On the occasion of World Hearing Day, Nellie Mosesova, an audiologist at the "Arabkir" Medical Center, answered questions from news.am. She addressed topics such as how parents can identify hearing issues in newborns, the significance of newborn hearing screening, its implementation in Armenia and its outcomes, the causes of congenital and acquired hearing loss and deafness, available treatments for deafness, and whether screening and cochlear implants will eliminate the need for sign language. How can parents recognize if their newborn child has hearing problems? During a child’s early developmental stages, identifying hearing issues can be challenging. While there are specific developmental milestones, such as reaction to sounds, these may not always be evident. For example, a 1-month-old baby may not display a noticeable reaction to sound, except for perhaps focusing their gaze or a slight startle to loud, sharp noises. By around 3 months of age, babies begin to respond better to human voices, showing recognition of their mother’s voice and displaying excitement even without visual contact. Around 6 months, they start babbling and can clearly locate the source of sounds. By 1 year, we expect the child’s first words. While these milestones are important, instrumental examinations provide more accurate results. Hence, newborn hearing screening tests are conducted in maternity hospitals in Armenia during the first days of a child’s life.    What is a newborn hearing screening test? The newborn hearing screening test is a mass screening conducted in stages. The initial stage takes place in the maternity hospital during the first days of the newborn’s life, before discharge. If hearing loss is suspected, the test is repeated, with the second stage completed no later than 2 months of age. If doubts persist, a comprehensive audiologic examination is conducted, including more complex tests to diagnose any hearing loss and determine its severity.   Since when has screening been performed in Armenia and what are the outcomes?  Newborn hearing screening in Armenia began in July 2008, initially in just 4 maternity hospitals. However, since 2018, nearly all maternity hospitals in Armenia have been equipped to perform this screening. The results align with international data, indicating that approximately one in a thousand children are born with hearing loss.    What are the causes of congenital hearing loss and deafness? Congenital hearing loss has various causes, often involving multiple factors. Genetics is the most common cause, accounting for 30-50% of cases. It's important to note that while labeled as hereditary, both parents may have normal hearing. Complications during pregnancy, particularly infections, are also significant contributors. Certain medications taken during pregnancy can lead to hearing loss. Additionally, premature or post-term (more than 42 weeks) births can increase the risk. Other contributing factors include maternal habits and comorbidities such as diabetes or anemia, which may affect fetal nutrition. What are the causes of acquired hearing loss and deafness? Acquired hearing loss often results from infectious diseases such as measles and COVID-19, as well as acute respiratory infections. Certain chemotherapeutic agents used in tuberculosis treatment can also lead to hearing loss. Additionally, traumatic brain injury and prolonged exposure to loud noise, often due to increased headphone use, are common causes.   What are the available treatment methods for hearing loss and deafness? For acute hearing loss, timely treatment within the first 5 days is crucial, as interventions after 2 weeks are less effective. Therefore, seeking medical attention promptly is essential in cases of sudden hearing loss, as delays can be critical. Alternatively, if treatment is not possible, compensatory measures can be taken. Hearing aids are commonly used for this purpose, and if ineffective, surgical interventions such as cochlear implantation may be necessary.   Is it possible to achieve the level that there is no need for a special language for deaf and mute people? Despite advancements in technology, including hearing aids and cochlear implants, there are still cases where these methods are ineffective, necessitating the use of sign language. However, with the rapid pace of technological development, there is hope that in the near future, both speech and hearing abilities can be significantly improved. 

Today is March 3rd, World Hearing Day. It is a reminder to highlight the importance of hearing and taking care of it. This year's theme, “Hearing Aid for All”, as advocated by the World Health Organization, underscores the necessity of addressing hearing impairments at every stage of life, from infancy to old age. To mark this day, we invite you to watch a video highlighting the latest mission of the Armenia Hearing Aid Project. This initiative was launched by the Los Angeles-based family of Haykuhi and Armen Kavoukjian, in partnership with the “Arabkir” United Children’s Charity Foundation. Since 2017, this project has provided high-quality digital hearing aids to thousands of individuals, including several hundred participants of the 44-Day War.   The "Armenia: Hearing Aid" Project's 2023 mission, which ran from September 11 to September 16, was tragically followed by the Azerbaijan's aggression in Artsakh on September 19 and the forced displacement of Armenians from their homeland.   HEARING THE WORLD BETTER   - I am extremely grateful. Your warm welcome and care is much appreciated! Thank you very much!  - Well done, everyone! I am deeply satisfied and grateful. Everything was well-organized, and the hospitality. It’s truly wonderful for those who appreciate it.   Countless expressions of gratitude fill the air as people depart, satisfied with the warm reception and service provided by dedicated specialists and young volunteers. They highlight the importance of attention and a caring attitude, underscoring that, in addition to receiving hearing aids, they have truly felt seen and cared for.   - The exceptional approach, attentive care, and positive attitude have left a deep emotional impact on me. I am genuinely surprised and moved by the outstanding level of service. - They explained everything carefully. - The 20-year-old volunteers displayed impressive organizational skills, ensuring an orderly arrangement. Everyone followed a structured process, taking turns without any disruptions. - The service was excellent. They welcomed me with grace, and I am extremely satisfied.   This initiative didn't happen overnight. The concept for this project originated in 2008 within the family of Armen and Haykuhi Kavoukjian, residents of Los Angeles. As partners with the renowned "Starkey" company, they regularly received updates about the company's global charitable missions, specifically in providing hearing aids to those in need. Recognizing the need in Armenia, they took action and launched their inaugural mission in 2017, partnering with the ARABKIR United Children’s Charitable Foundation and the ARABKIR Medical Center. Over three consecutive years, the Starkey team, under the leadership of founder Bill Austin, collaborated with the Kavoukjians and numerous volunteers, bringing the gift of hearing to thousands of individuals across Armenia, including Yerevan, Gyumri, Vanadzor, and Artsakh.   In 2020, as the global COVID-19 pandemic swept across the world, "Starkey" temporarily halted its project activities. Despite the ongoing need, particularly in Armenia where many individuals returned with hearing impairment from the 44-day war in Artsakh, the Kavoukjians swiftly redirected their efforts. This time, their focus was on aiding war participants by supplying high-quality hearing devices. The years 2021 and 2022 saw a dedicated emphasis on supporting those affected by the conflict.   Lusine Babayan - Country Coordinator, “Armenia Hearing Aid” Project - In 2020, we equipped 240 individuals, predominantly military personnel, with cutting-edge digital hearing aids featuring the latest technologies.   Once again in 2023, the Kavoukjian family, alongside volunteers from Starkey Cares and friends from Los Angeles, is in Armenia for the next mission. This time, the project specifically targets individuals who, for various reasons, were not part of government or other support initiatives.   Lusine Babayan - Country Coordinator, “Armenia Hearing Aid” Project - The primary concern we've identified is with individuals who do not have a recognized disability but are in need of hearing aids. Furnishing them with these devices has the potential to prevent job loss, boost social engagement, enhance their overall quality of life, enable participation in various activities, and assist in overcoming numerous challenges. Narek Mkrtchyan, the Minister of Labour and Social Affairs visited the mission site on the first day. He expressed high appreciation for the support extended to the country and its citizens through such initiatives.   Narek Mkrtchyan - Minister of Labour and Social Affairs of the RA - Significant efforts are currently underway to support individuals with hearing impairment, providing our citizens with access to cutting-edge devices utilized globally. This initiative is particularly noteworthy as it caters to specific target groups that may be excluded from state support programs. In our context, we have clearly defined target groups eligible for state support projects, making this initiative crucial in addressing a specific need. The project effectively complements existing state programs, with dedicated efforts over the years and the pivotal role played by the "Arabkir" medical center under the leadership of Mr. Babloyan. I extend my best wishes for the success of this initiative. It's essential to recognize that this goes beyond charity; it's about creating knowledge and value. This not only contributes to new infrastructures but also nurtures new knowledge, enabling our specialists to advance and elevate the field.   The dedication and care demonstrated by the Kavoukjian family and all supporters of the project are truly impressive, according to Ara Babloyan, the partner of the project in Armenia and the founder of the “Arabkir” United Children’s Charitable Foundation. They not only provided the idea but also secured the finances and actively participate in all missions, personally fitting the devices and giving the gift of hearing to our people.    Ara Babloyan - Founder, “Arabkir” United Children’s Charitable Foundation - What I appreciate most about the Kavoukjian family's approach and their organization is the lack of formality; it's all about substance. Our perspectives align, as we, too, set our goal with an emphasis on meaningful content right from the beginning. I'm delighted that we could come together and collaborate on this shared commitment.   Between September 11 and 16, close to 1000 individuals were equipped with hearing aids, with more than 100 of them being high-quality digital devices. A significant number of these devices were provided in pairs for dual-sided wearability. The recipients came from various locations, including Yerevan, Gyumri, Vanadzor, and other cities and villages. Additionally, beneficiaries from Artsakh, who were in Armenia during that period and unable to return due to the blockade, were also served. The project collaborated with provincial administrations and municipalities to facilitate the smooth transfer of beneficiaries.   - They called me, and then informed my husband about the day and time, so we immediately left our jobs and came from Gyumri to Yerevan. - I have a somewhat unusual sensation, but they reassured me that it's normal. They advised me to wear it and allow myself time to adapt. - It comes with an application which is great. You can adjust the volume, lower or raise it and also check the battery. - My previous device was broken, and our nurse told me about this project. She said I was included, so I came from Russia to receive the devices I really need.   The role of volunteers is particularly crucial in this endeavor. Volunteers are individuals from Palestine, Great Britain and the USA as well as students from various universities of Armenia. Volunteer - Here, we provide consultations and explain how to use and take care for the hearing-aid. We have a sample device and a box to illustrate proper care and cleaning. Volunteer - I am a physician and for me the primary reward is a profound personal fulfillment. At the day's conclusion, the knowledge that you've positively impacted people's lives, especially when you witness their satisfaction, makes all the efforts worthwhile. Volunteer -  I’ve participated in many volunteering programs, but this one is different because we’re helping the elderly. Doing everything we can to ensure they can hear brings us immense joy. - They are incredibly caring. I won't forget it; it will remain in my memory forever. The heartfelt welcome I experienced has filled me with genuine gratitude, and I'm even moved to tears. The surrounding warmth seemed to enhance my ability to hear.   This large-scale annual initiative becomes a reality through the dedicated efforts of volunteers and donors committed to assisting individuals with hearing impairment in Armenia. The primary financial support for this year’s mission was generated during a charity dinner organized by the “Armenia: Hearing Aid” Project on March 3, on the World Hearing Day.    Haykuhi Kavoukjian - Founder, “Armenia Hearing Aid” Project - We selected a venue with historical significance, where Charlie Chaplin once got married. Connecting the Silent film era with hearing, our gala evening was themed “Silent Film”, resulting in a successful fundraiser that received significant support. The Armenian community in Los Angeles believes in and supports us tremendously. It’s because of this fundraiser that we decided to provide high-quality digital devices to the 30-50-year-old Armenians, enabling them to seek employment, enhancing their quality of life.  The Starkey Foundation's initial goal was to empower us with knowledge to carry on their crucial work. Today, they take pride in our accomplishments. In the spirit of the English saying "flying solo," signifying readiness to navigate independently, we are now soaring on our own, and for that, we express our gratitude.   The “Armenia: Hearing Aid” Project team stands alongside our compatriots, always ready to support individuals with hearing impairment in improving their quality of life by enabling them to hear the world much better.   

  On the eve of the World Hearing Day, the news team of the Public TV Company visited the Speech Development Center at the "Arabkir" Medical Center, which caters to 40 children with hearing impairment attending classes 4 times a week.   Thanks to the dedicated work of the audiology service team, including doctors, audiometrists, audio therapists, art therapists, psychologists, and of course, parents, the children learn to speak and successfully integrate into public schools.   - What is your name? - Narek. - How old are you? - Seven. Narek is currently in the first grade and has profound (Level 4) congenital hearing loss. He visited the Speech Development Center at the “Arabkir” Medical Center to monitor his progress.   Suzanna Harutyunyan, Narek’s mother, shares: “We first heard Narek speak his first words, “mama”, “papa”, “ami” (red - “karmir” in Armenia), and “atach” (green - “kanach” in Armenian), when he was 4.5 years old. About a year later, following Roza’s advice, I began keeping a diary to track his progress, writing down the words in order. When I revisited the diary a year later on the same date, I was surprised to find out that Narek had learned 270 new words.   There are many guests gathered at the Speech Development Center on World Hearing Day, including former students who came to express their gratitude in person.   Among them is 7-year-old Mariam, reciting a poem. She has already decided to become a doctor - a dentist. At first glance, there are no signs that she has ever experienced hearing or speech difficulties. Audiologist Marine Grigoryan provides insight, “Mariam was diagnosed a bit later, but with early intervention and the use of prosthetics, significant progress has been made in improving the quality of her speech.”   Early diagnosis and timely interventions play a crucial role in overcoming challenges and facilitating social integration. Marine Grigoryan further emphasizes: “Mariam’s case exemplifies the importance of early intervention, from identification and diagnosis to the provision of prosthetics and specialized classes.”   Thanks to these efforts, Mariam now exhibits speech development comparable to her peers, highlighting the positive impact of early detection and appropriate interventions on a child's development. Dr. Nelli Mosesova emphasizes: “According to WHO data, approximately 5% of the global population experiences various forms of hearing impairment, a condition that is particularly prevalent among children. In fact, it ranks as one of the most common pathologies even among newborns, affecting roughly one in a thousand individuals on average.”   While hereditary factors account for 30-50% of cases of hearing loss, it's important to note that children with hearing impairments can also be born to parents without any prior history of such conditions. Dr. Nelly Mosesova explains, “There are various causes of hearing loss, with many cases attributed to conditions like acute respiratory infections or other illnesses, often resulting in temporary impairment.   The newborn hearing screening program was initiated in Armenia in 2008 and has been fully implemented nationwide since 2018. With advancements in modern medicine, there are many opportunities available to enhance children's hearing. To preserve the vital sense of hearing that connects us to the world, it is crucial to prioritize our health.

  The “24” news program of “Mir” TV company recently covered the topic of organ transplantation, highlighting the case of Yeghishe Khachatryan, who underwent a heart transplant. Yeghishe received his transplant surgery in Minsk and is currently receiving follow-up care at the “Follow-up Care Department for Organ Transplanted Patients” at “Arabkir” medical center. Reflecting on his experience, Yeghishe shares, “Thirteen years ago, I was given a second chance at life. The heart transplant was a turning point for me.”     After undergoing laboratory tests, a visit to the cardiologist, discussions about self-awareness, ultrasound of the heart, ECG, and other procedures every three months are part of Yeghishe Khachatryan’s routine. He holds a unique status as the sole individual in Armenia who has undergone a heart transplant.   Cardiologist Siranush Grigoryan remarks, “Yeghishe's condition remains stable. He diligently adheres to his appointments, medication regimen, and follows all medical advice. He maintains a healthy lifestyle, abstaining from harmful habits. It's essential for him to consume foods that promote lower cholesterol levels, engage in regular outdoor walks, and maintain physical activity."   In 2004, Yeghishe Khachatryan began experiencing symptoms such as chest pain, weakness, and shortness of breath, leading to a diagnosis of a heart attack. The second incident occurred 4 years later, but despite treatment in cardiology hospitals, his condition did not improve. After numerous consultations with medical professionals, it became evident that his heart and blood vessels were extensively damaged, rendering procedures such as stenting or shunting ineffective. The only viable solution was a heart transplant, a procedure not available in Armenia.    Reflecting on his journey, Yeghishe recalls, “By 2012, I was reliant on an oxygen machine for breathing. My brother accompanied me to Novosibirsk, where consultations confirmed that a transplant was my only hope. We were directed to a hospital in Minsk, where I was placed on the transplant waiting list. Within 15-20 days, a donor match was found - a thirty-year-old young man who tragically lost his life in a car accident.”   The procedure was conducted by the renowned cardiac surgeon, Doctor of Medical Sciences, Professor Yuri Ostrovsky. By that time, approximately 100 heart transplants had already been performed at the Minsk Cardiology Center.   Reflecting on the procedure, Professor Ostrovsky states, “The technology was well-developed, and we had accumulated significant experience. The decision to proceed with the transplant was based on the patient's condition. However, selecting a suitable donor-transplant match always presents challenges. Factors such as weight, height, blood type, and compatibility tests, including Cross Match, are considered. We ensured that all criteria were met before proceeding with the transplant.   The total cost of the surgery, tests and medications amounted to $55,000, which was covered by contributions from Yeghishe's brother and friends.   Expressing his gratitude, Yeghishe remarks, “Of course, I remember Yuri Petrovich. He is a kind person. I am thankful to him, the entire medical team, our doctors who continue to monitor my health, my brother, and to all those who helped. Having experienced this journey, I urge my fellow citizens to reconsider their views on organ donation. By consenting to organ donation from deceased relatives, many lives can be saved.”   In Armenia, only kidneys, liver, corneas are currently eligible for transplantation, with donors limited to close relatives. According to the Organ and Tissue Transplantation Act, individuals can be considered potential donors after death if their family members consent to organ retrieval. However, as of yet, there have been no instances of post-mortem organ donation. To address this, the Ministry of Health is working on changing the law to allow organs to be donated after someone passes away and to create a list of people waiting for transplants.   Elen Nazaryan, head of the Hemodialysis Department at the “Arabkir” Medical Center, underscores the significance of these proposed changes, stating, "Reforming the law would enable the establishment of a repository of posthumous donor organs, facilitating heart, lung, pancreas, and additional kidney transplants.   Currently, Armenia accommodates 1,100 dialysis patients, including 400 awaiting kidney transplants. The full implementation of a transplant recipient registry hinges on the integration of all major medical centers into the electronic healthcare system.   Experts contend that the adoption of posthumous donation protocols would significantly enhance the prospects of saving lives. Later in the evening, Yeghishe Khachatryan will gather with his family to commemorate his "second birthday" and express gratitude to those who bestowed upon him a renewed lease on life. 

February 29 is designated as Rare Disease Day in the medical calendar. According to the World Health Organization, diseases occuring in one in 2000 people or less are classified as rare. Globally, approximately 300 million people are affected by rare diseases, with medical literature documenting around 7,000 types, 80% of which have a genetic origin. Despite the common occurrence, diagnosis of rare diseases often takes an average of 4.8 years. This underscores the importance of early and accurate diagnosis, which is this year's theme, along with increasing treatment possibilities.   Rare diseases are also diagnosed periodically in various departments of the "Arabkir" medical center, including neurology and rheumatology. In Armenia, the frequency of such cases corresponds to patterns seen worldwide. Our specialists prioritize collaboration with international partners in diagnosing and managing rare diseases, striving tirelessly to enhance the life and quality of life of each patient.

  The Public TV has highlighted the adoption of a less invasive surgical method for diagnosing and treating children with epilepsy at the "Arabkir" medical center. This advancement in modern medicine, stereotactic electroencephalography, enables precise identification and removal of epileptogenic foci, leading to significant improvements in patients’ quality of life.    Niko Arzumanyan, the head of the Neurosurgery service at the “Arabkir” MC-ICAH, explains, “Through the sequential recording of brain electrical activity from each microelectrode of the implanted electrodes, relevant specialists identify the foci responsible for epileptic seizures in the patient during the study.” Stereo-EEG was performed for the first time on a child with epilepsy in Armenia. This method is considered one of the most modern and complex approaches to treating this condition. It involves a minimally invasive intervention, allowing for the precise identification of the epileptic focus by gathering information about the activity of brain cells.   Niko Arzumanyan explains, “When a specific epileptogenic zone is identified, we immediately conduct radiofrequency ablation of the indicated areas without any incision or damage to the skull. This procedure targets the identified foci, offering patients the opportunity to alleviate their epileptic seizures. For most patients, stereo-EEG provides crucial information, enabling us to identify the epileptogenic zone accurately. Subsequently, we perform open surgery to achieve optimal results.”   Biayna Sukhudyan explains, “Following the intervention, the patient, who previously experienced seizures monthly, remained seizure-free for a month. This outcome indicated the correctness of our decision, and we recognized that complete cessation of seizures was not achievable after the ablation. Another month elapsed before we performed surgery on the patient and surgically removed the identified focus.”   Armenian doctors, in collaboration with Bulgarian colleagues, conducted a stereo-EEG procedure on a 14-year-old child. The doctor elaborates that the intervention is facilitated through the use of a stereotactic system. Neurosurgeon Niko Arzumanyan further explains and demonstrates, “The device features numerous coordinates and angles, aiding us in pinpointing the exact location for electrode insertion into the brain. A 1.5mm incision is made in the skin, followed by a 2mm diameter incision in the skull, through which electrodes are carefully placed deep into the corresponding brain regions.” An epileptology dispensary operates within the "Arabkir" medical center, where approximately 3,800 patients under the age of 18 are registered.   Biayna Gagikovna explains, “It's important to note that surgery is not suitable for all epilepsy patients. Approximately 70% of patients can be effectively treated with medication, while around 30% have drug-resistant forms of the condition. Hence, only about 50% of patients are eligible candidates for epilepsy surgery. Epilepsy, being a chronic disease, can manifest in various ways, from motor to emotional seizures.”   Doctor Sukhudyan elaborates, “In childhood, we primarily encounter hereditary forms of epilepsy, although there are several acquired causes as well. These include infantile cerebral palsy, fetal asphyxiation at a young age, various infectious diseases affecting the brain, tumor diseases, and immune disorders. In other words, there can be numerous underlying reasons.”   If a person is having seizures in a public place, citizens often take the wrong steps when providing first aid, according to the doctor.   Doctor Sukhudyan advises, “It's crucial to avoid taking incorrect actions when providing assistance. Refrain from intervening, attempting to open the patient's mouth, pulling their tongue out, or trying to revive them forcibly, as such actions can be harmful. Instead, the first step is to gently turn the person onto their side and promptly call for emergency assistance.”  

  Novosti-Armenia Stories invited Astghik Ghazanjyan, an allergist-immunologist from the Respiratory Medicine, Allergology and Immunology service at the “Arabkir” medical center, to discuss immunity and dispel myths and misconceptions surrounding it.  

  Marina Melkumova, pediatrician and Adolescent Health Program Coordinator at “Arabkir” MC-ICAH, recently participated in a press conference hosted by “Armenpress” news agency. The conference focused on the activities of healthy lifestyle courses in schools, their content, and expected outcomes.  During the conference, Dr. Melkumova highlighted that the course topics aim to promote personal development, first aid skills, and the ability to avoid harmful effects. For more details, please follow the link.

  Watch Professor Ara Babloyan’s speech from the opening ceremony of the 4th Armenian Oncology Congress on News.am.  

  As a part of the #OPENFamilyEducation initiative, Knarik Sukiasyan, one of our pediatricians, has shared interesting facts about thermometers and temperature measurement. Listen to the specialist and remember that taking your child’s body temperature using your palm is simply wrong.

  As part of the #OPENFamilyEducation project, Anna Arakelyan, a pediatrician from the Department of Children under 1 year old, has shared important information for parents regarding the respiratory syncytial virus. She discussed its signs and the necessary actions to take if those signs are noticed.

  The specialists of the “Arabkir” medical center have joined the #OPENFamlilyEducation project to provide advice, raising parent awareness, and assisting with quick and correct orientation in case their child has health issues. Pediatrician Hasmik Vardanyan will discuss acute laryngotracheitis, commonly known in Armenia as “false croup”.  

  The team of neurosurgeons and neurologists at the “Arabkir” Medical Center is introducing modern methods for diagnosing and treating epilepsy in Armenia. Collaborating with colleagues from the University Hospital “St. Ivan Rilski” in Sofia, Bulgaria, our specialists recently performed stereo-EEG, a unique intervention that precisely identifies the source of epileptic seizure activity and facilitates coordination for subsequent surgical treatment. Further details can be found in the video on news.am. 14-year-old Eric, who has been dealing with drug-resistant epilepsy since childhood, now has an opportunity to overcome seizures. He underwent a modern examination at the “Arabkir” medical center, specifically stereo-EEG. This diagnostic and, in some cases, treatment method, accurately identifies epileptic seizure foci in the brain - a procedure performed for the first time in Armenia.   Unlike regular electroencephalography, stereo-EEG is a minimally invasive surgical procedure. Special electrodes are placed in deeper areas of the brain using a stereotactic system, recording epileptic activity.  “Firstly, stereo-EEG is primarily considered a diagnostic method. However, based on its results, a minimally invasive surgical treatment of epilepsy can be undertaken. After placing the electrodes, the neurological team examines all contacts. Upon identifying relevant epileptogenic foci, a discussion is held to determine whether to proceed with coagulation or the surgical removal of the area,” says Sevak Badalyan, a neurosurgeon from the “Arabkir” MC.   Eric’s case presented a unique challenge: despite undergoing various examinations, the epileptogenic focus could not be identified. To achieve accurate diagnosis, 12 electrodes have been placed in his brain, and specialists are monitoring the child’s brain electrical activity to decide the course of further treatment.  “The reason we opted for stereo-EEG in this patient was due to uncertainty about the origin of epileptic activity. While an epileptic focus was visible on the MRI, the description, videotape and EEG did not align. Clinicians entertained doubts that this identified focus was the one to be removed. Therefore, electrodes were placed not only in that focus but also in anterior areas that appeared more suspicious of causing the clinical picture of the seizure.By the second day after electrode placement, we were convinced that our hypothesis was correct. The identified area had no connection with Eric’s epilepsy, and seizures were originating from slightly anteriorly located areas on the same side. This allows us to plan the upcoming surgery accurately” says Biayna Sukhudyan, head of the Neurology and Epileptology service at the “Arabkir” MC.     The first stereo-EEG at the “Arabkir” Medical Center was conducted in collaboration with Bulgarian specialists. According to the pediatric neurologist Petia Dimova from Sofia, they have been working in partnership with Biayna Sukhudyan and the Neurosurgical team at the “Arabkir” MC for 15 years.   “It’s a wonderful team. Although this is the first case, they are already well-versed and capable of conducting similar procedures in the future, thereby assisting patients in Armenia. This hospital, under its management, is dedicated to making all modern diagnostics and treatment methods accessible to citizens, particularly children, in Armenia” says Petya Dimova, a pediatric neurologist from Bulgaria. The specialists are currently monitoring the child’s spontaneous seizures and conducting special stimulation to identify contacts for ablation. While small foci can be addressed with a temporary effect, the ultimate solution for treating the disease involves the surgical removal of the epileptogenic focus.

  Pediatrician Sergey Sargsyan, the head of the Institute of Children and Adolescent Health at the "Arabkir" Medical Complex, addressed questions from the Public Television Company "News" regarding Periodic disease / Familial Mediterranean Fever (FMF), a genetic condition prevalent among Armenians and relatively common in our population. Thanks to the dispensary control service established decades ago, cases of complications related to the disease and its consequential kidney failure have significantly decreased from 16% to 0 among children under the age of 18 with FMF.   Approximately 3600 children diagnosed with FMF are currently undergoing treatment in Armenia, including compatriots under the age of 18 residing in other countries with the same diagnosis. The doctor emphasizes that approximately 400 children receive this diagnosis annually, with a noticeable upward trend in recent years.   According to pediatrician Sergey Sargsyan, the head of the “Arabkir” Medical Center-ICAH “Periodic disease” is a hereditary disorder. Although some may refer to it as the “Yerevanian disease”, it is unrelated to the city of Yerevan. In the international classification, it is known as “familial Mediterranean fever”, affecting people from this region, including Armenians, Sephardic Jews, Arabs, and Turks, who naturally inherited the gene through centuries of mixing with different populations.   The disease can manifest with recurrent fever, abdominal pain, and may even lead to kidney failure. It is prevalent among the Armenian population, with most cases developing before the age of 20, depending on the type of gene.   Dr. Sargsyan explains, “One in five individuals has one gene, but a single gene is insufficient. For the disease to develop, two genes—maternal and paternal—must combine, in most cases.”   While in the 1990s, approximately 16% of children in our country experienced kidney complications before reaching adulthood, the current scenario has changed.    Sargsyan details, “The discovery of the gene, conducted by the Center of Genetics in Armenia, along with subsequent organizational efforts and the implementation of a unique ambassadorial model, where patients visit the center for treatment and check-ups, has led to a remarkable reduction. Today, I can report that the initial 16% has decreased a hundredfold. We now have unique cases where children develop kidney complications, at least in infancy.   The Children's Republican Center for Periodic Diseases at the “Arabkir” Medical Center provides treatment for children aged 0-18 years under the state order. Sergey Sargsyan adds, “People over the age of 18 can also receive appropriate medication and undergo monitoring at the regional health center. Various treatment and control models are available. The crucial aspect is to diagnose the disease promptly and at its earliest stage.

  Despite facing a surge in acute respiratory infections, our doctors have still found time to respond to journalists from various media outlets. The objective is to empower parents with information, ensuring that decisions concerning their child’s health are sensible, accurate and timely.   Anahit Sarukhanyan, a pediatrician from the Reception and Emergency Department, addressed questions from “Armlur”.

  The subject of acute respiratory infections was addressed by Public TV. Meri Marandyan, a pediatrician from the Reception and Emergency Department at the “Arabkir” medical center, provided answers to inquiries.   Listen attentively, stay informed and learn to effectively manage such situations with the appropriate steps. “Arabkir” Medical Center is currently experiencing a significant surge of visitors. The high activity in admissions is attributed to acute respiratory infections typical of the season.   Pediatrician Mary Mardanyan explains, “Most children are admitted already desaturated, exhibiting a bronchiolitis pattern, which is considered as 100% indication for admission to the hospital. This influx is due to the fact that a large percentage of cases involve babies who are oxygen-dependent and require intensive monitoring in hospital conditions.”   The medical center receives almost 120-125 patients daily, with influenza types A and B being prevalent among children.   The doctor advises, “I recommend that all children exhibiting symptoms characteristic of the virus, their parents should, first of all, contact the local pediatrician. The pediatrician will assess the child's condition and, if necessary, provide a referral for the hospital treatment. This approach will reduce both hospital referrals and the primary care/hospital stay of those children who really need us.” While October to May is considered the season for acute respiratory infections in Armenia, there has been a noticeable increase in morbidity in recent days. Romella Abovyan, head of the Department of Epidemiology of Infectious and Non-Infectious Diseases at the National Center of Disease Control of the Ministry of Health of the Republic of Armenia, states, “We are observing cases of influenza A with all its subtypes, circulating influenza B, and other respiratory viral infections such as parainfluenza, adenovirus, respiratory-syncytial (RS) virus, rhinovirus. Additionally, there are recorded cases of co-infections, where a person has multiple viruses simultaneously, like adenovirus with rhinovirus. This naturally complicates the clinical course further. As of the 8th January, we have recorded 1,547 cases in primary care, with 1,105 cases among 0-18-year-olds, constituting 71% of the total cases”.   In other words, compared to the previous day, the number of admissions increased by 1.8 times, compared to the same day last year, it rose by 4.9 times. Daily analysis revealed an increase in both emergency calls and hospitalizations.   Mrs. Abovyan reports, “There were 216 calls, of which 61 were among 0-18-year-olds, constituting 36% of total cases. Additionally, 24 emergency calls for pneumonia were registered, with 3 among 0-18-year-olds.”   As of January 8, 749 patients were hospitalized, marking an increase of 170 from the previous day. Abovyan attributes the sharp increase to people not seeking medical care during weekends.   Romella Abovyan emphasizes, “The Ministry of Health urges people to get vaccinated against the flu. This helps to make the disease easier to bear even if infected, and it’s important to avoid crowded places.”   In case of symptoms, avoid sending children to school and preschool, and consider wearing masks.

  Tamara Chagharyan, a pediatrician from the Reception and Emergency Department at the “Arabkir” medical center, responded to inquiries from “Epikentron” regarding acute respiratory infections.  In winter, acute respiratory viruses become active, with high infectivity primarily through the droplet route. Children constitute the most vulnerable group, accounting for 70% of infected individuals, according to the National Center for Disease Control and Prevention.   Especially during holidays, medical institutions operated with an overcrowded schedule. Viruses tend to spread, particularly during New Year's Eve visits to each other's homes. Pediatrician Tamara Chagharyan notes, “We have a significant increase in respiratory virus cases. While I wouldn't assert that this year's morbidity is higher than previous years - December, January, and February have always been burdened with acute respiratory viruses. Currently, diseases caused by the influenza A subtype virus are prevalent. Additionally, we are seeing frequent cases of respiratory syncytial virus infection.  Though less common among children, confirmed cases of Coronavirus infection are also present.    Common symptoms of the virus include fever, cough, runny nose, shortness of breath, general weakness and nasal congestion. To avoid complications, the pediatrician from the emergency department at the “Arabkir” Medical Complex advises parents against self-medication.   “It is advisable to contact the local pediatrician at the first signs of illness for appropriate advice. If there are symptoms requiring hospitalization, arrangements for the child’s referral to pediatric inpatient care are organized,” says Dr. Chagharyan.    6-year-old Ararat, currently receiving inpatient treatment, has managed to make friends with the other children in the ward in just a few days. Despite not complaining about the symptoms, he feels saddened to bid farewell to his newfound friends too soon.   Ararat expresses, “My friends left, but I stayed.”   The most effective method to avoid and prevent seasonal viruses is vaccination for both adults and children, emphasizes the pediatrician.   “Every year, starting from October and November, parents can apply to the regional polyclinic. Both children and adults should be vaccinated against influenza A and B subtypes. Another preventive method is to minimize contact with patients, frequently disinfect hands, and ventilate closed spaces.”   According to the National Center for Disease Control and Prevention, as of January 7, 579 citizens have been hospitalized, with 90% of them being children under 18 years old. Among those transferred to medical centers, 181 were diagnosed with pneumonia. No deaths from the virus have been reported in the last 10 days. With the start of the academic year, experts predict an increase in the disease.

  The Reception departments of pediatric hospitals experience a surge in activity during this time of the year, primarily due to the prevalence of acute respiratory infections. The most common one during this season is the respiratory syncytial virus. Astghik Baghdasaryan, Head of the Respiratory medicine and Allergology Department at the “Arabkir” medical center, has provided comprehensive insights into acute respiratory infections and their prevention.    If your child has an infection, please contact a pediatrician and adhere to the guidelines for reducing fever:  Lower the temperature if it reaches 38.60C and above, causing discomfort for the child.  If the child has fever but remains active, consider dressing them in light clothing, providing extra fluids, and placing a lukewarm compress on their forehead. When using antipyretic drugs, syrups and suppositories are preferable. For older children, tablets can also be used. Viral infections should not be treated with antibiotics as they have no effect on the virus. Avoid rubbing your child's skin with alcohol, as children’s skin has a well-developed absorbing ability, which can lead to toxic effects.  Remember, that your primary care pediatrician is your first point of contact. Reach out to them, and if inpatient care is considered necessary, they will refer you to the appropriate medical facilities.  

  May this Christmas Eve illuminate the path for everyone, bringing healing to the young and old in need, and welcoming all our beloved ones back home. May we labor in peace and work towards our cherished dream.   Wishing you a Happy New Year and Merry Christmas!

Attention! Dear colleagues, “Arabkir” United Children’s Charitable Foundation is pleased to announce the approval of a support program for professional and scientific development of forcibly displaced medical workers from Artsakh for the year 2024, with a total allocation of 2.400.000 AMD. The program is scheduled to commence on 03.01.2024. Medical workers, including physicians, nurses, lab workers and therapists who have been affected by the siege, war and forced displacement in Artsakh, are invited to apply for the program, without any age restrictions.   The program aims to provide partial financial support, up to 500.000 AMD, for participation in local and international symposia, short-term and long-term courses and training programs. Additionally, financial assistance will be available for publishing articles in internationally recognized, high-impact journals.   The amount of support granted will depend on the rating of the professional program, the extent of participation, and anticipated costs. Applicants are required to submit confirmation of their participation in conferences or other educational programs, details of expected costs, and, in the case of article publication, evidence of acceptance by the journal along with the associated publication fees.   Decisions regarding applications will be made by the board. Preference will be given to applicants with theses accepted for presentation at conferences. Each individual is eligible to apply for the program once a year.   Kindly direct your applications and inquiries to the program coordinator, Biayna Sukhudyan, at [email protected]. Applicants will be informed of the board’s decisions within 10 working days. 

  Dear parents, we've noticed many questions about pneumonia lately. The internet has lots of information about this disease, presenting its causes, classification, symptoms and of course, possible complications, ways of treatment and prevention.   In order not to get confused by the abundant and diverse information, we suggest checking out advice from Dr. Boyajyan. He is the head of the Pediatric-Pulmonology department of the “Arabkir” MC. Follow his advice, timely and accurately fulfill the specialist's appointments, without changing the list or quantity of drugs yourself.   Pneumonia is an acute infectious disease of the lungs, mostly caused by bacteria. Key symptoms:  fatigue and low energy,  fever, cough and shortness of breath, palpitations (fluttering in chest), muscle pain, headaches, abdominal pain. When to see a doctor:  difficulty or rapid breathing in your child,  bluish or grayish color in lips and fingertips, persistent fever of 38C or higher (children under 6 months) or 38.9C (older children). The child might be hospitalized, if: additional oxygen is required, pneumonia complications arise, your child has a chronic disease, medications can't be taken due to nausea or vomiting, no improvement within 48 hours of treatment. Prevention:  vaccinations,  encourage healthy lifestyle and diet.   Treatment: antibacterial therapy (bacterial pneumonia), oxygen therapy,  symptomatic therapy. 

  It is an honor for us to have been a partner of the Fund for Armenian Relief (FAR), particularly in supporting the organization’s medical projects for several years. A dedicated team of experienced specialists from the “Arabkir” medical center actively participates in these projects, serving as trainers for continuing professional development courses. Our doctors and nurses have shared and continue to share their professional knowledge and skills, both in Yerevan and in regions, and, until the recent distressing events, in Artsakh through FAR’s projects.   We express our heartfelt gratitude to FAR for their trust and for fostering exemplary partnership relations.

  Attention! Respected colleagues,   With the efforts of the International Center for Professional Development - ICPD, on December 15 and 16, at 16:00-20:10 Yerevan time, the 2nd Dr. Raffy Hovanessian International Medical Conference on Pediatric Gastroenterology and Hepatology will be held. The target audience is gastroenterologists, hepatologists, colorectal surgeons, endoscopists, pediatricians, pediatric surgeons, general surgeons, family physicians, infectious diseases specialists, anesthesiologists, digestive and metabolic diseases specialists, nutritionists, emergency specialists, intensivists, oncologists, pathologists, diagnostic imaging specialists, diagnostic laboratory specialists, endocrinologists.   Symposia will be held via Zoom. Participation is free of charge and requires mandatory registration. To register, please follow the link. https://cutt.ly/zwOqOsVC   Please remember, that only one person can register per email and participate. In case of incomplete data filling during registration, the participation will be considered invalid. Upon successful registration, a confirmation email will be sent to the registrant's provided email address immediately. The official language is English with simultaneous interpretation into Armenian.   Specialists who participate with 90% attendance in the 2-day conference will receive 8 CME credits.

Dear parents, You often ask us about various diseases, their symptoms, how they’re diagnosed, and treatment options and prevention methods. Among the topics that come up frequently is Familial Mediterranean Fever, which is very common among us.  Professor Gayane Amaryan has stepped up to answer the questions on the “Novosti Armenia” website. Get the lowdown on this condition and find the answers to your questions. 

  The Geneva Central Office of the World Health Organization has initiated a process of updating hospital pediatric guidelines, in which selected experts from all regions of the world participate: from the USA, Great Britain, India, Qatar, African, Asian, South American countries.   Sergey Sargsyan, an expert representing the Eastern European region of the WHO and serving as the head of the Institute of Children and Adolescent Health at "Arabkir" MC, along with his role as a consultant on pediatrics for the Ministry of Health, is actively contributing to this initiative. He served as a co-editor in developing the WHO European guideline for outpatient treatment, published in 2022.   Collaborating with the WHO, the Ministry of Health of the RA is translating the handbook for localized implementation in Armenia.   These combined efforts play a crucial role in developing tailored guidelines for Armenia and significantly enhancing the quality of healthcare for both children and adults.

Dear Pediatricians,   Happy Pediatrician's Day! Your dedication and care for our children are invaluable. The heartfelt drawings adorning the walls of your rooms stand as a testament to the unwavering love and trust your little patients have for you—a trust that serves as the best medicine.    May your health be robust as you continue to heal and nurture our children. Embrace the pure love they radiate, finding joy in every moment of care.

  “Arabkir” Medical Center is hiring nurses on a permanent basis, for shift and day work schedules.     Responsibilities: perform the appointments of doctors accurately and fully, with quality and on time, perform the organization of laboratory and instrumental examinations on time, monitor the results, perform therapeutic care of patients, diagnostic, treatment and prevention interventions according to the doctor’s appointment. Requirements: secondary vocational education, kind, friendly and willing to learn.    To apply, send your CV and motivational letter to [email protected].   

Dear colleagues, We are delighted to present the “Children’s development and developmental delays. Principles of early identification” guidebook. This publication is a collaborative effort between the “Arabkir” United Children’s Charitable Foundation and UNICEF Armenia. It is intended for doctors and nurses.    The publication program for this guidebook has been successfully executed with support from the Russian Federation. The training module was approved and endorsed by the Ministry of Health of Armenia.  The guidebook covers children’s developmental milestones, developmental disorders, detailed information on developmental assessments, early intervention strategies, and guidance for engaging with parents and caregivers.   The guidebook is available on the UNICEF Armenia page and “Arabkir” MC-ICAH website. 

  Dear compatriots, We are delighted to announce that our professional team at the "Arabkir" medical center has expanded with the addition of the following colleagues:   Ernest Lalayan, Pediatrician,  Ruben Khachatryan, Radiologist Armen Abrahamyan, Gastroenterologist and Endoscopist Liana Grigoryan, Speech Therapist   If you require our services, please feel free to register in advance:   for pediatric consultations, please call 015 400 300 and select extension 21 27,  to schedule ultrasonography appointment, please call 010 23 20 20, for GI consultations and endoscopic examinations, please call 015 400 300 and select extension 12 16, for speech therapy sessions, please call 010 26 47 62.

  This video from news.am discusses congenital clubfoot and hip joint dysplasia, the most common pathologies in pediatric orthopedics. Vahe Yavryan, the head of the Orthopedics and Traumatology department of the “Arabkir” medical center, presents details about these conditions.    The two most common conditions in pediatric orthopedics are congenital clubfoot and hip joint dysplasia. According to statistics, the incidence of clubfoot is 1.5 in 1000 newborns. About 40 children are born with hip joint dysplasia, where the joint does not develop properly, and 2 are born with complete joint dislocation. In recent years, significant advancements have been made in the approaches to addressing these two problems, which help prevent disabilities in children. Vahe Yavryan, the head of the Orthopedics and Traumatology department of the “Arabkir” medical center, explains that in the case of clubfoot, children used to undergo several surgeries, and 15 percent of them were disabled for the rest of their lives. However, everything changed in the 2000s when the Ponseti method was introduced. This method was brought to Armenia by Vahe Yavryan himself in 2012  after studying at Iowa University at the workplace of its author, Ignacio Ponseti, and then returning to the “Arabkir” medical center.  “The Ponseti method is a special casting technique that must be performed exactly as described. Its effectiveness has been proven through the treatment of millions of children with clubfoot. Following this, the second stage involves a subcutaneous tenotomy of the achilles tendon. This stage is necessary for 95 percent of children with clubfoot. Subsequently, the third stage requires children to wear braces. In Armenia, “Iowa” braces are used. While there are other types of braces available, the “Iowa” brace was designed by the University of Iowa. These three components of treatment are equally vital. In other words, it cannot be stated that minor surgery, casting or the brace is more important: the combination of these elements produces the result we have today,” says doctor Yavryan.    Thanks to this method, no child in Armenia has undergone complex surgery since 2012, and no child has suffered from disability due to clubfoot.  “Now we consider the sole, which not only rests on its entire surface but also retains its functionality and the range of movements in joints, as a significant treatment outcome. I always tell parents that if we adhere to the protocol, and if you want your child to play football, they can play football with that sole” he says.    Vahe Yavryan also points out that parents themselves can easily diagnose clubfoot: the sole cannot be straightened by hand. “Congenital clubfoot is a 4-component deformity that cannot be corrected with simple hand movement. The problem lies in the connective tissue and, most of the time, in the shortness of ligaments, leading to the dislocation and subluxation of the bones that make up the sole. It is impossible to confuse this with positional problems, which may be present in the prenatal stage and can be easily corrected by hand. I typically tell my students that there’s no need for a doctor to diagnose clubfoot because it’s such a visible deformity that parents can notice after childbirth. If the deformity is fully corrected by hand, it means it’s not a congenital clubfoot” says the pediatric traumatologist.   The doctor presents a complex clinical case: recently, a 5-year-old child was admitted to the hospital who had not received any treatment for clubfoot. “It was unusual for us that the child had not received any treatment before. Previously, it would have been difficult to imagine that a 5-year-old clubfoot could be treated with casting. However, as we are familiar with the literature and know that the Ponseti method is used not only for newborns, and there are articles about 10 year olds, so we decided to treat the child using this method. The child received 7 casts, after which we performed a subcutaneous tenotomy of the Achilles tendon and now the child is wearing orthosis. The results were satisfying. We have a sole that rests on the entire surface and is quite functional for a 5-year-old untreated case” he says.    And what are dysplasia and dislocation of the hip joint? The doctor mentions that there is a misunderstanding about the dislocation of the hip joint, as it is a result of birth. In reality, it is a congenital problem: dysplasia or underdevelopment of the joint, and the last stage being the dislocation.    “This has been a significant issue for orthopedics because the clinical examination and symptoms that we knew and still know, allowed us to diagnose the children who were born with joint dislocation and therefore, severely limited diagnosis those children who were born with dysplasia. In addition to clinical examination we had an alternative - X-ray, which did not allow us to make a diagnosis. From the 1960s-70s, sonographic examination of hip joints in newborns began to be applied and was eventually introduced by Austrian Professor Graf. Later it was accepted by the medical community as a proven diagnostic method and is now considered the gold standard of diagnosis” the specialist says.     Vahe Yavryan studied under Graf in Austria and then tested the method for a year in one of the maternity hospitals in Yerevan. After long-term collaboration with the Ministry of Health, ultrasound screening for hip joint issues was introduced in Armenia as part of the nationwide newborn screening program. Doctor Yavryan takes pride in noting that not all European countries have such screening programs. Thanks to the program, today in Armenia, children with disabilities caused by this problem are a rare occurrence. “The method has very high accuracy, approximately 99.9 percent. It allows us to detect even the smallest underdeveloped hip joint and take appropriate measures so that the child receives treatment in a timely manner. In 2007, according to official data, every year in the Republic of Armenia, we had 20 children who became 1st degree disabled due to dislocation or developmental dislocation of the hip joint. This is why the disability rate in our country was the highest. When I was just starting, my teacher performed open surgeries on nearly 30 children. To understand the changes that the screening has brought to our country, I can say that last year, there were only 4 cases due to hip joint dislocation. There is a golden rule, according to which we have early and late diagnosis. Early diagnosis is made within the first 3 months of the problem. When we initiate the treatment at that time, we can determine if it’s dysplastic or dislocated, and the probability of achieving an anatomically good, functional joint is 98 percent throughout one’s entire life,” says Yavryan.   At the “Arabkir” medical center, parents are provided with a special information sheet that provides detailed guidance on caring for a child with hip joint dysplasia to prevent joint dislocation. 

  Dear colleagues, We kindly inform you that on October 20-21, from 13:00 to 19:00, the joint pediatric conference of the Armenian Pediatric Association, the “Armenian Eyecare Project” Charitable Organization, and Children’s Hospital Los Angeles will take place at the DoubleTree by Hilton hotel Conference hall. The conference will be held in a hybrid format. For further details, please visit: https://learnwithopen.org/.../aecp-chla-21th.../ Advance registration is required. Registration link: https://us02web.zoom.us/.../WN_hRE5hbERQ5225YMb50asTg... Participants will receive CME credits from the Ministry of Health of the RA.

  The Public TV report on brave Mkrtich. The boy suffered shrapnel wounds in Vank village, Martakert. For the past few days, Vazgen has been caressing his son with extreme care, almost not touching. He dreads causing any more pain to his son. There are hundreds of pieces of shrapnel in his 13-year-old son’s body. He shares a recent photo taken in the hospital, relieved that his son is looking better now.   Vazgen Hovoyan: “My wife sent me to take pictures of our children. When I returned, she was out of the operating room.” His wife is also dealing with shrapnel wounds, and she is undergoing treatment in a different hospital.    They used to live in Vank village in Martakert after the 2020 war, having moved from Dadivank.    Mkrtich Hovoyan: “We were at home, just sitting, when…”   An explosion occurred. AnAzerbaijani missile, originally aimed at civilian objects, landed directly on their house.   Mkrtich Hovoyan: “First, there was a yellow light, then an explosion. Everything turned black afterwards. And…I woke up, but I can't remember whether I fell or not…My chest hurt, and I got back on my feet.”   They transported him to the hospital and performed two surgeries.   Albert Lalazaryan, Pediatric Surgeon: “He had a multifragmentary fracture of the left mandibular ramus, fortunately without displacement. He also had a first left rib fracture, again without displacement. In addition, he has a foreign body (fragments from the bomb) in the lower lobe of the left lung, with a lower lobe contusion of the left lung and hemothorax. There was also a foreign body in his spleen.”   His stomach was wounded in three parts, his small bowels in 15 places, and the large bowel in one.  Albert Lalazaryan, Pediatric Surgeon: “He underwent a surgery, during which a colostomy was created on the left side.” Mkrtich Hovoyan: “At first, these two wounds caused intense pain, and I couldn’t move my hand like this. But over time, these wounds healed.”    There was a foreign body in his right wrist area.     Mkrtich Hovoyan: “I could not feel my finger up to this part, and my thumb hurt as well. Surgeons operated on it, and now I can move all my fingers, except the thumb, which still hurts.”   Even today, he carries numerous shrapnel fragments in his soft tissue, from head to toe.   Albert Lalazaryan: “The most significant risk we face today is the fragment lodged in his lower lobe of the lung, which can damage the lung tissue during breathing movements and could, at some point, come into proximity with major blood vessels, potentially causing severe bleeding.”   Currently, they are awaiting removal of the fragment, which may also necessitate the removal of a part of his lung. Another concern is the foreign body in his spleen.   Albert Lalazaryan: “The fragment in the spleen is currently stable, and the risk of bleeding is relatively low, but there is a potential risk of infection. If an infection were to occur in the spleen, it would present a problem and we might need to consider spleen removal.”   Specialists assure that the effects of shrapnel wounds will become noticeable in the months ahead. However, Mkrtich remains positive and resolute:   Mkrtich Hovoyan: “Everything is going well.”