Journal of Clinical Medicine of Kazakhstan

J Clin Med Kaz 2015; 3(37):6-8

Authors: Ainur Doszhan, Roza Bektaeva, Marlen Doskali

From the handful of pioneering programmes, liver transplantation has expanded to hundreds of programmes in >80 countries. 1-year patient survival rates have exceeded 80% and outcomes continue to improve. This success has created obstacles. Ongoing challenges of liver transplantation include those concerning donor organ shortages, recipients with more advanced disease at transplant, growing need for retransplantation, toxicities and adverse effects associated with long-term immunosuppression, HCV recurrence. The priority strategic directions and mechanisms of development of high-tech care were identified in the State Health’s Development Program of the Republic of Kazakhstan "Salamatty Kazakhstan" for 2011 - 2015 years as. In that case, transplantation is becoming one of the important strategic directions of medicine in Kazakhstan, which has been rapidly developing in recent years. The research centers and regional clinics successfully have implemented the innovative grafting technologies to world standards in Kazakhstan. Today over 1 200 patients are needed for liver’s transplantation in Kazakhstan.

J Clin Med Kaz 2015; 3(37):14-18

Authors: Aliya Dzholdasbekova, Galina Fedotovskikh, Manarbek Askarov, Bayan Komsabakova, Ainur Baigenzhina, Argul Kairatova, Gulden Abylkassymova

The Aim: Heart failure (HF) is the major cause of death worldwide. Despite the available pharmacotherapy, prognosis is usually harsh. Here we assessed the safety and efficacy of autologous bone marrow-derivedmononuclear cell (BMMC)retransplantation in HF (left ventricular ejection fraction, LVEF <45%) at one-year follow-up. Methods: A whole number of 104 patients were included to the study (male=84 and female=20), age 27 untill 65 with Heart failure. All patients underwent standard examination (12-lead ECG, echocardiography, 6-minute walking test and laboratory tests). Results: After systemic BMMC retransplantation, EF was shown to rise at 12 months for both DCMP and ISCM (32,1+/-1,3 vs 41,3+/-1,6% and 32,2+/-1,2% vs 39,3+2,6%, respectively; p-value<0,005). ProBNP recognized as an early marker of HF tend to reduce sufficiently by 3 monthsand continued to recover at one-year follow-up for both diseases (3266,+/-344,4 vs 361+/-35,9 ng/ml; p-value<0,0001 and 4618+/-267 vs 286+/-35,9 ng/ml; p-value<0,0001 for ICMP and DCMP, respectively). Conclusion: Our results suggest BMMC transplantation is safe and well tolerated. BMMC infusion has improved systolic myocardial function, and a consequence has delayed the progression of HF, which is confirmed by recovering proBNP. Moreover, BMMC transplantation might favor by preliminarycell cultivation due to enhanced mitochondrial function.

J Clin Med Kaz 2015; 3(37):26-30

Authors: Ainura Dzhangaziyeva

The Aim: To determine the clinical manifestations of hepatitis A in hospitalized patients over 15 years of Republican Clinical Infectious Diseases Hospital of Bishkek city in different of the epidemics intensity periods. Methods: A retrospective analysis of case histories of patients over 15 years old hospitalized in 2002-03 and 2012-13 with confirmed hepatitis A by serology (ELISA, detection of a-HAV-IgM) is worked out. For the statistical analysis of the obtained results the EPI INFO 3.8.1. program and the «STATISTICA» application program package are used. Results: In epidemics the group of 15-20 years old patients of (62.6%) dominates and in «interepidemics» 31-40 years old patients (28.1%) prevail. Clinical features in adult patients during both periods generally have a typical icteric-cytolytic form (72% in 2002-03, 82.3% in 2012-13). The preicteric period does not have classic symptoms, but in «interepidemics» it has a tendency to prolongation. In the icteric period there is no positive dynamics, and in the epidemics the intoxication and hemorrhagic syndrome (18.4%) become more intensive. Conclusions: The Kyrgyz Republic is a high endemic country of hepatitis A with the disease incidence up to 560,20/0000. In different epidemics intensity the clinical and epidemiological aspects of HAV in adults varies.

J Clin Med Kaz 2015; 3(37): 37-42

Authors: Galina Fedotovskikh, Galiya Shaimardanova, Manarbek Askarov, Aigerim Smagulova

The Aim: To evaluate a morphological pictures of patients skin with systemic scleroderma (SSc) before and after of autologous hematopoietic fraction of bone marrow cells (SCs) transplantation. Methods: The skin biopsy from 15 patients were studied before and in 3 months after SCs transplantation. The samples were stained with hematoxiylin and eosin and Masson-trihrom. Immunochemical study was performed using the CD 31, 3, 19 markers. The electron microscopy ( EM) has been done by conventional method and embedded in Epon. The semithin section were stained with methylene blue, azure- 2 and basic fuchsin. Ultrathin section treated by uranylacetate and leadcitrate in accordance with Reynolds and examined with an EM Libra 120 (Carl Zeiss). Results: There were an epidermis atrophy, fibrosis of the connective tissue of derma and microvascular pathology in the skin samples before treatment. Nondifferentiated cells,active fibroblast and miofibroblast are presented there. In three month after treatment there were observed significant changes, namely: decreasing of skin density from 12,9 to 8,7, decreasing of the collagen deposit, neovascularisation, telocytes migration, activating of macrophages and fibroclasts which take part in remodeling of fibrous tissues. Restoration of epidermis, hair follicles and sweat glands. Conclussion: Transplantation of SCs cells make a contributions of fibrose reduction, angiogenesis and skin epithelium remodeling.

J Clin Med Kaz 2015; 3(37):47-51

Authors: Nelya Bissenova, Aigerim Yergaliyeva

The aim of this study: to compare microbiologic indicators of intestinal microbiocenosis of patients after acute intestinal infections in patients with chronic diseases of the digestive tract. Materials and methods. This is prospective bacteriological study, included 76 patients (40 men and 36 women). The first group consisted of outpatients who for 1-3 months before this study suffered an acute intestinal infection of bacterial etiology (n = 37). The second group consisted of 25 patients from the Department of Therapy diagnosed with chronic pancreatitis. The third group consisted of 14 patients from the Department of Transplantation diagnosed with liver fibrosis. Results. The deficit amount of content obligate microflora was most pronounced in patients with acute intestinal infection transferred. In 91.8% of the group surveyed the number of lactobacilli was below normal. 51.3% of patients had a reduced content of E. coli with normal enzymatic activity, at 43.2% defined quantitative reduction of bifidobacteria and 48.6% lack of enterococci. The biggest change from the facultative intestinal microflora was observed in the increase of inoculation opportunistic enterobacteria in patients of the first group - 43.2%; the second group - 20.0%, and the third group - 28.5%. In 54.0% of patients with the transferred acute intestinal infection and 21.4% for the third group of Staphylococcus aureus was detected. In patients of the second group Staphylococcus aureus was not found. Conclusions. Intestinal microflora of this patients is characterized by a decrease in the number of lactobacilli, bifidobacteria and E.coli with normal enzymatic activity. As part of the intestinal microbiota surveyed increased the number of opportunistic enterobacteria, Candida. The deficit amount of content obligate microflora such as bifidobacteria, lactobacilli and Escherichia coli with normal enzymatic activity was significantly lower (p <0.05) in patients with chronic disease compared with patients after acute intestinal infection

J Clin Med Kaz 2015; 3(37):57-59

Authors: Tuba Tülay Koca

The number of patients with lifestyle-related diseases is rapidly increasing in worldwide. İn recent studies both type 1 diabetes and type 2 diabetes mellitus (DM) was found firmly associated with high fracture risk. Although type 1 DM is associated with lower bone density, those with type 2 DM usually have normal/elevated bone density. Yet both types of DM, bone appears to be more fragile in microarchitecture. Not only hyperglisemia, but also oxidative stress induced deposition of advanced glycosylation endproducts (AGEs) in collagen, reduced serum level of ınsulin like growth factor 1 (IGF-1), hypercalciuria, renal failure, microangiopathy and inflammation are various mechanisms were hold responsible for lower bone qualty in diabetic population. Additionally falls arising from diabetes-related comorbidities are another possible contributing factor for pathologic fracture in DM. Here we present 13 years-old boy history of type 1 DM with right humerus posttraumatic fracture 1 months ago. Better knowledge on how diabetes and its treatments influence bone tissue will achieve the effective prevention of high fracture risk in both type 1 and type 2 DM patients.