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There is an extensive body of medical and scientific research literature on visceral leishmaniasis (VL) in the Caucasus, Central Asia, the Crimean Peninsula and the southern part of The Russian Federation that is written in Russian, making it inaccessible to the majority of people who are interested in the leishmaniases in general and VL in particular. This review and summary in English of VL in what was Imperial Russia, which then became the Soviet Union and later a number of different independent states intends to give access to that majority. There are numerous publications in Russian on VL and, mostly, those published in books and the main scientific journals have been included here. The vast geographical area encompassed has been subdivided into four main parts: the southern Caucasus, covering Armenia, Azerbaijan and Georgia; Central Asia, covering Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan; the Crimean Peninsula and the northern Caucasus, which is part of The Russian Federation. Only rare cases of VL have been recorded in the northern Caucasus and Crimean Peninsula. In the other countries mentioned, human VL has been more intense but epidemics like those associated with L. donovani in India and East Africa have not occurred. For most of the countries, there are sections on the distribution, clinical aspects, the causative agent, the reservoirs and the vectors. Serological surveys and research into therapy are also covered. Recent studies on VL in Uzbekistan covered the application of serological, biochemical and molecular biological methods to diagnose human and canine VL, to identify the leishmanial parasites causing them in Uzbekistan and neighbouring Tajikistan and the epidemiology of VL in the Namangan Region of the Pap District, Eastern Uzbekistan. More recently, two studies were carried out in Georgia investigating the prevalence of human and canine VL, and the species composition of phlebotomine sand flies and their rates of infection with what was probably L. infantum in Tbilisi, eastern Georgia and Kutaisi, a new focus, in western Georgia. Though published in English, summaries of this information have been included where relevant to update the parts on VL in Uzbekistan and Georgia.

Purpose: Data on the prevalence of gestational diabetes (GDM) is not available for Turkmenistan or any other central Asian country with large energy resources and rapidly increasing wealth and rates of obesity. We initiated a screening program to determine the prevalence of and the risk factors for GDM in Turkmenistan., Methods: Between March 2008 and March 2011, all pregnant women presenting to the Ene-Maehri-Merkezi perinatal center in Ashgabat before week 34 of pregnancy received a glucose screening test (after 26 weeks of pregnancy; 50 g glucose). If 60-min glucose was ≥7.8 mmol/l, an oral glucose tolerance test (oGTT) (75gr) was performed. GDM was diagnosed if ≥1 glucose values were abnormal (≥5.0, ≥10.0, ≥8.0 mmol/l at 0-, 60-, 120-min, respectively). Birth weight, 30 min glucose, and APGAR (1, 5, and 10 min) were recorded for all newborns., Results: Of 1,738 women, 22.7 % had a pathological screening test. 70 % of these, underwent an oGTT and of these, 39.5 % had GDM (overall prevalence 6.3 %). Age, BMI, parity, and blood pressure were associated with screening glucose (all p < 0.001). In a multivariate analysis, age, BMI, and family history for diabetes were associated with GDM. Newborns from affected mothers were heavier (3,622 ± 435 vs. 3,480 ± 464 g, p = 0.007) and developed postnatal hypoglycaemia more often (21.6 vs. 9.3 %, p = 0.001), while there was no difference in APGAR., Conclusions: GDM is a relevant problem in Turkmenistan and probably also in other central Asian countries. The prevalence is similar to other developing countries such as India or China. Risk factors are comparable to those determined in other parts of the world.

Treatment results of 1219 patients of elderly and senile age, hospitalized in surgical departments of Turkestan during 2001-2008 were analyzed. Demographic characteristics, spectrum of profile pathology as well as concurrent diseases were given. Operative activity and average hospital stay, hospital lethality and complication rates were defined.

Among the countries endemic for tropical diseases, Turkmenistan along with Uzbekistan has a special role to play in having basic scientific knowledge of leishmaniasis. This article summarizes the principal scientific findings in the course of the 20th century in respect of leishmaniasis and sand fly fevers. The most important results of studies on cutaneous and visceral leishmaniasis are cited. The role of different researchers in the epidemiology, epizootology, natural focality of these diseases, their clinical aspects, diagnosis, treatment, and prevention are described in detail. The paper gives information obtained by the latest studies on the etiology of leishmaniasis. The most important publications on this topic are assessed. Particular emphasis is laid on the results of the Anti-Leishmaniasis Expedition carried out by the researchers of the E.I. Martsinovsky Institute of Medical Parasitology and Tropical Medicine to the Tedjen oasis of Turkmenistan.

Anopheles artemievi (a member of An. maculipennis complex species) described from the Transfergana region (South Kyrgyzstan) in 2004 was first found in the Lebap veloyat (Eastern Turkmenistan). A single larva of this species was collected together with An. superpictus in the irrigation channel of a rice field. Species affiliation has been proven by a polymerase chain reaction-restriction fragment length polymorphism method. This species is to be included into a list of Anopheles species of Turkmenistan.

Central Asia has experienced a rapid increase in HIV. HIV interventions and prevention programmes are needed that adequately appreciate and account for the ways that ongoing cultural, political and economic changes in this region affect HIV risk reduction efforts. Drawing on relevant literature, this paper provides a contextual foundation to better understand the impact of context on HIV risk behaviour in the countries of Central Asia and to begin the conversation on the contextual factors of Islam and polygamy.

Prevalence of vcs genes coding the type III secretion system (T3SS) in cholera vibrios of different serogroups isolated in Russia and neighboring countries was studied for the first time. Virulent strains of O1 and O139 serogroups as well as toxigenic Vibrio cholerae strains of other serogroups contained no T3SS genes. Unlike mentioned strains, 29.2% of atoxigenic non O1/non O139 cholera vibrios isolated from patients in Russia and neighboring countries contained the T3SS genes cluster, which might contribute to the pathogenic properties of these strains.

Based on the long-term (1961-1992) study of the parasitic systems of zoonotic cutaneous and visceral leishmaniasis in the context of a landscape, the authors made an epidemiological regional and typological zoning of Turkmenistan. Regional zoning identified 13 districts by zoonotic cutanenous leishmaniasis and 6 districts by visceral leishmaniasis. While typologically zoning according to the human hazard ofzoonotic cutaneous leishmaniasis, the authors divided the landscapes of Turkmenistan into 5 groups: hyperendemic; mesoendemic; hypoendemic; enzootic by cutaneous leishmaniasis, but not dangerous to man; nonenzootic by cutaneous leishmaniasis and not dangerous to man. While typologically zoning with respect with visceral leishmaniasis, the authors divided them into 4 groups: epidemically hazardous landscapes of sandy deserts and semisavanna low-mountain of South-Eastern Turkmenistan; epidemically hazardous landscapes of foothills, low-mountains, and middle mountains of Kopetdag; epidemiologically potentially dangerous landscapes of the piedmont plain of Kopetdag and the valley of the Murgab river; nonenzootic landscapes in terms of visceral leishmaniasis, and those not dangerous to man.

Large outbreaks and sporadic cases of hepatitis E have been reported in Central Asia. We assessed the genetic relatedness of hepatitis E virus (HEV) strains from outbreak and sporadic cases in Turkmenistan. Specimens from outbreak and sporadic cases of acute hepatitis non-A, non-B were tested by reverse transcription (RT)-polymerase chain reaction (PCR) to identify the presence of HEV RNA; nucleotide sequences were analyzed. HEV RNA was detected from 23/156 (15%) outbreak cases and 2/23 (9%) sporadic cases. The HEV outbreak isolates represented 14 unique sequences with genetic distances varying between 0.3% and 8.6%, 12 of which were closely related, with distances between 0.3% and 5.6%. Two unique sequences from outbreak cases 32 and 42 were closely related (99.7%) and shared 91.8-93.4% of sequence with the other 12 strains. The two strains were closely related to the previously published isolates from Burma (99.7-100%) and India-Madras (95.7-96.1%). The two 1994 sporadic HEV strains were 97.4% distinct, wile revealing 91.4-94.1% homology to 1985 strains, and 94.4-94.7% to HEV from the neighboring China and Pakistan. Genetic diversity of HEV that caused the hepatitis E outbreak in Turkmenistan in 1985 suggests heterogeneity of viral sources. Sporadic hepatitis E that occurred in 1994 was caused by viral strains genetically distinct from those causing the outbreak in 1985, yet closely related to HEV from neighboring countries. The study suggests that circulation of a broad variety of strains of HEV may occur in Central Asia, regardless of international borders, presenting a significant public health threat to the population of the region., ((c) 2007 Wiley-Liss, Inc.)

Background: There is a health crisis in Turkmenistan similar to, but more severe than, in other Central Asian countries. This paper asks whether the health crisis in Turkmenistan is attributable to the consequences of the dictatorship under president Niyazov, who died in 2006., Methods: The basis for this paper was a series of semi-structured in-depth interviews with key informants complemented by an iterative search of internet sites, initially published as a report in April 2005, and subsequently updated with feedback on the report as well as a comprehensive search of secondary information sources and databases., Results: This paper describes in depth three areas in which the dictatorship in Turkmenistan had a negative impact on population health: the regime's policy of secrecy and denial, which sees the "solution" to health care problems in concealment rather than prevention; its complicity in the trafficking of drugs from Afghanistan; and the neglect of its health care system., Conclusion: The paper concludes that dictatorship has contributed to the health crisis facing Turkmenistan. One of the first tests of the new regime will be whether it can address this crisis.

Multidrug-resistant tuberculosis (MDR-TB) has emerged as a major threat to TB control, particularly in the former Soviet Union. To determine levels of drug resistance within a directly observed treatment strategy (DOTS) program supported by Médecins Sans Frontières in two regions in Uzbekistan and Turkmenistan, Central Asia, we conducted a cross-sectional survey of smear-positive TB patients in selected districts of Karakalpakstan (Uzbekistan) and Dashoguz (Turkmenistan). High levels of MDR-TB were found in both regions. In Karakalpakstan, 14 (13%) of 106 new patients were infected with MDR-TB; 43 (40%) of 107 previously treated patients were similarly infected. The proportions for Dashoguz were 4% (4/105 patients) and 18% (18/98 patients), respectively. Overall, 27% of patients with positive smear results whose infections were treated through the DOTS program in Karakalpakstan and 11% of similar patients in Dashoguz were infected with multidrug-resistant strains of TB on admission. These results show the need for concerted action by the international community to contain transmission and reduce the effects of MDR-TB.

Visceral leishmaniasis (VL) morbidity in the population of the south-eastern Turkmenistan and the epizootic activity of a natural focus were studied. A definite cyclic recurrence of the processes occurring in the natural focus of VL, which was associated with solar activity changes was found. The regularities found make it possible to predict the increase in the epizootic tension of a natural focus of VL in this region and the incidence of this disease among the population in 2002-2004.

Aim: To present results of a rapid assessment of cataract in Turkmenistan., Methods: 6120 eligible people of 50 years and older were selected by systematic random sampling from the whole of Turkmenistan. A total of 6011 people were examined (coverage 98.2%)., Results: Cataract is the major cause of bilateral blindness (54%), followed by glaucoma (25%). The age and sex adjusted prevalence of bilateral cataract blindness (VA <3/60) in people of 50 years and older was 0.6% (95% CI: 0.4 to 0.9), with a cataract surgical coverage of 75% (people). For VA <6/60 the prevalence was 2.6% (95% CI: 2.1 to 3.2) in people aged 50 and above, approximately 0.26% of the total population. In this last group the surgical coverage was 44% (people) and 32% (eyes). Of the patients operated with IOL implantation 8.2% could not see 6/60, 44.8% of those operated without IOL could not see 6/60. The main barrier to cataract surgery was indifference ("old age, no need for surgery"), followed by "waiting for maturity.", Conclusion: To increase the cataract surgical coverage in Turkmenistan the intake criteria should be lowered to VA <6/60 or less. At the same time the visual outcome of surgery can be improved by expanding the number of IOL surgeries and routine monitoring of cataract outcome. Additional investments will be required to provide all eye surgeons with appropriate equipment and skills for IOL surgery.

Aim: To study epidemiological characteristics of cryptosporidosis (CS) in conditions of arid climate which contributes to suppression of the immune status of the organism., Material and Methods: 1935 patients were treated for acute intestinal infection with watery diarrhea in Ashkhabad hospital in 1994-1999. Monocryptosporidiosis was diagnosed in 511 of them. Also, 46 mothers of CS children and 32 foci of the infection were examined. Cryptosporidial oocysts in the feces were detected by the Fulleborn's method. The preparations were stained by Ziehl-Neelsen., Results: CS incidence in Turkmenistan was high, especially in children aged 2 to 7 years and adults aged 31-35 and 46-50 years. CS occurs throughout the year, but the morbidity is higher in summer and winter. The leading route of transmission is alimentary, it prevails over contact, watery and perinatal.

Polymerase chain reaction (PCR) detected the presence of various genes associated with virulence in genome of strains V. cholerae eltor isolated in Turkmenistan territory during epidemic and epidemic-free perios. It was found that a complete set of virulence genes (ctxA+, tcpA+ and toxR+) contained strains isolated from patients, carriers and environment only in cholera epidemics. Strains isolated from the environment in the period free of epidemics did not contain ctxA and tcpA in 78.2% of cases, but 5.2% of the strains carried a complete set of virulence genes. There were also nontoxigenic strains containing genes tcpA and toxR. Such strains were isolated from the environment (16.6%) and vibrion carriers (42.9%). Isolated were also strains V.cholerae eltor carrying bacteriophage CTX phi with incomplete set of virulence genes and having genotype ctxA-, ace+ and zot+. Almost all the strains ctxA-, tcpA+ carry attRS1-site in genome. This shows that such strains may transform into toxigenic as a result of infection with bacteriophage CTX phi.

An important feature of the foci of zoonotic cutaneous leishmaniasis (ZCL) in Turkmenistan and Uzbekistan is a 6-10-month break in transmission when Leishmania parasites persist in great gerbils (Rhombomys opimus)--the main host for three species (L. major, L. turanica and L. gerbilli). Almost all (95%) of the laboratory-maintained R. opimus experimentally infected with L. major cured their infections within 6 months, a situation which, if mirrored in field conditions, cannot provide reliable persistence of the infection to the next transmission season. However, infections with L. turanica alone persisted for a mean of 15 months, and mixed infections of L. major and L. turanica persisted even longer (mean = 25 months), parasites of both species remaining detectable in the skin for at least 18 months. Isoenzyme identification of 664 isolates obtained from wild-caught R. opimus, and of 58 cloned strains developed from them, showed that L. turanica, which is non-pathogenic for humans, tends to predominate in the gerbils from all types of natural ZCL foci, including those which are hyper-endemic; in June, L. turanica may be present in 80%-100% of the R. opimus in the foci. In contrast, infections with L. major alone occur far less commonly, and are especially hard to find at the beginning of the transmission season. However, 5%-25% of great gerbils in these foci are each infected with a mixture of L. major and L. turanica. In hyper- and meso-endemic foci, the proportion of L. major within mixed infections of Leishmania increases significantly towards the end of transmission season (August-September). It would appear, therefore, that mixed L. major/L. turanica infections in R. opimus promote the persistence of L. major between transmission seasons.

Malaria is one of the main health problems facing most developing countries having a hot climate. It is a problem in Turkmenistan. The country is situated in Central Asia, north of the Kopetdag mountains, between the Caspian Sea to the west and the Amu-Darya river to the east. Turkmenistan stretches for a distance of 1,100 km from west to east and 650 km from north to south. It borders Kazakhstan in the north, Uzbekistan in the east and north-east, Iran in the south, and Afghanistan in the south-east. Seven malaria vector species are found in Turkmenistan, the main ones being Anopheles superpictus, An. pulcherrimus, and An. martinius. The potentially endemic area consists of the floodplains of the Tejen and Murgab rivers, with a long chain of reservoirs built along them. In 1980 most cases of imported malaria were recorded in military personnel who had returned from service in Afghanistan. In the past years, only tertian (Plasmodium vivax) malaria has been recorded and there have been no death from malaria over that period. In the Serkhetabad (Gushgi) district there are currently 5 active foci of malaria infection, with a population of 22,000 people. In 1999, forty nine cases of P. vivax malaria were recorded in Turkmenistan. Of them, 36 cases, including 4 children under 14 years were diagnosed for the first time while 13 were relapses. There were 88 fewer cases than those in the previous year (by a factor of 2.8). There were 17 more cases of imported malaria than those in 1998 (by a factor of 1.7), most of which occurred in the foci of malaria infection (Serkhetabad, Tagtabazar, and Kerki districts), in the city of Ashkhabat and in Lebap, Dashkhovuz and Akhal Regions. The emergence of indigenous malaria in the border areas was due to the importation of the disease at intervals by infected mosquitoes flying in from neighbouring countries (e.g. Afghanistan), the lack of drugs to treat the first cases and the lack of alternative insecticides. Most patients suffer from tertian malaria, which is the most dangerous from the epidemiological point of view since the main vectors in Turkmenistan, are highly susceptible to P. vivax infection. The particular dangerous phenomenon is the higher incidence of imported tertian malaria in rural areas where sick people and those who carry the parasite come into close contact with highly susceptible vectors. Thus, the risk that new malaria outbreaks will occur and the disease will become reestablished in the country is very high. It is also influenced by major changes in water use in the country, which have aggravated the mosquito situation. In the area around the Karakum canal and river basins, 17 large reservoirs have been constructed, with very extensive filtration ponds around them, which have become breeding ground's for malaria mosquitoes. There are 1219 water areas without any economic significance in the country, covering a total area of 1054 ha, which require regular treatment with insecticides. With assistance from the WHO European Regional Office, Dr. Guido Sabatinelli in particular, Turkmenistan has developed a plan for preventive malaria control measures for 1999-2001, which has been approved in a decree issued by the Ministry of Health and Medical Industry. The material support received has made it possible to provide large-scale prophylaxis for people who suffered from malaria in 1997-1999, seasonal treatment for people living near the active foci of the disease and interseasonal prophylaxis for people visiting these areas. Seasonal treatment with Dellaguil was made in 4,590 people living in the active foci of malaria infection, and 2,281 fixed-term military personnel belonging to the units stationed in the active foci of malaria infection. In all foci of infection, every person with malaria or carrying the parasite underwent epidemiological investigation and all cases were entered in health clinic records. In 1999, four seminars were held to train 75 specialists from all administrative areas in ways of improving senior staff's skills in the laboratory diagnosis of malaria. The laboratory equipment which the country has received makes it possible to train high-level specialists and to equip its main malaria diagnosis centers with microscopes and reagents. The received insecticides and sprayers enable mosquitoes to be eliminated in an area of 960,000 sq. km (240 foci of infection): for this, our sincere thanks and gratitude are due to Dr. Guido Sabatinelli. Specialists teams have been created in each region by a decree of the Ministry of Health and Medical Industry to conduct mosquito elimination activities, with personal responsibility for their progress. Three-day vector control seminars have been held for disinfectors in all regions. We should stress that 5 extra posts have been created in the parasitology department of the Central Laboratory of Hygiene and Epidemiology, State Epidemiological Surveillance Service in order to strengthen preventive malaria control activities in Turkmenistan (organizational and methodological support for health facilities, staff training, etc.). To prevent the emergence of new breeding grounds for malaria vectors, the state system of health surveillance over the hygiene and technical status of water facilities and the rules governing their work have been reinforced. Local executive authorities do every effort to eliminate small, economically unprofitable water areas by draining, filling in or cleaning them. All existing and potential mosquito breeding grounds within a three-kilometer radius of any community were identified. These water areas were certified and their previous certifications analyzed, taking into account any changes and additional information which has become available about the area. Seasonal variations in the number of larvae and imagoes were monitored in the specimen areas of water and daytime resting sites. The existing vector species were identified and a list of the main species in all areas was prepared. Water areas were treated in accordance with epidemiological instructions. These activities yielded positive results: only 10 cases of locally transmitted malaria were recorded throughout the country in 1999. To interrupt the endemic process of malaria in Turkmenistan, the following plan for 1999-2001 has been adopted. To improve the equipment and material base of a sanitary and epidemiological surveillance service and malaria diagnosis laboratories (vehicles, sprayers, microscopes, chemical reagents, etc.). To continue effort to recruit staff to fill vacancies for parasitologists, entomologists, and parasitology laboratory physicians in the sanitary and epidemiological surveillance service at regional, subregional, and district level. In April 2000, two six-day seminars were held for epidemiologists, parasitologists, and entomologists, organized jointly with WHO representatives at the Central Laboratory for Hygiene and Epidemiology. Two seminars on the laboratory diagnosis of malaria for laboratory physicians were also intended to be held in April 2000. To continue to treat malaria patients and parasite carriers throughout the year to prevent relapses. To continue activities to eliminate mosquitoes, to monitor seasonal variations in the number of vector larvae and imagoes in the specimen areas of water and daytime resting sites mosquito habitats, to identify the existing vector species, and to prepare a list of main species in all areas. To strengthen preventive health monitoring. To provide effective support of health care service by the state border guard service of Turkmenistan by supplying drugs for curative and preventive treatment of its staff. To provide the quantities of insecticides required for mosquito elimination and support staff training. To improve malaria control activities by reporting all cases of malaria promptly, conducting a high-quality epidemiological investigation of every case and a prompt laboratory diagnosis, and providing the parasitology departments of sanitary and epidemiological surveillance service at all levels with all-terrain vehicles, microscopes, and effective communication systems which they require. We are very happy to be cooperating with WHO and grateful for the help it has provided.

As a result of comprehensive research on the causative agents and vectors of malaria and wide use of synthetic antimalarials and highly effective residual insecticides, endemic malaria was eliminated in Turkmenistan by 1960. During the period 1965-1980, 23 local cases of malaria were recorded in Turkmenistan. These local cases were confined to the regions of Mary and Akhal, on the borders of neighbouring countries. In 1998 the epidemiological situation in the country worsened and local transmission of infection resumed. During the year the number of cases recorded was 137:134 being a first diagnosis of the disease and three being relapsed cases. In comparison with 1997, the previous year, incidence was up by 123 cases (a 9.7-fold increase), while the incidence of imported cases of malaria went up by 11 (a 2.2-fold increase), principally in Dashkhovuz and Lebar regions, being brought in from malaria foci in Gushgin district, Turkey, Azerbaijan and Tadjikistan. Local transmission of malaria went up by 111 cases (a 27.7 fold increase); 108 cases were recorded in Gushgin district, Mary region. The first case of malaria in Gushkin district was detected in June 1998. At that time there were five active foci. The approximate number of inhabitants in the active focus area was 10,000. The appearance of local malaria in border districts was caused by the periodic influx of infected mosquitos from neighbouring countries (Afghanistan).

The relationships of changes in the incidence of zoonotic cutaneous leishmaniasis (ZCL) in the Mary velayat, Turkmenistan, to those in hydrometeroelogical factors in 1951 to 1993 were first analyzed and the regularities found were evaluated. There is an inverse relationship of the incidence to the temperatures of the preceding winter. The long persistence of sun shining seems to have a negative impact on the foci of ZCL. There is an insignificant correlation of humidity, precipitation, and winds. In the years marked by high waters in the valley foci, increased soil moisture content causes a reduction in their epidemic activity.

We review the literature on statistical genetic analyses of blood pressure in samples from various ethnic backgrounds using different statistical methods and packages. We then provide the results of a complex segregation analysis performed on familial data on systolic and diastolic blood pressure in 2 ethnically different populations, Chuvashans and Turkmenians. Two types of major gene models were tested in the segregation analysis: Model type 1 tests for a Mendelian mode of transmission and estimates genotype-specific averages regardless of age and sex effect, and model type 2 estimates age and sex effects on each of 3 genotypes within the putative major genotype. In both total samples, by both types of segregation analysis, familial aggregation of both systolic and diastolic blood pressure was inconsistent with the Mendelian mode of inheritance. In the next step of analysis the pedigrees in both samples were sorted into 2 groups on the basis of 2 likelihoods as obtained under Mendelian and nontransmission models for each entire sample. This procedure resulted in the appearance of 2 subsamples (large and small) in each ethnic sample. The segregation analysis that was carried out then on the larger subsample provided consistent evidence to support the major gene effect on systolic and diastolic blood pressure in 2 ethnic groups. Interestingly, model type 2 showed that in both ethnically different large subsamples, for each sex the genotype predisposing to a larger mean value of systolic (or diastolic) blood pressure also displayed the highest rate of blood pressure increase with age. We discuss in detail possible sources of heterogeneity in familial transmission of blood pressure observed in our 2 samples, and we suggest a method to improve the analysis of heterogeneity for trait inheritance.

In the presence of the low spread of HIV infection a sharp increase in sexually transmitted diseases is noted. Nevertheless, taking into account a rise in STD, the reality of the potential risk of the spread of HIV is emphasized. Thus, in 1996 morbidity is syphilis was found to grow 7.2 times in comparison with 1992, amounting to 37.5 cases per 100,000 of the population; morbidity in gonorrhea amounted to 32.4 cases per 100,000 of the population with the proportion coming to medical institutions not exceeding 30%. A high proportion of hepatitis B virus carriers was also established (from 15% to 30% of healthy persons), while morbidity in virus hepatitides rose twofold for the period of 1994-1995. During recent years the service for the prophylaxis of AIDS was noted to considerably decrease measures on mass screening. At the same time the article attracts attention to the necessity of increasing the work on the dissemination of information and education on HIV/AIDS drug among addicts, prostitutes and homosexuals. The Draft National Program of the Prophylaxis of HIV infection and STD for 1998-2002 has been worked out. Great importance of methodological and financial assistance rendered since 1994 by international organizations, including WHO, UNFPA, etc., have been emphasized.

Phylogenetic analysis of HTLV-I variants persisting among population of Turkmenistan and the Republic of Georgia (situated on both sides of the Caspian Sea, not far from a known HTLV-I cluster in Northern Iran) has been carried out. HTLV-I isolates from the above countries were obtained in the course of seroepidemiological investigations. In all, 1,510 blood-donor samples from Turkmenistan and 47 blood samples from hematological patients from Georgia, were tested with different screening and confirmatory assays, including commercial ones. As a result, 7 infected individuals (3 blood donors and 4 relatives of one blood donor) from Turkmenistan and 3 infected individuals (one ATL patient and 2 of his relatives) from Georgia were found. In addition, 4 HTLV-I isolates from Turkmenistan and one from Georgia were cloned and part of their LTR was sequenced. Phylogenetic analysis of sequenced isolates allowed us to conclude that these isolates belonged to sub-type A, one of 3 sub-types of the "Cosmopolitan" type. We found that most of the Turkmenian isolates formed a tight cluster and shared common nucleotide substitutions with isolates originating from Northern Iran (Mashhad). The data obtained suggest that there is a new endemic focus of HTLV-I infection in the Caspian Sea region. Further investigations are required to confirm this hypothesis.

The prevalence [correction of incidence] of diseases of the buccal mucosa is assessed from records on dental status of 494 subjects engaged in cotton industry. A high prevalence [correction of incidence] of oral diseases is revealed. Candidiasis of the oral cavity and diseases of the lips are referred to occupational in this category of patients.

Aim: The study of clinical symptoms of gastrointestinal lesions in subjects invaded with cryptosporidia., Materials and Methods: From 1994 to 1997 383 patients with monocryptosporidiasis were observed. 75.7% of them were children. Cryptosporidia oocysts were identified in fecalia using Fulleborn technique. The specimens were stained according to Cill-Nilsson., Results: Clinically, the invasion was characterized by acute onset, severe course in children, involvement of the whole gastrointestinal and respiratory tracts., Conclusion: Monocryptosporidiasis runs in Turkmenistan a more severe course compared to countries with moderately hot climate.

Characteristics of personality and emotional condition were studied in 160 patients from Moscow (Russia) and Chardzhou (Turkmenistan) with various gastroenterological diseases: duodenal ulcer, chronic gastritis, chronic cholecystitis, irritable colon syndrome. Actual psychogenia occurred frequently in all the patients, children's psychogenia was more frequent in Moscow patients with duodenal ulcer. In patients with duodenal ulcer and chronic gastritis both from Moscow and Chardzhou the incidence of stress in everyday life was rather high. All the examinees suffered from mild or moderate depression found more frequently in Moscow patients with chronic gastritis.

Seroepidemiological and molecular-biological screening of 1510 donor blood samples, collected from the residents of the town of Ashgabat (Turkmenistan), for lymphotropic virus of human T-cellular leukemia (HTLV) virus revealed one donor with a high level of immune response to a wide spectrum of viral proteins. Three donors were serologically assessed as dubious, for their sera contained antibodies to gag gene protein but no antibodies to env gene protein. Screening of family members of the donor infected with HTLV-1 revealed four more highly reactive carriers of HTLV-1 virus. The presence of proviral sequences of HTLV-1 in the lymphocyte DNA of infected donor and her relatives was confirmed by polymerase chain reaction and subsequent Southern-blot hybridization of specific amplification products. Proviral sequences of gag, pol, and LTR genes were detected in all the cases. Short-term culturing of peripheral blood lymphocytes of all seropositive subjects was associated with expression of HTLV-1 structural proteins. Analysis of the possible routes of transmission of HTLV-1 isolated in Turkmenistan permits us to hypothesize an Iranian origin of the isolated virus strain.

Attempts were made to analyse the relationships of changes in the pattern of zoonotic cutaneous leishmaniasis (ZCL) morbidity by the 1951-1993 statistics of the Turkmenistan Ministry of Health by the areas of Maryĭskiĭ velaiat with heliogeophysical factors. For quantitative characterization of solar activity changes, various indices were used; among them there was the Wolf number, radio radiation flux at a wavelength of 10.7 cm. and the geomagnetic Aa-index. In some many-year observations, vague cyclic variations were detected on a personal computer by spectral and periodogram analyses proved to be effective in other diseases. Correlation and cross-correlation analyses were used to evaluate the possible relationships between the morbidity rates and the changes in heliogeophysical factors. The study has revealed that the epidemic activity of ZCL foci is characterized by cyclicity with variations of about 2.4, 3.6, 6.9, and 11.2 years. The changes in ZCL morbidity in the areas, including the natural ZCL foci of Murgab delta landscapes, slightly differ from those in the areas with valley foci in the south part of the velayat in the duration and expression of cycles. At the same time sun-caused 11-year cycles are observed in all groups of the areas, though they are slightly more pronounced in the north than in the south. The greatest epidemic outbreaks (1956-1957, 1965, 1977, and 1986-1988) occurred in various areas of the Murgab oasis on an average of 1-3 years after the minimum of 11-year solar cycles. Noteworthy, they are greatly marked in odd solar activity cycles (the 1957 and 1977 outbreaks) in many areas. Among the parameters chosen, the radio flux of solar radiation at a wavelenght of 10.7 cm and the Wolf number (the correlation coefficients are as high as 0.30-0.50 at P = 0.95) are closely related with ZCL morbidity changes when the plot is shifted. At the same time the values of the geomagnetic Aa-index are unlikely to greatly affect changes in the epidemiological situation. The regularities revealed are of particular significance for long-term prediction of the greatest rises of ZCL morbidity rates. Taking into account the estimated solar activity changes within the next years, one may expect activation of natural ZCL foci and, in case of untimely use of prophylactic measures, the following rise in the population's morbidity in 1998-1999.

Long-term studies of the spread zoonotic cutaneous leishmaniasis (ZCL) and visceral leishmaniasis (VL) have revealed that the prevalence of the disease is associated with definite landscapes. ZCL is constantly notified in the valley-delta, undermountainous (lowland) landscapes. VL is common in the sandy desert areas of the southeastern Kara-Kum, in the valley on Murgab, in the piedmont and low-mountainous areas of the Kopet-Dagh. The spread of ZCL coincides with the landscape P .papatasi distribution and that of VL with P.turanicus. There is cyclic recurrence in activation of a VL natural focus and an association of case histories with definite administrative areas in particular periods.

The article deals with the results of the study of causes of the pronounced territorial irregularity in the morbidity levels of shigellosis Sonnei. The analysis of the statistical data collected at 15 territories (large and small towns) revealed that differences in morbidity levels were determined mainly by the activity of the alimentary route of the transmission of infection (the degree determination was 78.4%). The levels of consumption of milk and dairy products by the population was the most important epidemiological determinant (the degree of determination was 54.1%). The levels of morbidity in shigellosis Sonnei were greatly influenced by the scope of the population survey for enteric infections, made by the bacteriological method (the degree of determination was 58.8%). The decrease of morbidity in shigellosis, observed at present in the Russian Federation, reflects a sharp drop in the production of milk and dairy products.

A series of synthetic peptides derived from proteins encoded by open reading frames 2 and 3 (ORF2 and ORF3) of the hepatitis E virus was used in an enzyme immunoassay to determine the localization of epitopes in these proteins. Five peptides spanning almost the entire ORF3 protein sequence and 12 peptides from the ORF2 protein were synthesized. Serum samples collected from outbreaks in three different regions of the world (Turkmenistan, Kenya, and Mexico) were analyzed by a peptide-based enzyme immunoassay. Primary analysis of the peptides was accomplished with the use of serum samples obtained from Middle Asia. Four of 5 peptides from the ORF3 protein and 4 of 12 peptides from the ORF2 protein specifically reacted with antibody from sera of HEV-infected patients. Peptides representing immunodominant epitopes were used for the analysis of serum samples from outbreaks in Kenya and Mexico. The data indicate that these synthetic peptides may be used to develop a diagnostic test to detect antibody to the hepatitis E virus.

The study of location of the gene for inborn dominant nokhur kataracta is going on. No linkage of this gene with the locus of alpha-globin gene (16p13.3) and the locus (7q36-qter) was revealed. Additional evidence was obtained for a possible location of the gene for inborn dominant nokhur kataracta on the 14 chromosome. The maximal lod value equaled to 1.089 at theta = 0.20 in the analysis of kataracta genes and alpha-1-antitrypsin (14q32.1), and 0.846 at theta = 0.30 for the kataracta gene and D14S13 (14q32.1-q32.32). For the alpha-1-antitrypsin gene the maximal lod value was 2.24 at theta = 0.05.

Incidence rate of some diseases and mortality have been analyzed basing on the examination of 714 females aged 18-50 and 176 fatal outcomes in 23-82-year-old females. The disease prevalence and death rate showed the trend to an increase with growing number of deliveries. Multiparas die more frequently of cardiovascular diseases the risk of which proved the highest in the group of multiparas over 45 years of age.

Epidemiologic and sociohygienic studies carried out among nulliparous, biparous, and multiparous women living in the urban and rural territories of Turkmenistan, have demonstrated a high incidence of caries and periodontitis among multiparous women. The CDL index at the age of 25-29 was 4.46 teeth in nulliparous women, 7.62 teeth in biparous women, and 9.02 in multiparous women. At the age of 45-49 this index was 8.96 carious teeth in biparous women and 12.03 teeth in multiparous women. Only 7-8% of teeth were filled in all the examinees, 42% of the teeth were carious, and 50% of the teeth were removed. Similar data were obtained in analysis of the incidence of periodontitis. Every nulliparous woman aged 25-29 had 0.20 sextant with a pathologic dentogingival pouch, biparous women had 0.41 and multiparous women 0.89 sextant. The course of the pathologic process grew in severity with age, particularly so in multiparous women as against biparous ones.

The authors analyze the results of C-ELISA, used in screening of the population in combined foci of zoonotic cutaneous leishmaniasis and visceral leishmaniasis in two types of landscapes in Turkmenistan. In the deltas, on the plains [correction of planes] and oases, where the incidence of zoonotic cutaneous leishmaniasis is very high, 1.6% of the examinees were found to have antibody to L. major. The antibodies in this condition are detectable only during the acute stage of the disease and persist for just a few months after convalescence. The share of the positive sera with antibody to L. donovani sensu lato was the minimal (0.48%) in the population of the alluvial plain [correction of plane] at the Kopet-Dag hills, the highest share (4%) of the population with such antibodies lived in the sandy deserts in the interfluvial areas of southern-eastern Turkmenistan. The authors have validated the criteria for the assessment of the endemicity level of leishmaniasis foci with due consideration for various incidence rates of visceral and zoonotic cutaneous leishmaniases and the specific features of the immune response in these nosologic forms. They suggest that a positive serologic response be considered as the basic criterion of a visceral leishmaniasis focus, and the disease incidence and the number of subjects who had had this disease in the focus--the basic criterion for the assessment of a zoonotic cutaneous leishmaniasis focus endemicity.

A total of 900 children aged 3, 6, and 12 were examined. The findings evidence a lowered rate of salivary secretion and salivary levels of Ca and P, as well as a lower solubility of enamel for Ca and P in the children born fifth-eight. The incidence of dental hypoplasia and caries in these children was higher than in those born second in the family. Pregnancy aggravations (anemia, gestosis, etc.) in women who had had multiple deliveries and frequent diseases of their infants are the factors conducive to the reduction of dental resistance to caries and hypoplasia. The children born after multiple deliveries of their mothers should be referred to a risk group, and they should be observed by dentists and pediatricians since infancy. In regions with low fluorine levels in potable water antenatal caries prevention with fluorine preparations should be carried out. The program of comprehensive prevention of dental diseases should comprise both medical and social aspects.

Analysis of hereditary disease load of the populations with different genetic structure has demonstrated the necessity of a regional approach to the organization of the medico-genetic aid to the community. It has been shown that in Central Asia, the requirement of the medico-genetic aid is almost 2 times higher than in the Russian Federation. Bearing in mind the age-associated reproduction data, those differences are three times as higher. To make the work of the medico-genetic consultations more efficient, it is necessary to increase the portion of prospective counselling at the expense of an active approach to identifying patients in the populations.

Analysis is given of a high level of invalidity in 508 patients in four regions to whom invalidity due to tuberculosis was first established in 1987-1989. The main factors responsible for invalidity included progress of a tuberculous process, ineffective chemotherapy, untimely diagnosis, the presence of serious attendant diseases, functional disorders of the affected organs, complication of the disease, asocial way of life (chronic alcoholism, narcomania), and insufficient material provision of large families. Most invalids had a combination of the above factors.

This work is devoted to research on the selective screening possibilities of hormonodependent tumours of the female reproductive system organs (endometrial cancer, ovarian cancer, breast cancer). After morbidity analysis using case-control study elucidation of risk factors affecting cancer of the uterine cervix, endometrium, ovary and breast were carried out on of female population the Ashkhabad (311 cancer patients and 14872 healthy women). Using established risk factors and mathematical methods optimized computer programmes were developed processing individual risk and models forming risk groups or hormonedependent tumours which were used in practice. As a result in the risk group were found 0.9% subclinical states and hormonedependent tumours (control -0.16%). The research accomplished has shown the practical importance of hormonedependent selective screening and necessity of elucidating new disease-epidemiological and laboratory risk factors in cancer of the reproductive system's organs.