Journal of Clinical Medicine of Kazakhstan

J Clin Med Kaz 2015;1(35):11-14

Authors: Tuba Tülay Koca, Aydın Arslan

Juvenile idiopathic arthritis (JIA) is the most common inflammatory disease in childhood. JIA is subdivided into six categories, all of which differ in etiological factors, clinical phenotype, prognosis, laboratory tests and response to therapy. To start appropriate treatment in patients with JIA and to inform patients correctly, it is essential to know the individual prognosis. This emphasizes the need for research on novel and more accurate biomarkers to assess disease acitivity. A biomarker comprises small samples from the patient such as blood, urine and saliva, obtained by non-invasive techniques. These serum biomarkers such as S100 proteins (S100A12,S1008/9), myelin related proteins (MRP8/14), single nucleotide polymorphism (SNPs) and newly vectra DA have been suggested for the prediction of disease course and relapse risk. İn this review we summarize the biomarkers for JIA.

J Clin Med Kaz 2015;1(35):21-25

Authors: Arystan Seidalin, Adilzhan Albazarov, Rahim Tojiboyev, Saule Nurakaeva, Ayana Sygay, Vladimir Dikolayev

The aim: Assessment of a surgical treatment modality for patients with an obstructive hypertrophic cardiomyopathy. Materials and methods: From 2013 to 2014 year cardiac surgery department of National Scientific Medical Center (Astana, Kazakhstan) performed 14 procedures for correction of an obstructive cardiomyopathy. Morrow procedure in isolated form or in combination with correction of other cardiac pathology had been utilized. Isolated form of Morrow procedure was used in 3 patients (21.4%), in other 11 cases in combination with coronary artery bypass surgery (CABG) – 3 (21,4%); CABG with mitral valve repair – 6 (42,8%); David procedure – 1 and a section of the myocardium muscular bridge – 1 case. Results: early and long-term results of surgical correction of an obstructive cardiomyopathy are presented. The average pressure gradient was 13.9 + 6 mm Hg (prior to operation of 79.7+61.3 mm Hg). Average thickness of the interventricular septum after myomectomy was 13,7 + 3,3 mm (prior to surgery 23.1+3.2 mm). In cases when correction of valve pathology was performed simultaneously, function of valves by echocardiographic control was also estimated (size of gradient and regurgitation). Satisfactory clinical results were obtained in 12 patients. Two patients died in early postoperative period. Conclusions: we recommend expanded myomectomy techniques, as opposed to classical Morow procedure. Our department experience with these procedures shows that this approach leads to considerable clinical improvements in the patients with obstruction of the left ventricular outflow tract.

J Clin Med Kaz 2015;1(35):30-33

Authors: Berik Koichubekov, Anuar Shaikhin

The aim of this study was to demonstrate effectiveness of biofeedback in the correction of mental and emotional state in patients with metabolic syndrome. Methods. 31 volunteer patients with metabolic syndrome between the ages of 18 to 45 years of Regional Clinical Hospital of Karaganda were selected to participate in the study. Biofeedback sessions conducted on software-hardware complex "Morskiye glubiny." Evaluation of psycho-emotional state was carried out on five grounds and carried out prior to the study, in the middle and after the last session. For comparison of dependent groups was used nonparametric Wilcoxon U-test. Results. Analysis of the data showed a statistically significant reduction in the main indicators of mental and emotional stress, such as mental stress, asthenic condition, trait anxiety, and reactive anxiety. Conclusion. The study and the data show the effectiveness of biofeedback method for the correction of mental and emotional stress in patients with metabolic syndrome.

J Clin Med Kaz 2015;1(35):40-44

Authors: Assel Matalipova, Leonid Karp, Tatyana Potapchuk, Bakhyt Seisebayeva

The objective of the research is to identify problems/issues related to the professional development of the doctors in rural healthcare service. Materials and methods. The combined research approach has been applied as the design of the Research, which included a quantitative collection of the statistical data and qualitative characteristics expressed in obtaining personal opinion of the doctors about the problems existing in the area of professional development. A social survey has been conducted (anonymously filled questionnaires) among the rural doctors on the Northern Kazakhstan (Akmola and North Kazakhstan Oblast). “Survey on Studying Professional Development of the Healthcare Personnel in Rural Healthcare” consisted of 48 questions of open-end and closed questions. With the help of a mechanical random (non-repeated) sampling 175 doctors from central district (rayon) hospitals have been selected. The selection of the observation unit from among the general population has been carried out by applying the random number table. Considering the total number of the rural doctors in two oblasts the selected sampling plays only a representative role. The statistical tools included calculation of extensive indicators (indicators of distribution). For comparing statistical significance of the group a fitting criteria (chi-square) has been applied. Results. The Research identified that the majority of the doctors have a desire to enhance and further develop their professional skills; a great number of the surveyed respondents (86,7%) would love to upgrade their professional level. The doctors, who have attended refresher courses/trainings, were able, upon return to work, apply in practice the knowledge they have acquired, and this contributed to the enhancement of their professional skills. The survey on the frequency/periodicity of the post-graduate education have shown that over half (54,2%) of the responding doctors consider that training (further development) of the doctors once in five years would be feasible. For that purpose the majority of the responding doctors (40,6%) wish to be trained/to develop their professional skills at the Medical University, 36,5% - at the Oblast Center where the specialists from the capital would be invited too, 22,9% prefer to travel to another region. It was recorded that many forms of the professional development (participation in international conferences and workshops, trainings at the leading national and international clinics) are not available to the major part of the employees. Conclusion. The analysis of the ways of professional development, in general, revealed satisfaction of the doctors in rural healthcare service in the context of the subject matter. The majority of the doctors strive towards professional growth and development, which shows the existing potential. Almost half of the responding doctors (56,0%) were able to apply in practice the acquired knowledge, which has enhanced their practical skills as well.

J Clin Med Kaz 2015;1(35):51-54

Authors: Doszhanova G., Abduldayeva A., Maulenkul T., Beketay G.

The aim - to assess the health status of older people, depending on their age and gender identity. The health status of the elderly was studied based on the assessment of the physical condition and adaptive capacity. Materials and Methods: We used materials of primary and secondary sources on the following methods: information - analytical, content analysis, ratios, comparison indications, indications of visuality, statistical and causative - consecutive methods. The study group included 133 people aged 60-89 years, including men-50.4% and women - 49.6% living in Astana. Out of them elderly - 74.4% of people, senile age - 25.6% of people with an average age - 71 years. Elderly men accounted for - 42%, senile - 9% among older women, this figure was 33% and 16% of senile age women, respectively. Results: The index of the physical condition in older men and women was 0.432 ± 0.02 and 0.419 ± 0.01 in men and women of senile age, the figure was 0.205 ± 2.19 and 0.362 ± 1.16. The range of index values of physical condition in older men corresponds to below-average level of physical condition in older women it is equal to the average level. People of senile age the range of the index of physical condition in men and women corresponds to a low and below the average level. Group III health is observed in male and female of elderly and senile age, as well as in elderly women with lower adaptive capacity of 3.49 points (poor adaptation), and Group IV the lowest health is observed in senile age men, whose adaptive capacity is above 3. 5 points (failure of adaptation). Conclusion: Analyzing the results obtained it may be noted overvoltage regulation systems, accompanied by a change in the level of inadequate functioning of the main systems of the body and the presence of pathological diseases in elderly and senile decompensation, which is more pronounced, manifested in men than in women that lead to the disruption of adaptation.

J Clin Med Kaz 2015;1(35):59-61

Authors: Tuba Tülay Koca

Joint hypermobility is a connective tissue disorder commonly seen in childhood and adolescence. The Beighton hypermobilty score is an easy and practical method to determine joint laxity and hypermobility. Some major and minor criteria based on symptoms and objective signs (arthralgia, back pain, spondylosis, spondylolysis/lystesis, dislocation/subluxation, scoliosis, soft tissue rheumatism, marfanoid habitus, skin hyperextensibility, ocular symptoms, varicose veins, hernia, uterine/rectal prolapse) have been determined for diagnosis of benign hypermobility syndrome. A 13 year-old female presented with long-standing complaints of anterior knee pain which increased at night in particular, also pain and stiffness in her pain. She was of thin and tall phenotype. İn her medical history, frequent ankle sprains were reported. İn her physical examination determined dropping eyelids, myofascial tender points in the trapezius muscle, hyperextensible elbows, wrists, thumbs, metacarpophalangeal and knee joints and moisture on palmar aspect of the hands. Laboratory parameters and conventional radiographic observations were normal. In benign hypermobility syndrome, clumsiness, motor retardation, poor coordination, recurrent joint sprains and limited school-based activities may be seen in the history and examination. Delayed diagnosis may lead to poor control of pain, limitations in home-life, schooling and daily activities. We recommend to patient to use joint protective methods, to make modifications in daily life, to avoid heavy physical activities and use pain-relief medication.

J Clin Med Kaz 2015;1(35):66-68

Authors: Aigul Abdrakhmanova, Vitaliy Koikov, Banu Khandillayeva

The article analyzes the staffing of health facilities and analysis of the current state of training for the health care organizations universities in the Republic of Kazakhstan. The main problem of Health: imbalance and low-skilled personnel, which is largely a consequence of the imperfect system of training organizations Medical Education. The solution to this problem requires a revision of state standards of medical education at the undergraduate, internship and residency with clearly defined deliverables: list of knowledge skills that graduates should possess medical graduates.