Gastroenterologist Sanoat Maksudalievna Mamurova reflects on her patients, our tendency to endure pain, and why taking care of our health begins with paying attention to ourselves. Throughout my 45 years in medicine, I have come to realize one simple truth: people often find time for everything except their own health. We rush to work, take care of our families, and deal with everyday responsibilities. Sometimes we skip breakfast, grab a quick lunch, and have dinner late in the evening. And when we experience heaviness after eating, heartburn, or abdominal discomfort, we reassure ourselves: “I probably ate something that didn’t agree with me. It will pass.” And indeed, sometimes the discomfort goes away on its own. But at other times, what seems like an ordinary symptom may be a sign of a condition that requires medical attention. Throughout my career, I have met people with different personalities, backgrounds, and life stories. And each time, I am reminded that the person sitting in front of me is not simply a patient with a particular diagnosis, but a human being who may need both physical and emotional support. “Doctor, I Didn’t Think It Was Anything Serious…” I believe this is a phrase that almost every experienced physician knows well. Imagine a familiar situation. A person experiences discomfort after meals for a long time. At first, they ignore it. Later, they try changing their diet, taking familiar medications, or following advice from family and friends. For a while, they feel better. But then the symptoms return. Only then do they decide to seek professional medical advice. Situations like this are familiar to gastroenterologists. The causes of digestive discomfort can vary greatly, ranging from functional disorders to conditions that require medical examinations and treatment. That is why I always try to explain one important thing to my patients: do not diagnose yourself. Not every abdominal pain means gastritis. Heartburn is not always caused by what we eat. And the absence of severe pain does not necessarily mean that everything is fine. For me, it is important that patients understand what is happening in their bodies, why certain examinations are necessary, and what purpose each prescribed treatment serves. After all, successful care begins with mutual trust between a doctor and a patient. Our Bodies Know How to Warn Us. We Just Need to Learn to Listen The digestive system is a complex mechanism in which every organ plays an important role. The stomach, intestines, liver, gallbladder, and pancreas are closely interconnected. Their functioning can be influenced by diet, lifestyle, medications, emotional well-being, and many other factors. Over the years, I have become increasingly convinced of how important it is to explain even the simplest medical concepts to patients. For example, frequent heartburn is not always a harmless consequence of a heavy meal. Recurring abdominal pain, changes in bowel habits, unexplained weight loss, or persistent discomfort after eating are reasons to consult a physician and investigate the underlying cause. Difficulty swallowing, blood in the stool, persistent vomiting, and other concerning symptoms require particular attention. Sudden severe abdominal pain, vomiting blood, or passing black, tarry stools require emergency medical care. At the same time, I do not believe that people should live in constant fear of every sensation in their bodies. My role as a physician is not to frighten patients, but to help them understand when lifestyle adjustments may be sufficient and when professional medical care is necessary. Five Simple Habits Your Body Will Thank You For Many people believe that taking care of their digestive health means following strict diets, accepting numerous restrictions, and giving up their favorite foods. But developing healthy habits does not always require dramatic changes. First — try to maintain regular eating habits. There is no single ideal meal schedule that suits everyone. However, frequently skipping meals and then overeating can contribute to discomfort. The key is to find a routine that meets your body’s individual needs. Second — pay attention not only to what you eat, but also to how you eat. Eating calmly, choosing moderate portions, and avoiding habitual overeating may help reduce digestive discomfort. Third — avoid self-medicating. Even familiar medications for heartburn or abdominal pain should not become a permanent way of suppressing symptoms without identifying their underlying cause. Fourth — never ignore recurring symptoms. If discomfort keeps returning, interferes with your daily activities, or is accompanied by other changes in your well-being, it is important to seek medical advice. Fifth — remember that digestive health is closely connected to your overall lifestyle. Adequate sleep, physical activity, balanced nutrition, and stress management all play important roles in maintaining well-being. Most importantly, do not follow restrictive diets simply because they have worked for someone you know. Every person is different, and therapeutic diets for specific medical conditions should be tailored to the individual diagnosis. 45 Years in Medicine: What My Patients Have Taught Me With time comes the understanding that being a doctor is about much more than medical knowledge, diagnosis, and prescribing medications. Behind every consultation is a personal story. Some patients arrive feeling anxious because they fear a serious diagnosis. Others are exhausted by symptoms that interfere with their ability to work, rest, and enjoy everyday life. And some simply want to understand why they have been feeling unwell for so long. Every one of them deserves attention. I believe that every patient should have the opportunity to speak openly about their concerns, ask questions, and receive clear, understandable explanations. Sometimes, knowing the name of a disease is not enough. People want to understand how to manage their condition, which habits they should change, and what can genuinely help improve their well-being. Medicine is constantly evolving. New diagnostic technologies are emerging, treatment methods are improving, and clinical guidelines continue to develop. Yet one thing remains unchanged — the importance of human trust. Even after 45 years of professional practice, I remain convinced that a good doctor must not only possess knowledge and experience but also know how to listen. Do Not Put Your Health on Hold We often tell our loved ones: “Take care of yourself,” “Don’t overwork,” or “Please make sure you see a doctor.” But how often do we say these same words to ourselves? Taking care of our health does not have to begin with a serious diagnosis or complicated treatment. Sometimes the first step is simply noticing a recurring symptom, reconsidering everyday habits, or seeking professional advice at the right time. I wish more people would stop accepting pain and persistent discomfort as an unavoidable part of life. Do not wait until familiar symptoms begin to limit your opportunities, interfere with your work, disturb your rest, or affect the time you spend with loved ones. After 45 years in medicine, I have learned that health is not something we should remember only when we become ill. It is something we need to value and care for every single day. Take care of yourself. Listen to your body. And remember that seeking medical attention in time is an act of responsibility toward yourself and those you love.
Pain that women have grown used to over the years may be a sign of a serious disease. Many women regard painful periods as a natural part of life. Severe cramps, constant discomfort, the need to take painkillers, and even missing work or classes are often considered normal. But should menstruation really be accompanied by such intense pain? According to the World Health Organization (WHO), around 190 million women worldwide have endometriosis — approximately 10% of women of reproductive age. Despite its prevalence, the condition often remains undiagnosed for many years. Endometriosis can significantly reduce quality of life, cause chronic pelvic pain, and affect reproductive health. Its symptoms may resemble those of other gynecological conditions, making timely diagnosis difficult. How can you tell when menstrual pain is no longer normal? Which symptoms should not be ignored? Is it possible to detect endometriosis at an early stage and preserve reproductive health? We asked Rozikul Anarkulovich Fozilbekov — Head of the Gynecology Department, a surgeon with 26 years of professional experience — to answer these and other important questions. 1. Rozikul Anarkulovich, many women have grown accustomed to enduring painful periods since adolescence. Where is the line between ordinary menstrual discomfort and pain that may indicate a serious illness? Pain that makes you cancel your plans is not normal. Mild discomfort on the first or second day of the cycle is acceptable. But if an ordinary pill does not help, you have to miss work or classes, and things only get worse over the years, that is a warning sign, not a “feature of your body.” 2. What is endometriosis, why does it develop, and what happens in a woman’s body when she has this condition? Imagine that the tissue lining the inside of the uterus has “moved” to the ovaries, peritoneum, or bowel. And every month it bleeds where it should not. Inflammation develops around it, followed by adhesions and scars — hence the pain. There is no single cause: heredity, immunity, and hormones all play a role. About one in ten women has the disease. 3. Which early signs of endometriosis are most often overlooked? Can the condition develop without noticeable symptoms? The most insidious symptom is the one you have grown used to. This includes pain during periods and intimacy, bloating and painful bowel movements on menstrual days, spotting, and constant fatigue. Sometimes the disease remains silent for years and is discovered only when a woman cannot get pregnant. 4. Why do some women live with endometriosis for years without knowing they have it? What usually delays diagnosis? On average, the road to a diagnosis takes 7–10 years. Women are told, “Put up with it; everyone has pain.” The symptoms masquerade as cystitis, bowel problems, or back pain. And an ordinary ultrasound done “just to tick a box” may miss small lesions. 5. Can endometriosis affect young girls, including teenagers? When should parents be concerned about their daughter’s painful periods? Yes, and more often than people think. Mothers, take notice if your daughter misses school because of her periods, takes painkillers by the handful, complains of nausea, or faints on those days. The advice “Have a baby and it will go away” does not work here. 6. Apart from painful periods, what other symptoms may indicate endometriosis? Can pain occur between periods or spread to the lower back, bowel, or other areas? It can. Pain may occur in the middle of the cycle, in the lower back and sacrum, and radiate down a leg. If the bowel is affected, going to the toilet is painful; if the bladder is affected, urination is frequent and painful. Add heavy periods, anemia, and chronic fatigue, and the picture becomes clear. 7. Is it true that endometriosis can cause infertility? How can it affect natural conception and pregnancy? It is not a sentence, but it is a serious risk: endometriosis is found in 30–50% of women who cannot become pregnant. It causes adhesions in the fallopian tubes, reduces the egg reserve, and interferes with conception. The good news is that many patients become pregnant naturally or with IVF; such pregnancies simply need closer monitoring. 8. How is endometriosis diagnosed today? Is ultrasound enough, or are other tests needed to confirm the diagnosis? Surgery just to make a diagnosis is no longer mandatory. Most often, a careful examination and expert transvaginal ultrasound are enough; if deep disease is suspected, an MRI is performed. Laparoscopy is needed when there is no clear answer or treatment is required. 9. Some women rely on painkillers every month to manage severe menstrual pain. What are the risks of suppressing symptoms without finding the underlying cause? A pill switches off the alarm, but not the fire. While the pain is suppressed, the disease may spread, forming cysts and adhesions and affecting neighboring organs. Years of taking painkillers also take a toll on the stomach and kidneys. If you cannot get through a single cycle without a pill, look for the cause rather than increasing the dose. 10. What modern treatments are available for endometriosis? When is medication sufficient, and when might surgery be needed? We start with hormonal therapy: it “puts the lesions to sleep” and completely relieves pain for many women. Surgery, usually laparoscopic, is needed for large cysts, involvement of the bowel or urinary tract, when pills do not work, and for infertility. Important: the surgeon must have experience specifically in endometriosis. The first operation is the most important. 11. Can endometriosis be cured completely, or does it require long-term management? Can it return after treatment? I will be frank: this is a chronic disease. After surgery, without maintenance treatment, it returns in about one in five patients within five years. But it can be kept under control: you can live without pain, work, and have children. The main thing is regular follow-up. 12. Finally, what is your most important advice for women who have endured painful periods for years and keep postponing a gynecological appointment? Which symptoms mean they should seek medical advice? Stop putting up with it. Pain is not a personality trait or “a woman’s lot”; it is a symptom. See a gynecologist if: • painkillers do not help; • your periods disrupt your life; • intimacy or going to the toilet during your period is painful; • your periods are very heavy; • you have not become pregnant for more than a year (or more than six months if you are over 35). Early diagnosis means simpler treatment and a better chance of preserving the possibility of becoming a mother.
Fever, a lingering cough, persistent runny nose and repeated colds are among the most common reasons parents consult a pediatrician. The problem becomes particularly noticeable when a child starts attending kindergarten or daycare and comes into contact with more infections. However, not every frequent cold indicates a weakened immune system. What matters is not only the number of illnesses but also their duration, severity, complications and the child's overall condition. What Do International Statistics Tell Us? According to the American Academy of Pediatrics (AAP, 2026), children in their first two years of life may experience an average of 8–10 colds each year. Respiratory infections generally become less frequent with age. At the same time, UNICEF statistics highlight the importance of promptly identifying serious illnesses. According to international estimates for 2024, lower respiratory tract infections, including pneumonia, accounted for approximately 13% of all deaths among children under five worldwide. There is also encouraging evidence. According to the World Health Organization (WHO, 2024), global vaccination programs have prevented approximately 154 million deaths over the past 50 years. These figures emphasize the importance of prevention, timely diagnosis and appropriate treatment. An ordinary viral cold must, however, be distinguished from illnesses requiring closer medical attention. Where is the boundary between the natural development of immune defenses and a pathological condition? Which treatment mistakes do parents make most often, and why should antibiotics not always be the first response? We discussed these questions with Gulnoza Kamoliddinovna Azizova, pediatrician and pediatric gastroenterologist, Doctor of Philosophy (PhD) in Medical Sciences. Interview with a Pediatrician: 15 Important Questions About Children's Health 1. Many parents complain that their child is ill almost every month. How many colds per year are considered acceptable at different ages, and when should frequent illnesses become a cause for concern? Young children experience colds much more frequently than adults, and this alone does not indicate an immunodeficiency. According to the AAP, children in their first two years have approximately 8–10 colds per year, particularly if they attend daycare. In school-age children, infections generally become less frequent, averaging around four episodes annually, although individual variation is considerable. The main criterion is not the number of episodes on the calendar, but the nature of the illnesses. If a child grows and gains weight normally, feels well between episodes and recovers without unusual complications, this is more likely to represent a normal age-related pattern. Warning signs include recurrent confirmed pneumonia, severe bacterial infections, hospitalizations, prolonged fever, poor weight gain and repeated need for intravenous antibiotics. I therefore advise parents to keep a simple illness diary: date, symptoms, duration, confirmed diagnosis and treatment. It provides more useful information than a general impression that the child is “always sick.” [1, 4] 2. Why do some children seem constantly ill after starting kindergarten or daycare? Is this a natural stage of exposure to infections, or could it indicate an underlying health problem? The main reason is a sharp increase in exposure to respiratory viruses. In groups of young children, infections spread more easily through the air, hands and shared objects. At the same time, children have not yet developed immune memory to many viruses, so colds may follow one another during the first period of daycare attendance. However, it is important not to draw the mistaken conclusion that a child must go through numerous infections to “train” the immune system. The immune system develops without deliberate exposure to infection, and infections can sometimes cause complications. It is better to reduce transmission risks: wash hands, ventilate rooms, follow the vaccination schedule and keep a child out of group activities when clearly ill and unable to participate normally. If frequent infections are accompanied by poor growth, persistent wet cough, repeated episodes of pneumonia or unusually severe illness, another cause needs to be investigated, ranging from asthma and allergies to disorders of immune defense. [1, 4] 3. Parents often say, “My child has a weak immune system.” What does this actually mean in pediatrics, and what signs may suggest an immunodeficiency? “Weak immune system” is not a medical diagnosis. A healthy child's immune system may function normally despite frequent seasonal viral infections. A true immunodeficiency is an established defect in specific mechanisms of immune defense; it may be congenital or acquired, for example through severe malnutrition or the use of certain medications. According to the American Academy of Allergy, Asthma & Immunology, warning signs include infections caused by unusual pathogens, recurrent pneumonia, deep abscesses, infections that are difficult to treat with standard therapy, poor growth or weight gain, and a family history of immunodeficiency. A combination of findings matters more than any isolated count of colds. When there is a justified suspicion, the pediatrician begins with the medical history, examination and targeted investigations and, if needed, refers the child to a pediatric immunologist. Buying an “immunomodulator” without a diagnosis is neither diagnosis nor treatment. [4, 15] 4. How dangerous is a high temperature in a child? When can a fever be monitored at home, and when is urgent medical attention necessary? Fever is a manifestation of the immune response, not an independent measure of infection severity. In children older than six months, breathing, activity, responsiveness, fluid intake, urination and general condition matter more than the thermometer reading alone. When a child is otherwise well, has no warning signs and can be monitored reliably, a mild fever can often be managed at home with adequate fluids and observation. There are important age-related exceptions: a temperature of 38°C or higher in an infant younger than three months requires urgent medical assessment; in children aged 3–6 months, a temperature of 39°C or higher calls for prompt examination. Immediate help is needed for difficulty breathing, marked drowsiness or unresponsiveness, seizures, signs of dehydration, neck stiffness or a rash that does not fade when pressed. Fever-reducing medications should primarily be used to relieve discomfort, at an age- and weight-appropriate dose. Aspirin must not be given to children with a viral infection. If fever persists for five days or more, the child needs assessment, including consideration of Kawasaki disease and other causes. [5, 10] 5. A common mistake is starting antibiotics independently for a cough, runny nose or fever. Why is this dangerous, and when are antibiotics truly needed? Most common colds are caused by viruses, against which antibiotics do not work. Uncontrolled antibiotic use raises the risk of adverse reactions, disrupts the microbiota and contributes to bacterial resistance. Moreover, starting treatment without an examination can obscure the true cause of the illness. Antibacterial treatment is needed for a confirmed or reasonably suspected bacterial infection—for example, certain types of pneumonia, urinary tract infection, streptococcal tonsillitis following appropriate testing, and some cases of middle-ear infection. In bacterial sinusitis, clinicians consider symptoms lasting more than ten days without improvement, renewed worsening after initial improvement, or a severe onset with high fever and purulent discharge. A physician selects an antibiotic according to the diagnosis, the child's age and weight, allergies and local bacterial resistance patterns. Green nasal discharge or fever alone is not an automatic indication for antibiotics. [6] 6. Can what initially seems like an ordinary cold develop into pneumonia? Which early symptoms should alert parents, even if the fever has already subsided? Yes. Sometimes a viral infection affects the lower respiratory tract, and sometimes a bacterial infection develops on top of it. However, not every prolonged cold leads to pneumonia, and the color of mucus alone cannot establish the diagnosis. Early warning signs include rapid breathing at rest, retraction of the spaces between the ribs or lower chest during inhalation, shortness of breath, chest pain, marked weakness, refusal to drink and deterioration after a period of improvement. In infants aged 2–12 months, 50 or more breaths per minute is a threshold for rapid breathing; from one to five years, 40 or more breaths per minute. These are screening indicators, not substitutes for a physician's assessment. Importantly, a fall in temperature does not rule out pneumonia. If breathing becomes labored, the child develops bluish discoloration, cannot drink or appears markedly lethargic, emergency care is needed. Chest X-rays are performed when clinically indicated, not for every child with a cough. [7, 5] 7. If a child's cough continues for several weeks after an illness, is it always a lingering symptom? Which conditions should be ruled out first? No, although a cough can indeed persist for some time after a viral infection. According to CHEST guidelines, a daily cough lasting longer than four weeks in a child should be regarded as chronic, and its cause should be investigated. Assessment begins with the characteristics of the cough: whether it is wet or dry, occurs during the day or at night, is associated with exercise, and whether there is wheezing, coughing after meals, fever or poor weight gain. Possible causes include asthma, protracted bacterial bronchitis, pertussis, allergies and ear, nose and throat disorders. If the cough began suddenly after a choking episode, an inhaled foreign body must be excluded. If a cough occurs daily for more than four weeks, the child needs an examination and, when indicated, chest radiography and spirometry if old enough to perform the test correctly. Cough syrups or antibiotics should not be prescribed for months without identifying the cause. [8, 14] 8. Parents often use nebulizers, cough syrups and various medications on their own. Which home treatments may be ineffective or even dangerous for a child? The greatest risks are associated with uncontrolled use of combination “cold remedies,” cough suppressants, antibiotics and inhaled medicines. The FDA does not recommend over-the-counter cough and cold medicines for children under two years; manufacturers generally label these products as unsuitable for children under four. Some preparations contain several active ingredients, making accidental double dosing easy. A nebulizer is a device for delivering a prescribed medicine, not a universal treatment for a runny nose. In typical bronchiolitis, NICE does not recommend routine use of inhaled bronchodilators or corticosteroids. Steam inhalation over hot water is also dangerous because it can cause burns. For an uncomplicated cold, adequate fluids, rest, saline nasal drops or sprays and gentle age-appropriate nasal clearing are usually sufficient. For children older than one year, a small amount of honey may sometimes reduce nighttime coughing; honey is contraindicated before the age of one because of the risk of botulism. [9–11] 9. Vitamins, immunomodulators and products marketed to “strengthen immunity” are widely advertised. Is there convincing scientific evidence that they work, and what genuinely helps protect children's health? There is no universal medication that “boosts” a healthy child's immune system and reliably prevents colds. For most advertised immunomodulators, convincing evidence from high-quality pediatric studies is lacking. Correcting a proven deficiency is a separate matter: for example, vitamin D is important under age-specific recommendations to prevent rickets, but this does not mean that high doses protect against respiratory viral infections. Notably, an updated 2025 meta-analysis combining 46 randomized trials and more than 64,000 participants found no statistically significant overall preventive benefit of vitamin D supplements against acute respiratory infections. A Cochrane review likewise did not establish a reduction in the frequency of colds in the general population with regular vitamin C intake, although the duration of symptoms may be slightly shorter. The best-supported measures are vaccination, balanced nutrition, adequate sleep, avoiding tobacco smoke, good hygiene and timely treatment of specific diseases. Vitamins should be prescribed for medical indications, not as a substitute for these measures. [12, 13, 3] 10. Can persistent nasal congestion or a recurring cough be caused by allergies, bronchial asthma or enlarged adenoids rather than infection? How can these conditions be distinguished? Yes, and this is one of the common sources of diagnostic mistakes. Viral infections typically begin relatively suddenly and improve gradually. Allergic rhinitis often involves repeated sneezing, itchy nose or eyes, watery discharge, an association with pollen, household dust or animals, and no significant fever. With asthma, wheezing, shortness of breath, chest tightness and coughing may recur, especially at night or during exercise. However, an isolated cough does not by itself prove asthma: diagnosis is based on the overall symptom pattern and, when age permits, objective testing of lung function. Enlarged adenoids may cause persistent mouth breathing, snoring, nasal obstruction and recurrent middle-ear infections. Clarification may require assessment by a pediatrician, allergist, ear-nose-throat specialist or pulmonologist. These conditions should not be treated independently with antibiotics for months. [14, 19, 20] 11. Parents sometimes request as many tests as possible to find the cause of frequent illnesses. Which investigations have real diagnostic value, and which are usually unnecessary? Good diagnosis starts not with a large package of laboratory tests but with a detailed history, review of height and weight, vaccination status and examination of the lungs, nasopharynx, skin and lymph nodes. A healthy child with typical viral colds usually does not need extensive laboratory testing. If there are signs of anemia, nutritional problems or prolonged inflammation, the physician orders targeted tests. When immunodeficiency is reasonably suspected, initial tests may include a complete blood count with differential and quantitative IgG, IgA and IgM levels interpreted using age-specific reference ranges; depending on the clinical picture, complement studies, post-vaccination antibody levels and other specialized investigations may follow. A persistent cough calls for a different diagnostic approach. Without specific indications, broad “immune panels,” tests for every possible virus, extensive allergen panels or tumor markers should generally be avoided: they often produce results that are difficult to interpret and do not change treatment decisions. [15, 8] 12. What roles do sleep, nutrition, iron deficiency, physical activity and environmental conditions play in the frequency and severity of childhood illnesses? What should parents prioritize? Everyday lifestyle factors do not create a “super immune system,” but they significantly affect general health and a child's ability to cope with illness. A varied, balanced diet with adequate protein, iron and other nutrients is important. Iron deficiency can cause weakness and anemia; testing and treatment should depend on age, diet and risk factors rather than the assumption that “every child needs iron supplements.” Sleep is particularly important. According to CDC guidance, children aged 1–2 years need about 11–14 hours of sleep per 24 hours, those aged 3–5 years need 10–13 hours, and those aged 6–12 years need 9–12 hours. Daily outdoor time and age-appropriate activity support overall health but do not replace medical prevention. One of the most important steps is to completely eliminate tobacco smoke from the home and car. Secondhand smoke is known to increase the risk of respiratory infections, ear infections and severe asthma attacks in children. [16, 17] 13. Some parents are afraid to vaccinate children who frequently get sick. When should vaccination actually be postponed, and is a frequent cold itself a contraindication? A history of frequent colds is not in itself a contraindication to vaccination. According to CDC recommendations, a mild upper respiratory infection, slight runny nose or low-grade fever usually does not require postponing a scheduled vaccine. The clinician makes the final decision after assessing the child's current condition and the specific vaccine. Postponement is generally considered during a moderate or severe acute illness, primarily to avoid confusing symptoms of the illness with possible post-vaccination reactions. True contraindications vary by vaccine: examples include a severe allergic reaction to a previous dose or a vaccine component; certain live vaccines are contraindicated in some severe immunodeficiency conditions. Timely vaccination may be particularly important for children at increased risk of serious infections. Parents should not independently delay vaccinations for months because of every runny nose; if doses have been missed, discuss an individualized catch-up schedule with the pediatrician. [18, 3] 14. Which symptoms in a child must never be ignored? Name the warning signs that require immediate emergency medical attention rather than waiting until the next day. Call emergency medical services immediately if a child has severe breathing difficulty, chest retractions, blue lips or skin, pauses in breathing, failure to respond, seizures, profound weakness or altered consciousness. Inability to drink or feed, severe dehydration, fever with neck stiffness, and a red-purple rash that does not fade when pressed are especially concerning. An infant younger than three months with a temperature of 38°C or higher needs urgent medical assessment even if the baby appears relatively calm. In children aged 3–6 months, a temperature of 39°C or higher also requires prompt evaluation. A separate emergency is sudden coughing and choking during eating or playing with small objects: a foreign body in the airway must be suspected. The key rule is to assess not only the thermometer but also breathing, consciousness, skin color, drinking and the speed at which the child's condition is worsening. [5, 7] 15. If you could give parents only three recommendations to reduce the risk of serious illnesses in children, what would they be? And which common mistakes in caring for children's health do you consider most dangerous? First, vaccinate children on schedule and do not skip preventive checkups. Vaccination prevents a number of potentially serious infections and is one of the most effective public health measures. Second, build health-promoting habits every day: balanced nutrition, enough sleep, physical activity, clean air free from tobacco smoke and routine hand hygiene. These measures may sound less impressive than advertisements for “immune-boosting drugs,” but they have much stronger scientific support. Third, recognize warning signs and seek medical care promptly, especially for breathing difficulties, dehydration, altered consciousness and unusually severe illness. The most dangerous mistakes are uncontrolled antibiotic use, relying on unproven remedies instead of appropriate assessment, missed vaccinations and trying to “wait out” signs of a medical emergency. Parents do not need to become doctors; they need to know when home care is no longer enough. [3, 5, 6, 17, 18]
Joint pain, fractures, sports injuries and modern treatment methods: what do global statistics tell us, and when is surgery truly necessary? According to the World Health Organization (WHO), approximately 1.71 billion people worldwide live with musculoskeletal conditions. These conditions are among the leading causes of reduced mobility and disability. The scale of the problem continues to grow. Population ageing, excess body weight, insufficient physical activity and the consequences of injuries are creating additional challenges for modern trauma and orthopaedic care. At the same time, modern diagnostic, treatment and rehabilitation methods can, in many cases, relieve pain, restore mobility and improve patients' quality of life. We spoke with Abduaziz Shadievich Babakulov, Head of the Traumatology and Orthopaedics Department at AKFA Medline, about the most common joint conditions, why injuries should never be underestimated and what modern orthopaedics can offer. 1. According to international statistics, musculoskeletal conditions affect more than 1.7 billion people. Why has this problem become so widespread, and what factors are driving the rise in cases? There are several reasons, and they act simultaneously. The first is population ageing: people are living longer, and age-related changes gradually accumulate in cartilage, bones, ligaments and muscles. Conditions that previously did not have time to develop are now seen in millions of patients. The second reason is lifestyle. Excess weight, sedentary work, long hours spent at a computer or in a car, and insufficient movement weaken the muscles that normally protect the joints and spine. Diabetes, smoking and vitamin D deficiency also deserve mention, as they adversely affect bone and connective tissue health. The third is injury: road traffic accidents, falls at home and sports-related injuries. An inadequately treated joint injury can often develop into post-traumatic osteoarthritis several years later. Finally, we have become better at diagnosing these conditions. However, it is important to understand that most are chronic: they do not simply disappear and their prevalence accumulates in the population. This is why, according to WHO, low back pain is now one of the leading causes of disability worldwide. 2. According to the Global Burden of Disease study, approximately 595 million people had osteoarthritis in 2020. Which joints are most commonly affected, and why is the condition now diagnosed in younger patients as well? The knees are affected most often, accounting for the largest proportion of osteoarthritis cases. Next come the hips, the small joints of the hands (particularly in women), and joints in the spine and feet. These joints either bear much of the body's weight or are used continuously throughout the day. Osteoarthritis is no longer exclusively a disease of older people. In younger patients, it most often develops after an injury, such as a meniscal tear, an anterior cruciate ligament tear or an intra-articular fracture. An injured joint no longer functions normally, so its cartilage wears out faster. Other causes include excess weight, congenital anatomical characteristics (such as hip dysplasia), altered leg alignment (bow legs or knock knees), occupational and sporting overload, and hereditary factors. Warning signs include pain when taking the first steps after rest, morning stiffness, joint crepitus and progressively restricted movement. The earlier treatment begins, the longer it may be possible to preserve the patient's natural joint. 3. According to WHO, approximately 1.8 billion adults worldwide do not meet the recommended level of physical activity. How does a sedentary lifestyle affect joint health, and why do even young people experience knee and spinal pain? Articular cartilage has no blood vessels of its own. It receives nutrients from synovial fluid, and this exchange takes place during movement, as loading and unloading alternate. In a sense, cartilage is 'nourished' by movement. A sedentary lifestyle makes this process less effective. In addition, muscles weaken without regular exercise. The quadriceps muscle is particularly important for the knee, acting as a shock absorber and stabiliser. For the spine, the back, abdominal and gluteal muscles perform this role. When this muscular support is weak, more load falls directly on the joints, ligaments and intervertebral discs. Among young people, knee and back pain is often associated with prolonged sitting, poor posture while using a computer or smartphone, and sudden transitions from inactivity to intense exercise, for example, sitting in an office all week and then playing football at the weekend. We see many patients with patellofemoral pain syndrome and non-specific low back pain. WHO recommends that adults perform 150–300 minutes of moderate-intensity physical activity per week, such as brisk walking, swimming or cycling, together with muscle-strengthening exercises at least twice a week. For most people, this is the best 'preventive medicine' for their joints. 4. International studies indicate that approximately 178 million new fractures occurred worldwide in 2019. Which types of fracture are the most dangerous, and how effectively can modern treatment restore the function of an injured limb? I would identify several particularly dangerous groups. These include proximal femoral fractures in older people (including femoral neck fractures). Without timely treatment, patients may become bedridden and develop pneumonia, thrombosis or pressure sores, while mortality in the first year remains high. Pelvic fractures are dangerous because of the risk of major bleeding; spinal fractures because they may damage the spinal cord; open fractures because of infection; and fractures involving blood vessel or nerve injury. Intra-articular fractures also deserve special attention: even if the bone heals successfully, an inaccurately restored joint surface may lead to osteoarthritis later on. Modern trauma surgery can achieve very good outcomes. Minimally invasive fixation techniques are used, including intramedullary nails and locking plates inserted through small incisions. We aim to operate on older patients with hip fractures within the first 24–48 hours and help them stand as early as the following day. For femoral neck fractures, we often proceed directly to joint replacement. With prompt and appropriate treatment, most patients return to their usual lives. The timing of medical assessment, the quality of surgery and subsequent rehabilitation are decisive. 5. WHO estimates that approximately 37 million falls require medical attention each year. Which symptoms after a fall or other injury require an immediate assessment by a trauma specialist? You should seek immediate medical attention or call an ambulance if, after an injury: – a limb looks visibly deformed or is in an unnatural position; – you cannot bear weight on a leg or move an arm or your fingers; – pain is severe and does not ease at rest, or swelling or bruising increases rapidly; – your fingers become numb, tingle, feel cold or turn pale, which may indicate nerve or blood vessel damage; – there is a wound over the injury, particularly if bone is visible; – a crack or pop was heard during the injury and the joint subsequently gives way or feels unstable; – back pain after a fall is accompanied by leg numbness or weakness, or problems with urination; – there has been a blow to the head, loss of consciousness, vomiting or a severe headache. Older people need particular attention. Even a seemingly minor fall from standing height can cause a femoral neck fracture. Pain in the groin or hip and difficulty putting weight on the leg after a fall warrant urgent investigation. As a general rule, if pain following an injury does not resolve within a few days, you should see a doctor, even if it 'doesn't seem serious'. Before being examined, do not attempt to straighten or reset the limb yourself, do not apply heat to the injured area and keep it at rest. 6. MRI, CT and digital X-ray imaging are now used to diagnose musculoskeletal injuries. How is the appropriate imaging method selected, and which injuries can remain undetected during a routine examination? The choice always begins with a clinical examination. The doctor assesses how the injury happened, considers the patient's symptoms and performs specific clinical tests before deciding which investigation is needed. We treat the patient, not the scan. X-ray imaging is the basic and most accessible method. It shows bones clearly, including fractures, dislocations and signs of osteoarthritis. Digital radiography produces higher-quality images with lower radiation exposure. Computed tomography (CT) is needed when a detailed assessment of bone is required, such as in complex intra-articular fractures, pelvic and spinal fractures, and surgical planning. Three-dimensional reconstruction allows the surgeon to 'see' the fracture from every angle in advance. MRI is the preferred method for soft tissues: menisci, ligaments, cartilage, tendons and the shoulder's rotator cuff. It can also identify bone marrow oedema, stress fractures and occult fractures. Ultrasound is sometimes added to assess tendons and joint effusions. Injuries that may be missed during a routine examination or even on X-rays include scaphoid fractures of the wrist, undisplaced femoral neck fractures, stress fractures, osteoporotic vertebral compression fractures, anterior cruciate ligament and meniscal tears, ankle ligament injuries and osteochondral lesions. The reverse is also important to remember: MRI is very sensitive and often detects age-related changes in the menisci or intervertebral discs in people over 40–50 who have no symptoms at all. MRI findings must therefore always be interpreted alongside the clinical picture. 7. The ESCAPE study, published in JAMA Network Open, showed that exercise therapy can be no less effective than arthroscopic surgery for certain degenerative meniscal tears. When is surgery genuinely necessary, and when can it be avoided? The ESCAPE study and several other studies have indeed changed treatment approaches. They concern degenerative meniscal tears in middle-aged and older adults, when the meniscus gradually wears down, often against a background of early osteoarthritis, without a significant injury. In such cases, a structured exercise therapy programme lasting several months produces results comparable to arthroscopy in terms of pain and function. Some patients who do not improve with exercise therapy subsequently undergo surgery, so conservative treatment does not rule out an operation later. For a degenerative tear without a locked joint, we therefore start with conservative management: therapeutic exercise, weight management, short courses of anti-inflammatory medication and, if necessary, intra-articular injections. It is important to understand that arthroscopy does not treat osteoarthritis itself. Surgery is genuinely indicated when: – the tear is traumatic, especially in a young, active patient, in which case we aim to repair and preserve the meniscus; – the joint becomes mechanically locked, meaning the knee 'jams' and cannot straighten because a meniscal fragment has moved; – the meniscal tear is accompanied by an anterior cruciate ligament tear and knee instability; – there is a meniscal root tear that causes complete loss of its function; – approximately three months of conservative treatment have failed. The decision is always individual and takes into account age, the type of tear, cartilage condition and the patient's activity requirements. 8. Global Burden of Disease researchers predict that the number of people with osteoarthritis could approach one billion by 2050. Can the progression of the condition be slowed, and which preventive measures have proven effective? Yes, it is possible to slow the progression of osteoarthritis, although modern medicine cannot yet fully restore worn cartilage. There are currently no medications proven to stop cartilage deterioration. The foundation of treatment is therefore lifestyle change rather than tablets. The measures with the strongest evidence base, included in international guidelines, are: – regular therapeutic exercise: strengthening the thigh and gluteal muscles, flexibility and balance exercises, and aerobic activities such as walking, swimming or cycling on a stationary bike; – weight loss and weight management; – patient education: understanding the condition and pacing physical activity appropriately; – comfortable footwear and, when needed, orthotic insoles or a walking stick for significant pain; – timely and comprehensive treatment of joint injuries, including ligament restoration and meniscus preservation; – injury prevention for athletes through dedicated warm-up programmes and neuromuscular training. As for popular chondroprotective supplements, hyaluronic acid and platelet-rich plasma (PRP) therapy, evidence of effectiveness is limited and conflicting, and leading international guidelines do not regard them as essential treatments. Their use is decided individually, but relying solely on them without making lifestyle changes is a mistake. 9. According to NICE clinical guidelines, losing 10% of body weight may provide greater benefit for people with osteoarthritis than losing 5%. How much does excess weight affect the knees and hips, and can weight loss reduce the need for surgery? The effect is substantial. While walking, every additional kilogram of body weight increases the load on the knee joint by approximately 4 kilograms, and even more during stair climbing or squatting. Consequently, losing just 5 kg reduces the load on the knee by approximately 20 kg with each step. But it is not only about mechanics. Fat tissue is a metabolically active organ that produces substances contributing to chronic inflammation throughout the body, including in the joints. This is why osteoarthritis is more common in people with obesity even in joints that do not bear body weight, such as the finger joints. Studies confirm that weight loss of 10% or more, combined with exercise, substantially reduces pain and improves joint function, with a noticeably greater effect than a 5% reduction. This is why NICE recommends aiming for that target. Can losing weight reduce the need for surgery? In the early and moderate stages of osteoarthritis, yes: it can delay joint replacement for years. In advanced disease, when cartilage has been destroyed, weight loss cannot replace surgery, but it can make the procedure safer. Severe obesity increases the risks of infection, thrombosis, other complications and wear of the prosthetic joint. Weight loss is therefore beneficial at every stage. 10. According to the International Osteoporosis Foundation, one in three women and one in five men over the age of 50 may experience an osteoporotic fracture during the rest of their lives. Why does fracture risk increase with age, and which preventive methods are most effective? Bone tissue loses density and strength with age. In women, this process accelerates sharply after menopause because oestrogen levels decline, which is why osteoporosis is considerably more common among women. Osteoporosis can remain asymptomatic for a long time, and the first sign is often a fracture itself. Another part of the problem is falling. As people age, muscle mass decreases (sarcopenia), balance, vision and coordination deteriorate, and some medications cause dizziness or drowsiness. Fragile bones combined with frequent falls are a major reason for fractures of the femoral neck, vertebrae and radius. The most effective prevention includes: – sufficient calcium, vitamin D and protein intake; – strength and balance training, which improve bone and muscle health and reduce the risk of falls; – avoiding smoking and excessive alcohol consumption; – bone density testing (densitometry) for women after 65 and men after 70, or earlier when risk factors are present; – prescribed medication for confirmed osteoporosis, which has been shown to reduce fracture risk; – a safer home environment with good lighting, no slippery rugs and grab rails in the bathroom. It is very important that anyone over 50 who has already experienced a fracture from a minor injury be assessed for osteoporosis. One such fracture substantially increases the risk of another. 11. According to a systematic review published in The Lancet, approximately 82% of total knee replacements remain in place without revision for 25 years. How reliable are modern artificial joints, and when is joint replacement the best treatment option? Modern joint implants are among the most reliable and successful devices used in surgery. The cited figures for 25-year knee implant survival were largely obtained with earlier generations of implants; today's materials, designs and surgical technologies are even more advanced. For most patients, this means that a joint replacement will last many years and, for older people, often for the remainder of their lives. Joint replacement becomes the best treatment when: – a patient has severe osteoarthritis with persistent pain, including pain at night or at rest; – pain and restricted movement seriously interfere with walking, working or daily self-care; – several months of conservative treatment have not helped; – there is avascular necrosis of the femoral head or severe joint deformity; – an older patient has sustained a femoral neck fracture. I would emphasise that indications are determined not by an image alone but by how much the condition reduces quality of life. Sometimes an X-ray shows severe changes while the patient remains active, and sometimes the opposite is true. It is also important to know that the entire joint does not always need to be replaced. If damage is confined to one compartment of the knee, a partial (unicompartmental) knee replacement may be possible. After modern surgery, patients can often stand the following day, and the outcome depends greatly on the quality of rehabilitation. 12. WHO estimates that approximately 2.4 billion people worldwide may need rehabilitation services. What role does rehabilitation play after fractures and orthopaedic surgery, and what advice would you give patients to maintain joint health for years to come? Rehabilitation is not an optional addition to treatment; it is a complete and essential part of it. An operation can be performed perfectly, but without proper recovery the patient may still have a poor outcome: a stiff joint, weak muscles and an abnormal walking pattern. Early mobilisation reduces the risk of thrombosis, pneumonia, muscle wasting and contractures. After joint replacement or fracture fixation, we aim to get patients on their feet within the first 24 hours. Rehabilitation then continues for weeks or months, restoring range of motion, muscle strength, balance and normal walking, followed by a return to work and sport. Much depends on the patient's own commitment and regular exercise at home. My recommendations for maintaining healthy joints in the long term are: – move every day and include strength training; – keep your body weight under control; – warm up before sport and increase exercise intensity gradually; – wear comfortable shoes and lift heavy objects correctly, bending your knees and keeping your back straight; – do not smoke, as smoking impairs fracture healing and tissue repair; – do not ignore pain or delay seeing a doctor after an injury; – after the age of 50, pay attention to bone health and have your bone density assessed. 13. Many patients complain of sharp heel pain, particularly when taking their first steps after waking up. This is often called a 'heel spur'. What actually causes the pain, can the condition be treated without surgery, and which treatments are genuinely effective? This is one of the most common misconceptions. Heel pain, especially during the first steps in the morning or after rest, is most often caused by plantar fasciitis: overload and degenerative changes in the plantar fascia where it attaches to the heel bone. The 'spur' itself, a bony projection visible on X-ray, is also present in many people who have no pain at all. It is a consequence of prolonged tension on the fascia rather than the cause of the pain. We therefore need to treat the overloaded fascia, not the 'spur'. Contributing factors include excess body weight, prolonged standing or walking, running, flat feet or high arches, tight calf muscles and a shortened Achilles tendon, and stiff or worn-out footwear. The good news is that in roughly 9 out of 10 cases, the condition resolves without surgery within several months. The most effective measures include: – daily stretching of the plantar fascia and calf muscles, particularly before the first steps in the morning; – comfortable, well-cushioned shoes and orthotic insoles with arch support; – weight loss and a temporary reduction in high-impact activities; – short courses of anti-inflammatory medication; – shockwave therapy for persistent cases. Corticosteroid injections provide only temporary relief and carry a risk of fascia rupture and thinning of the heel's fat pad, so their use is limited. Surgery is rarely needed and is considered when comprehensive conservative treatment has failed over 6–12 months. If heel pain occurs at night, is accompanied by numbness or begins after an injury, an examination is necessary: a stress fracture, nerve compression or another cause may be responsible. 14. Sometimes a person notices that their shoulder is starting to hurt and that lifting the arm or reaching behind the back is becoming increasingly difficult. Could this be a sign of a so-called 'frozen shoulder'? Why does the condition develop, and can full movement be restored? Yes, these symptoms may indicate adhesive capsulitis, also known as 'frozen shoulder'. In this condition, the shoulder joint capsule becomes inflamed, then thickens and contracts with scar tissue, effectively tightening around the joint. It most commonly affects people aged 40–60, with women affected slightly more often than men. The risk is significantly higher in people with diabetes or thyroid disorders and after injuries, operations or prolonged immobilisation of the arm. Frequently, no clear cause is identified. The condition has three stages: pain and stiffness first increase (the 'freezing' stage); then pain subsides but movement remains severely restricted (the 'frozen' stage); and finally mobility gradually returns (the 'thawing' stage). The entire process can take one to three years. It is important to distinguish frozen shoulder from rotator cuff injuries, impingement syndrome and osteoarthritis. In capsulitis, both active and passive movement are restricted: even the doctor cannot fully raise or rotate the patient's arm. An orthopaedic assessment is therefore necessary. Treatment is conservative in most cases: therapeutic exercises with gentle stretching within tolerable pain limits, anti-inflammatory medication and, in the early stage, an intra-articular corticosteroid injection that can effectively relieve pain. Patients with diabetes also need to control their blood glucose. If treatment is unsuccessful, hydrodilatation or arthroscopic capsular release may be considered. Most patients regain full or nearly full mobility, although some have a minor residual restriction. Patience and regular exercise are essential. 15. Many people, especially women, develop a 'bump' near the big toe. Why does hallux valgus (a bunion) develop, can special footwear and orthotic insoles stop it from progressing, and when does surgery become necessary? First, let me dispel a common myth: the 'bump' is not a deposit of salts. It is a foot deformity in which the first metatarsal bone deviates inwards and the big toe moves outwards towards the other toes. The prominent head of the metatarsal bone is what looks like a 'bump'. Heredity plays the main role: the condition often occurs in several generations of the same family. Narrow, pointed shoes, high heels, flat feet and weak ligaments make the deformity worse. This is why women are affected much more frequently. Comfortable shoes with a wide toe box and soft uppers, orthotic insoles, toe spacers and night splints can reduce pain, pressure and friction. But we must be clear: they cannot correct a deformity that has already developed, and there is no reliable evidence that they halt its progression. These measures relieve symptoms rather than cure the condition. Surgery becomes necessary when: – pain persists despite appropriate footwear and insoles; – finding suitable shoes becomes difficult; – the deformity continues to progress; – secondary changes develop, such as hammer toes, calluses and pain beneath the metatarsal heads. Surgery solely for cosmetic reasons, without symptoms, is generally not recommended. Modern surgery involves corrective osteotomies, including minimally invasive techniques performed through small incisions. Patients can usually begin walking in special postoperative shoes almost immediately, return to ordinary footwear after approximately 6–8 weeks and achieve full recovery in around 3–6 months. Global medical statistics show that musculoskeletal disorders and injuries remain among the most significant challenges facing modern healthcare. However, timely diagnosis, individually selected treatment and properly organised rehabilitation can often preserve mobility, prevent complications and improve quality of life. Particular attention should be paid to symptoms that patients often dismiss as temporary discomfort: heel pain, restricted shoulder movement, foot deformity or intermittent knee pain. These may indicate conditions that require professional assessment and an individualised approach to treatment. Modern trauma and orthopaedic care focuses not only on treating injuries but also on restoring people's functional abilities. AKFA Medline — a comprehensive approach to diagnosing, treating and restoring musculoskeletal health.
Bakhadirov Said Kamilovich — Endocrinologist at AKFA Medline, MD, PHD With 17 years of clinical experience. Diabetes, thyroid disorders, obesity and hormonal health. Introduction Endocrine disorders are among the major challenges facing healthcare today. They can develop gradually and remain relatively symptom-free for a long time, while affecting the cardiovascular system, metabolism, reproductive health and overall well-being. According to the International Diabetes Federation (IDF), approximately 589 million adults aged 20–79 were living with diabetes in 2024. Of these, an estimated 252 million were unaware that they had the condition. Obesity is another major public health challenge. According to the World Health Organization (WHO), 2.5 billion adults were overweight in 2022, including more than 890 million living with obesity. Hormonal disorders affecting women also deserve particular attention. WHO estimates that polycystic ovary syndrome (PCOS) affects 10–13% of women of reproductive age, and many cases remain undiagnosed. These figures highlight the importance of timely diagnosis, prevention and evidence-based treatment of endocrine conditions. How can hormonal problems be recognized? Why do some people struggle to lose weight despite following a diet? Do thyroid conditions always require medication? Can type 2 diabetes be prevented? We discussed these and other important questions with Bakhadirov Said Kamilovich, MD, an endocrinologist at AKFA Medline with 17 years of clinical experience. 13 Questions for the Endocrinologist 1. Diabetes and obesity: why is the number of patients continuing to rise? Question: According to the International Diabetes Federation, almost one in nine adults aged 20–79 is living with diabetes. Why are endocrine and metabolic conditions becoming so widespread, and which factors increase the risk of developing them? Answer: The growing prevalence of type 2 diabetes and obesity is associated with several factors, including changes in dietary patterns, insufficient physical activity, population ageing and genetic susceptibility. It is important to understand that diabetes is not simply the result of eating too much sugar. Its development involves complex mechanisms, including reduced tissue sensitivity to insulin and a gradual decline in the pancreas's ability to produce enough insulin. Some people remain at increased risk even when their body weight is relatively normal. Prevention therefore involves more than limiting sugar: it requires a comprehensive assessment of lifestyle, weight, family history and metabolic risk factors. 2. Persistent fatigue, sleepiness and reduced productivity: could these indicate a hormonal disorder? Question: Many people experience chronic fatigue, daytime sleepiness, hair loss and changes in weight for years, attributing everything to stress. Which symptoms may genuinely suggest an endocrine problem, and when should someone seek medical advice? Answer: Such symptoms can occur in several endocrine conditions, including hypothyroidism, diabetes and certain other disorders. For example, an underactive thyroid may cause fatigue, intolerance to cold, dry skin and constipation. Elevated blood glucose can sometimes cause increased thirst, frequent urination and unintended weight loss. However, these symptoms are not specific to endocrine disease. They can also occur with anaemia, sleep disorders, inadequate nutrition and many other conditions. Not every case of fatigue should be attributed to a “hormonal imbalance” or high cortisol levels. The clinician's role is to identify plausible causes and select the tests that are actually appropriate for the individual patient. 3. Thyroid nodules: how dangerous are they? Question: According to the American Thyroid Association, more than 90% of thyroid nodules are benign. Why do these nodules develop, which features require closer attention, and does finding a thyroid nodule always mean surgery is necessary? Answer: Thyroid nodules are relatively common, especially with increasing age. Most do not cause noticeable symptoms and are discovered incidentally during an ultrasound examination. When a nodule is found, it is important to assess its size, ultrasound characteristics and the functioning of the thyroid gland. In selected cases, a clinician may recommend fine-needle aspiration biopsy. The presence of a nodule alone is not an indication for surgery. Many benign nodules require monitoring rather than active treatment. At the same time, normal thyroid hormone levels do not exclude a nodule that warrants further evaluation. 4. Can thyroid disease cause weight gain? Question: Many patients believe that an underactive thyroid explains their excess weight. How much does hypothyroidism actually affect body weight, and is weight loss likely after thyroid hormone levels are normalized? Answer: Hypothyroidism can contribute to weight gain, partly through fluid retention. However, substantial obesity cannot always be explained by reduced thyroid function. When hypothyroidism is confirmed, appropriately prescribed thyroid hormone replacement can restore hormone levels and improve symptoms related to the deficiency. These medications, however, are not intended as weight-loss treatments for people with normal thyroid function. Taking thyroid hormones without medical supervision in an attempt to lose weight can lead to heart rhythm disturbances and other complications. Treatment should be prescribed only when medically indicated. 5. Diabetes can remain symptom-free for years. How can it be detected early? Question: IDF estimates suggest that more than 250 million adults worldwide are living with undiagnosed diabetes. Why can the condition remain unnoticed for so long, and which tests can identify it at an early stage? Answer: Type 2 diabetes often develops gradually. In its early stages, blood glucose levels may rise without any obvious change in how a person feels. Sometimes it is detected incidentally during a routine health assessment. Diagnostic tests include fasting plasma glucose, glycated haemoglobin (HbA1c) and, when indicated, an oral glucose tolerance test. According to American Diabetes Association criteria, an HbA1c value of 6.5% or higher may meet the diagnostic threshold for diabetes. In the absence of unequivocal hyperglycaemia, however, the diagnosis must be confirmed. HbA1c is also unsuitable for diagnosis in certain clinical situations. Screening is particularly important for people with a family history of diabetes, excess weight, high blood pressure or other risk factors. 6. Prediabetes: is it possible to prevent type 2 diabetes? Question: In the major Diabetes Prevention Program study, intensive lifestyle changes reduced the risk of developing type 2 diabetes by 58% over approximately three years. What does a diagnosis of prediabetes mean, and can blood glucose levels return to the normal range without medication? Answer: Prediabetes means that blood glucose levels are above the normal range but do not yet meet the diagnostic criteria for diabetes. It signals an increased risk of type 2 diabetes, not an inevitable progression to the condition. Changes in diet, increased physical activity and weight reduction when appropriate are central to prevention. In the Diabetes Prevention Program, participants aimed to lose approximately 7% of their initial body weight and achieve at least 150 minutes of physical activity per week. The study showed that this approach can substantially reduce diabetes risk. Medication may also be considered for prevention in selected patients. The key is to view prediabetes as an opportunity to address risk factors early, not as an unavoidable future diagnosis. 7. Insulin resistance: a real medical issue or an overused label? Question: The term “insulin resistance” is increasingly used on social media. Persistent hunger, sugar cravings, abdominal fat and difficulty losing weight are often blamed on it. What is insulin resistance, and does everyone need insulin blood tests or a HOMA-IR calculation? Answer: Insulin resistance refers to reduced responsiveness of the body's tissues to insulin. It can be associated with abdominal obesity, prediabetes, type 2 diabetes and polycystic ovary syndrome. However, it cannot be diagnosed from physical appearance or symptoms alone. A raised insulin level by itself is also not a universally accepted diagnostic criterion for a disease. Routine insulin testing and HOMA-IR assessment are not necessary for every patient. In most clinical situations, assessing body weight, waist circumference, glucose, HbA1c, blood lipids and other risk factors is more useful. 8. Why is losing weight so difficult for some people even when they follow a diet? Question: According to WHO, more than 890 million adults were living with obesity in 2022. Why do some patients struggle to lose weight despite dietary restrictions and exercise? At what point does excess weight become a medical condition that requires specialist treatment? Answer: Obesity is a chronic, multifactorial disease influenced by genetics, neurohormonal regulation of appetite, eating patterns, sleep, the environment and other factors. After weight loss, the body can adapt: hunger, satiety signals and energy expenditure may change. These adaptations can make maintaining weight loss difficult, which is why simply telling patients to “eat less” is not always sufficient. An evaluation should consider body mass index, waist circumference, associated health conditions and possible secondary causes of weight gain. Treatment may include individualized nutritional care, physical activity, behavioural support and, when appropriate, medication or bariatric surgery. 9. Weight-loss injections: a medical breakthrough or a risky trend? Question: GLP-1 receptor agonists have become one of the most widely discussed treatments in modern endocrinology. In December 2025, WHO published guidance on their use in obesity care. How effective are these medicines, who may benefit from them, and why should they not be used without medical supervision? Answer: Medicines in this class affect the mechanisms that regulate appetite and satiety. Some are also used to treat type 2 diabetes. Clinical trials show that, when appropriately selected, they can produce substantial weight loss and improvements in certain metabolic measures. However, they are not a universal solution for everyone who wants to lose weight. Before prescribing them, a clinician must assess indications, contraindications, other medical conditions, possible side effects and interactions with other treatments. Common side effects include nausea, vomiting and other gastrointestinal symptoms. More serious risks can also occur and require appropriate medical oversight. Weight-loss medicines should not be started or used without a clinician's guidance. They should form part of a comprehensive treatment plan rather than replace healthy eating and physical activity. 10. Polycystic ovary syndrome: why do so many women remain unaware of it for years? Question: According to WHO, polycystic ovary syndrome (PCOS) affects 10–13% of women of reproductive age, and up to 70% of cases may go undiagnosed. Which symptoms should prompt further assessment, and how does PCOS affect metabolic and reproductive health? Answer: PCOS is a common endocrine condition that can involve irregular menstrual periods, elevated androgen levels, acne, excessive hair growth and ovulatory dysfunction. Its presentation varies considerably between individuals. Some women only seek medical attention when they encounter difficulties conceiving. PCOS is associated not only with reproductive concerns but also with a greater risk of insulin resistance and type 2 diabetes. Diagnosis is made using a combination of clinical and laboratory findings after other explanations for the symptoms have been excluded. Ultrasound findings alone are not sufficient to diagnose PCOS. When recognized in time, management can be tailored to control symptoms, reduce metabolic risks and support reproductive health. 11. Can hormonal disorders cause infertility? Question: WHO estimates indicate that approximately one in six people worldwide experience infertility at some point in their lives. What role do endocrine conditions play, and which hormonal problems are most commonly considered when assessing women and men with infertility? Answer: The endocrine system plays an essential role in regulating reproductive function in both women and men. In women, ovulatory problems may be associated with PCOS, thyroid disorders, elevated prolactin or other endocrine conditions. In men, certain hormonal disorders can affect sperm production and sexual function. Infertility, however, is not always hormonal in origin. Anatomical, genetic and other factors can also contribute. When pregnancy does not occur as expected, a comprehensive assessment of both partners is important. Ordering an extensive hormone panel without considering the clinical situation is not appropriate. Testing should be individualized. 12. Osteoporosis: why do bones become fragile, and how can fractures be prevented? Question: Women face an increased risk of bone loss after menopause. Under the 2025 US Preventive Services Task Force (USPSTF) recommendations, osteoporosis screening is recommended for women aged 65 years and older. How do hormonal changes affect bone strength, and can osteoporosis be identified before the first fracture? Answer: Osteoporosis is characterized by reduced bone strength and an increased risk of fractures. The decline in oestrogen after menopause is particularly important because it accelerates bone loss. Age, family history, low levels of physical activity, certain endocrine disorders and long-term use of some medications can also affect bone health. Bone mineral density can be measured using dual-energy X-ray absorptiometry (DXA). Decisions about screening should be based on age and individual risk factors. Prevention includes adequate calcium and vitamin D intake, physical activity, resistance training and fall-prevention measures. The priority is to identify people at high fracture risk before serious complications occur. 13. Which hormone tests are actually useful for preventive care? Question: So-called “hormone check-ups” that include dozens of tests — cortisol, insulin, thyroid hormones, vitamin D and more — have become popular. Which tests genuinely help detect endocrine disease, and why is testing “every hormone” not always beneficial? Answer: There is no single list of hormone tests that every person needs to undergo regularly. Testing should be guided by age, symptoms, family history, medications and risk factors. For example, glucose and HbA1c tests are used to assess disorders of glucose metabolism. When thyroid dysfunction is suspected, testing typically begins with thyroid-stimulating hormone (TSH), with further tests ordered when indicated. Cortisol, prolactin, sex hormone and other measurements should be requested for specific clinical reasons. Not every healthy adult requires regular vitamin D testing. International guidance does not support indiscriminate testing in the absence of appropriate indications. Excessive testing can lead to incidental abnormal results, unnecessary follow-up investigations and inappropriate treatment. Good preventive care is about identifying genuine risks and conditions in time, not ordering the largest possible number of tests. Conclusion Endocrine conditions may develop quietly over time, gradually affecting metabolism, cardiovascular health, reproductive function and quality of life. International medical statistics confirm that diabetes, obesity, thyroid disease and other hormonal disorders deserve serious attention from clinicians and patients alike. Advances in endocrinology make it possible to identify many conditions earlier, manage them effectively and reduce the likelihood of complications. Early diagnosis, evidence-based treatment and an individualized approach remain the foundations of modern endocrine care. Persistent fatigue, unexplained weight changes, menstrual irregularities, excessive thirst and other new symptoms may warrant an assessment by a healthcare professional. People should avoid taking hormone medicines on their own, undergoing unnecessary tests or delaying consultation when concerning symptoms occur. Seeing an endocrinologist at the right time can help identify illness and preserve long-term health and quality of life. At AKFA Medline, patients can consult an endocrinologist for an assessment of endocrine health, appropriate diagnostic testing and an individualized plan for further care.
Interview with Maksud Marufovich Muradov, Head of the Cardiac Surgery Department Cardiovascular diseases remain the leading cause of death worldwide. According to the World Health Organization, in 2022 alone they were responsible for approximately 19.8 million deaths , accounting for around 32% of all deaths worldwide . But behind these figures are not only heart attacks and emergency situations. In some patients, the coronary arteries gradually become narrowed; in others, the heart valves stop functioning properly; and some people live with heart disease for years without realizing that surgical treatment may eventually become necessary. The words “heart surgery” still cause significant fear. Patients are concerned about virtually everything: Will the heart be stopped during surgery? How high is the risk? Can surgery be avoided? Which valve should be chosen? And will a person be able to return to normal life after surgery? The most important questions about modern cardiac surgery are answered by Maksud Marufovich Muradov . Вставленный текст — Maksud Marufovich, at what point in cardiac treatment does a cardiac surgeon become involved? When are medications no longer enough? — Yes, one of the most common misconceptions is that a cardiac surgeon only becomes involved when medical treatment has “failed.” In reality, surgery and medication are not competitors; they are different stages of one treatment strategy. A cardiac surgeon becomes involved in three key situations: 1. When the possibilities of medication have been exhausted. For example, in severe atherosclerosis of the coronary arteries or critical valve stenosis. Medication can lower blood pressure, heart rate, or cholesterol levels, but it cannot physically “dissolve” a dense plaque or widen a narrowed valve. 2. When there is a life-threatening risk that precedes the symptoms. Sometimes a patient feels relatively well, but based on examinations such as echocardiography, coronary angiography, or CT, we see that the anatomy of the disease is critical. In such cases, surgery is not performed simply to relieve symptoms, but to prevent a heart attack or sudden death. 3. As part of the Heart Team approach. Today, the decision is not made by one doctor alone. A cardiologist and a cardiac surgeon assess the patient together. If we understand that surgery at an early stage can give a person another 15–20 years of active life without disability, we do not wait until medications stop helping. So, surgery is not a “last chance”; it is a timely tool for restoring quality and length of life. Вставленный текст — Many patients are afraid of the very phrase “you need heart surgery.” Does a recommendation for surgery always mean that the situation is already critical? — Patients’ fear is completely understandable: in our culture, the heart is perceived as something almost untouchable. But in reality, a recommendation for surgery most often means the opposite — we are acting in time, before the situation becomes critical. In modern cardiac surgery, there are two scenarios: 1. Emergency surgery. This is when a catastrophe occurs, for example, an acute heart attack with complications or aortic dissection. In such cases, we really are saving a life immediately. 2. Elective surgery. This accounts for the vast majority of operations. Here, our goal is to act proactively. We recommend intervention precisely when the heart still has a good reserve and the body can tolerate treatment well and recover quickly. If we wait until the situation becomes “critical,” the risks of surgery increase significantly, while its potential benefit may be lower. Therefore, elective surgery is neither a sentence nor a last resort; it is a conscious step that protects against heart attack and disability and helps return a person to a full life. Вставленный текст — Could you explain in simple terms which heart diseases most often require surgical treatment today? — If we put complex terminology aside, surgical intervention is most often required for three types of conditions: Severe forms of coronary artery disease. When the coronary arteries are critically narrowed by plaques in several places and stenting is either no longer possible or is unlikely to provide a lasting result. Acquired or congenital heart valve defects. Primarily involving the aortic and mitral valves — stenosis or insufficiency that causes the heart to work under enormous strain. Aortic aneurysms and dissections. A bulging or separation of the wall of the body’s main blood vessel that requires reconstruction before critical complications occur. In most cases, modern medicine allows these problems to be treated electively, restoring normal anatomy and extending life for decades. Вставленный текст — One of the most common fears among patients is: “My heart will be stopped during the operation.” Does the heart really have to be stopped, and how does the body function during that time? — The phrase “heart stoppage” frightens everyone, but in the operating room it is not a catastrophe; it is a high-tech pause. While the surgeon carefully repairs a valve or blood vessel, a special heart-lung machine takes over the work of breathing and circulating the blood. The brain, kidneys, and all other organs continue to receive oxygen and nutrients while the heart is resting. In some cases — for example, during bypass surgery — we work on a beating heart using special stabilizers. So, stopping the heart during surgery is not about death; it is about creating ideal conditions to save the heart. Вставленный текст — How dangerous is open-heart surgery today? What does surgical risk actually depend on? — In short, today the risk of elective heart surgery is incomparably lower than the risk of living with an untreated disease. Over the past 20–30 years, cardiac surgery has made tremendous progress. Whereas mortality and severe complications were previously measured in tens of percent, today the survival rate in elective surgery exceeds 98–99% . What does the risk actually depend on? Patients often think that everything depends on how “difficult the operation is,” but surgical risk is determined by three key factors: 1. The status of the operation — elective versus emergency. This is the main factor. If a patient comes for elective surgery — when the body is compensated, tests have been checked, and there is no acute heart failure — the risk is minimal, around 1–2%. If the patient is brought by ambulance with an acute catastrophe or in a state of shock, the risk increases several times over. 2. Associated diseases and overall health status. We assess not only the heart but the entire body: kidney and lung function, the presence of diabetes, previous strokes, and the condition of the vessels in the neck and lower limbs. These underlying conditions often determine the complexity of the postoperative period. 3. Age and the body’s reserves. Age itself is no longer considered a contraindication. We successfully operate on patients in their 70s and even over 80. However, we always assess what is known as frailty — the biological reserve of the tissues and organs. For objective assessment, special scoring systems are used worldwide, such as EuroSCORE and STS Score . Dozens of patient parameters are entered, and the program calculates the mathematical percentage of risk. Modern surgery is not guesswork; it is precise calculation. Вставленный текст — A patient is offered surgery, but feels relatively well and decides to wait. How dangerous can such a decision be? — The absence of symptoms is not necessarily a sign of good health; it may simply mean that the heart’s internal reserves are compensating for the disease. The heart can “endure” and adapt for a very long time. Waiting is dangerous for three reasons: Heart cells can die silently. When symptoms finally appear, part of the heart muscle may already have turned into scar tissue that cannot be restored. Elective surgery can become emergency surgery. The risk of an elective procedure may be around 1%, while emergency surgery in the setting of a heart attack is much more dangerous. Time can be lost. The heart may become enlarged to such an extent that surgery is eventually too late. “Proactive” surgery is a way of preserving a healthy heart rather than trying to restore what has already been destroyed. Вставленный текст — Is there an age after which it is too late to perform heart surgery? For example, can patients aged 70–80 or older undergo successful surgery? — Chronological age is simply a number. We operate not on a date of birth, but on a person’s biological status ! Today, patients aged 70, 80, and 85 successfully undergo heart surgery. The development of minimally invasive and tissue-sparing technologies has made it possible to perform procedures with minimal trauma and faster recovery. If the heart and other organs retain sufficient functional reserve, we have no right to deny someone a better quality of life simply because of their age. Heart surgery at the age of 80 today is not simply a risk; it is an opportunity to give a person another 10–15 years of active, happy life with their loved ones. Вставленный текст — Regarding coronary artery disease: when is stenting sufficient, and when is coronary artery bypass grafting required? — The choice between stenting, or percutaneous coronary intervention, and coronary artery bypass grafting is based on the anatomical complexity of the disease and the international SYNTAX Score . Stenting is preferable when the patient has isolated disease affecting one or two coronary arteries, short localized plaques, and a high surgical risk for open surgery. Coronary artery bypass grafting (CABG) is indicated when there is disease involving the left main coronary artery, three-vessel disease — especially when combined with diabetes or a reduced left ventricular ejection fraction — as well as diffuse calcification. In complex cases, bypass surgery provides more complete myocardial revascularization and significantly reduces the need for repeat procedures in the future. Вставленный текст — Patients often ask: “Why can’t you just place several stents instead of performing major surgery?” How is the decision made between stenting and bypass surgery? — Imagine that you have an old water pipe that is rusty along its entire length. You can put five patches — stents — on it. But a year later, it may start leaking somewhere else. Or you can install a new parallel plastic pipe — a bypass — once and forget about the problem for 20 years. Placing four or five stents in a blocked vessel may mean that the patient has to return every few years for additional procedures because of recurrent blockages. The decision is not made by one doctor alone, but by the Heart Team . We calculate the extent of vascular disease using the SYNTAX Score . If the disease is extensive or the patient has diabetes, statistically, bypass surgery provides significantly more years of life without heart attacks than placing numerous stents. Вставленный текст — In heart valve disease, when can a patient continue observation, and when is delaying surgery already dangerous? — Management of valve disease is strictly guided by clinical and echocardiographic criteria. Dynamic observation is appropriate for moderate stenosis or insufficiency, or for severe borderline valve disease, if the patient has no clinical symptoms and the parameters of the left and right ventricles — including end-systolic dimensions and ejection fraction — as well as pulmonary artery pressure remain within normal limits. Indications for surgical treatment , including valve repair or replacement, include: The appearance of significant symptoms such as shortness of breath, angina, or syncope. An asymptomatic reduction in ejection fraction below 50% in aortic or mitral valve disease. Progressive enlargement of the heart chambers — for mitral regurgitation, a left ventricular end-systolic diameter of ≥40 mm. Newly developed atrial fibrillation or pulmonary hypertension. Timely valve reconstruction or replacement prevents the development of irreversible myocardial dysfunction. Вставленный текст — If a valve needs to be replaced, patients hear about mechanical and biological prosthetic valves. What is the difference, and how is the appropriate option chosen? — What is the difference between a mechanical and a biological valve? It is essentially a choice between two approaches: Mechanical valve — once it is implanted, the need for repeat surgery is minimized. It is made from highly durable carbon material and can last for more than 50 years. However, the patient must take lifelong blood-thinning medication — anticoagulants. Biological valve — it reduces the need for long-term anticoagulant therapy. It is made from specially treated biological tissue. However, the valve lasts an average of 12–15 years, after which it may need to be replaced. The basic formula for choosing is simple: Younger patients are more often given mechanical valves in order to avoid repeat surgery years later. Older patients (65+) are more often given biological valves because they can last longer relative to the patient’s expected lifespan, while the bleeding risk associated with blood-thinning medication becomes more important. Вставленный текст — Does modern cardiac surgery necessarily involve a large incision in the chest? Which procedures can now be performed less invasively? — A large sternotomy is no longer necessary in many cases! Modern cardiac surgery can be performed through a minimally invasive access measuring just 4–5 centimeters . Through a small incision between the ribs, under video-camera guidance, we can successfully perform: Repair and replacement of the mitral and aortic valves; Coronary artery bypass surgery ( MIDCAB ); Removal of tumors and correction of congenital heart defects in adults. The main advantage is that the breastbone remains intact. This means significantly less pain, no need for prolonged chest bracing, and the patient may be able to drive and return to normal life within 2–3 weeks. Вставленный текст — Are there situations in which a person can live for years with a serious heart problem and have almost no symptoms? — Yes! The heart is a remarkable silent worker. It will work extremely hard and adapt until the very last moment. A person may live for years without realizing that they have three dangerous conditions: Aortic aneurysm — it may cause no pain at all until it reaches a critical size. Valve disease — the heart muscle simply pumps harder to compensate for the defect, while the person may only slow down slightly when walking and assume that they are simply “getting older.” Ischemia in people with diabetes — because of reduced nerve sensitivity, a person may experience minor heart attacks without a single episode of pain. Remember: feeling well is not a guarantee of a healthy heart. Some of the most dangerous diagnoses in cardiac surgery are often discovered during routine check-ups in people who came simply “to get checked.” Вставленный текст — What symptoms should prompt a person to see a cardiologist as quickly as possible: shortness of breath, chest pain, swelling, irregular heartbeat, loss of consciousness? — Remember the “red five” — symptoms for which delaying medical attention can be life-threatening: 1. Pressure-like or burning chest pain, especially if it radiates to the arm or jaw — a risk of heart attack. If it lasts more than 15 minutes, call an ambulance. 2. Shortness of breath with minimal walking or at night — this may signal valve disease or weakness of the heart muscle. 3. Loss of consciousness — this may indicate dangerous rhythm disturbances or valve stenosis. 4. Pauses or irregularities in the pulse — a manifestation of arrhythmia that can lead to stroke. 5. Swelling of the legs toward the evening — an indication that the heart is struggling to cope with the workload. Each of these symptoms is your heart asking for help. Do not ignore it! Вставленный текст — Is it true that after heart surgery a person has to severely restrict physical activity for the rest of their life? — The main misconception is: “Heart surgery makes a person disabled.” In reality, the opposite is true! Before surgery, you lived with restrictions caused by the disease. Surgery removes those restrictions. Restrictions are usually necessary only during the first 1.5–2 months , while the tissues heal. And after that? We do not simply allow movement — we actually encourage it! Swimming, walking, cycling, sports, traveling, and active work can all become possible again. The goal of modern cardiac surgery is not simply to give a person additional years of life, but to give them those years without shortness of breath, pain, and fear. Вставленный текст — What mistakes do patients most often make after a successful operation? — A successful operation is only half the journey. The main task afterward is to avoid four classic mistakes: 1. Stopping medications because “nothing hurts anymore.” Stopping statins or blood-thinning medications without medical advice can lead to blockage of new bypass grafts and blood clots. 2. Returning to smoking. Smoking after surgery can quickly damage even the most successful bypass grafts and blood vessels. 3. Going to extremes. It is dangerous both to remain completely inactive and to start doing heavy physical work only one month after surgery. Physical activity should increase gradually. 4. Forgetting about heart ultrasound and laboratory tests. Once a year, your “renewed” heart should be assessed by a specialist. The surgeon gives the heart a new resource; your task is to protect it! Вставленный текст — Can the disease return even after a technically perfect operation if a person does not change their lifestyle and does not take the prescribed medications? — The short answer is: YES, the disease can return if the lifestyle is not changed. A cardiac surgeon corrects the anatomy, but cannot eliminate atherosclerosis itself. If, after an ideal bypass operation, a person returns to smoking, eats a fatty diet, and stops taking statins, new bypass grafts may become blocked by plaques within 2–3 years instead of lasting 20 years. Surgery is not permanent immunity against disease; it is a second chance . The surgeon gives you additional quality years of life, but how you use those years depends on you. Вставленный текст — You work with the human heart every day, literally holding it in your hands. Has your profession changed your own attitude toward life and health? — When you hold a human heart in your hands every day, you stop treating life as something eternal and guaranteed. The most important thing surgery has taught me is that life is incredibly fragile, but at the same time remarkably resilient when we take care of the body. I see blood vessels damaged by smoking and cholesterol, and I understand that our health is a daily choice. I have learned to value time and my loved ones much more, and, of course, I try to set a personal example for my patients through physical activity, nutrition, and attention to my own body. Вставленный текст — And the final question. If you could give people only one piece of advice that would help many of them never end up on an operating table, what would you say? Modern cardiac surgery is capable of solving problems that seemed extremely difficult only a few decades ago. But the outcome of treatment depends not only on the surgeon and the technology. One of the key factors is time . The earlier a heart disease is detected, properly assessed, and the optimal treatment method is chosen, the greater the opportunity to preserve the patient’s heart function and quality of life. Therefore, the main question should not only be: “Is surgery frightening?” It should also be: “What will happen to my heart if I delay the surgery that I need?”
Head of the Ophthalmology Department, Consultant Ophthalmic Surgeon of the Highest Category, MD, PhD Jamshid Furkatovich Mamatov on eye diseases that can remain symptom-free for years, warning signs that should never be ignored, and mistakes that may cost a person their vision. We tend to assume that everything is fine with our eyes as long as we can see well. There is no pain, we can read text on our phones, recognize faces — so there seems to be no urgent reason to visit an ophthalmologist. But that is precisely where one of the major problems lies. According to the World Health Organization, at least 2.2 billion people worldwide live with near or distance vision impairment . Of these, at least 1 billion cases could have been prevented or remain amenable to correction . The leading causes of vision impairment worldwide include uncorrected refractive errors, cataract, glaucoma and diabetic retinopathy. The problem is not limited to the diseases themselves. Many people postpone an eye examination until their vision has already begun to deteriorate noticeably. Can a person see well and still have a serious eye disease? Why can glaucoma remain unnoticed for years? Does using a phone really damage eyesight? Should people wait for a cataract to “mature”? And which symptoms mean that an ophthalmologist should be consulted not tomorrow, but today? We discussed these and other questions with ophthalmologist Dr. Jamshid Furkatovich Mamatov. — Dr. Mamatov, can a person have an eye disease that is gradually threatening their vision while still seeing well? Yes, and that is the main danger. Many diseases do not initially affect visual acuity — the ability to distinguish fine details in the center of vision. Peripheral vision, contrast sensitivity or retinal blood vessels may be affected first. The brain compensates for some of these changes, while the second eye may partially compensate for a defect in the first. Glaucoma — peripheral vision is affected first. Diabetic and hypertensive retinopathy — retinal vascular changes are often painless. Early cataract and age-related macular degeneration — people may gradually adapt to the changes. Epidemiological studies suggest that approximately half of people with glaucoma are unaware of their diagnosis. In areas where access to ophthalmic care is limited, the proportion may be as high as 90%. — What is glaucoma? Why can it develop for years almost unnoticed, and can vision already lost because of glaucoma be restored? Glaucoma is a chronic disease of the optic nerve in which nerve fibers gradually die and the visual field becomes progressively narrower. The main modifiable risk factor is elevated intraocular pressure (IOP). Why is it often unnoticed? There may be no pain, vision loss usually begins in the periphery, and central vision can remain relatively preserved until the later stages. The brain and the other eye can also mask the defects. By the time symptoms become noticeable, a significant portion of the visual field may already have been lost. Lost vision cannot be restored , because damaged optic nerve fibers do not regenerate. Treatment — including eye drops, laser procedures or surgery — has one main goal: to stop or slow disease progression. Clinical studies have shown that each 1 mmHg reduction in IOP is associated with approximately a 10% reduction in the risk of glaucoma progression. This is why early diagnosis is so important. Risk factors include: age over 40, glaucoma in parents or siblings, myopia, diabetes and long-term use of corticosteroid medications. Close relatives of people with glaucoma should undergo an eye examination. — If intraocular pressure is within the normal range, can a person be sure they do not have glaucoma? No. Normal-tension glaucoma exists, and it accounts for a significant proportion of open-angle glaucoma in some Asian populations, including Japan, Korea and China. In addition, IOP fluctuates throughout the day, while corneal thickness can affect measurement results. Diagnosis is based on a combination of findings, including optic nerve head examination, OCT (optical coherence tomography), visual-field testing, gonioscopy, pachymetry and follow-up over time. The opposite situation can also occur: elevated IOP without optic nerve damage, known as ocular hypertension . Such patients require monitoring but do not necessarily require treatment. — If someone wakes up and suddenly notices that vision in one eye has become worse, can they wait a few days? No. They should seek medical attention the same day, ideally within hours. Sudden loss or significant reduction of vision should be considered an emergency until proven otherwise. Retinal artery occlusion — essentially an “eye stroke.” The retina can tolerate a lack of blood flow for only a limited number of hours. The American Heart Association recommends managing such patients as stroke patients. Retinal vein occlusion, retinal detachment, vitreous hemorrhage, acute glaucoma, optic neuritis and ischemic optic neuropathy can also cause sudden visual loss. In people over 50 with headache and pain while chewing, giant cell arteritis should be considered. Without urgent corticosteroid treatment, the second eye may also be lost. Do not use eye drops on your own and do not wait for the problem to “go away.” Sudden visual loss may also signal a major vascular event, including a TIA or stroke, so cardiovascular risk should be assessed after the ophthalmic examination. — How dangerous are sudden flashes, “lightning,” numerous black spots or the sensation of a dark curtain appearing from the side? They can be very serious. These may be signs of a retinal tear or retinal detachment, and an examination is required within 24 hours. With age, and earlier in people with myopia, the vitreous body can detach from the retina and exert traction on it. This may cause flashes of light. Blood or pigment can appear as numerous dark spots, while a “curtain” may indicate that the retina is already detaching. According to clinical recommendations, retinal tears are found in approximately 10–15% of patients presenting with acute posterior vitreous detachment. A retinal tear can often be sealed with laser treatment in an outpatient setting within minutes, preventing retinal detachment. Retinal detachment requires surgery, and the earlier it is treated — particularly before the central retina is affected — the better the outcome. The risk is higher in people with high myopia, previous eye trauma or previous cataract surgery. — When are ordinary “floaters” relatively harmless, and when can they indicate serious retinal disease? Usually less concerning: floaters that have been present for a long time, remain stable, are few in number, and are not accompanied by flashes, shadows or reduced vision. Warning signs: sudden onset, a significant increase in number, a “rain” or “soot-like” appearance, flashes, shadows or a curtain, reduced vision, onset after trauma or surgery, inflammation, or the presence of diabetes. Any new floaters require a dilated fundus examination. Even if no retinal tear is found, a repeat examination after several weeks may be recommended because a retinal tear can develop later. — Do phones and computers actually damage eyesight, or is the main issue how long and at what distance we use them? The problem is primarily related to viewing time and distance, not the screen itself. Screens do not cause retinal disease or permanently “ruin” eyesight in adults. However, during prolonged near work, people blink less frequently, which can lead to digital eye strain — dryness, burning, fatigue and headaches. There is currently no convincing evidence that blue light from screens damages the retina. A 2023 Cochrane review did not find a clear benefit of blue-light-filtering glasses for reducing visual fatigue, and the American Academy of Ophthalmology does not recommend them for this purpose. Keep the monitor approximately an arm's length away. Keep the phone at least 30–40 cm from your eyes. Take a short break every 20 minutes and look into the distance. Make a conscious effort to blink more frequently. If the eyes are dry, preservative-free lubricating drops may be used. — Can frequent smartphone and tablet use increase the risk of myopia in children, and what role does outdoor time play? Yes, there is an association, and outdoor time is an important protective factor. Myopia is spreading rapidly. Projections suggest that by 2050, approximately half of the world's population may be affected by myopia. Prolonged near work, including smartphone use, has been associated with a higher risk of myopia. Daylight exposure and looking into the distance are protective. Randomized studies in schoolchildren have shown that additional outdoor time can reduce the incidence of new-onset myopia. The International Myopia Institute recommends approximately two hours outdoors per day . At the same time, children should be protected from excessive ultraviolet exposure with appropriate clothing and UV-protective sunglasses . According to WHO recommendations, screen use is not recommended for children under two years of age, while for children aged 2–4 years it should generally be limited to no more than one hour per day. When myopia is already present, its progression may be slowed using low-dose atropine, orthokeratology, specially designed spectacles and myopia-control soft contact lenses. These options should be selected by an ophthalmologist. — If a child starts squinting, sitting closer to the television or holding a phone very close to their face, how seriously should parents take these signs? Seriously. The child should undergo an eye examination within the next few weeks rather than waiting for a routine school screening. Children rarely complain because they do not know how other people see. Possible causes include myopia, hyperopia, astigmatism, strabismus and amblyopia (“lazy eye”) . Children should have their refraction assessed under cycloplegia , meaning after pupil dilation, because otherwise the measurement may be inaccurate. Amblyopia is most effectively treated before approximately 7–8 years of age; the effectiveness of treatment decreases later. — Is it true that if you start wearing glasses all the time, your eyes become “dependent” on them and your vision gets worse? No. This is a myth. Glasses do not weaken the eyes. Myopia is related to the elongation of the eyeball and progresses independently of whether a person wears glasses. The feeling that vision has become worse without glasses usually occurs because we become accustomed to seeing a sharp image. Under-correction does not slow myopia progression. In children, appropriate glasses are important for normal visual development; without them, amblyopia may develop. — Can eye exercises actually reduce myopia or eliminate the “minus” prescription? No. This is another myth. Eye exercises cannot reverse the anatomical changes responsible for myopia or eliminate the refractive error. The appropriate approach is accurate optical correction and, where necessary, evidence-based myopia-control treatment under an ophthalmologist's supervision. — Can vitamins, lutein, blueberries or various supplements genuinely improve vision? Most such claims are exaggerated. No dietary supplement restores normal vision or replaces glasses. One evidence-based formulation is AREDS2 , which can reduce the risk of progression from intermediate to advanced age-related macular degeneration by approximately 25%. It is intended for people with the appropriate diagnosis and should be recommended by a physician. Supplements have not been shown to prevent macular degeneration or cataract in healthy individuals. There is no convincing evidence that blueberries improve vision. Omega-3 fatty acids did not demonstrate benefit for dry eye in the large DREAM trial. Lifestyle measures that genuinely matter include not smoking, controlling blood pressure and blood glucose, protecting the eyes from UV radiation, and maintaining a diet rich in vegetables — particularly green leafy vegetables — and fish. — How safe is it to buy over-the-counter “redness relief” eye drops and use them regularly without consulting an ophthalmologist? It is not considered safe. Many such drops contain vasoconstrictors. They provide temporary relief but may cause rebound redness and dependence with regular use. In susceptible individuals, they may also trigger an acute angle-closure glaucoma attack. The main problem is that these drops can mask the underlying cause of redness, such as allergy, dry eye, inflammation, keratitis or glaucoma. A red eye accompanied by pain, photophobia or reduced vision requires an examination rather than self-medication. Self-use of steroid eye drops such as dexamethasone is particularly dangerous because they can cause glaucoma and cataract and may worsen herpetic keratitis. — If someone constantly experiences dryness, burning and a gritty sensation, are artificial tears enough? They may be sufficient for mild cases, but persistent symptoms require evaluation of the underlying cause. Dry eye disease is multifactorial. Possible underlying causes include meibomian gland dysfunction, blepharitis, allergy, Sjögren syndrome and other systemic diseases, medication side effects, contact-lens-related problems and incomplete eyelid closure. Treatment may include preservative-free lubricating drops, eyelid hygiene, warm compresses and modification of environmental factors such as air conditioning, dry air, dust and prolonged screen exposure. If symptoms persist for more than two weeks, or if there is pain, photophobia or reduced vision, medical evaluation is recommended. — How dangerous is it to occasionally sleep in contact lenses or wear them longer than recommended? It is dangerous, and even occasional overnight wear carries a risk. Sleeping in contact lenses increases the risk of microbial keratitis, including corneal ulcers. Reduced oxygen availability and easier bacterial penetration can result in serious infection. A corneal ulcer may lead to corneal scarring, permanent vision loss and, in severe cases, the need for corneal transplantation. Replace lenses according to the recommended schedule. Replace the lens case every three months. Daily disposable lenses are among the safest options. Never wash or store contact lenses in water. Do not swim or shower while wearing them. If redness, pain or photophobia develops, remove the lenses and seek medical attention the same day. — Should people still wait for a cataract to “mature,” or is that approach outdated? That approach is outdated. In the past, cataract surgery was more traumatic, so doctors often waited until the cataract became “mature.” Modern phacoemulsification with intraocular lens implantation is a minimally invasive procedure that usually takes approximately 15–20 minutes under local anesthesia. According to modern ophthalmic recommendations, the indication for surgery is vision loss that interferes with daily life — working, reading, driving or moving around safely. There is no need to wait for the cataract to become “mature.” Surgery may also be performed earlier for medical reasons, such as the risk of angle-closure glaucoma or the need to examine and treat the retina in patients with diabetes. — Can delaying cataract surgery for too long make subsequent treatment more difficult? Yes. A hypermature cataract becomes denser and more difficult to remove, while the risk of complications and corneal damage increases. In addition: secondary glaucoma and inflammation may develop because of a swollen or degenerating lens; the opaque lens can make examination and treatment of the retina more difficult, particularly in patients with diabetes; poor vision increases the risk of falls and fractures in older adults. Unfortunately, some patients present with very advanced, dense cataracts, making both surgery and recovery more difficult. — Is laser vision correction suitable for almost everyone nowadays? No. It is not suitable for everyone. The decision should be made after a comprehensive eye examination, including corneal topography and tomography. Important contraindications and limitations include: age below 18, and usually below 21, or unstable refraction during the previous year; thin cornea , keratoconus or suspected keratoconus; severe dry eye disease; ocular inflammation; glaucoma; significant cataract; uncontrolled systemic diseases such as diabetes or autoimmune disorders; pregnancy and breastfeeding; very high degrees of myopia, where other options, such as phakic intraocular lenses, may be considered. Laser vision correction does not eliminate age-related presbyopia. After approximately 40–45 years of age, reading glasses may still be needed. — Can an ophthalmologist identify signs of diabetes, hypertension or other systemic diseases during a routine eye examination? Yes. The retina is one of the few places in the body where blood vessels and neural tissue can be directly observed without an incision. A fundus examination can sometimes be the first step toward identifying an underlying systemic disease. Diabetes: microaneurysms, retinal hemorrhages and exudates. Hypertension: narrowing of retinal arterioles, hemorrhages and, in severe cases, optic disc swelling. Other conditions: emboli associated with carotid artery stenosis, increased intracranial pressure, autoimmune and infectious uveitis, optic neuritis associated with multiple sclerosis, thyroid disorders and lipid metabolism abnormalities. — Which eye symptoms do you consider genuine “red flags” that should never wait for a routine appointment? In short: any sudden change in vision, eye pain or eye trauma should be treated as urgent. Same-day emergency assessment: sudden loss or marked reduction of vision in one or both eyes; flashes, a sudden shower of floaters, a shadow or curtain in the visual field; severe eye pain with redness, nausea, headache and halos around lights — possible acute glaucoma; chemical injury — immediately rinse the eye with water for 15–20 minutes and then seek medical care; eye trauma or penetrating injury; a painful, red, light-sensitive eye, particularly in a contact lens wearer; sudden double vision, drooping eyelid or unequal pupils; a white pupil or sudden strabismus in a child. Assessment within 1–3 days: distortion of straight lines or a central spot in the visual field; reduced distance or near vision; difficulty driving at night; persistent dryness, burning or watering for more than two weeks; gradually increasing “haze” or cloudiness; frequent squinting, headaches while reading, or bringing objects close to the face in children; any new eye symptoms in a person with diabetes. — Do you often encounter situations in which vision could have been preserved if the patient had sought medical attention earlier? Unfortunately, yes. This is one of the most common causes of irreversible vision loss. Typical examples include: glaucoma diagnosed only at the “tunnel vision” stage; retinal detachment in patients who waited for the “curtain” to disappear; proliferative diabetic retinopathy in people who had never undergone a fundus examination; wet age-related macular degeneration diagnosed late; corneal ulcers in contact lens wearers or patients who self-medicated; amblyopia diagnosed after the age of 8–9. According to the WHO World Report on Vision (2019), at least 1 billion people worldwide have vision impairment that could have been prevented or has yet to be appropriately addressed. — If someone sees well, has no pain and has never visited an ophthalmologist, why should they undergo preventive eye examinations? To detect disease while there is still an opportunity to preserve vision. Many sight-threatening conditions, including glaucoma, diabetic retinopathy and macular degeneration, can be asymptomatic in their early stages. A routine eye examination usually takes 20–30 minutes and may include visual acuity testing, IOP measurement, fundus examination and, when indicated, OCT. An approximate screening schedule: healthy adults — a baseline examination at age 40; every 2–4 years until age 54, every 1–3 years between 55 and 64, and every 1–2 years after 65; earlier and more frequently for people with diabetes, hypertension, a family history of glaucoma, high myopia, contact-lens use, long-term corticosteroid use, autoimmune disease or previous eye trauma; children — at ages 3–5, before starting school, and every 1–2 years thereafter; children with myopia should generally be examined every six months. DON'T WAIT UNTIL YOUR VISION GETS WORSE One of the most important principles in ophthalmology may sound paradoxical: good vision today does not always mean that your eyes are completely healthy. Some diseases develop gradually, and people simply adapt to the changes. Others may remain painless and cause little or no noticeable discomfort for a long time. In certain conditions, however, how quickly a person seeks medical attention directly affects whether their vision can be preserved. That is why preventive eye examinations are important — not only when vision has already deteriorated, but to identify problems before they begin to threaten sight. We often take our vision for granted — until we begin to lose it.
Neurology Without Myths: 15 Important Questions for a Neurologist Headaches, migraine, dizziness, numbness in the limbs, neck and back pain, and sleep disturbances are symptoms experienced by millions of people. Yet many continue to tolerate their discomfort, take painkillers on their own, or postpone seeing a doctor. According to the World Health Organization, in 2021, diseases and conditions affecting the nervous system affected approximately 3.4 billion people — around 43% of the global population. Neurological conditions are also among the leading causes of ill health and disability worldwide. Which symptoms should never be ignored? How is migraine different from an ordinary headache? Is a herniated disc always responsible for back pain? When is an MRI really necessary? These common questions are answered by Nigora Saidganievna Kadyrkhodjaeva, an AKFA Medline neurologist with 19 years of clinical experience, MD, PhD . Her professional interests include neurology, neuropsychology, transcranial magnetic stimulation (TMS), and the use of botulinum toxin therapy in neurology, including the treatment of primary chronic headaches. 1. What are the most common reasons patients consult a neurologist? The most common complaints include headaches, dizziness, neck and back pain, numbness or tingling in the arms and legs, muscle weakness, sleep disturbances, and memory problems. Patients may also seek neurological care for tremor, impaired coordination, tinnitus, changes in sensation, various pain syndromes, consequences of stroke, and conditions affecting the peripheral nervous system. It is important to understand that the same symptom can have very different causes. For example, dizziness may be associated with the vestibular system or may occur as a manifestation of other medical conditions. A neurologist’s task is therefore not simply to relieve the symptom but to identify its underlying cause. 2. Which neurological symptoms do people most often underestimate or ignore? Particular attention should be paid to sudden numbness or weakness in an arm or leg, especially on one side of the body, speech disturbances, facial asymmetry, sudden visual impairment, an unusually severe headache, and sudden loss of coordination. People also frequently ignore recurring headaches, intermittent numbness in the fingers, balance problems, back pain radiating into an arm or leg, memory problems, and sleep disturbances. If a symptom keeps returning, becomes progressively worse, or begins to interfere with daily life, it should not simply be tolerated. A medical assessment is necessary. 3. When does an ordinary headache become a reason to see a neurologist? If headaches occur regularly, become more severe, or change from their usual pattern, the cause should be investigated. It is particularly important to seek medical advice if: • the headache is new and unusually severe; • attacks are becoming more frequent; • the pain is accompanied by vomiting, visual or speech disturbances, sensory changes, or weakness; • the headache follows a head injury; • painkillers are required too frequently; • headaches interfere with work, sleep, or everyday activities. A sudden, extremely severe headache that reaches maximum intensity within seconds or minutes is an important warning sign and requires urgent medical evaluation. 4. What is migraine, and how is it different from an ordinary headache? Migraine is a neurological disorder in its own right, not simply a “very bad headache.” A typical migraine attack can last from several hours to several days. The pain is often throbbing, may be more pronounced on one side of the head, and can worsen during ordinary physical activity. Migraine headaches are often accompanied by nausea and increased sensitivity to light, sound, and smells. However, not every patient has the classic presentation. Diagnosis is therefore based primarily on the characteristic symptoms and the patient’s medical history. 5. What symptoms are typical of migraine, and what commonly triggers an attack? In addition to headache, patients may experience: • nausea; • increased sensitivity to light and sound; • irritability; • difficulty concentrating; • significant fatigue; • worsening symptoms with physical activity. Migraine triggers vary from person to person. Common triggers include too little or too much sleep, emotional stress, skipping meals, dehydration, certain hormonal changes, and sudden changes in daily routine. Keeping a headache diary can be very useful. Patients can record when an attack occurred, how long it lasted, possible triggers, associated symptoms, and medications taken. This helps the physician identify patterns and choose the most appropriate treatment strategy. 6. What is migraine with aura, and how does it present? Aura consists of temporary, reversible neurological symptoms that most commonly occur before the headache, although they may sometimes occur without a subsequent headache. Visual aura is the most common type. A person may see flashing spots, zigzag lines, flashes of light, or temporary blind spots in the visual field. Sensory symptoms are also possible, such as tingling or numbness that gradually spreads along the arm or face. Temporary speech disturbances occur less commonly. If these symptoms occur for the first time, particularly if they develop suddenly, they should not automatically be assumed to be migraine. Some manifestations can resemble a transient ischemic attack or stroke, so medical evaluation is important. 7. Can migraine be treated, and what modern treatments are available today? Migraine can be effectively managed with modern treatment. The main goals are to reduce the frequency, duration, and intensity of attacks and to improve the patient’s quality of life. Treatment generally has two components. The first is acute treatment, aimed at stopping or reducing an attack once it begins. Depending on the situation, a physician may prescribe migraine-specific medications or other appropriate treatments. The second is preventive therapy. This may be considered when attacks are frequent, prolonged, or significantly affect the patient’s daily life. Botulinum toxin therapy may be used in selected patients with chronic migraine. Modern neurology also offers newer preventive therapies that target biological pathways involved in migraine development. The choice of treatment depends on the frequency of attacks, associated medical conditions, previous treatment, and the patient’s individual characteristics. 8. Is a brain MRI necessary for frequent headaches or migraine? Not every person with headaches needs an MRI. If the clinical picture is typical of a primary headache disorder such as migraine, and the neurological examination does not reveal any warning signs, additional imaging may not be necessary. MRI is usually recommended when the physician needs to rule out a secondary cause of headache — for example, when the pattern of pain has changed, neurological symptoms have appeared, the clinical picture is unusual, or other concerning signs are present. The appropriate sequence is therefore to have a clinical consultation and neurological examination first, followed by diagnostic testing when indicated. 9. What causes dizziness, and when can it be a warning sign? Patients may use the word “dizziness” to describe very different sensations: a spinning feeling, instability, loss of balance, near-fainting, or a sensation of “brain fog.” The causes are equally varied. One common cause is benign paroxysmal positional vertigo, in which symptoms are triggered by changes in head position. Other causes may involve the inner ear, nervous system, cardiovascular system, or other medical conditions. If dizziness begins suddenly and is accompanied by speech disturbance, weakness or numbness in the limbs, double vision, severe loss of coordination, or a new intense headache, urgent medical attention is required. 10. What can numbness, tingling, or a “pins and needles” sensation in the arms and legs indicate? These sensations can have many different causes, ranging from temporary compression of a nerve to disorders affecting the spine, peripheral nerves, or central nervous system. For example, numbness in the hand may result from compression of a particular nerve, while symmetrical numbness in the feet may occur in peripheral neuropathy. The physician assesses exactly where the numbness occurs, how severe it is, and whether it is associated with pain, muscle weakness, or changes in reflexes. Medical evaluation should not be delayed if sensory changes are progressive or accompanied by muscle weakness. 11. What early signs of stroke should everyone know? The most important feature of stroke symptoms is that they usually appear suddenly. Face: Ask the person to smile. One side of the face may droop. Arm: Ask the person to raise both arms. One arm may drift downward or may not be raised at all. Speech: Ask the person to repeat a simple sentence. Their speech may become slurred, or they may be unable to speak correctly. Other symptoms can include sudden visual impairment, severe dizziness, loss of coordination, or numbness or weakness on one side of the body. If stroke is suspected, do not wait to see whether the symptoms disappear. Emergency medical assistance should be called immediately. The sooner the patient reaches a specialized medical facility, the greater the opportunity for effective treatment. 12. Why are neck and back pain now common even among younger people? Is a herniated disc seen on MRI always the cause of pain? No. Finding a disc protrusion or herniation on MRI does not necessarily mean that it is responsible for the patient’s pain. Changes in the intervertebral discs can also be found in people who have no pain at all. For this reason, a physician always interprets MRI findings together with the patient’s symptoms and the results of the neurological examination. Pain may arise from muscles, spinal joints, ligaments, irritation of neural structures, or other factors. Among younger people, a sedentary lifestyle, prolonged computer use, insufficient physical activity, inappropriate loading of the spine, and stress can all contribute to neck and back pain. The goal is to treat the patient and the actual cause of the symptoms — not simply an MRI image. 13. Can chronic stress, anxiety, and lack of sleep cause or worsen neurological symptoms? Yes. Sleep, emotional wellbeing, and the nervous system are closely interconnected. Chronic stress and sleep deprivation can worsen headaches, migraine, muscle tension, dizziness, difficulty concentrating, and fatigue. Some patients develop a vicious cycle: stress disrupts sleep, poor sleep increases the sensitivity of the nervous system, symptoms become more intense, and this in turn increases anxiety. However, it is incorrect to attribute every symptom solely to stress without proper evaluation. Other possible medical causes should first be excluded. 14. What mistakes do patients most commonly make when self-treating headaches, migraine, or other neurological symptoms? One of the most common mistakes is the uncontrolled and excessively frequent use of painkillers. When certain medications are used too often, headaches themselves can become more frequent, leading to what is known as medication-overuse headache. Another mistake is treating MRI findings instead of considering the patient’s actual clinical condition. Patients may also take medications “for circulation,” vitamins, sedatives, or other treatments without first establishing the actual cause of their symptoms. In neurology, an accurate diagnosis should come first. Treatment should then be selected according to that diagnosis. 15. What do you recommend for preventing neurological diseases and maintaining a healthy nervous system? There is no single universal pill that can protect the nervous system from every neurological disease. Everyday habits have the greatest long-term importance. It is important to: • remain physically active; • monitor blood pressure; • monitor blood glucose and cholesterol levels; • avoid smoking; • maintain a regular sleep schedule; • follow a balanced diet; • avoid chronic sleep deprivation; • avoid unnecessary or uncontrolled medication use; • pay attention to psychological and emotional wellbeing. Timely medical consultation is also extremely important. People should not wait until a symptom becomes unbearable. Recurrent headaches, sensory changes, severe dizziness, muscle weakness, and other neurological symptoms should be professionally assessed. The key message: do not simply get used to symptoms Headache, dizziness, or numbness does not always indicate a serious disease. However, it is not always possible to determine the cause without proper medical evaluation. In modern neurology, a diagnosis is not based on a single symptom or on an MRI result alone. The physician evaluates the patient’s complaints, medical history, and neurological status before deciding which additional investigations are actually necessary. If sudden weakness on one side of the body, facial asymmetry, speech or visual disturbance, or loss of coordination occurs, medical care should be sought immediately. Timely diagnosis not only allows the correct condition to be treated but also helps prevent unnecessary investigations and inappropriate self-treatment.
Arterial Hypertension: Why High Blood Pressure Should Not Be Ignored Arterial hypertension is one of the most common cardiovascular conditions. Its main danger is that elevated blood pressure can remain virtually symptom-free for years while gradually damaging the heart, blood vessels, kidneys, and other organs. According to the World Health Organization, in 2024 approximately 1.4 billion adults aged 30–79 years were living with hypertension . At the same time, around 44% of people with hypertension were unaware that they had the condition . This is why monitoring blood pressure is important even when you feel perfectly well. What is arterial hypertension? Blood pressure reflects the force exerted by circulating blood against the walls of the arteries. According to the 2024 European Society of Cardiology (ESC) Guidelines , arterial hypertension is defined as persistent office blood pressure of 140/90 mmHg or higher . However, the diagnosis is usually not based on a single measurement. A physician may recommend repeated measurements, home blood pressure monitoring, or 24-hour ambulatory blood pressure monitoring. The 2024 ESC Guidelines also define a category of elevated blood pressure as office systolic blood pressure of 120–139 mmHg and/or diastolic blood pressure of 70–89 mmHg . These values do not yet meet the criteria for hypertension but warrant assessment of the patient’s overall cardiovascular risk. Blood pressure readings should always be interpreted individually, taking into account age, coexisting conditions, risk factors, and overall cardiovascular risk. Why does hypertension develop? In most cases, there is no single identifiable cause. Several factors may contribute to elevated blood pressure at the same time: • genetic predisposition; • excess body weight; • low levels of physical activity; • excessive salt intake; • smoking; • excessive alcohol consumption; • chronic stress; • insufficient sleep; • diabetes mellitus; • kidney disease; • metabolic disorders; • age-related changes in the blood vessels. The more risk factors a person has, the more important it becomes to monitor blood pressure regularly and assess cardiovascular health. What symptoms can occur with high blood pressure? One of the main characteristics of hypertension is that it often causes no obvious symptoms . A person may feel completely well while having persistently elevated blood pressure. When blood pressure rises significantly or complications develop, symptoms may include: • headache; • dizziness; • weakness; • shortness of breath; • rapid or irregular heartbeat; • chest pain or discomfort; • visual disturbances; • reduced exercise tolerance. However, these symptoms are not specific to hypertension. You should not rely solely on how you feel. The most reliable way to know your blood pressure is to measure it . Why is high blood pressure dangerous for the heart? When blood pressure remains persistently elevated, the heart has to work against greater resistance. Over time, this can lead to structural changes in the heart muscle and blood vessels and increase the risk of cardiovascular complications. Uncontrolled hypertension increases the risk of: • myocardial infarction; • stroke; • heart failure; • certain cardiac arrhythmias; • chronic kidney disease; • damage to the blood vessels of the eyes. For this reason, timely diagnosis and regular blood pressure monitoring are extremely important. How should blood pressure be measured correctly at home? Proper measurement technique helps obtain more reliable results. Before measuring your blood pressure, sit quietly for approximately 5 minutes . Your back should be supported, your feet should be flat on the floor and uncrossed, and the arm with the cuff should be positioned approximately at heart level. For home monitoring, a validated automatic blood pressure monitor with an appropriately sized cuff should be used. It is generally recommended to take two measurements, 1–2 minutes apart, in the morning and evening . For an initial assessment of home blood pressure, measurements should preferably be taken over several days, ideally for approximately 7 days , with the results recorded. A blood pressure diary helps the physician assess blood pressure levels and evaluate the effectiveness of treatment. In some cases, a cardiologist may recommend 24-hour ambulatory blood pressure monitoring (ABPM). How is arterial hypertension diagnosed? The assessment of a patient with elevated blood pressure begins with confirmation of the blood pressure level, evaluation of overall cardiovascular risk, and assessment for possible target-organ damage. Depending on the patient’s condition, the physician may recommend: • repeated blood pressure measurements; • home blood pressure monitoring or 24-hour ABPM; • electrocardiography (ECG); • echocardiography; • blood and urine tests; • measurement of blood glucose and lipid levels; • assessment of kidney function; • assessment of albuminuria; • additional investigations when clinically indicated. The purpose of the evaluation is not only to confirm the presence of hypertension but also to determine overall cardiovascular risk, identify possible causes of elevated blood pressure, and assess the condition of target organs. Can hypertension be controlled? Yes. In most cases, blood pressure can be effectively controlled. A physician may recommend lifestyle changes and, when necessary, antihypertensive medication. The following measures are particularly important: • reducing excess body weight; • engaging in regular physical activity; • limiting salt intake; • maintaining a balanced diet; • stopping smoking; • limiting alcohol consumption or avoiding it altogether; • getting adequate, high-quality sleep; • monitoring blood cholesterol and glucose levels; • measuring blood pressure regularly. If a patient has already been prescribed blood pressure-lowering medication, they should not stop taking it on their own once their blood pressure returns to normal . Normal blood pressure while receiving treatment often means that the therapy is working. Any changes to the medication or its dosage should only be made after consultation with the treating physician. When should you see a cardiologist? A medical consultation is recommended if: • blood pressure is repeatedly elevated; • blood pressure readings have become higher than usual; • palpitations or irregular heartbeats occur; • shortness of breath develops; • chest pain or discomfort occurs; • physical activity becomes more difficult to tolerate; • hypertension has already been diagnosed but blood pressure remains unstable; • previously prescribed treatment no longer controls blood pressure adequately. There is no need to wait for pronounced symptoms to develop. The earlier cardiovascular risk factors and target-organ damage are identified, the sooner appropriate measures can be taken to control them. When is urgent medical attention required? If blood pressure is very high, particularly ≥180/120 mmHg , it should be measured again after several minutes of rest. If the blood pressure remains this high, medical attention should be sought. If very high blood pressure is accompanied by: • severe chest pain or significant chest discomfort; • severe shortness of breath; • sudden weakness or numbness of the face, arm, or leg; • speech disturbance; • sudden deterioration of vision; • loss of consciousness; • any other sudden and severe symptoms, emergency medical assistance should be called immediately. Do not wait until high blood pressure starts causing symptoms Arterial hypertension can remain asymptomatic for a long time. Regular blood pressure monitoring is therefore one of the simplest ways to detect the problem early and reduce the risk of cardiovascular complications. If you notice repeated elevations in your blood pressure or would like to assess your cardiovascular health, consult a cardiologist at AKFA Medline University Hospital. For an initial assessment of home blood pressure, measurements should preferably be taken over several days, ideally for approximately 7 days , with the results recorded. A blood pressure diary helps the physician assess blood pressure levels and evaluate the effectiveness of treatment. In some cases, a cardiologist may recommend 24-hour ambulatory blood pressure monitoring (ABPM). How is arterial hypertension diagnosed? The assessment of a patient with elevated blood pressure begins with confirmation of the blood pressure level, evaluation of overall cardiovascular risk, and assessment for possible target-organ damage. Depending on the patient’s condition, the physician may recommend: • repeated blood pressure measurements; • home blood pressure monitoring or 24-hour ABPM; • electrocardiography (ECG); • echocardiography; • blood and urine tests; • measurement of blood glucose and lipid levels; • assessment of kidney function; • assessment of albuminuria; • additional investigations when clinically indicated. The purpose of the evaluation is not only to confirm the presence of hypertension but also to determine overall cardiovascular risk, identify possible causes of elevated blood pressure, and assess the condition of target organs. Can hypertension be controlled? Yes. In most cases, blood pressure can be effectively controlled. A physician may recommend lifestyle changes and, when necessary, antihypertensive medication. The following measures are particularly important: • reducing excess body weight; • engaging in regular physical activity; • limiting salt intake; • maintaining a balanced diet; • stopping smoking; • limiting alcohol consumption or avoiding it altogether; • getting adequate, high-quality sleep; • monitoring blood cholesterol and glucose levels; • measuring blood pressure regularly. If a patient has already been prescribed blood pressure-lowering medication, they should not stop taking it on their own once their blood pressure returns to normal Normal blood pressure while receiving treatment often means that the therapy is working. Any changes to the medication or its dosage should only be made after consultation with the treating physician. When should you see a cardiologist? A medical consultation is recommended if: • blood pressure is repeatedly elevated; • blood pressure readings have become higher than usual; • palpitations or irregular heartbeats occur; • shortness of breath develops; • chest pain or discomfort occurs; • physical activity becomes more difficult to tolerate; • hypertension has already been diagnosed but blood pressure remains unstable; • previously prescribed treatment no longer controls blood pressure adequately. There is no need to wait for pronounced symptoms to develop. The earlier cardiovascular risk factors and target-organ damage are identified, the sooner appropriate measures can be taken to control them. When is urgent medical attention required? If blood pressure is very high, particularly ≥180/120 mmHg , it should be measured again after several minutes of rest. If the blood pressure remains this high, medical attention should be sought. If very high blood pressure is accompanied by: • severe chest pain or significant chest discomfort; • severe shortness of breath; • sudden weakness or numbness of the face, arm, or leg; • speech disturbance; • sudden deterioration of vision; • loss of consciousness; • any other sudden and severe symptoms, emergency medical assistance should be called immediately. Do not wait until high blood pressure starts causing symptoms Arterial hypertension can remain asymptomatic for a long time. Regular blood pressure monitoring is therefore one of the simplest ways to detect the problem early and reduce the risk of cardiovascular complications. If you notice repeated elevations in your blood pressure or would like to assess your cardiovascular health, consult a cardiologist at AKFA Medline University Hospital .
Dr. Dilmurod Samikhovich Yunusov, a urologist and uro-oncologist with over 25 years of experience, discusses the risk factors, early signs, and modern treatment methods for urological cancers. Onco-urological diseases represent a significant public health concern worldwide. According to data from the International Agency for Research on Cancer (IARC), more than 2.5 million new cases of prostate, bladder, and kidney cancer were recorded globally in 2022 alone. These figures highlight the importance of timely diagnosis and early cancer detection, when a wider range of treatment options may be available. In this article, Dr. Dilmurod Samikhovich Yunusov, a urologist and uro-oncologist, discusses the characteristics of onco-urological diseases, their risk factors, symptoms, diagnostic methods, and treatment approaches. 1. What Is Uro-Oncology? What is uro-oncology, and which diseases fall within this field? Oncology is the branch of medicine that studies tumors, their causes, and the methods used for their detection, treatment, and prevention. In simple terms, every living organism consists of cells that continuously divide, regenerate, grow, and adapt to their environment. An oncologist specializes in studying and managing diseases that arise when these normal cellular processes become disrupted. Cells may undergo structural or functional changes due to genetic or epigenetic factors. When only one or a few abnormal cells are present, these changes are generally undetectable. The immune system can recognize and eliminate many abnormal cells before they develop into clinically significant abnormalities. However, when abnormal cells accumulate and proliferate uncontrollably, they may form a tumor. Tumors are classified as benign or malignant. Malignant tumors are cancerous growths. Each type has distinct characteristics and requires an individualized diagnostic and treatment approach. Uro-oncology specifically focuses on tumors affecting the urinary system and male reproductive organs, including cancers of the kidneys, urinary bladder, prostate, and other organs of the genitourinary system. Which onco-urological diseases do you encounter most frequently in your clinical practice? According to global statistics, men are particularly affected by several types of urological cancer. Prostate cancer is among the most frequently diagnosed cancers in men worldwide. Bladder and kidney cancers are also significant oncological diseases affecting the genitourinary system. In our clinical practice, the distribution of these diseases largely reflects global epidemiological patterns. However, as mentioned earlier, the entire human body is composed of cells that undergo numerous cycles of division and renewal throughout life. Consequently, tumors can develop in virtually any organ or tissue. The European Association of Urology (EAU) provides clinical guidelines covering the prevention, diagnosis, treatment, and follow-up care of urological diseases, including urological cancers. These guidelines are regularly reviewed and updated to reflect the latest scientific evidence and advances in clinical practice. As specialists, we strive to remain informed about these developments and incorporate current evidence-based recommendations into patient care. Which age groups are most susceptible to developing onco-urological diseases? Imagine a typical working day. At the beginning of the day, you feel refreshed and well-rested, allowing you to perform your tasks accurately and efficiently. However, as the day progresses, fatigue may affect your performance and increase the likelihood of errors. A somewhat similar process occurs in the human body as it ages. Most cancers are diagnosed more frequently in older adults. Over time, cells undergo repeated cycles of division, and genetic alterations may accumulate, increasing the likelihood of malignant transformation. Tumors occurring in childhood are often associated with genetic factors, whereas cancers developing later in life may result from a combination of accumulated genetic changes, environmental exposures, and other risk factors, including exposure to carcinogens. Therefore, onco-urological diseases can occur in individuals of different age groups. It would be inappropriate to exclude any patient from further assessment solely on the basis of age. Nevertheless, epidemiological data allow us to identify populations at higher or lower risk. For example, in the case of prostate cancer, discussions about prostate-specific antigen (PSA) testing are commonly recommended from approximately 50 years of age for men without additional risk factors. For individuals with an increased risk of prostate cancer, including those with a significant family history, such discussions may begin earlier, around the ages of 40–45. The appropriate age for initiating PSA testing and the frequency of subsequent examinations should be determined individually, taking into account the patient’s risk factors, overall health, and current clinical guidelines. To better understand the relevant risk factors and appropriate preventive measures, I recommend consulting a specialist, as this is a complex topic that requires an individualized approach. Why is it important to detect onco-urological diseases at an early stage? Recently, we have often heard people say, “Cancer has become much more common. We did not see so many cases in the past.” However, as medical professionals, we recognize that improvements in scientific knowledge, medical technology, and diagnostic capabilities have enabled us to identify many oncological diseases at earlier stages. Advances in diagnostic techniques have also improved our understanding of cancer and contributed to the development of more effective treatment strategies. Today, several treatment options are available for many types of cancer, depending on the disease, its stage, and the patient’s individual characteristics. Early diagnosis is particularly important because detecting cancer before it has progressed may provide more treatment options and improve the likelihood of a favorable outcome. Conversely, when cancer is diagnosed at an advanced stage, the range of available treatment options may become more limited, making disease management more challenging. 2. Main Causes and Risk Factors What factors increase the risk of developing kidney, bladder, and prostate tumors? Risk factors can generally be divided into two categories: modifiable and non-modifiable. Modifiable risk factors include lifestyle-related factors such as diet, physical activity, and harmful habits. Non-modifiable risk factors are those beyond our control, such as age, genetic predisposition, and certain inherited characteristics. Smoking is one of the most significant preventable risk factors for cancer, including several types of urological cancer. Other modifiable risk factors include obesity, occupational or environmental exposure to harmful substances, such as certain industrial chemicals and cadmium, and excessive alcohol consumption. Non-modifiable or underlying risk factors include hereditary predisposition and certain pre-existing medical conditions. Chronic kidney disease may also be associated with an increased risk of kidney cancer. It is important to understand that the significance of individual risk factors varies depending on the specific type of cancer. 3. Symptoms That Require Medical Attention What are the early symptoms that may indicate the presence of an onco-urological disease? One of the main challenges in uro-oncology is that symptoms may not appear until the disease has reached a relatively advanced stage. Many onco-urological diseases develop without noticeable symptoms, particularly in their early stages. For this reason, patients frequently consult us after an abnormality has been discovered incidentally during an examination for another medical condition or during a preventive health assessment. Nevertheless, one of the most important warning signs in urological practice is hematuria, which refers to the presence of blood in the urine. Hematuria can be classified into two types: • Gross hematuria: visible blood in the urine, which may cause the urine to appear pink, red, or brown. • Microscopic hematuria: blood that is not visible to the naked eye but is detected during laboratory urine testing. In patients with prostate conditions, lower urinary tract symptoms may also occur. These include changes in urinary flow, urgency (a sudden and difficult-to-control need to urinate), a sensation of incomplete bladder emptying, and nocturia (the need to wake up repeatedly at night to urinate). It is important to emphasize that these symptoms are not specific to cancer. They may also occur in a range of benign urological conditions. However, patients experiencing such symptoms should undergo an appropriate medical evaluation to identify the underlying cause and, where clinically indicated, rule out malignancy. If you notice any of these symptoms, do not delay seeking medical advice from a qualified specialist. What diseases may be associated with the presence of blood in the urine? Blood in the urine may be associated with tumors affecting the urethra, urinary bladder, ureters, or kidneys. An experienced urologist may use the appearance of the urine and the characteristics of the bleeding as part of the initial clinical assessment. However, these findings alone cannot reliably establish the source of bleeding. Hematuria can also have non-oncological causes, including urinary tract infections, urinary stones, injuries affecting the urinary tract, and side effects of certain medications. Therefore, the presence of blood in the urine requires appropriate medical evaluation to determine its cause. 4. Diagnosis of Onco-Urological Diseases What is the first step in evaluating a patient with suspected urological cancer? The diagnostic approach depends on the type of cancer suspected. In patients with suspected prostate cancer, the initial assessment may include measurement of prostate-specific antigen (PSA) levels, a digital rectal examination (DRE), and multiparametric magnetic resonance imaging (MRI) of the prostate. When bladder cancer is suspected, cystoscopy is performed to examine the inside of the urinary bladder using a specialized optical instrument. If a suspicious lesion is identified, tissue may be obtained for histopathological examination, typically through transurethral resection or biopsy. In cases of suspected kidney cancer, contrast-enhanced computed tomography (CT) is commonly used to evaluate the kidneys and surrounding structures. A multiphasic CT examination may include several imaging phases following intravenous contrast administration: • Arterial phase: approximately 20–30 seconds after contrast administration. • Nephrographic phase: approximately 80–120 seconds after contrast administration. • Excretory or delayed phase: approximately 5–15 minutes after contrast administration. The exact imaging protocol and timing are selected according to the clinical indication and the diagnostic objectives. In which cases is a biopsy necessary? When a suspicious lesion is identified in the urinary bladder or prostate, a biopsy or tissue sampling is generally required to establish an accurate diagnosis and determine the nature of the lesion. As mentioned earlier, tumors may be either benign or malignant. Histopathological examination allows specialists to identify the characteristics of the tissue and establish the diagnosis. The results play a crucial role in determining the subsequent treatment strategy and assessing the patient’s prognosis. 5. Treatment of Onco-Urological Diseases What treatment methods are used for tumors of the kidneys, urinary bladder, and prostate? Treatment depends on the location and type of the tumor, the stage of the disease, and the patient’s overall health. For kidney tumors, surgical treatment may involve either radical nephrectomy, which is the removal of the entire affected kidney, or partial nephrectomy, which involves removing the tumor while preserving the healthy portion of the kidney. The removed tissue is then sent for histopathological examination. Based on the results, the stage of the disease, and other clinical factors, the medical team determines whether additional treatment or surveillance is necessary. For bladder cancer, the treatment strategy largely depends on whether the tumor has invaded the muscular layer of the bladder wall. In cases of non-muscle-invasive bladder cancer, transurethral resection of the bladder tumor (TURBT) is commonly performed. Depending on the tumor’s characteristics and risk category, additional intravesical treatment and regular follow-up may be recommended. For muscle-invasive bladder cancer, treatment may involve neoadjuvant chemotherapy followed by radical cystectomy, which is the surgical removal of the urinary bladder, in appropriately selected patients. Other treatment approaches may also be considered depending on the patient’s condition and the characteristics of the disease. For localized prostate cancer, treatment options include active monitoring, radical prostatectomy, and radiotherapy. The ProtecT trial demonstrated that, for selected patients with clinically localized prostate cancer, prostate cancer-specific mortality remained low following active monitoring, surgery, or radiotherapy during long-term follow-up. However, these approaches differ in their effects on disease progression, adverse effects, and quality of life. Therefore, treatment should be selected individually following a comprehensive assessment and discussion between the patient and the treating specialist. When is surgical intervention necessary, and which minimally invasive surgical techniques are used in uro-oncology? Minimally invasive techniques are widely used in uro-oncology for both diagnostic procedures and surgical treatment. As mentioned earlier, obtaining tissue samples is an important part of diagnosing suspected prostate and bladder cancer. A prostate biopsy is commonly performed using a specialized needle under ultrasound guidance. MRI findings may also be used to guide the sampling procedure. This technique allows tissue samples to be obtained without making a conventional surgical incision. Bladder biopsies and transurethral resections are performed using endoscopic instruments introduced through the urethra, also without external surgical incisions. When surgical treatment is indicated, minimally invasive approaches, including laparoscopic and robot-assisted surgery, may be used for selected urological cancers. Compared with conventional open surgery, these techniques may reduce the size of surgical incisions, postoperative pain, and the duration of recovery in appropriately selected patients. Enhanced Recovery After Surgery (ERAS) protocols are designed to support early mobilization and recovery following surgical procedures. Depending on the type of surgery and the patient’s postoperative condition, mobilization may begin within the first few hours after the operation, sometimes as early as six hours after surgery. However, the timing of mobilization and the overall recovery process must always be individualized. 6. Prevention and Early Detection What measures can help reduce the risk of developing certain onco-urological diseases? Lifestyle modification plays an important role in reducing the risk of several types of cancer. The main preventive measures include quitting smoking, limiting or avoiding alcohol consumption, engaging in regular physical activity, maintaining a healthy and balanced diet, and keeping body weight within a healthy range. Avoiding unnecessary exposure to harmful substances and following appropriate preventive healthcare recommendations are also important. Screening examinations should be performed according to individual risk factors and current clinical guidelines. Although these measures cannot completely eliminate the risk of developing cancer, they can contribute to reducing the risk of certain malignancies and improving overall health. Who is recommended to undergo preventive urological examinations, and under what circumstances? A preventive consultation with a urologist can be beneficial, particularly for individuals who have an increased risk of developing urological diseases. Regular urological monitoring is especially important for patients with a family history of onco-urological diseases, as well as those experiencing any of the previously mentioned warning signs or symptoms. The need for screening and the frequency of preventive examinations should be determined individually by a specialist. What recommendations do you give to patients with a hereditary predisposition to cancer? I recommend taking your health seriously, attending regular preventive medical examinations, and following the screening schedule recommended by your healthcare provider.Patients with a significant family history of cancer should discuss their individual risk factors with a specialist to determine whether additional examinations or genetic counseling may be appropriate. 7. Conclusion: Expert Opinion What advice would you give to patients who notice concerning symptoms but postpone visiting a urologist because they are afraid of a possible diagnosis? Fear will not prolong your life, but courage might. Do not allow fear of a possible diagnosis to prevent you from seeking timely medical attention. Remember that your doctor is on your side. Our responsibility is to support you, establish an accurate diagnosis, and identify the most appropriate treatment strategy for your individual situation. If you have noticed concerning symptoms or are already aware of a suspicious mass or lesion, do not miss the opportunity to receive medical care at the appropriate time. Early detection can provide more treatment options and improve the chances of a favorable outcome.
Bahrom Rustamovich Rustamov is an andrologist and urologist with 19 years of professional experience. His main areas of practice include male reproductive health, infertility, erectile dysfunction, varicocele, azoospermia, and the diagnosis and treatment of other complex andrological conditions. Microsurgery holds a special place in Dr. Bahrom Rustamovich’s clinical practice. He is a specialist who introduced microsurgical techniques such as Micro-TESE and vasoepididymostomy for the treatment of severe male infertility and azoospermia in Uzbekistan. His areas of practice also include microsurgical varicocele repair, surgical treatment of Peyronie’s disease, and penile implantation for erectile dysfunction. Infertility Is Not Only a Woman’s Problem Infertility is one of the major challenges in reproductive health today. According to the World Health Organization, approximately 1 in 6 people of reproductive age experience infertility during their lifetime. A scientific analysis published in 2025 on male infertility in Central Asia reported that the average proportion of infertile couples in Uzbekistan and Kazakhstan is around 15–17%, with a male factor identified in approximately 40–50% of cases . In the study itself, an isolated male factor was identified in 52.9% of 957 patients who sought medical care for infertility. Male infertility may be associated with a low sperm count or complete absence of sperm, abnormalities in sperm motility and morphology, obstruction of the reproductive tract, hormonal disorders, varicocele, and other factors. Nevertheless, when pregnancy does not occur for an extended period, the woman is often the first partner to undergo evaluation. In reality, reproductive health is the health of the couple . That is why we spoke with andrologist Bahrom Rustamovich about the causes of male infertility, its diagnosis and treatment, and modern microsurgical options. What diseases and conditions most commonly cause male infertility? One of the most common causes is varicocele, which is the enlargement of the veins around the testicle. This condition can increase local temperature and impair blood circulation, potentially having a negative effect on spermatogenesis. Another important group of causes includes hormonal disorders, complications of sexually transmitted infections, obstruction of the reproductive tract, as well as cryptorchidism and genetic conditions such as Klinefelter syndrome. In addition, smoking, alcohol consumption, obesity, and prolonged exposure to high temperatures can also negatively affect sperm quality. In many cases, the underlying cause can be identified and appropriate treatment can be provided. Can a man have a reproductive problem even if he feels completely healthy? Yes, this is quite common. Erectile function, sexual desire, and a general feeling of good health are not directly correlated with spermogram parameters. For example, varicocele or mild hormonal abnormalities may remain asymptomatic for years while still affecting sperm quality. Therefore, if a couple has regular sexual intercourse but pregnancy does not occur within one year, a man is advised to undergo evaluation, including a spermogram, regardless of how healthy he feels. What does a male fertility evaluation begin with? The evaluation begins with a detailed medical history and physical examination. The doctor asks about lifestyle, previous illnesses, surgical procedures, and medications. This is followed by an objective examination of the genital organs.The main test is a spermogram , which assesses sperm count, motility, and morphology. Hormonal tests and ultrasound examinations may also be ordered when necessary. If the spermogram result is abnormal, does that mean the man is infertile? No. One abnormal spermogram result does not by itself mean that a man is infertile. Sperm quality can be temporarily affected by illness, stress, heat exposure, or prolonged sexual abstinence. Therefore, if the result is questionable or abnormal, a repeat spermogram may be recommended after 2–3 weeks. A diagnosis is made based on multiple test results together with the overall clinical picture. Can male infertility always be treated with medication? No, not always. The treatment approach depends on the underlying cause. If the problem is caused by a hormonal disorder, medication may produce good results. However, varicocele or obstruction of the reproductive tract may require microsurgical treatment. In some severe cases, assisted reproductive technologies such as IVF/ICSI may be used. Therefore, treatment is always selected on an individual basis. In which cases are microsurgical procedures used? The choice of microsurgical technique depends on the specific condition. For example, in cases of significant varicocele, microsurgical varicocele repair may be performed. If the reproductive tract is obstructed, vasoepididymostomy — a procedure designed to restore the continuity of the reproductive tract — may be performed. When sperm production within the testicle is impaired, Micro-TESE can be used to locate and retrieve sperm. What is Micro-TESE, and who is it recommended for? Micro-TESE is a surgical technique used to retrieve sperm from testicular tissue with the assistance of an operating microscope. It is primarily used in cases of non-obstructive azoospermia , a condition in which sperm production within the testicles is significantly impaired. The use of an operating microscope allows the surgeon to identify areas of tissue where sperm production is more likely to be preserved, potentially increasing the chance of sperm retrieval. Retrieved sperm can subsequently be used for IVF/ICSI . Does azoospermia mean that having a biological child is impossible? No, it does not necessarily mean that. If azoospermia is caused by obstruction of the reproductive tract, the obstruction can often be surgically corrected. In cases of non-obstructive azoospermia, Micro-TESE may provide an opportunity to retrieve sperm directly from the testicular tissue. Retrieved sperm can then be used for IVF/ICSI. Therefore, with an accurate diagnosis and an appropriate treatment strategy, many men may still have the opportunity to become biological fathers. Does varicocele affect male fertility? Yes. Varicocele is one of the most common and potentially correctable causes of male infertility. Enlarged testicular veins can increase local temperature and negatively affect sperm production. Varicocele often causes no noticeable symptoms and may therefore be detected during a physical examination or ultrasound examination. Depending on its severity and the individual clinical situation, varicocele can be successfully treated surgically, and sperm parameters may improve significantly following treatment. What is special about microsurgical treatment of varicocele? The main advantage of the microsurgical technique is that an operating microscope allows the surgeon to precisely identify the enlarged veins and ligate them while preserving the surrounding arteries and the vas deferens. This can significantly reduce the risk of recurrence and complications compared with open or laparoscopic procedures. The recovery period is relatively short, and many patients can return to their usual activities within one or two days. Does an andrologist only treat infertility? No. An andrologist deals with a broad range of conditions related to male reproductive and sexual health.In addition to infertility, this includes erectile dysfunction, testosterone deficiency, premature ejaculation, penile curvature and injuries, Peyronie’s disease, and other conditions. An andrologist may also treat certain functional problems involving the testicles and prostate.In other words, andrology covers a broad spectrum of male health concerns. Is surgery also used to treat erectile dysfunction? Yes, but only in selected cases — primarily when medication and lifestyle changes have not produced satisfactory results. In some patients, shockwave therapy or injectable medications administered directly into the penis may also be considered. For severe organic erectile dysfunction, penile implant surgery is an effective treatment option.In general, surgery is considered a later-stage treatment option. Less invasive approaches are usually tried first. What is your main principle when treating patients? I consider an individualized approach to every patient and treatment directed at the specific underlying cause to be the fundamental principles of care. Treatment should be based on evidence-based medicine and, whenever possible, should begin with the least invasive options.It is also important to communicate with patients openly and respectfully, without embarrassment or stigma. This is not something to be ashamed of — it is a medical issue that requires professional care.The goal is not simply to relieve the symptoms, but to address the underlying cause of the problem whenever possible. What advice would you give men who are experiencing difficulties when trying to conceive? First of all, I recommend not delaying a consultation with a specialist. Early identification of the problem can make treatment easier. A spermogram is a simple and accessible first step, and there is no reason to feel embarrassed about undergoing the test. Lifestyle changes can also be beneficial, including quitting smoking, limiting alcohol consumption, and avoiding excessive exposure to high temperatures.Most importantly, both partners should undergo evaluation together. A comprehensive assessment of both partners can help identify the cause of the problem more quickly and determine the appropriate next steps. Book an Andrology Consultation If you are experiencing difficulties when trying to conceive or have questions related to male reproductive or sexual health, you can schedule a consultation with AKFA Medline andrologist Bahrom Rustamovich Rustamov . The specialist will assess your condition, recommend the necessary diagnostic tests, and develop an individualized treatment plan based on the results.
Strategic Implementation and Clinical Efficacy of the EDGE MP1000 Robotic Surgical System at AKFA Medline: A Comprehensive Analysis The Transformation of Minimally Invasive Surgery in Central Asia The landscape of surgical care within the Central Asian region is undergoing a profound structural transformation, catalyzed by rapid technological adoption, significant private sector investment, and the rising clinical capabilities of independent medical institutions. Historically, the region has relied heavily on traditional open surgical techniques, characterized by large incisions, significant intraoperative blood loss, extended hospitalization, and prolonged convalescence. The gradual transition to standard laparoscopy introduced minimally invasive benefits but remained constrained by two-dimensional visualization, counter-intuitive instrument mechanics, and restricted degrees of freedom. The recent deployment of the EDGE MP1000 robotic surgical system at AKFA Medline University Hospital in Tashkent, Uzbekistan, represents a critical inflection point in regional healthcare delivery. 1 This integration marks the transition from conventional minimally invasive surgery to high-acuity robotic-assisted procedures. The acquisition of multi-port robotic technology fundamentally alters the therapeutic paradigms available for complex urological, gynecological, thoracic, and hepatobiliary conditions. 2 By domesticating world-class surgical capabilities, AKFA Medline not only elevates the national standard of care but also structurally reorients the geoeconomics of medical tourism, establishing a localized center of excellence capable of retaining patients who previously sought advanced interventions abroad. 5 Institutional Infrastructure and International Clinical Governance The successful deployment of high-acuity surgical robotics requires an institutional backbone built on rigorous safety protocols, stringent clinical governance, and comprehensive medical education. The operation of advanced telemanipulators demands an environment where perioperative nursing protocols, instrument sterilization, and surgeon credentialing align with absolute global standards. AKFA Medline operates as the foremost private multidisciplinary clinic in Central Asia, a position validated by its adherence to international quality benchmarks. In 2020, the institution successfully passed its initial accreditation by Joint Commission International (JCI), becoming the sole holder of the JCI Gold Seal of Approval among private facilities in Uzbekistan. 7 This status was reaffirmed in 2023, confirming the hospital's sustained commitment to patient safety, advanced diagnostic and treatment methodologies, and strict adherence to international clinical protocols. 7 The JCI framework ensures that the integration of the EDGE MP1000 is supported by standardized performance improvement plans, continuous data collection, and robust corrective action mechanisms—essential components for mitigating the inherent risks associated with introducing novel surgical platforms. 9 While state institutions such as the National Children's Medical Center (BMTM) recently achieved JCI certification in 2024, AKFA Medline remains the pioneer in the private sector, uniquely positioned to service the adult demographic requiring complex robotic interventions. 7 Beyond clinical operations, the institution functions as a critical node for medical education. AKFA Medline holds official status as an American Heart Association (AHA) International Training Center. 12 This authorization allows the hospital to deliver globally certified courses in Basic Life Support (BLS), Advanced Cardiovascular Life Support (ACLS), and Pediatric Advanced Life Support (PALS), thereby strengthening emergency care capacity across the region and ensuring that the surgical and anesthetic teams supporting the robotic program possess elite resuscitative skills. 12 Furthermore, the academic integration of the facility is exemplified by its partnership with Central Asian University (CAU). The establishment of the CAU Residency program at AKFA Medline, highlighted by a live broadcast of a surgical operation utilizing the EDGE MP1000, demonstrates a strategic commitment to training the next generation of domestic surgeons. 1 The presence of integrated simulation software within the robotic platform allows surgical residents to acquire and refine psychomotor skills in a high-fidelity, risk-free environment before transitioning to the clinical operating theater. 4 Epidemiological Determinants of Surgical Volume The clinical utilization of the EDGE MP1000 at AKFA Medline is intrinsically linked to the unique epidemiological profile of Uzbekistan, which is heavily influenced by geographical, climatic, and environmental factors. These regional pathologies dictate the highest-demand service lines for robotic surgery: urology and gynecology. The Urolithiasis Epidemic and Environmental Factors Urolithiasis (kidney stone disease) is exceptionally prevalent in Uzbekistan, functioning as a primary driver for urological surgical volume. While the global prevalence of urolithiasis ranges between 5% and 10% in Europe and Asia, the national average in Uzbekistan is documented at 4.5%, with significant regional disparities heavily skewed by localized environmental degradation. 13 The desiccation of the Aral Sea has created a localized ecological crisis, fundamentally altering the habitat, elevating atmospheric particulate matter, and deteriorating groundwater quality. 15 The high mineral concentrations in regional drinking water sources, combined with the extreme heat of the Central Asian climate, exacerbate systemic dehydration, leading to urine supersaturation and subsequent crystalluria. 13 Geographic Region Documented Prevalence of Urolithiasis (%) Bukhara Region 8.5% Khorezm Region 8.2% (Recent Data) / 6.8% (Historical Data) Karakalpakstan 7.7% Sirdarya Region 6.9% Surkhandarya Region 3.5% Fergana Valley Estimated > 4.0% due to extreme dry heat Tashkent Region 1.9% National Average 4.5% As patients from highly affected regions such as Khorezm and Bukhara migrate to Tashkent for advanced medical care, AKFA Medline faces a sustained, high-volume influx of complex urolithiasis presentations. Gynecological Morbidity and the Demand for Fertility Preservation In parallel with urological pathologies, gynecological conditions such as uterine fibroids (leiomyomas), ovarian cysts, severe endometriosis, and pelvic organ prolapse represent a substantial burden of disease among the adult female demographic in Uzbekistan. The cultural context of Central Asia places a profound emphasis on family structures and childbearing. Consequently, the surgical management of benign gynecological conditions demands techniques that prioritize the preservation of the uterus and ovarian reserve. Traditional open gynecological surgeries, such as abdominal myomectomies or total abdominal hysterectomies, necessitate large laparotomy incisions. These procedures are associated with significant intraoperative blood loss, a high risk of postoperative pelvic adhesion formation (which can independently cause secondary infertility), and extended hospitalizations averaging 5 to 7 days. 17 Standard laparoscopy mitigates some of these risks but is technically limited when dealing with deep intramural fibroids that require complex, multi-layer intracorporeal suturing to reconstruct the myometrium adequately. 19 The inability to precisely reconstruct the uterine wall laparoscopically often leads to a higher conversion rate to open surgery or an increased risk of uterine rupture during subsequent pregnancies. This dynamic creates a critical clinical necessity for robotic-assisted gynecological platforms. Evolution of Urological and Gynecological Interventions The algorithmic management of the aforementioned pathologies is experiencing a paradigm shift driven by technological feasibility. Algorithmic Management of Urolithiasis The management of kidney stones at institutions like AKFA Medline has historically relied on a tiered, ascending-acuity approach. For smaller, uncomplicated calculi (typically 1.5 cm) located in the renal pelvis or upper ureter, Extracorporeal Shock Wave Lithotripsy (ESWL) remains the first-line non-invasive intervention. 20 ESWL utilizes high-energy acoustic shock waves generated by a lithotripter outside the body. These waves travel through the skin and soft tissues, focusing directly on the stone to fragment it into smaller, passable pieces. 20 While highly appealing due to its non-invasive nature, ESWL exhibits high failure rates for large, dense (calcium oxalate monohydrate or cystine), or anatomically complex stones. 21 When ESWL fails or is contraindicated, the standard of care traditionally shifts to retrograde ureteroscopy with laser lithotripsy or Percutaneous Nephrolithotomy (PCNL). 22 PCNL involves creating a tract directly from the flank into the renal collecting system to extract large stones, boasting the highest success rate for substantial stone burdens. 24 However, PCNL is inherently invasive, carrying risks of severe hemorrhage, pleural injury, and damage to adjacent visceral organs. 24 The advent of the EDGE MP1000 introduces a superior, highly efficacious modality for complex presentations, particularly when substantial stone burdens are accompanied by anatomical anomalies such as ureteropelvic junction (UPJ) obstruction. In such cases, robot-assisted pyelolithotomy combined with pyeloplasty allows for meticulous tissue dissection, the intact extraction of massive staghorn calculi without the risk of fragment dispersion inherent to lithotripsy, and the high-fidelity, watertight suturing of the renal pelvis. 25 Clinical series evaluating robotic pyelolithotomy demonstrate durable radiographic resolution of obstruction and total stone-free rates that rival or exceed PCNL, without the associated percutaneous hemorrhagic risks. 26 Advancements in Pelvic and Gynecological Surgery In the realm of gynecology and pelvic reconstruction, the limitations of the human hand and the rigidity of standard laparoscopic instruments are most evident when operating deep within the narrow confines of the female pelvis. Procedures such as sacrocolpopexy (for pelvic organ prolapse) and the excision of deep infiltrating endometriosis require meticulous dissection near critical structures, including the ureters, bladder, and rectum. 19 The integration of robotic surgery dramatically alters the trajectory of these procedures. The robotic endo-wrists allow for the precise, multi-angle suturing necessary for effective vault suspension or myometrial closure. 19 Clinical data demonstrates that robot-assisted gynecological procedures significantly reduce hospital readmission rates (by up to 52%), lower the prevalence of deep vein thrombosis and pulmonary emboli by 77%, and accelerate the return to normal daily activities. 17 Patients undergoing robotic procedures frequently resume work and normal functions within 6 days post-operation, compared to 12 days following traditional open gynecological surgeries. 18 Furthermore, robotic assistance in benign gynecological illness exhibits a markedly lower conversion rate to open procedures compared to conventional laparoscopy. 19 Technological Architecture of the EDGE MP1000 System To fully comprehend the clinical efficacy of AKFA Medline's robotic program, an exhaustive technical analysis of the EDGE MP1000 platform is required. Developed by Shenzhen Edge Medical Company (founded in May 2017), the MP1000 represents the vanguard of multi-port robotic surgical systems, having secured National Medical Products Administration (NMPA) approval in December 2022 following rigorous clinical trials. 2 System Engineering and Master-Slave Biomechanics The MP1000 architecture operates on an intuitive master-slave control paradigm and is physically divided into three primary components: the patient cart, the surgeon console, and the vision system. 2 The patient cart utilizes an advanced four-arm suspension structure mounted on a two-stage boom. 2 This integrated, boom-mounted design facilitates rapid docking procedures over the patient, significantly reducing preoperative setup times compared to older, separated-mount systems. 2 Each of the four robotic arms is engineered with 12 structural joints, allowing for a remarkably wide operating range and the utilization of various preset anatomical guidance positions. 2 The critical biomechanical advantage of the MP1000 lies in the distal instrumentation. Each individual robotic arm provides seven degrees of freedom (DOF). 30 These seven DOF perfectly replicate, and indeed exceed, the biomechanics of the human wrist—incorporating pitch, yaw, roll, and intracorporeal articulation. The master-slave console scales down the surgeon's gross macroscopic hand movements into corresponding microscopic movements of the instruments inside the patient's body. 2 This natural dexterity is indispensable for complex maneuvers, such as the vesicourethral anastomosis during a radical prostatectomy, ensuring absolute precision in spatially constrained environments. 35 Optical Visualization and Latency Mitigation Surgical precision is inherently and inexorably tied to visual fidelity. The MP1000 integrates a proprietary, self-developed immersive 3D high-definition vision system. 2 The optical apparatus provides native and digital image magnification scaling up to 10–20x, granting the operating surgeon an unparalleled view of the microvasculature, fascial planes, and nerve plexuses. 2 A persistent challenge in early telemanipulation systems was image transmission latency—the delay between the movement of the camera and the rendering of the image on the surgeon's console, which can induce severe visual-motor dissonance. The MP1000 utilizes advanced processing algorithms to achieve ultra-low display lag, independently verified at under 40 milliseconds, ensuring highly responsive, real-time visual feedback. 30 Furthermore, the vision system incorporates Indocyanine Green (ICG) fluorescence imaging capabilities. 2 By injecting the ICG fluorophore intravenously, the surgeon can toggle to a near-infrared fluorescence mode to visualize tissue perfusion, map lymphatic drainage pathways for oncological lymph node dissections, and identify critical neurovascular bundles in real-time, thereby drastically reducing the risk of ischemic complications or unintended nerve damage. 2 Tremor Filtration and Ergonomics Human physiological tremor is an unavoidable limitation in traditional microsurgery. The MP1000 circumvents this biological constraint through sophisticated tremor filtration algorithms embedded within the surgeon console. 2 The system computationally identifies and continuously dampens physiological hand tremors, ensuring that only intentional, smooth movements are translated to the robotic end-effectors. 2 The ergonomic design of the console itself reduces the physical fatigue experienced by surgeons during prolonged, complex oncological cases. In prospective clinical trials evaluating the ergonomics of the MP1000 using the National Aeronautics and Space Administration Task Load Index (NASA-TLX), the system achieved a highly favorable overall score of 6.70 4.81, indicating minimal physical and cognitive strain on the operator. 34 Technical Specification EDGE MP1000 da Vinci Si Robotic Arms Structure 4 (1 camera, 3 working) 4 (1 camera, 3 working) Arm Mounting Architecture Integrated boom-mounted Separated mount Endoscopic Placement Interchangeable on any of the 4 arms Fixed exclusively on the middle arm Table 2: Technical Specifications Comparison: EDGE MP1000 vs. Legacy Robotic Platforms. 2 The clinical efficacy of the MP1000 is robustly supported by prospective, single-arm clinical studies. In a rigorous evaluation of the system for upper urinary tract repair surgeries, surgeons successfully completed all cases without a single conversion to standard laparoscopic or open surgery. 34 The average docking time was exceptionally swift at 4.1 minutes (IQR, 3–5 min), minimizing non-operative anesthetic time. The average estimated blood loss (EBL) across complex reconstructions was merely 58.5 mL (IQR, 20–100 mL), and the mean length of hospital stay was documented at 6.95 days, with no patients experiencing Clavien-Dindo grade III or higher-grade postoperative complications. 34 Postoperative renal function, measured by the estimated glomerular filtration rate (eGFR), was successfully preserved, yielding a short-term surgical success rate of 100%. 34 Geoeconomic Shifts in Regional Medical Tourism The strategic acquisition of the EDGE MP1000 by AKFA Medline transcends clinical utility; it is inextricably tied to the macroeconomic dynamics of regional medical tourism and healthcare capital retention. Historically, the deficit in advanced medical infrastructure and high-tier surgical technology pushed affluent and middle-class Central Asian patients to seek treatment outside the region. 5 While Uzbekistan is strengthening its position as a regional healthcare destination—attracting over 86,000 international patients primarily from neighboring Tajikistan and Kyrgyzstan in 2025—it simultaneously experiences a massive outflow of its own citizens seeking complex surgical oncology, cardiology, and robotic interventions. 6 Data indicates a severe cross-border patient flow directed primarily toward Turkey, India, and Germany. 5 For instance, a single private hospital in Turkey reported treating approximately 12,000 Uzbek patients in one year. 6 Turkey, which treats over 700,000 international patients annually, leverages its modern hospitals (such as the Acibadem and Anadolu networks), JCI accreditations, and cost structures that are 50% to 70% lower than those in the United States or Western Europe to dominate the Eurasian medical tourism market. 40 India mirrors this volume, receiving an estimated 700,000 medical travelers seeking affordable excellence in oncology and orthopedics, while Germany attracts patients valuing precision medicine and rigorous regulatory standards. 40 By aggressively localizing the implementation of the EDGE MP1000, AKFA Medline effectively neutralizes the primary "push factors" that drive this medical exodus: insufficient domestic medical technology, perceived lower service quality, and the unavailability of specific advanced treatments. 5 Concurrently, the hospital capitalizes on overwhelming local "pull factors." Patients who undergo complex, robot-assisted radical prostatectomies or myomectomies domestically eliminate the exorbitant costs of international flights, extended hotel stays, and medical translation services. 5 Furthermore, they benefit from geographical proximity, cultural affinity, the comfort of recovering in a native linguistic environment, and the crucial psychological support of nearby family members. This strategic positioning allows AKFA Medline to capture a highly lucrative demographic: the educated, urban, middle-class adults aged 35–65 residing in Tashkent and surrounding metropolitan areas. This cohort possesses the disposable income required for private healthcare but has historically exported that capital due to a lack of domestic technological parity [User Query]. Strategic Patient-Facing Communication Architecture The integration of advanced robotic technology necessitates a highly sophisticated communication strategy to bridge the gap between clinical reality and public perception. The target demographic in Tashkent is digitally literate, health-conscious, and discerning, yet they often harbor latent fears and skepticism regarding medical automation. A primary barrier to the widespread patient acceptance of robotic surgery is the entrenched misconception of autonomous operation. The strategic narrative must aggressively and immediately dismantle the myth that the robot makes independent surgical decisions or operates without human oversight. The communication framework must clearly define the robotic system as an advanced, highly calibrated telemanipulator—an extension of the surgeon's physical hands that filters out physiological limitations and scales movements for unprecedented microscopic precision. 2 Drawing upon the communication paradigms established by leading global institutions such as the Cleveland Clinic and the Acibadem Healthcare Group, the messaging must be warm, scientifically authoritative, and inherently family-oriented [User Query]. In the Central Asian cultural context, health decisions are rarely individualized; they are deeply familial, communal decisions. Therefore, emphasizing clinical metrics—such as minimal blood loss, 0.5–1 cm incisions, and reduced recovery times—must be immediately contextualized as emotional and practical benefits. A shorter hospital stay is not merely a metric of bed turnover; it is the ability for a mother to return to her children, or a professional to return to their career, with minimal disruption and pain [User Query]. Furthermore, the messaging must integrate highly specific Search Engine Optimization (SEO) keywords to capture existing digital intent. Keywords such as роботизированная хирургия Узбекистан , EDGE MP1000 , AKFA Medline робот , малоинвазивная урология Ташкент , and роботическая гинекология must be seamlessly woven into the narrative structure without compromising the natural flow or the clinical authority of the text [User Query]. The subsequent section provides the exact execution of this strategic communication framework. It is formatted as a comprehensive, SEO-optimized, patient-facing article in Russian, meticulously calibrated to the specifications required. This deliverable synthesizes all technical, clinical, and institutional variables analyzed in this report into an accessible, visually descriptive narrative designed to foster profound trust and drive patient acquisition for AKFA Medline's robotic surgery program. Strategic Conclusions The empirical evidence, clinical trials, epidemiological data, and strategic communication frameworks analyzed within this comprehensive report elucidate several foundational conclusions regarding the trajectory of advanced healthcare delivery in Uzbekistan: 1. Clinical Superiority and Direct Epidemiological Alignment: The deployment of the EDGE MP1000 system aligns flawlessly with the stark epidemiological realities of Central Asia. The robotic system's unparalleled capacity to facilitate complex, intracorporeal urinary tract reconstruction directly addresses the high, climate-driven burden of severe urolithiasis. 16 Concurrently, its microscopic precision in tissue-sparing dissection meets the surging demographic demand for fertility-preserving, minimally invasive gynecological interventions, drastically reducing recovery times from 12 days to 6 days or less. 18 2. Macroeconomic Retention Through Technological Parity: By neutralizing the profound technological deficit that traditionally drove the affluent and middle-class demographics to seek surgical care in hubs like Turkey, India, or Germany, AKFA Medline structurally reorients the Eurasian medical tourism market. 6 The synthesis of independent JCI accreditation, state-of-the-art multi-port robotic platforms, and highly trained personnel localized within Tashkent establishes a powerful domestic retention magnet for healthcare capital, reversing a decades-old trend of medical capital flight. 6 3. The Imperative of Trust-Based, Culturally Calibrated Communication: High-capital medical technology remains drastically underutilized if the target demographic lacks specific health literacy or harbors unchecked technophobia. The formulated communication strategy successfully translates highly complex mechanical engineering parameters (such as algorithmic tremor filtration, 7 degrees of freedom, and ultra-low optical latency) into resonant emotional and practical patient benefits (significantly reduced postoperative pain, rapid family reintegration, and profound scar minimization). 30 Ultimately, the integration of the EDGE MP1000 multi-port system within AKFA Medline's JCI-accredited clinical framework represents substantially more than a routine institutional upgrade. It is a definitive, permanent paradigm shift in Central Asian medical excellence, establishing a highly sustainable, domestic standard of care that possesses the clinical and operational rigor necessary to compete effectively on the global healthcare stage. Works cited 1. 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