Journal of Clinical Medicine of Kazakhstan

J Clin Med Kaz 2014;4(34):5-9

Authors: Aigul Abdrakhmanova, Zaure Baygozhina, Maral Kaliyeva

During the years of the Soviet system nurses had lost their independence, initiative, creative approach to work, which led to the low level of professional competence and professional status of nurses. Global changes in Kazakhstan health system are largely dependent on the competence of medical staff, particularly nurses. New generation nurses training in – Bachelor of Nursing will not only improve the profession’s prestige, but will provide the opportunity to transfer a large share of the doctors functionality to nurses, and subsequently will improve the deficiency of medical staff.

J Clin Med Kaz 2014;4(34):20-24

Authors: Almagul Zhussupova, Agzam Zhumadilov, Sholpan Nurmanova, Alexander Zlotnik, Askhat Bekmukhanbetov, Marat Abduov, Igor Kim

Currently, much attention has been paid to the value of the presence of biomarkers in blood and cerebrospinal fluid in acute ischemic stroke. The results of experimental studies have shown that an increase in biomarkers particularly glutamate demonstrated high sensitivity and specificity with a positive prognostic value. High levels of glutamate could be regarded as a marker for high risk of development of cerebral tissue infarction. However, the fact that the reduced level of glutamate in the blood of patients with an ischemic stroke might lead to positive results need to be confirmed in further clinical studies.

J Clin Med Kaz 2014;4(34):30-33

Authors: Gulzhan Alibekova, Saule Abisheva

This review article presents the results of randomized, multicenter studies on the use of various forms of methotrexate in the world. The analysis of effectiveness and safety, as well as the side effects of the drug has been conducted. According to the review of the articles subcutaneous forms of methotrexate have better bioavailability than the oral forms, even when starting with a low dose. Accordingly high doses are absorbed better. The gradual increase in subcutaneous dose provides linear gain in effect, unlike the oral forms. The article is recommended to rheumatologists, physicians and general practitioners. Volume 4, Number 34 (2014)

J Clin Med Kaz 2014;4(34):40-45

Authors: Almaz Makenjan uulu

The aim of our research to study opportunities and effectiveness of the internal iliac artery ligation in the management of severe obstetric hemorrhage in the conditions of emergency obstetric care. Methods. We analyzed 328 cases of emergency treatment of severe obstetric hemorrhage in the various levels of health facilities of the Kyrgyz Republic from January 2004 to December 2013. The control group comprised 149 cases of obstetric hemorrhage, which was produced by a hysterectomy as the primary surgical method to stop bleeding (traditional method). The main group - comprised 179 cases of hysterectomy combined with ligation of the internal iliac arteries. According to the methods used study was divided into 2 subgroups. Subgroup 1A 68 cases where hysterectomy as a method of haemostasis was ineffective and subsequently ligation of internal iliac arteries was used to achieve definite haemostasis. Subgroup 1B 111 cases in which initially ligation of internal iliac arteries was used to stop haemorrhage and then a hysterectomy was used for medical reasons. Results. The use of ligation of internal iliac arteries reduce the amount of intraoperative blood loss and improves the final outcome of an emergency situation. In the main group there was no patient mortality. In the control group mortality was 34.2% of all cases. The cause of death is mainly due to uncontrolled bleeding and the development of multiple organ system failure. Conclusion. Timely internal iliac artery ligation is an effective method to combat the massive blood loss, and reduces the amount of additional blood loss. Volume 4, Number 34 (2014)

J Clin Med Kaz 2014;4(34):49-53

Authors: Nikolay Scherbina, Mikhail Makarenko, Iryna Kuzmina

The aim: study significance of fetal thrombophilias (FT) in development of different forms of fetal growth restriction syndrome (FGRS). Methods: The method of polymerase chain reactions was conducted to analyze blood from umbilical cord for FT of 77 new-born children with symmetric form (25 newborns - 1st group), and asymmetric form (52 – 2nd group) of SGIF and at 30 healthy new-borns (control group). Analysis of inherited fetal thrombophilia included: polymorphism of factor of V Leiden, determination of mutation of gene of folate dependent enzyme of methylene-tetra-hydrofolate reductase MTHFR С677Т, polymorphism «4 G/5G» in the gene of inhibitor of activator of plasminogen I type of PAI - I, polymorphism of «I/D» in the gene of tissue activator of plasminogen, polymorphism in the gene of Hageman’s factor FHag «46С/Т », polymorphism of «- 455G/A» in the gene of Fibrinogenum, and also mutation in the gene of prothrombin of G20210A and multigene form of thrombophilias. Results: The fetal inherited thrombophilias identified in the different forms of SGIF. Frequency of their discovery of the symmetric form of SGIF substantially higher in comparison to the asymmetric form of FGRS. Combination of a few mutations predominates among the studied forms of FGRS. Fetal thrombophilias are important differentially-diagnostic signs of development of various forms of FGRS. Conclusion: Research of fetal thrombophilias allows to use them as markers of development of one or another form of FGRS and confirm genetic nature of development of symmetric form of FGRS. Volume 4, Number 34 (2014)

J Clin Med Kaz 2014;4(34):58-60

Authors: Xeniya Chshugareva, Alexey Pak

Histiocytosis X is a disease with unclarified etiology. Pathomorphological characteristic of the disease is based on formation of unique granulomas which affect various organs and tissues. Lung involvement can procced in an asymptomic manner. Typical symptoms of pulmonary histiocytosis X are: labored breathing, nonproductive cough, tiredness and/or pleuritic chest pain, sudden spontaneous pneumothoraxes might develop in some patients. Death might proceed after few months. Volume 4, Number 34 (2014)

J Clin Med Kaz 2014;4(34):66-69

Authors: Yernur Ainayev, Yersaiyn Zhiyenbayev, Ulanbek Balpukov, Zhexembay Bakyt, Gafur Khairli

This message is clinical report of case of treatment of Peyronie disease using oral mucosa graft during the operation corporoplasty. Patient with severe dorsal deformity of a penis was operated in our clinic. During the operation, we used oral mucosa graft for closing defect of tunica albuginea. Satisfactory results were achieved in postoperative period such as reduction in the angle of curvature of the erect penis fromabout 55 to 10 degrees, maintaining morning erections, disappearance of pain during erection. Volume 4, Number 34 (2014)

J Clin Med Kaz 2014;4(34):75-76

Authors: Zhanna Khamzina

This message describes the results of a study aimed at investigating the effectiveness of the implementation of innovative methods of fundin of inpatient care. The study showed that the results of the reforms Unified national health system which aims to reduce the volume of inpatient services and budget, contributed to the improvement of the whole system of health care funding in Kazakhstan. Volume 4, Number 34 (2014)

J Clin Med Kaz 2014; 3(33):8-12

Authors: Gunay Akbarova

It is presented an overview of the results of own studies in 39 settlements of Mugan, Shirvan, Ganja and Lenkoran-Kazakh economic regions of Azerbaijan during the period since 2005 to 2013 in this article. It was diagnosed the types of congenital and hereditary abnormalities, installed options of inheritance and frequency of their distribution by means of biochemical, hematological and molecular-genetic methods. The additional analysis by Reverse Dott-Blot Hybridization StripAssay and Big DyeTM Terminator DNA methods were hold in ambiguous clinical and laboratory results. The obtained results will make the basis of nation-wide register of congenital and hereditary diseases and will help in the differential diagnosis and treatment.

J Clin Med Kaz 2014; 3(33):17-21

Authors: Nelya Bissenova, Aigerim Yergaliyeva

The aim of this study was to analyses etiological structure from sputum of patients with progressive respiratory infections. Materials and methods. The sputum of hospitalized patients diagnosed with progressive respiratory infection during 2009-2013 was included to the prospective bacteriological study. Initial seeding material conducted a quantitative method on nutrient medium according to guidelines. The identification of isolates and antibiotic susceptibility testing were performed by microbiological analyzer Microtax, MiniApi and Vitek 2-Compact. The etiological factor was defined at a concentration of 106 and above. The results were subjected to statistical analysis. We determined averages, an averages error (m), Students test, a confidence interval (p). The probability of null hypothesis did not exceed 0.05 (p<0.05). Results. A total of 838 strains (43 species) were obtained from sputum of patients with progressive respiratory infections during 2009-2013. Streptococcus pneumoniae was determined in 337 (40.2%) strains, Moraxella catarrhalis – 17.0%, Streptococcus viridans – 12.1%, Streptococcus pyogenes – 6.3%, Staphylococcus aureus – 4.4%, Pseudomonas aeruginosa – 2.1% of total isolates. Conclusions. Streptococcus pneumoniae and Moraxella catarrhalis were the most frequently pathogens (40.2% and 17.0% respectively) from sputum of patients with progressive respiratory infections in our region.

J Clin Med Kaz 2014; 3(33):29-31

Authors: Ilknur Sahin, Ilknur Albayrak, Fatih Pektas, Sevket Arslan, Ali Yavuz Karahan, Adem Kucuk

Familial Mediterranean fever (FMF) is an auto-inflammatory disease characterized by recurrent attacks of fever and serositis. Limited data suggest that the prevalence of sacroiliitis is increased in patients with FMF. Ankylosing spondylitis (AS) is a common inflammatory rheumatic disease characterized by inflammation of the axial joints, peripheral oligoarthritis, and enthesitis. Symptoms related to back pain should be investigated thoroughly in order to diagnose AS and distinguish symptoms related to it from FMF. We presented a 46 year old man who diagnosed FMF and AS.

J Clin Med Kaz 2014; 3(33):34-38

Authors: Arystan Seidalin, Adilzhan Albazarov, Rahim Tojiboyev, Timur Sarsengaliyev, Vladimir Dikolayev, Aidos Yerpashov

This message is clinical report of rare case of traumatic false aneurism of a descending thoracic aorta as a result of blunt trauma and aneurism of abdomen aorta and right iliac artery caused by injury of the right hip with formation of an arterio-venous fistula. Patient has been traumatized in a car accident. However, injury of thoracic and abdomen aorta were found much later (in 22 years) when there were symptoms of heart failure. In our clinic the patient was delivered "on a stretcher" with the expressed decompensation of heart function.

J Clin Med Kaz 2014; 3(33):41-43

Authors: Yerkebulan Burkitbayev

The purpose of this article was to consider various scenarios of realization of a strategic paradigm, and, first of all, from the point of view of probability of approach of the most adverse probable scenario conditions. This Article considers the key parameters and characteristics of the most significant risks from external and internal environment of JSC “National Medical Holding” by SWOT method. It allowed to give a structured description of the situation at JSC “National Medical Holding” and to give an initial assessment of the current situation.

J Clin Med Kaz 2014; 3(33):47-48

Authors: А.K. Segizbayeva, S.А. Shaimerdenov, V.S. Rakhmetova

Complex approach of the Center for Hepatology of Astana city to diagnosis and treatment of chronic viral hepatitis is presented in this material.

J Clin Med Kaz 2014;2(32):8-13

Authors: Mukhit Dossov, Anatoliy Kolos

Respiratory diseases worldwide is one of the major causes of morbidity and mortality. Increases search treatments that prevent the development of inappropriate ventilation after thoracic surgery. In this regard, non-invasive assisted ventilation is a promising method. In the world of medical practice devoted a lot of work on this topic. Despite the variety and quantity of data research, there is no consensus on the relative effectiveness and feasibility of non-invasive ventilation. Results of these studies is impossible to introduce domestic medical practice due to lack of consensus and solutions. That is, there is a need for the results of our study. So, it is important to note the lack of clear guidelines in relation parameters (PEEP, Rasb) non-invasive ventilation. Therefore, given the Results of this review, to determine the optimal parameters of non-invasive ventilation and performance evaluation of this method is our purpose to.

J Clin Med Kaz 2014;2(32):21-25

Authors: Gulziya Ismailova, Raushan Rakhimzhanova, Galiya Kadyrova

Lung cancer (LC) is the main reason of cancer mortality at around the world. Shortage of clinical signs of an early stage often leads to diagnostics of LC at late stage. Current of LC is aggravated by smoking factor which promotes cancer development with heavy KRAS mutation. LC with KRAS mutation has very bad prognosis, a treatment strategy is only standard, and effective treatment of cancer with KRAS mutation are absent in the world. Overall survival rate is 2-6 months from beginning the clinical manifestations. The only opportunity to increase of the overall survival rate at patient’s cohort is detection of LC at early stage, before clinical manifestations. Low-dose computer tomography is the most effective screening method for diagnostics of early LC.

J Clin Med Kaz 2014;2(32):33-37

Authors: Nelya Bissenova, Aigerim Yergaliyeva

The aim of this study was to analyses the antibiotic susceptibility of Streptococcus pneumoniae strains isolated from patients with progressive respiratory infections. Methods. Sputum of hospitalized patients diagnosed with progressive respiratory infection during 2009-2013 was included to the prospective bacteriological study. Initial seeding material conducted a quantitative method on nutrient medium according to guidelines. The identification of isolates and antibiotic susceptibility testing were performed by microbiological analyzer Microtax, MiniApi, Vitek 2-Compact. The etiological factor was defined at a concentration of 106 and above. The results were subjected to statistical analysis. We determined averages, an averages error (m), Students test, a confidence interval (p). The probability of null hypothesis did not exceed 0.05 (p<0.05). Results. Streptococcus pneumoniae was the most frequently isolated from sputum with progressive respiratory infection. Antibiotic susceptibility testing showed that Streptococcus pneumoniae had 100% susceptibility to vancomycin. The susceptibility to beta-lactams ranged from 56.6% to penicillin up to 80.1% to cefuroxime. The most activity from quinolones was levofloxacin – 82.6% susceptibility strains of Streptococcus pneumoniae. Macrolides showed susceptibility rate below 50%. Conclusions. 1) Streptococcus pneumoniae had 100% susceptibility to vancomycin. 2) The susceptibility of Streptococcus pneumoniae was above 80% to levofloxacin, cefuroxime, ceftriaxone.

J Clin Med Kaz 2014;2(32):43-48

Authors: Mukhit Dossov, Murat Smailov, Anatoliy Kolos, Rahim Tojiboyev

Aim: To evaluate the effectiveness and appropriateness of the non-invasive ventilation (NIV) after thoracic surgery. Methods: We have studied 2 groups of patients: the first group included 32 patients, who in the early postoperative period were performed NIV and a second group with 30 patients who received standard therapy. The physical parameters, blood gas levels, the length of stay in the intensive care department and patient satisfaction on a visual analog scale were evaluated. NIV sessions conducted up to 3 hours immediately after extubation in CPAP mode with the following parameters: starting from PEEP 4mbar and increasing every 10 minutes for 2 mbar until 10 mbar. Results: During NIV systolic blood pressure in the first group was lower than in the second group (p <0,05). Blood gas levels (PaO 2) and respiratory index (PaO2/FiO2) was significantly higher in the first group. NIV with PEEP to 6mbar was rated "satisfactory" by 37.5% of patients and was rated as "good" by 65.6% of patients. More than 90% of patients rated "excellent" NIV with PEEP 4 mbar and 6mbar. Patients of the first group was transferred from ICU to clinical ward for one hour earlier (p <0.05) than those of the second group. Conclusions: NIV was effectively with 6mbar of PEEP in patients after thoracic surgery and improved hemodynamic and blood gas parameters.

J Clin Med Kaz 2014;2(32):54-59

Authors: Farida Bayserkina

The aim of research was to conduct a comparative analysis and identify the main trends in infant mortality in Kazakhstan by regions for 1991-2012 years. Methods: The source of served as a summary of the births and deaths of children under 1 year of age in the Republic of Kazakhstan by regions in 1991-2012 year. Conducted a retrospective research of infant mortality in the Republic of Kazakhstan for 14 years and regions. Almaty and Astana using statistical indicators of demographic yearbooks submitted Kazakhstan Agency for Statistics. Absolute and relative mortality ratio was used for purpose of study the demographic indicators. The object of study included children aged under 5 years old who died from various causes of death. International Classification of Diseases and Health was used 10 reviews for coding causes of death (ICD -10). Results: In Kazakhstan, the highest rates of infant mortality have been recorded in Kyzylorda - 25.1 (per 1,000 live births), South Kazakhstan region - 25, Zhambyl - 23.8, East Kazakhstan - 22.5, Aktobe - 20.9, Karaganda - 20.7. Birth rate increased and was 20.4 per 1000 people. Among the causes of infant mortality rank first conditions originating in the perinatal period (82.3%), second - congenital malformations (17.8%), the third - respiratory diseases (8.5%) and the fourth - other. In the Southern region has features seasonally adjusted mortality rate for children on the first year of life. If the infant mortality rate in the country is slightly higher in July, August, January and February, the South Kazakhstan region of the peak index falls in June, July, August and September. Therefore, this calls for careful attention to the summer peak of infant mortality. Success in its reduction will depend on how effective will be measures against seasonal outbreaks of intestinal infections in the region. Conclusions:Analysis of the structure of causes of maternal mortality characterizes adverse health trends babies first year of life, in the structure of causes of infant mortality in the ten years of the Republic of Kazakhstan place I occupy conditions originating in the perinatal period, congenital malformations. What can be said about the diseases of the respiratory system, where rates have dropped significantly, but continues to occupy third place due to high mortality rates in areas such as South Kazakhstan, Akmola, Kyzylorda, Mangystau.

J Clin Med Kaz 2014;2(32):65-68

Authors: Elmira Chuvakova, Timur Sarsengaliyev, Boris Tsoy

Coarctation of heart aorta is a serious congenital defect of the aorta manifested in the narrowing of the aorta. Absence of treatment of that defect can result in a heart failure or death. Multi-bar Scanner is one of the best and available diagnostic methods. The value of CT in the visualization of aortic coarctation is discussed in the article. If any signs or symptoms should appear, the most common symptom is high blood pressure (hypertension), shortness of breath, especially during physical exercise, headache, muscle weakness, leg cramps or cold feet.

J Clin Med Kaz 2014;2(32):73-75

Authors: Yuriy Kim, Samat Saparbayev, Bolatbek Kayupov, Zhuldyzay Kassymova, Aynara Darbayeva

After liver transplantation due to recurrent HCV infection, recurrence of hepatocellular carcinoma is common. It leads to graft loss and patient’s death. Adoptive immunotherapy based on natural killers has huge potential in prevention of hepatitis C recurrence and subsequent hepatocellular carcinoma development.

7-16

Authors: Б.А. Каюпов, С.С. Сапарбаев, С.К. Уалиева, Ж.А. Касымова

В данной статье представлен аналитический обзор по вопросу применения стволовые клетки в комплексном лечении хронической почечной недостаточности. По всему миру отмечается неуклонный рост числа больных, нуждающихся в длительной (пожизненной) заместительной терапии гемодиализом или в трансплантации почки. Во всех экономически развитых странах число вновь поступающих на диализ больных превышает число умерших, а общая группа пациентов, получающих заместительную почечную терапию, постоянно увеличивается. Несмотря на достаточно широкое использование в клинике фетальных клеток и тканей, остаются нерешенными многие теоретические вопросы фетотрансплантации. Данный факт диктует необходимость проведения широкого спектра теоретических и прикладных работ с эмбриональными и фетальными клетками.

20-25

Authors: В.Х. Алтынова, А.Ж. Айнакулов, Н.Б. Нигматуллина, Н.М. Мустапаева, С.С. Рахимжанова, М.А. Хван, М.Б. Бамыш, Н.Б. Амреева

Трансплантация почки у детей в сравнении с гемодиализом и перитонеальным диализом является радикальным методом заместительной терапии, позволяя, в случае успеха, в максимальной степени помогает вернуть ребенка к нормальной жизни в обществе. Современная иммуносупрессивная и комплексная медикаментозная терапия позволяют достигнуть длительного функционирования трансплантата. Сложность адаптации ребенка в новых условиях жизни после пересадки почки требует особенно тщательно подходить к вопросам мониторинга посттрансплантационного периода.

35-42

Authors: Х. Исмаилов, Ш. Кадимов, К. Мюслимов, Ч. Ахмедова

Беременность у пациенток с терминальной хронической почечной недостаточностью (тХПН), находящихся на диализном лечении, наблюдается редко. Нарушение репродуктивной функции этих больных, как полагают, связано с рядом факторов. Анализ различных исследований, проведенных с 1992 по 2003 г., показал, что беременность возникает у 1–7% женщин, находящихся на хроническом диализе. В данной статье описан клинический случай беременности у пациентки с терминальной хронической почечной недостаточностью от периода выявления беременности до родоразрешения.

44

Authors: Ж.А. Доскалиев, С.Н. Жариков, М.Ш. Курмангужина

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48

Authors: Г.М. Куттымуратов, Т.А. Султаналиев, Ж.А. Абишева, Б.К. Жаркимбеков, В.К. Алтынова, Г.Д. Кутателадзе, Т.А. Курманов, А.А. Гниненко, В.В. Риб, Ж.Д. Унисов, А.А. Бекмухамбетов, М.Н. Асыкбаев

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52

Authors: Р.Ш. Вахитова, М.И. Хасанова, В.А. Дамоцев, Р.М. Газизов

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54

Authors: М. Бамыш, В. Алтынова, М.А. Хван

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58

Authors: М.Р. Байкелова, М.А. Рыбакова

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61

Authors: А.Ж. Карабаева, А.М. Есаян, И.Г. Каюков, М.И. Кадинская

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65

Authors: А.Ж. Карабаева, А.М. Есаян, И.Г. Каюков

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67

Authors: Н.Т. Джайнакбаев, С.А. Омартаев, Е.А. Карибаев, С. Мунар, А.А. Селибаев

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71

Authors: Е.А. Карибаев, С.А. Омартаев, Ж.Т. Смаилов, А.А. Селибаев, С. Мунар

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74

Authors: Г.Н. Чингаева, А.М. Нугманова, Э.Б. Алимжанова, М.Н. Кулкаева, А.А. Бисекен, С.М. Досым, Д.Б. Исмаилова

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77

Authors: Д.А. Айыпова, Э.Н. Ахунова, Р.Р. Калиев

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82

Authors: А.М. Нугманова, С.А. Диканбаева, Г.Н. Чингаева, А.О. Байбадилова

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86

Authors: А.М. Нугманова, Г.Н. Чингаева, С.А. Диканбаева

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90

Authors: Ahmet Yalcin, Derya Kaymak, Ebru Uz, Kamile Silay, Isilay Taskaldıran

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92

Authors: A. Nogaibayeva, S. Moldakhmetova, S. Tuganbekova, N. Krivoruchko

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96

Authors: Э.К. Чувакова, Т.И. Сарсенгалиев, Б.В. Цой

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99

Authors: Б. Стамбол, К. Рамазан, Б.М. Усманов, М.К. Алиханов

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102

Authors: Г.К. Бахтиярова

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106

Authors: Б.А. Абеуова, Г.Н. Чингаева, Н.Б. Нигматуллина, Е.А. Кунц

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110

Authors: С.Б. Дюсенова, К.Б. Жактаева, Е.А. Кунц, Л.А. Андреева, Л.Б. Ибраимова, С.М. Садвакасова

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113

Authors: С.С. Молдахметова, Д.К. Туребеков, А.Т. Ногайбаева

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118

Authors: М.Ю. Сопоев, Т.Л. Бестаева, Ф.У. Дзгоева

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121

Authors: Р.Э. Тожибоев, М.А. Досов, А.Э. Гайпов, М.А. Вершинин, Р.З. Сагнаев, М.Е. Копбаев, А.Н. Танирбергенов, И.К. Карменов

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124

Authors: Suleyman Karakose, Selman Unverdi, Beyza Algul Durak, Eyup Koc, Murat Duranay

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J Clin Med Kaz 2014;1(31):8-12

Authors: Araylym Beisbekova, Feruza Ospanova

Iodine deficiency usually affects the vulnerable part of the population such as women of reproductive age and children. Therefore it is necessary to consolidate and put on a long-term, priority based on periodic monitoring of quality control universal salt iodization and iodine supply of the population, aimed at further elimination of iodine deficiency disorders. In this review article we have discussed and illustrated the experience of many countries on the way to the elimination of iodine deficiency by the introduction of universal salt iodization. About the necessity to raising the state structure for the promulgation of regulations, quality control on the production level of iodized salt.

J Clin Med Kaz 2014;1(31):18-24

Authors: Yaroslav Tolstiak

The aim. We sought to explore the relative frequencies of Ebstein-Barr (EBV) in adult patients with SLE and their correlation with disease activity and autoantibody. Methods: 56 adult patients satisfying the 1997 American College of Rheumatology (ACR) Classification Criteria for SLE and 31 healthy controls were included in this case-control study. All patients were subjected to complete clinical and laboratory evaluation to determine the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and the British Isles Lupus Assessment Group index (BILAG). Sera from both groups were analyzed for Ebstein-Barr nucleus antigen immunoglobulin G (EBNA IgG), immunoglobulin M virus capsid antigen EBV (IgM VCA EBV) and IgG VCA EBV antibodies against EBV. Qualitative real time polymerase chain reaction (PCR) for diagnosis of virus presense in blood, saliva and pharyngeal scrape was performed for 35 SLE patients. Results: 83.8% SLE patients were positive for IgG anti-EBNA, 63,6% IgG anti-VCA EBV; 68,7% SLE patients were positive for IgM anti-VCA EBV antibodies. EBV DNA were detected by PCR for blood (39,1%), saliva (25%) and pharyngeal scrape (75%) of SLE patients. Correlation of Ebstein-Barr antibodies and autoantibodies in patients with SLE presentation Anti-EBNA positive correlation with аutoantibody, except anti-Sm (р>0,05). A statistically significant lower SLEDAI was found in IgG anti-VCA EBV positive patients. Patients with SLE had higher frequencies of anti-EBV compared to healthy controls. Conclusions: Correlation of Ebstein-Barr antibodies and autoantibodies in patients with SLE for relation of them with development and flares of SLE.

J Clin Med Kaz 2014;1(31):33-37

Authors: Krystyna Chympoy, Natalia Pashkovska

The aim. To study peculiarities of the indices of the cellular adhesion and endothelial functional state in patients with CDLD (chronic diffuse liver diseases) depending on Pro197Leu polymorphism GPX1 gene. Methods. 28 patients with CDLD aged were examined. We have determined Pro197Leu polymorphism GPX1 gene, the level of soluble intercellular adhesion molecule – 1 type (ICAM-1), desquamated endothelial cells and the content of nitrogen monoxide (NO) metabolites in the blood serum. Results. In patients with CDLD there is a relation between the expression of Pro197Leu polymorphism of GPX1 gene and indices of cellular adhesion, which is revealed by a reliably higher content of ICAM-1 in the blood serum in homozygotic carriers of Leu-allele. Changes of the endothelial functional state in patients with chronic diffuse liver diseases are associated with Pro197Leu polymorphism of GPX1 gene, which is proved by a reliably higher index of desquamated endotheliocytes amount and lower level of NO metabolites in the carriers of LeuLeu-genotype. Conclusions. It was еstablish dependence of level cellular adhesion and endothelial function in patients with chronic diffuse liver disease from gene polymorphism distribution Pro197Leu GPX1.

J Clin Med Kaz 2014;1(31):45-47

Authors: Kakharman Yesmembetov, Dmitriy Kogay, Gulmira Mukhamadieva, Nurgul Yesmembetova, Alexey Tsoy

A 16-year old male was admitted with complaints on sore throat, unilateral knee joint pain and general weakness. Pre-operation lab check revealed normal values of all liver tests except of hyperbilirubinemia due to elevated unconjugated bilirubin. Due to persistently normal liver tests, except of unconjugated hyperbilirubinemia, and repetitive episodes of jaundice in a young male with no signs of alcoholic, metabolic and viral liver disease, diagnosis of Gilbert syndrome was made, which was later confirmed by UGT1A1 gene mutations test. Gilbert syndrome is the most prevalent inherited disorder of bilirubin metabolism, affecting 10% of the population. Nonhemolytic unconjugated hyperbilirubinemia, without any effect on prognosis and life expectancy of the patient is the distinctive feature of Gilbert syndrome. Gilbert syndrome is usually diagnosed by exclusion of other more prevalent liver diseases, in difficult diagnostic situations use of UGT1A1 gene mutation is advised.

J Clin Med Kaz 2014;1(31):52-54

Authors: Gulzhan Dosmagambetova

Borderline mental disorders are weakly pronounced disturbance of human mental activity (neurotical level). They develop on the border between mental health and true mental illness, but they are separate nosological entities. They are polymorphic in clinical manifestations, but at the same time they have common characteristics. Without specific treatment they tend to become chronic with the development of social maladjustment with the development of social maladjustment. This article provides structural analysis of some anxiety phobic disorders