Prevalence of Serum IgG Antibodies to Cystic Echinococcus Antigen among Patients in an Uzbekistan Emergency Hospital.

Cystic echinococcosis (CE) is one of the most widespread zoonotic helminthiases, which can last an asymptomatic infection for several years. The purpose of this study was to demonstrate serum antibody prevalence of CE among asymptomatic people in Uzbekistan using ELISA. A total of 2,547 serum samples were collected, 66 from confirmed CE patients and 2,481 of patients with other diseases than CE at a hospital in Tashkent, Uzbekistan. The serum samples were screened for CE specific IgG antibodies by ELISA using cystic fluid antigen obtained from sheep. The serum antibody positive rate was 89.4% (59/66) in CE and 3.6% (89/2,481) in other disease patients. The present ELISA recognized 89.4% sensitivity and 96.4% specificity. The ELISA absorbance of positive samples was distributed 0.271-0.971 for CE and 0.273-0.887 for other disease patients. The other disease patients with high absorbance over 0.3 were 50 (2.0%) who were presumed to be active CE patients. The patients in their 40s showed the highest positive rate of 5.2% (P=0.181), and women were 4.4% while men were 3.1% positive (P=0.136). The data confirmed that there are many asymptomatic patients of CE in Tashkent. It is indicated that CE is an endemic disease of public health importance in Uzbekistan.

Kidney Transplant for a Patient With Inferior Vena Cava and Abdominal Aorta Abnormalities.

Here, we describe an interesting case of a patient with the duplication of inferior vena cava, high-positioned bifurcation of the abdominal aorta with transposition of iliac arteries, and right renal aplasia associated with end-stage renal disease who underwent kidney transplant. In this case, the patient with anorectal malformations with a vaginal fistula was prepared and underwent a kidney transplant. During the surgery, we discovered duplicated inferior vena cava and transposed iliac arteries. After the surgery, computed tomography angiography revealed the inferior vena cava duplication with the 2 connections between the right and left inferior vena cava with the formation of an anomalous circle, high-positioned bifurcation of the abdominal aorta at the level of the L2 vertebral body, and transposition of right and left iliac arteries. Also, we observed the right kidney aplasia and absence of blood circulation in the left native kidney. In our case, a delayed diagnosis of pyelonephritis resulted in the progression to end-stage renal disease that necessitated a kidney transplant, during which we found these anomalies. We confirmed the asymptomatic course of these anomalies, diagnosed only during radiological imaging or surgical intervention. Patients with congenital anomalies of the kidney and urinary tract should undergo complete investigations before surgical decisions. Diagnosis of this pathology in the preoperative period, especially in transplant patients, will alert the surgery team in advance of the operation and allow preparation for the intraoperative difficulties that are typically associated with anomalies such as inferior vena cava transposition or aplasia.

Robotic versus Laparoscopic Liver Resections for Colorectal Metastases: A Systematic Review and Meta-Analysis.

Colorectal cancer is the third most common cancer worldwide, and the liver is the most common localization of metastatic disease. The incidence of minimally invasive liver surgery is increasing, and robotic surgery (RLR) is believed to overcome some limitations of a laparoscopic approach (LRL). We performed a systematic review and meta-analysis of operative and short-term oncologic outcomes of the laparoscopic versus robotic-assisted liver resection for colorectal liver metastases. An online search of PubMed, Embase, Scopus, and the Cochrane databases was performed. Eight studies involving 3210 patients were considered eligible for the meta-analysis. In the LRL group, a higher conversion to open rate (12.4%) was observed compared to the RLR (6.7%; p = <0.001). 30-day mortality was 0.7% for the LRL group compared to 0.5% for the RLR group (p = 0.76). Mortality in longer periods among LLR and RLR amounted to 18.2% vs. 8.0% for 1-year mortality (p = 0.07), 34.1% vs. 26.7% for 2-year mortality (p = 0.13), and 52.3% vs. 48.3% for 3-year mortality (p = 0.46). The length of hospital stay was 5.6 ± 2.5 vs. 5.8 ± 2.1 days, respectively (p = 0.47). There were no significant differences between the incidence of individual complications in the LRL and RLR groups (p = 0.78). Laparoscopic or robotic approaches for colorectal liver metastases are comparable in terms of safety and effectiveness. There are significant advantages to robotic surgery, although there is still no long-term evidence concerning overall survival, and the number of patients operated on using RLR remains small.

Features of Kidney Transplant in Pediatric Recipients: Experience of a Single Center.

OBJECTIVES: Congenital abnormalities of the kidneys and the urinary tract are common reasons for endstage renal disease in children. We studied the features of postoperative management and possible complications after pediatric kidney transplant. MATERIALS AND METHODS: We retrospectively analyzed 29 children aged from 9 to 18 years who underwent kidney transplants from April 2018 to December 2013 (17 boys and 12 girls). All recipients were on hemodialysis for 3 to 18 months (mean of 10.17 ± 4.52 mo). Etiology of end-stage kidney disease included chronic glomerulonephritis (n = 12 [41.4%]), urolithiasis (n = 3 [10.3%]), and congenital abnormalities of the kidneys and the urinary tract (n =14 [48.3%]), including urinary reflux (n = 5 [17.2%]). Donors were parents in 16 cases, siblings in 5, uncles in 5, and aunts in 3 cases. HLA mismatching ranged from 2 to 5 (mean of 2.93 ± 1.39). Three patients had intraoperative nephrectomy, and 2 patients had hydronephrosis and urethroplasty with megaureter to prevent urinary tract infection. RESULTS: Six patients (20.6%) had early postoperative complications: 2 with delayed graft function, 1 with venous anastomosis thrombosis, 2 with hematoma around the graft, and 1 with lymphocele. Venous anastomosis thrombosis was eliminated by open thrombectomy, with graft function restored on postoperative day 17. The lymphocele was eliminated by puncture and drainage. Hematomas did not require surgical correction and blood transfusion. Ten patients (34.4%) had late postoperative complications: 1 with stricture of vesicoureteral anastomosis, 3 with vesicoureteral reflux, and 5 with urinary tract infection (3 with bacterial culture). Stricture of vesicoureteral anastomosis was successfully resolved by open surgery. Vesicoureteral reflux was eliminated with hydrogel. One patient developed chronic kidney rejection within 6 months because of noncompliance with posttransplant regimen and required transplantectomy. CONCLUSIONS: A major factor in reducing frequency of infections after surgery is the recipient's nephrectomy.

Serodiagnosis of echinococcosis by ELISA using cystic fluid from Uzbekistan sheep.

According to increase of travel, the cases of imported echinococcosis have been increasing in Korea. The present study was undertaken to develop a serodiagnostic system for echinococcosis in Korea. For diagnosis of echinococcosis, the fluid of Echinococcus granulosus hydatid cysts was collected from naturally infected sheep in Uzbekistan. Also serum samples of infected patients who were surgically confirmed were collected in a hospital in Tashkent, Uzbekistan. According to the absorbance of 59 echinococcosis positive and 39 negative control serum samples, the cut-off value was determined as 0.27. The sensitivity and specificity of ELISA with hydatid fluid antigen were 91.5% and 96%, respectively. The antigen cross-reacted with the serum of some cysticercosis or clonorchiasis patients. However, immunoblot analysis on the cystic fluid recognized antigenic proteins of 7-, 16-, and 24-kDa bands in their dominant protein quantity and strong blotting reactivity. In conclusion, the present ELISA system using hydatid cyst fluid antigen from Uzbekistan sheep is sensitive and specific for diagnosis of echinococcosis cases.

Infection status of hydatid cysts in humans and sheep in Uzbekistan.

Uzbekistan is endemic of cystic echinococcosis (CE). In order to estimate endemicity of CE, we collected data from emergency surgery due to CE in 2002-2010 and also investigated the prevalence of hydatid cysts in the liver and lungs of sheep at an abattoir in Uzbekistan from July 2009 to June 2010. In 14 emergency hospitals, 8,014 patients received surgical removal or drainage of CE during 2002-2010, and 2,966 patients were found in 2010. A total of 22,959 sheep were grossly examined of their liver and lungs, and 479 (2.1%) and 340 (1.5%) of them were positive for the cyst in the liver and lungs, respectively. Echinococcus granulosus is actively transmitted both to humans and sheep, and CE is a zoonotic disease of public health priority in Uzbekistan.

Three-Year Experience of Kidney Transplantation at a Single Center in Uzbekistan.

OBJECTIVES: In this study, we analyzed the results of the first 100 kidney transplants from related donors performed at the Republican Research Center of Emergency Medicine in Uzbekistan. MATERIALS AND METHODS: This study included 100 patients who underwent kidney transplant from a living donor at the Republican Research Center of Emergency Medicine from March 2018 to January 2021. RESULTS: Immediate graft function was noted in 84 cases (84%) and delayed graft function in 16 cases (16%). Delayed graft function occurred mainly when multiple vessels were present in a donor kidney (35.5%) compared with the presence of a single renal artery and vein (12.1%). The delayed graft function was influenced by the average duration of warm ischemia (80.26 ± 38.35 min with multiple arteries and 50.44 ± 14.44 min with a single renal artery and vein; P = .001). There were 3 cases (3%) of acute cellular rejection, which was successfully treated with pulse therapy and methylprednisolone; there was also 1 case (1%) of hyperacute rejection, which resulted in graft removal. Complications in the form of ureteral stenosis were noted in 2 cases (2%) and ureteral necrosis with anastomotic insufficiency in 1 case (1%). Two recipients (2%) underwent renal graft nephrectomy. In our short-term study, 1-year survival rate for kidney transplant patients was 93%, with graft survival rate of 91%. CONCLUSIONS: Delayed graft function developed when duration of warm ischemia was increased, which was influenced by the number of vessels in the donor kidney. This is an important prognostic factor for acute rejection development. The risk of vascular complications increases due to postoperative hemodialysis trough, with development of delayed graft function. Recipient deaths during the first year after kidney transplant were mainly from pulmonary embolism, infection, and sepsis as a result of immunosuppression, hypovolemic shock, and acute ischemic stroke.

Morphology of Acute Liver Failure During Treatment With a Combination of Drug Therapy and Transplanted Cultured Hepatocytes.

OBJECTIVES: We analyzed liver tissue morphology dynamics in experimental animals with acute liver failure during treatment with a combination of transplanted cultured embryonic hepatocytes and the hepatoprotective drug Erbisol. MATERIALS AND METHODS: We studied 30 white outbred male rats weighing 250 to 350 g, divided into 6 groups with 5 animals in each group. Acute liver damage was induced by a hepatotoxic model of acute liver failure for which carbon tetrachloride was applied (200 µg CCl4/100 g body weight with toxin-to-oil volume ratio of 1:1). To obtain cultured embryonic hepatocytes, we used an enzymatic-mechanical process that caused only minimal cell damage. This method is known to improve the output of viable cultured embryonic hepatocytes, improve the morphological-functional properties of the hepatocytes, and reduce the process time during procurement, and thereby reduce the overall time from procurement to the subsequent culturing of the obtained cells. Transplant of cultured embryonic hepatocytes was performed intrape-ritoneally at a dose of 50 million (0.5 × 108) cells. Morphological studies were performed on day 7 and day 21 of the experiment. RESULTS AND CONCLUSIONS: There were significant morphological changes in livers from animals with acute liver failure, caused by widespread necrosis and an elevated inflammatory response. Treatment with injections of cultured embryonic hepatocytes induced regeneration of the liver parenchyma cells and reduced the inflammatory response, both of which were further reduced in rats that received combined treatment of transplant with Erbisol. Combined application of cultured embryonic hepatocytes and Erbisol potentiated the effects of both treatments, which produced intensive proliferation of hepatocytes, hypertrophy and polyploidization of hepatocyte nuclei, and an early restoration of liver structure and organ mass.

Organ Donation in Uzbekistan: Achievements and Prospects for Further Development.

Here, we describe the current situation regarding organ transplant in Uzbekistan. The legalization of paired-kidney exchange programs for donors with incompatible blood types in Uzbekistan will allow more opportunities for organ donation. The phased implementation of the transplant program with that of deceased-donor organ transplant can be carried out only with the involvement of public, cultural, and religious figures, and not only health professionals, to permanently shift the paradigm in the population.

The First Successful Kidney Transplant to a Child With Abnormality of Urinary Tract in Uzbekistan: Case Report.

Kidney transplant has become a common surgical treatment for patients with end-stage chronic kidney disease. Chronic kidney disease in children is a major health problem in the world, with increasing incidence and prevalence. Uzbekistan is a young country, and surgeons were able to first perform kidney transplant surgery only in 2017. Here, we report a case of the first successful kidney transplant to a child in Uzbekistan. The patient, a 13-year-old boy with end-stage chronic kidney disease due to abnormal development of the urinary tract, received a kidney transplant from his father as a living donor. The diagnosis (abnormal development of the urinary tract, insufficiency of the vesicoureteral segment, and ureterohydronephrosis on both sides) was revealed when the boy was 4 years old, which resulted in vesicoureteral segment plastic surgery at diagnosis. Ten years later, the patient developed end-stage chronic kidney disease. At day 9 posttransplant, creatinine levels decreased from 0.53 to 0.043 mmol/L. Ultrasonography and Doppler imaging showed normal graft size and echogenicity and adequate flow in the renal and iliac vessels. The patient was discharged on posttransplant day 10 in good condition. For children with chronic kidney disease, the main cause is congenital abnormalities of the kidney and urinary tract. Kidney transplant in pediatric patients has become a common surgical procedure and is associated with high success rates. Early and accurate diagnosis and timely management of abnormal development of the urinary tract can reduce the rate of end-stage chronic kidney disease in children.

Equipment and skills shortage in Uzbekistan.

In this article, supplied with the help of the International Federation of Hospital Engineering (IFHE), five co-authors from the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ)--a German organisation that seeks to encourage and co-ordinate international cooperation in areas ranging from sustainable development to fund management, and its partner organisation, IFHE member, the Republican Research Center of Emergency Medicine (RRCEM) in Uzbekistan, discuss the use of medical technology in the central Asian country. They also explain how a GIZ project is helping to boost the number of skilled staff, improve quality assurance and management in procurement, logistics, and maintenance, and promote good training of medical and technical staff, across Uzbekistan.