues with dysfunction of the adrenal gland, central circulatory disorders, leading to a violation of haemodynamic parameters in all organs, perfusion in peripheral blood vessels, polyorgan failure. The main nonspecific response reaction, which is characteristic of the adrenal gland in maternal mortality of different aetiologies, is associated with diapedesis blood transfusion in the buttocks area of the adrenal layer, multifocal necrosis in spongiostitis, an increase in lipid infiltration and necrobiosis in the stitoplasm of cells, massive haemorrhagic foci in the urinary cavity and the formation of foci with sharply changed histioarchitectonics after necrosis, and acute renal gland failure. It was characterised by the presence of morphological changes. These changes mainly serve as a direct stepping stone to the mechanism of tanogenesis of the occurrence of maternal mortality in pregnancy.

LOCOREGIONAL RECURRENCE OF BREAST CANCER AFTER RADICAL MASTECTOMY: RISK FACTORS, DIAGNOSIS, AND REGIONAL MANAGEMENT STRATEGIES

Mirjalol Djurayev — 2025-06-28

Relevance. Locoregional recurrence (LRR) of breast cancer (BC) following radical mastectomy presents a significant clinical challenge and is associated with reduced survival. Objective. To assess the risk factors for LRR and develop regional recommendations for effective surveillance and treatment strategies. Materials and methods of the study. A retrospective-prospective analysis of 206 breast cancer patients treated between 2017 and 2024 in the Samarkand region was conducted. The study focused on tumor characteristics, molecular profiles, treatment modalities, recurrence localization, and survival outcomes. Research results. The LRR rate was 5.4%. Most recurrences occurred in women aged 31–50 and in patients with stage IIB–IIIA tumors. Hormone receptor status, HER2 expression, Ki-67 index, and completeness of adjuvant therapy were significant predictors of recurrence. The proposed management algorithm, based on molecular stratification and regional resources, demonstrated potential for improving long-term outcomes. Conclusion. Personalized follow-up and therapy plans based on tumor biology and regional guidelines are essential for reducing recurrence and improving survival in postmastectomy breast cancer patients.

CLINICO-MOLECULAR CHARACTERISTICS AND THERAPEUTIC STRATEGIES FOR LOCORREGIONAL RECURRENCE OF BREAST CANCER AFTER SURGICAL INTERVENTION

Mirjalol Djurayev — 2025-06-28

Relevance. Breast cancer remains one of the most common and socially significant malignancies among women. Given the high frequency of mastectomies, the risk of locoregional recurrences remains substantial, necessitating the development of effective diagnostic, surveillance, and therapeutic algorithms. Objective. To identify clinical, morphological, and molecular risk factors for breast cancer recurrence and to propose a stratification system and personalized approach to treatment and follow-up. Materials and methods of the study. The study included 206 patients with verified breast cancer who underwent mastectomy. Imaging, immunohistochemical (IHC) typing, and tumor marker monitoring were used. Molecular subtypes, Ki-67 index, and completeness of therapy were assessed. Statistical analysis was performed using the StatTech environment. Research results. A high recurrence risk was found in patients with HER2-positive and triple-negative tumors, stage IIB–IIIA, and high Ki-67 levels. Incomplete adjuvant therapy significantly increased recurrence probability. A follow-up algorithm and risk stratification system were developed. Conclusion. Locoregional breast cancer recurrences are associated with tumor biology and insufficient treatment. Therapy individualization based on IHC profiles improves survival and reduces oncological burden.

THE IMPORTANCE OF MODERN DIGITALIZATION IN MONITORING WOMEN WHO ARE LABOR MIGRANTS WITH HIV INFECTION

Inobatkhon Каlniyazova — 2025-06-28

Relevance: Currently, the role of mobile population groups in preventing the spread of HIV infection among labor migrants is being increasingly studied. Global migration poses a number of challenges for mobile populations living with HIV/AIDS, including economic and environmental factors, lack of access to health services and information, and lack of timely and quality access to treatment and prevention support. The objective of the study: to improve the organization of the remote monitoring system for women - labor migrants infected with HIV. Research materials: The official reports of the AIDS Control Center of the Republic of Uzbekistan as of 01.01.2022 were taken as a basis. Research methods: epidemiological and statistical methods were used. Research results: in modern conditions, the assessment of the health status of a patient of any age requires an individual (personal) approach. In the course of our study, the creation of a booklet with recommended digital content for migrant workers living with HIV infection will allow for preventive measures, including raising awareness of the HIV/AIDS problem, conducting individual risk factor assessments, conducting high-quality education on HIV/AIDS issues, and implementing remote epidemiological сontrol. Conclusion: In modern conditions, the assessment of the health status of a patient of any age requires an individual (personal) approach. The booklet with digital content for HIV-infected migrants developed during our study will allow for an individual assessment of risk factors for each HIV-infected migrant and the timely and high-quality implementation of HIV-related activities.

MENTAL DISORDERS IN PATIENTS WITH NEWLY DIAGNOSIS OF TUBERCULOSIS

Nargiza Mamatova — 2025-06-28

Relevance. The problem of tuberculosis, as an infectious disease, does not lose its heart against the background of a widespread decrease in tuberculosis. The results of the study indicate the development of borderline mental disorders in patients with tuberculosis after diagnosis, the elimination of which will help increase the effectiveness of complex treatment of tuberculosis. Purpose of the study. Before the end of the second month of anti-tuberculosis chemotherapy, we set ourselves the goal of analyzing the development of observed mental disorders in patients of different ages with newly diagnosed tuberculosis, as well as comparing the obtained results with the control group of healthy people. Materials and methods of the study. The study involved 120 patients who were first diagnosed with tuberculosis. 78 of the patients were male and 42 were female. The control group consisted of relatively healthy people who regularly visited polyclinics, namely 135 men and 45 women. The study was conducted using the method of differential diagnosis of depressive states by V. Zung, adapted by T.I. Balashova. The study was conducted in outpatient and inpatient settings with the participation of patients with depression of mental or organic origin. Research results. Neurogenic mild depression was observed in 18 (23,1%) men and 14 (33,3%) women. A masked depression was observed in 5 (6,4%) men and 8 (19,04%) women. Such people are chronically tired, sleep poorly at night and are excessively sleepy during the day, their memory deteriorates sharply, and they have difficulty concentrating on a particular type of activity. Despite the relatively low percentage of patients in this category, close supervision by a doctor is required. Such individuals experience such conditions as a state of constant depression, a slowdown in mental and labor activity, somatoneurological disorders, a decrease in life needs, a pessimistic assessment of oneself and its place in the surrounding reality. Conclusion. To identify patients in need of measures to improve their mental state, as well as patients with tuberculosis for the first time, the V. Zung method of differential diagnosis of depressive states, adapted by T. I. Balashova, can be used. In the majority of patients with newly diagnosed tuberculosis, depressive disorders were not detected by the end of the second month of chemotherapy. As a result of the study, it was found that patients with tuberculosis diagnosed for the first time experience mild depression more often than healthy people. Therefore, psychological and even some medical care specially organized to overcome depressive tendencies of different degrees may be needed at the end of the second month of chemotherapy for patients diagnosed with tuberculosis for the first time.

EFFICACY OF EVEROLIMUS IN COMBINATION WITH LETROZOLE, MEGESTROL ACETATE, AND PACLITAXEL FOR RECURRENT ENDOMETRIAL CANCER

Sergey Kamishov — 2025-06-28

Introduction. Everolimus, an mTOR inhibitor, has already demonstrated efficacy in endometrial cancer, but experience with its use in Uzbekistan is limited. Resistance to standard therapy often develops in recurrent/metastatic endometrial carcinoma, underscoring the need for novel treatment regimens. Objective. To assess the efficacy and safety of everolimus‐based combination therapies in this patient population. Materials and methods. This retrospective, single‐center study (May 2022 – June 2024) enrolled 44 patients who had previously received platinum and paclitaxel. In Group 1 (n = 14), patients received everolimus 10 mg daily in combination with letrozole, megestrol acetate, or paclitaxel; Group 2 (control, n = 30) received the same regimens without everolimus. Tumor response was evaluated every eight weeks using RECIST v1.1, and toxicity was graded according to CTCAE v5.0. Results. The objective response rate was 28.6% in the everolimus group versus 13.3% in controls (p = 0.18), while the disease control rate was 78.6% versus 50.0% (p = 0.047). Median time to progression (TTP) increased to 6.2 months (HR 0.46; p = 0.011), and median overall survival (OS) to 28.0 months (HR 0.55; p = 0.032). Grade 3–4 stomatitis and hyperglycemia each occurred in 14% of patients; only one patient discontinued therapy due to toxicity. Conclusion. The addition of everolimus significantly improved disease control and prolonged TTP and OS with acceptable safety, supporting its use in this setting and corroborating existing phase II data.

ON THE SIGNIFICANCE OF THE SCORE-2 RISK SCALE FOR CARDIOVASCULAR COMPLICATIONS AMONG PATIENTS WITH PREDIABETES

Shakhnoza Yusupova — 2025-06-28

The aim of the study is to consider and evaluate the value of the SCORE-2 cardiovascular risk scale among patients with prediabetes. Material and methods of the study. The study included 45 people aged 40 to 65 years, including 25 men with an average age of 59.3±8.2 years and 20 women with an average age of 55.2±7.1 years. The control group consisted of 20 healthy people. Research methods: included general clinical methods, biochemical tests (fasting blood glucose level and 2 hours after a meal, glycated hemoglobin, bilirubin, both direct and indirect, ALT, AST, PTI, coagulogramm, C-reactive protein, urea, creatinine, lipid spectrum), hormonal studies (if necessary, insulin and C-peptide levels in the blood) and instrumental methods: ECG, ultrasound of the endocrine glands and internal organs, chest X-ray and others. Research results. When assessed using the SCORE2 scale, patients were divided into risk groups: 17 of them were in the low risk group, 15 in the moderate risk group, 7 in the high risk group and 6 in the very high risk group. The estimated risk of death and non-fatal CVD ranged from 0.3% to 53.2%, with a mean value of 8.8±7.5%. According to the SCORE2 scale, all patients were classified into the high and very high risk categories, comprising 18 and 27 patients, respectively. Conclusions. 1. The SCORE2 scale, used to calculate non-high-density lipoprotein cholesterol (non-HDL-C) levels, provides a more individualized risk assessment, showing more unfavorable results among the Uzbek ethnic group. The SCORE2 system has a more differentiated approach to determining individual cardiovascular risk.

NEUROLOGICAL COMPLICATIONS IN DIABETICS

Nilufar Avazova — 2025-06-28

This scientific article provides a comprehensive analysis of neurological complications in diabetes mellitus, particularly focusing on diabetic neuropathy. The study systematically examines the clinical manifestations, pathogenesis, diagnostic approaches, and contemporary treatment methods associated with this condition. It is well-established that diabetic neuropathy is among the most prevalent and debilitating neurological complications affecting the quality of life and work capacity of patients with diabetes. Based on modern scientific literature, practical observations, and statistical data, the article explores the etiopathogenetic mechanisms contributing to the development of diabetic neuropathy. These include chronic hyperglycemia, oxidative stress, accumulation of advanced glycation end-products, and microcirculation disorders. The article also discusses the various clinical types of neuropathy, including distal symmetric polyneuropathy, autonomic neuropathy, mononeuropathy, radiculopathy, and diabetic amyotrophy, along with their diagnostic and therapeutic principles. The early detection of diabetic neuropathy and implementation of a multidisciplinary, comprehensive treatment strategy are emphasized as essential for preserving patients’ quality of life. Furthermore, the article highlights the importance of stable glycemic control, metabolic balance restoration, the introduction of screening programs, and the use of antioxidants, neuroprotective agents, and medications for neuropathic pain as part of modern therapeutic approaches. The conclusions drawn from the study have significant practical relevance for healthcare systems, providing guidance for the prevention, early diagnosis, and effective treatment of neurological complications associated with diabetes. Combining theoretical insights with applied recommendations, this research serves as a valuable methodological and scientific foundation for further studies in the field.

THE IMPORTANCE OF MODERN DIAGNOSTIC METHODS IN DETECTING AND TREATING MYCOPLASMA PNEUMONIA IN CHILDREN

Gulnoz Kholikova — 2025-06-28

Introduction. Late detection of atypical forms of community-acquired pneumonia is one of the urgent problems and leads to an increase in the duration of treatment. This is due to the late detection of SARS by family clinics, district medical associations, incorrect diagnosis, improper treatment, delay in treatment, late admission of patients to the hospital. Purpose of the study: To correctly conduct treatment tactics by identifying clinical, laboratory, and instrumental features of atypical pneumonia in children. Materials and methods of research. The study was conducted among 160 children aged 3 months to 16 years who applied to the regional children's multidisciplinary center (RCMC) in the autumn-winter period of 2024. At the direction of family polyclinics and district medical associations, 128 children went to the hospital with a diagnosis of Community-acquired pneumonia, 32 sick children received antibiotic therapy against acute respiratory infections at home, after unsuccessful treatment they went to the hospital and were admitted to the pulmonology department on the 7-9 day of illness. The results of the study. The clinical diagnosis of pneumonia was confirmed in 132 (82.5%) of 160 children during an extended examination at the RCMC. Pneumonia was not confirmed in 28 (17.5%) children after X-ray examination. Obstructive bronchitis was confirmed in 12 (42.8%) of them, bronchiolitis in 5 (17.6%), acute respiratory viral infections in 6 (21.4%), and influenza in 5 (17.6%). Of the 132 children diagnosed with BP, 46 were examined using polymerase chain reaction (PCR) and enzyme immunoassay (ELISA), and mycoplasma pneumonia was diagnosed. The results of the study: The clinical diagnosis of pneumonia was confirmed in 132 (82.5%) out of 160 children during an extended examination at RCMC. In 28 (17.5%), pneumonia was not confirmed after X-ray. Obstructive bronchitis was diagnosed in 12 cases (42.8%), bronchiolitis - in 5 cases (17,6%), acute viral respiratory infection - in 6 cases (21,4%), and flu - in 4 cases (5). Of the 130 children diagnosed with pneumonia, 46 underwent polymerase chain reaction (PCR) testing and enzyme immunoassay (ELISA) to confirm mycoplasmal pneumonia. Conclusions.Mycoplasmapneumoniais the mostcommoncausative agent of atypical,which is registeredmainly in preschoolandschool-age children over5years of age.

CLINICAL MANIFESTATIONS OF CENTRAL NERVOUS SYSTEM DAMAGE IN NEWBORNS, DEPENDING ON THE SEVERITY OF PERINATAL ENCEPHALOPATHY

Shoxista Nabieva — 2025-06-28

120 newborns with moderate and severe perinatal CNS lesions who were in the neonatal pathology department were examined. The study showed a high reliable incidence of perinatal CNS damage in newborns in the studied groups. An analysis of studies of the clinical manifestations of damage to the nervous system of a newborn in perinatal encephalopathy has shown that changes in the state of the central nervous system can further affect the health of the child, and with late diagnosis and severe cases, the disease can occur with a complicated long-term course of the disease perinatal encephalopathy of newborns.

FEATURES OF CHANGES IN IMMUNOLOGICAL PARAMETERS AND DNA METHYLATION IN CHILDREN AGED 7-10 YEARS ENGAGED IN SWIMMING

Svyatoslav Babich — 2025-06-28

The article deals with the features of adaptive processes for changing immunological parameters and epigenetic DNA methylation in children aged 7-10 years who are engaged in swimming. The aim of the study: to study the characteristics of changes in immunological parameters and epigenetic DNA methylation in children aged 7-10 years involved in swimming. Material and methods. The study involved 30 children aged 7-10 years, who were divided into 3 groups. Group 1 included 10 children aged 7-10 years who were not involved in any kind of sport - control. Group 2 included 10 children aged 7-10 years who had been swimming for 1 year. Group 3 included 10 children aged 7-10 years who had been swimming for 3 years. Cytokines, DNA methyl-transferase 1 and 5-methyl-2'-deoxycytidine content were determined by ELISA using standard kits. Statistical data processing was performed using Microsoft Office Excel 2010 by the variation statistics method with calculation of arithmetic means and their errors (M±m). The statistical significance of differences between independent samples with normal distribution was assessed using Student's t-test. Differences were considered significant at p<0.05. Research results. In children of 7-10 years old engaged in swimming, with an increase in the duration of the usual training process, compared with children who are not engaged in any kind of sports, there was a significant increase in blood after 1 year, and after 3 years of training, a significant decrease in the indicators taken into account, more pronounced in the study of IL-6, TGF-β1 and less pronounced in the study of TNF-α, IL-10. During the peak of training load, similar, but more pronounced changes in these indicators were detected compared to the indicators of the usual training process. When studying the activity of DNA methyl transferase 1 and the content of 5-methyl-2'-deoxycytidine with an increase in the duration of swimming, an unreliable decrease in these indicators was observed after 1 year and a significant decrease after 3 years of training compared with children who do not engage in any sports. During the peak training load, there was also a significant decrease in these indicators after 1 year and more pronounced after 3 years of training, relative to the results of children who do not engage in any kind of sports. Conclusion. With an increase in physical activity in duration and intensity, the level of cytokines, the activity of DNA methyltransferase 1 and the content of 5-methyl-2'-deoxycytidine decrease, which indicates a decrease in adaptation processes.

FEATURES OF CHANGES IN METABOLIC PARAMETERS AND DNA METHYLATION IN CHILDREN AGED 7-10 YEARS ENGAGED IN SWIMMING

Svyatoslav Babich — 2025-06-28

Many studies conducted with athletes do not take into account the features of adaptive changes in metabolism. This leads to ambiguity and contradictory data on many indicators in response to a single physical load. This applies to the energy substrates used, hormonal background, changes in carbohydrate and lipid metabolism. Many studies conducted with athletes do not take into account the features of adaptive changes in metabolism. This leads to ambiguity and contradictory data on many indicators in response to a single physical load. This applies to the energy substrates used, hormonal background, changes in carbohydrate and lipid metabolism. Some metabolites, such as lactate, can directly regulate the activity of epigenetic modification enzymes. The aim of the study: to study the features of changes in metabolic indicators and epigenetic DNA methylation in children aged 7-10 years involved in swimming. Material and methods. The study involved 30 children aged 7-10 years, who were divided into 3 groups. Group 1 included 10 children aged 7-10 years, who were not involved in any kind of sports - control. Group 2 included 10 children aged 7-10 years, who had been swimming for 1 year. Group 3 included 10 children aged 7-10 years, who had been swimming for 3 years. Lipids, DNA methyl-transferase 1 and 5-methyl-2'-deoxycytidine content were determined by ELISA, glucose and lactic acid - on a biochemical autoanalyzer from Mindray (China) using standard kits. Statistical data processing was performed using Microsoft Office Excel 2010 by the method of variation statistics with calculation of arithmetic means and their errors (M±m). The statistical significance of differences in independent samples with normal distribution was assessed using the Student t-test. Differences were considered significant at p<0.05. Study results. The indicators characterizing metabolic processes and DNA methylation were studied in children aged 7-10 years, obtained during regular training and at peak loads during preparation for competitions. The results obtained allowed us to draw the following conclusion. After 1 year of training, in children was observed a significant decrease in total cholesterol, triglycerides, VLDL and non-significant LDL, as well as a significant increase in HDL, glucose and lactic acid. At the same time, children after 3 years of training showed a significant decrease in total cholesterol, triglycerides, LDL and VLDL, as well as a significant increase in HDL compared with similar results in children who do not play sports. There was also a significant decrease in glucose and lactic acid levels relative to children who were engaged in swimming for 1 year. A significant decrease in the activity of DNA methyl transferase 1 and the 5-methyl-2'-deoxycytidine index was revealed after 1 year and more pronounced after 3 years of training at the peak of the training regime relative to the usual training process. Conclusion. The presented changes in children aged 7-10 years are probably associated with a shift in metabolic processes towards increased catabolism in order to adapt to increased physical exertion and the duration of the training process.

COMPARATIVE DIAGNOSTICS OF BRONCHOPULMONARY COMPLICATIONS IN YOUNG CHILDREN WITH WHOOPING COUGH

Ravshan Sultonov — 2025-06-28

Whooping cough remains one of the leading causes of infant mortality worldwide. This article presents a comparative diagnosis of bronchopulmonary complications in young children infected with respiratory syncytial virus and pertussis virus. The study was conducted on 50 children with pertussis at the central polyclinic of Termez city, Surkhandarya region, during 2023-2024. All 50 children with whooping cough were divided into age groups as follows: 1-year-old children formed the 1st group, 2-year-old children formed the 2nd group, and 3-year-old children formed the 3rd group. When examining the disease by gender in the study: Bronchopulmonary complications in boys were categorized into subgroups based on the results of objective and instrumental examinations and were assessed as follows: Bronchopneumonia in 18 (36%) patients, acute bronchitis in 16 (32%) patients, laryngitis in 6 (12%) patients, and bronchitis+laryngitis in 9 (18%) patients. In girls, bronchopulmonary complications were studied by subgroups as follows: bronchopneumonia was observed in 6 (12%) patients, acute bronchitis in 16 (32%) patients, laryngitis in 15 (30%) patients, and bronchitis+laryngitis in 13 (26%) patients. In conclusion, among the bronchopulmonary complications in children with whooping cough, bronchopneumonia was observed in 38% of boys, while acute bronchitis was seen in 32% of girls. It was found that 30% of all examined patients were not vaccinated at all, of which 10% had not yet reached the age for vaccination. Whooping cough tends to be severe in children, mainly in early childhood (1-3 years old), due to incomplete vaccination against the disease. These cases require a special therapeutic approach.

MARKERS OF ENDOTHELIAL DYSFUNCTION IN CHILDREN WITH OBESITY

Elnara Ibragimova — 2025-06-28

Endothelial dysfunction plays a leading role in the progression of cardiovascular disease in children with obesity. The article discusses the prognostic values of early markers of endothelial dysfunction in children with obesity. The aim of the study: to study early markers of endothelial dysfunction in children and adolescents with abdominal obesity to predict the development of cardiovascular risk. Materials and methods: A total of 56 obese children aged 10-18 years were examined on an outpatient basis. Anthropometric, general clinical and biochemical studies of the lipid and carbohydrate spectrum were performed in all study groups. The levels of leptin, trimethylamine-N-oxide (TMAO) and von Willebrand factor (vWF) were determined in plasma by enzyme-linked immunosorbent assay (ELISA). Study results: A close relationship between severe obesity in children with hyperleptinemia and leptin resistance was revealed. The highest values of the von Willebrand factor content and TMAO level were found in children with abdominal obesity. In children with a uniform type of obesity, these indicators had moderate values. Conclusion: Leptin resistance, elevated levels of TMAO and von Willebrand factor lead to endothelial dysfunction and, accordingly, a high risk of developing cardiovascular pathology in children with abdominal obesity.

OPTIMIZATION OF TREATMENT FOR PATIENTS WITH DRUG-RESISTANT PULMONARY TUBERCULOSIS

Sevginoz Khodjiyeva — 2025-06-28

Relevance.Drug-resistant pulmonary tuberculosis (DR-TB) remains one of the most serious threats to public health, particularly in resource-limited and transitional economies. Resistance of Mycobacterium tuberculosis to key anti-tuberculosis drugs such as isoniazid and rifampicin significantly reduces the effectiveness of standard treatment regimens, which are often lengthy, toxic, and associated with low patient adherence. This underscores the importance of evaluating the effectiveness of short, individualized regimens incorporating newer-generation drugs. This study aimed to compare the clinical efficacy and tolerability of traditional long-term versus short individualized treatment regimens for DR-TB in Uzbekistan. Materials and methods of the study .A retrospective analysis was conducted on 120 patient medical records from the Republican Tuberculosis Dispensary between 2020 and 2023. Patients were divided into two groups: 65 patients received short-term individualized regimens (6–9 months) including bedaquiline, delamanid, and linezolid, while 55 patients were treated with standard regimens (18–20 months). Evaluation criteria included bacteriological conversion time, relapse rates, incidence of moderate/severe adverse effects, and treatment adherence. Research results.Short regimens showed superiority across all measured indicators: average time to bacteriological conversion was 16 weeks (vs. 28 in the control group), relapse rate within 12 months was 7% (vs. 15%), incidence of adverse effects was 26% (vs. 42%), and treatment adherence reached 89% (compared to 64% in the standard group). All differences were statistically significant (p < 0.05). Conclusion. The findings confirm the high clinical and epidemiological effectiveness of short individualized regimens for DR-TB. Their implementation can significantly improve treatment quality, increase patient adherence, reduce the risk of resistant strain transmission, and lower the burden on healthcare systems. Given these advantages, it is advisable to integrate these regimens into the updated national tuberculosis treatment protocols in Uzbekistan.

DISSEMINATED PULMONARY TUBERCULOSIS IN HIV-INFECTED PATIENTS

Sevginoz Khodjiyeva — 2025-06-28

Relevance.The present study is aimed at reviewing the clinical, radiological and immunological features of disseminated pulmonary tuberculosis in patients with HIV infection. Amid the growing HIV pandemic/AIDS and the global burden of tuberculosis, this combination poses a serious threat to public health and requires a systematic approach to diagnosis, treatment and prevention. Materials and methods of the study.The article presents generalized data from clinical observations, epidemiological reports of the World Health Organization, as well as the results of scientific research published in the databases PubMed, Scopus and RSCI. Research results. A comparative analysis of the management tactics of patients with HIV/TB coinfection was carried out. It has been established that disseminated tuberculosis develops mainly in patients with severe immunodeficiency (CD4 <200 cells/µl). The clinical picture is atypical, and diagnosis requires the use of modern molecular and imaging techniques. Complex therapy, including antiretroviral drugs and anti-tuberculosis drugs, significantly improves the prognosis, but the mortality rate remains high. Conclusion. Early diagnosis and an interdisciplinary approach to the treatment of disseminated tuberculosis in HIV-infected people are key factors in reducing mortality and improving the quality of life of patients. Further research is needed to optimize treatment regimens and prevention programs.

SERUM CYSTATIN C FOR RISK STRATIFICATION IN PATIENTS WITH PREDIABETES

Shakhnоza Yusupova — 2025-06-28

The aim of the investigation is to study the value of Cystatin-C among patients with prediabetes for risk stratification. Material and methods of the study. Our study included 55 people aged 18 to 65 years, including 35 men with an average age of 54.3±3.2 years and 20 women with an average age of 51.1±2.1 years. The study was conducted at the Andijan Regional Endocrinology Dispensary. The control group consisted of 20 healthy people. Research methods: included general clinical methods, biochemical tests (fasting blood glucose level and 2 hours after a meal, glycated hemoglobin, bilirubin, both direct and indirect, ALT, AST, PTI, coagulogram, C-reactive protein, urea, creatinine, lipid spectrum, Cystatin-C), hormonal studies (if necessary, insulin and C-peptide levels in the blood) and instrumental methods: ECG, ultrasound of the endocrine glands and internal organs, chest X-ray and others. Research results. Prediabetes is a risk factor for ASCVD (prediabetes: CI: 1.08–1.15; P < 0.001), chronic kidney disease (prediabetes: CI: 1.02–1.14; P < 0.001; ), and heart failure (prediabetes: CI: 1.01–1.14; P = 0.03; ). Compared with hemoglobin A1c (HbA1c) levels less than 5.0%, covariate-adjusted risks were significantly increased for ASCVD with HbA1c greater than 5.4%, chronic kidney disease greater than 6.2%, and heart failure greater than 7.0 In the same way, the average values of CRP and Cystatin-C were significantly increased in comparison with the control group (p < 0.005). Conclusions: Cystatin C can be used as an early biomarker of chronic kidney disease (CKD) and is associated with prediabetes. It can help identify patients with preclinical kidney disease who are at increased risk of developing chronic kidney disease. Elevated cystatin C levels can detect CKD even in its early stages, when other markers such as creatinine have not yet changed significantly.

ANALYSIS OF THE CARDIOVASCULAR SYSTEM CONDITION IN PATIENTS WITH CHRONIC KIDNEY DISEASE IN THE SAMARKAND REGION

Gulshon Mukhitdinova — 2025-06-28

Chronic kidney disease (CKD) is a serious issue in modern healthcare. Numerous studies conducted over the past ten years have shown that the likelihood of cardiovascular diseases (CVD) increases even with a slight decrease in glomerular filtration rate (GFR) and continues to rise as CKD progresses, reaching its peak at the terminal stage. The risk of cardiovascular pathology in CKD patients increases as GFR declines, and mortality associated with this condition significantly exceeds the overall population mortality rate. The prolonged course of CKD often leads to secondary changes in the cardiovascular system, including dystrophic changes in the myocardium, atherosclerosis, arterial hypertension, left ventricular hypertrophy, electrolyte imbalances, and conduction and rhythm disturbances. All these processes contribute to the onset and progression of cardiovascular diseases. Objective. To study the structural and functional changes in the cardiovascular system in patients with CKD at different stages of the disease. Materials and methods. To achieve the research objectives, objective, subjective, and laboratory-instrumental methods were used, along with Doppler echocardiography (EchoCG) in 100 patients who underwent examination and treatment at Samarkand City Hospital from 2022 to 2023. Results. Laboratory test analysis revealed decreased hemoglobin and hematocrit levels in the blood. Echocardiographic studies were conducted on 100 patients to assess structural changes in the heart and their severity at various stages of CKD. The study examined key EchoCG parameters characterizing heart structures, including left ventricular wall thickness, left ventricular myocardial mass, and the condition of the heart valve apparatus. Conclusion. The results of our study indicate that anemia plays a significant role in the development and progression of cardiovascular diseases, which are highly prevalent in CKD patients. A consistent correlation was found between the frequency, nature, and severity of left ventricular remodeling and the decrease in GFR.

TIC EPILEPSY IN THE UZBEK POPULATION: CLINICAL AND ENCEPHALOGRAPHIC ASPECTS (PILOT STUDY)

Dilorom Nurmatova — 2025-06-28

Relevance. Tic disorders in children are one of the most common forms of hyperkinesis in pediatric neurological practice, demonstrating a high incidence of comorbidity with various neuropsychiatric and neurological disorders. One of these conditions, which has a significant impact on the course and prognosis of the disease, is epilepsy. The aim of the study was to carry out a clinical and physiological study to analyze the pathogenesis and clinical characteristics of epilepsy in children with tic hyperkinesis. Materials and methods of research. The present study analyzes the pathophysiological and clinical features of 189 children with tic hyperkinesis, 19 of them with concomitant epilepsy. The results of the study. Analysis of the data obtained suggests that there is a common pathogenetic basis between tic disorders and epilepsy. It is assumed that both conditions may be caused by dysfunction of the corticostriato-thalamo-cortical ring, which plays a key role in regulating motor activity, filtering sensory information, and implementing cognitive-behavioral programs. Conclusion. Epilepsy is one of the comorbid pathologies associated with tic hyperkinesis in children, and early electroencephalographic examination in children with tics will allow verification of epileptic activity for further rational patient management. Keywords: tic disorders, hyperkinesis, epilepsy, children, comorbidity, YGTSS, cortico-striato-thalamo-cortical system, neurophysiology.

POSTOPERATIVE COMPLICATIONS OF ADENOTONSILLOTOMY: FREQUENCY AND PREVENTION

Islom Shamatov — 2025-06-28

Adenotonsillotomy is one of the most commonly performed surgical procedures in pediatric otorhinolaryngology. Despite its high efficacy in treating obstructive airway disorders, the risk of postoperative complications remains significant. The most frequent complications include hemorrhage, infections, respiratory disturbances, and scar formation. This article provides a review of current literature on the incidence of complications following adenotonsillotomy and examines effective prevention methods, including preoperative preparation, the use of advanced surgical technologies, and a multidisciplinary approach to patient management. Special attention is given to promising strategies aimed at reducing the risk of postoperative bleeding and improving clinical outcomes.

ASSOCIATION OF THE Gln27Glu POLYMORPHISM OF THE β2-ADRENOCEPTOR GENE WITH LIPID METABOLISM FEATURES IN PATIENTS WITH BRONCHIAL ASTHMA

Khusan Turdibekov — 2025-06-28

Relevance. Considering the key role of β₂-adrenoceptors in bronchodilation mechanisms, as well as their involvement in the regulation of metabolic processes, the analysis of genetic variants of the β₂-adrenoceptor gene is of particular importance for understanding the pathogenesis of bronchial asthma, especially in the presence of concomitant metabolic disorders, including dyslipidemia and obesity. Objective. To determine the association between the Gln27Glu polymorphism of the β₂-adrenoceptor gene and lipid metabolism parameters in patients with bronchial asthma, taking obesity phenotype into account. Materials and Methods. The study included 81 patients with bronchial asthma. The diagnosis was established according to GINA criteria. The mean age of the patients was 42.5 ± 1.41 years, with a mean disease duration of 10.1 ± 0.73 years. Total cholesterol, triglycerides, low-density and high-density lipoproteins, and atherogenic index were analyzed. Genotyping of the Gln27Glu polymorphism of the β₂-adrenoceptor gene was performed using PCR. Results. The highest total cholesterol level was observed in obese patients with the Gln27Gln genotype (6.44 ± 0.17 mmol/L), whereas in obese patients with the Gln27Glu genotype it was significantly lower (5.69 ± 0.16 mmol/L; p < 0.01). Similarly, LDL levels were highest in obese patients with the Gln27Gln genotype (3.91 ± 0.13 mmol/L), compared to those with the Gln27Glu genotype (p < 0.01). HDL levels were similar across all groups (1.19–1.51 mmol/L) without statistically significant differences (p > 0.05). The atherogenic index was highest in the obese Gln27Gln group (4.45 ± 0.18), while in the Gln27Glu group it was significantly lower (3.29 ± 0.16; p < 0.001). Conclusion. The Gln27Gln genotype in the presence of obesity is associated with adverse lipid profile changes, including elevated total cholesterol, triglycerides, LDL, and atherogenic index, indicating an increased atherosclerotic risk in this patient group. Final Remark. The Gln27Gln genotype combined with obesity may serve as a potential marker of unfavorable prognosis characterized by lipid metabolism disturbances and an increased risk of cardiovascular complications.

IRRIGATION SOLUTIONS IN CLINICAL ENDODONTICS: TYPES, PROPERTIES, AND ACTIVATION MECHANISMS

Islomjon Sattarov — 2025-06-28

Relevance. Effective disinfection of root canals is one of the key factors for successful endodontic treatment. The complex anatomical structure of the canals, formation of necrotic tissue layers, and the presence of bacterial biofilms complicate complete cleaning and disinfection. Therefore, an in-depth study of irrigation solutions and their activation methods is highly relevant. By determining the properties, efficacy, and safety of irrigants such as sodium hypochlorite (NaOCl), EDTA, and others, it is possible to develop optimal clinical protocols. In particular, identifying the advantages of activation technologies such as passive ultrasonic irrigation (PUI) in biofilm removal is of great practical importance for dental practitioners. Materials and methods of the study. The literature review is based on an analysis of scientific articles published between 2000 and 2024. Articles were searched using the PubMed, Scopus, and Web of Science databases. The search keywords included “endodontic irrigation,” “root canal disinfection,” “irrigant activation,” and “sodium hypochlorite endodontics.” A total of 86 articles were initially identified, of which 48 were deemed relevant to the topic. The selection criteria included the chemical composition and efficacy of irrigation solutions, comparative analysis of irrigation protocols, and mechanisms of irrigant activation. The main focus was on analyzing the physicochemical properties and activation methods (ultrasonic, sonic, laser-assisted) of NaOCl, EDTA, CHX, MTAD, and QMix irrigants. Research results. Sodium hypochlorite (NaOCl) was recognized as the “gold standard” irrigant due to its broad-spectrum antimicrobial and tissue-dissolving properties. A 17% EDTA solution effectively removed the necrotic layer. A 2% chlorhexidine solution provided prolonged antimicrobial effects but lacked tissue-dissolving capabilities. Modern solutions such as MTAD and QMix demonstrated multifunctionality and promising results. Meta-analyses showed that the combination of NaOCl and EDTA with ultrasonic activation yielded the most effective outcomes. The recommended optimal clinical protocol included initial irrigation with NaOCl, intermediate rinse with 17% EDTA, and final rinse with NaOCl; ultrasonic activation was applied at all stages. Conclusion. Irrigation plays a crucial role in ensuring the success of endodontic treatment. NaOCl remains the primary irrigant due to its antimicrobial and tissue-dissolving properties, while EDTA is an effective adjunct for removing necrotic and bacterial layers. Activation methods, especially ultrasonic irrigation, enhance the efficacy of irrigants and demonstrate superiority in biofilm removal. Optimal protocols combine NaOCl and EDTA with ultrasonic activation to ensure maximum disinfection and minimal risk.

MANAGEMENT AND OUTCOMES OF HOSPITALISED CHILDREN WITH COMMUNITY-ACQUIRED PNEUMONIA COMPLICATED BY PLEURAL EFFUSION

Nigina Aminova — 2025-06-28

Abstract: The aim of this study was to investigate the hospitalisation of children with community-acquired pneumonia complicated by pleural effusion. Children without significant comorbidities, aged less than 18 years, admitted between 1 February 2022 and 25 February 2025 to the pulmonology and surgery departments of the SRChMMC with any pneumonia discharge code, who had an ultrasound findings of effusion/empyema, were studied. During the study period, 87 children without serious comorbidities were hospitalised for confirmed EP. The mean length of hospital stay was 9 days (Q1-Q3 6-11 days), 27 (31 %) were hospitalised in ORIT. Most (61, 70%) underwent procedural drainage. Length of hospital stay was not related to the amount of effusion but was associated with the time of drainage (0.60 days longer stay per day of delayed drainage, 95% CI 0.19-1.0 days). Microbiological diagnosis was more frequently made by PCR analysis of pleural fluid (43/59, 73%) than by blood culture (9, 10%); the main aetiological pathogens were S. pneumoniae (33, 38%), S. pyogenes (14, 87%) and S. aureus (7, 8%). Discharge on a narrow-spectrum antibiotic (e.g., amoxicillin) was much more common when a pathogen with complicated pleural effusion was identified than when it was not (68% vs. 24%, p < 0.001). Thus, children with OPV were usually hospitalised for prolonged periods. Surgical procedural drainage was associated with a shorter hospital stay. Examination of pleural fluid often facilitated microbiological diagnosis, which itself was associated with more adequate antibiotic therapy.