Journal of Clinical Medicine of Kazakhstan

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.