Journal of Clinical Medicine of Kazakhstan

J Clin Med Kaz 2016;4(42):22-26 doi:10.23950/1812-2892-2016-4/jcmk-00362

Authors: Medet Toleubayev

Development of the issue of medical malpractice for professional offense acute medical and legal challenge facing modern healthcare. Question about this issue becomes relevant because of the need for social and legal protection of health workers and ensuring patients' rights. In the course of the historical development of the health systems of many developed foreign countries in connection with the improvement of the quality and complexity of the various medical procedures, our colleagues are always faced with the question of responsibility of doctors. First of all, it is connected with the development of insurance systems in health care. The development of industries such as legal services, democracy, transparency, empower patients and the transition to a partnership model of treatment has led to the emergence of various kinds of trials. In such processes, the doctor has always acted as a defendant. Increasing the number of such processes has prompted health organizations to study the problem of medical errors, which were aimed at preventing and reducing such processes.

J Clin Med Kaz 2016; 3(41):6-13 doi:10.23950/1812-2892-2016-3-6-13

Authors: Mehtap Tınazlı, Gaukhar Bakhtiyarova

Sarcoidosis is a systemic autoimmune disease characterized by noncaseatinggranulomatous inflammation with unknown etiology.Although the lungs and respiratory system are most commonlyinvolved, sarcoidosis may involve virtually any part of the body,including the locomotor system, eyes, skin, lymph nodes. Diagnosis attained via consensus between the clinical presentation and natural history, pattern of major organ involvement, confirmatory biopsy, and response to therapy. Histopathological features remain the gold standard in diagnosis. Radiologic staging in sarcoidosis is based on the chest X-ray. If chest radiographis normal, high-resolution computed tomography (HRCT) can demonstrate pathological changes in a detailed manner. Sarcoidosis generally follows a benign course with occasional spontan remissions. The most important causes of mortality are acute and chronic respiratory failure, pulmonary hypertension and hemoptysis due to aspergillosis. When treatment is indicated, glucocorticoids remain the only recognized effective therapy for active sarcoidosis. Level of evidence for management of sarcoidosis is low, generally reflecting the results of limited number of clinical studies, case series and expert opinion. In selected cases, biological agents including, tumour necrosis factor inhibitors, seem to be promising.

J Clin Med Kaz 2016; 3(41):21-26 doi:10.23950/1812-2892-2016-3-21-26

Authors: Natalia Chekalina

Objective: to study the effect of polyphenolic antioxidant resveratrol on markers of inflammatory activation of the endothelium (ET) in patients with stable coronary heart disease (CHD) in conjunction with autoimmune thyroiditis (AIT). Methods. The study involved 30 patients with coronary artery disease: stable angina pectoris, FC II with concomitant autoimmune thyroiditis, euthyroidism (study group), control group consisted of 20 healthy subjects. After 1 month of standard stabilizing therapy (β-blockers, statins, aspirin) for study group, in blood of participants was identified the levels of circulating endothelial microparticles (CEM) CD32+CD40+ by cytofluorometry, after which for study group additionally was appointed resveratrol at a dose of 100 mg per day and after 2 months we re-analyzed these indicators. Results.In patients with stable coronary artery disease combined with AIT found increased amount of CEM CD32+CD40+. Under the influence of resveratrol in patients with CHD combined with AIT was revealed a significant reduction of the amount of CEM CD32+CD40+ in the peripheral blood, that can be the result of its effect on intracellular molecular cascades associated with nuclear transcription factor kappa B (NF-kB). Conclusion. Resveratrol demonstrates the anti-inflammatory and protective action for endothelium: it reduces the indicator of inflammatory activation ET CEM CD32+CD40+ in the blood in patients with stable CHD combined with AIT.

JClinMedKaz 2016; 3(41):30-33 doi:10.23950/1812-2892-2016-3-30-33

Authors: Marat Ospanov, Yuryi Olkhovik, Dastan Rustemov, Rustem Utebaliev

The observation is described the successful treatment of the child with VATER association. We made the correction of esophageal atresia with lower trachea-oesophageal fistula, anal atresia withrectourethral fistula. Performed surgical operations: retrosternal esophagoplasty the stomach, gastrooesophageal anastomosis in the neck with an antireflux mechanism, anosphincteroplasty.

J Clin Med Kaz 2016; 3(41):37-40 doi:10.23950/1812-2892-2016-3-37-40

Authors: Sholpan Bulekbayeva, Zholtay Daribayev, Galymzhan Zhylkybayev, Daulet Amanzhol, Meyram Kaliyasov

Objective: To increase the efficiency of rehabilitation measures in the treatment of movement disorders. Rehabilitated 16 patients aged 1 to 5 years, of which 14 patients were children with cerebral palsy (87.5%), 2 patients with congenital malformations of the central nervous system (12.5%). 10 children (63%) had spastic syndrome with an average of 3.5 points on a scale of Ashworth, the remaining 6 (37%) - Children with a flaccid syndrome. Furthermore, according to the classification of large motor functions GMFCS, 12 children (75%) corresponded to level 5, 4 patients (25%) – to the 4th level. On a scale large motor functions GMFM average before treatment was 8.7%. There was held a course of comprehensive rehabilitation with the use of traditional kinesitherapy, hydro kinesitherapy, physiotherapy and elements of Reflex locomotion. Results:The analysis of assessment data indicates that 16 children had average 8.7% on GMFM scale at the time of admission, and after the rehabilitation with elements of Reflex locomotion- 10.7%. Thus, the improvement rate was 2%. Evaluate patients at Ashworth spasticity scale did not give reliable results on the influence of methods of Reflex locomotion on spasticity due to the short period of rehabilitation and low frequency of sessions per day. Conclusions:The experience of the elements of this methodology has shown the need for further study of the efficacy for longer period of application, covering a larger number of patients, as well as in combination with other methods of Kinesitherapy (Bobath, the PNF, etc.).

J Clin Med Kaz 2016; 2(40):6-13 doi:10.23950/1812-2892-2016-2-6-13

Authors: Nailya Sheveleva, Larissa Minbayeva

The article provides literature review that reflect a modern view on the problem of articular pathology treatment and rehabilitation. Step-by-step osteoarthritis management schemes, published in the leading recommendations (NICE, OARSI, HKOA) are presented. The results of modern clinical trials, systematic reviews and meta-analyzes on the use of various methods of physical therapy for joints diseases treatment from the standpoint of evidence-based medicine are analyzed. Etiopathogenetic and clinical substantiation for inclusion of physiotherapy measures in rehabilitation programs were given to help maximizing the impact on all links of the pathological process chain. The use of different methods and techniques of physical therapy for osteoarthritis is currently debated, because of the contradictory literature data. Low level of evidence does not allow including physical therapy in the leading guidelines of osteoarthritis management. The reasons for low level of evidence might be small samples and insufficient degree of randomization in the majority of studies. Different sensitivity of patients to physical therapy and presence of associated diseases necessitate individualization of rehabilitation program that makes further large-scale assessment of impact of the physical factors difficult. However, considering physical therapy infinite possibilities, scientists continue to actively explore, constantly improve and implement a lot of new, highly effective methods of physiotherapy in rehabilitation process of osteoarthritis, proving the prospects of this type of conservative therapy.

J Clin Med Kaz 2016; 2(40):22-26 doi:10.23950/1812-2892-2016-2-22-26

Authors: Samat Kozhakhmetov, Almagul Kushugulova, Akbota Kakimova, Talgat Nurgozhin, Zhaksybay Zhumadilov

Statins widely used in clinical practice in decreasing the level of lipids in blood plasma. Difference of response for therapy may be associated with structural changes in genes of metabolism of drugs. Main polymorphisms of genes of metabolism which impact on effectiveness and security of rosuvastatin are studied in review.

J Clin Med Kaz 2016; 2(40):31-35 doi:10.23950/1812-2892-10.23950/1812-2892-2016-2-31-35

Authors: Yevgen Lisovskyy, Kenzhe Kussainova

Research objective was the evaluation of effectiveness of the dynamic proprioceptive correction in complex rehabilitation of patients with Children Cerebral Palsy. Methods. The results of diagnostics and treatment of 80 patients at age from 4 to 7 years with Children’s Cerebral Palsy, diplegical form, level of severity II-IV according to GMFCS, were analyzed. 55 children of study group were treated with complex rehabilitation program included dynamic proprioceptive correction; 25 children of control group were treated with standard complex rehabilitation program. The state of muscular tone were estimate in patient of both groups according to Ashworth scale, dynamics of motor function according to GMFCS with calculation program GMAE, indicators of bioelectrical brain activity with computer complex Nihon-Kohden EEG-1100К. Results. The analysis of our date demonstrates that patients treated with rehabilitation program included dynamic proprioceptive correction have statistically significant advantage over patients of control group in the gaining of new motor skills. Investigation of EEG-indicators shows that the correction of pathological afferentation makes activate influence on the brain cortex and decrease pathological influence of subcortical and thalamus structures on the cortical electrogenesis. Conclusions. The data of conducted investigation confirm the effectiveness of the method of dynamic proprioceptive correction in the treating of patients with Children Cerebral Palsy.

J Clin Med Kaz 2016; 2(40): 43-49 doi:10.23950/1812-2892-2016-2-43-49

Authors: Galiya Orazova, Leonid Karp, Gulnar Rakhimbekova, Anargul Nogayeva

Objective. Create a mathematical model and forecast esophageal and stomach cancer case rate in Kazakhstan up to the year 2020. Methods: It is retrospective, descriptive-analytical study. Primary information sources during performance of this work were indicators of oncological service of the Republic of Kazakhstan for 1990-2014. Forecasting on the level of esophageal and stomach cancer case rate was performed through the development of time-series model and their extrapolation. The length of the forecast period was identified by the length of actual data series. Total forecast in the country up to the year 2020 was made on the basis of data for 1990-2014. Unfortunately, due to the insufficiency of data in archives, we failed to obtain the required volume of data across the country regions for the specified period. Comparatively short regional database, which covers the period from 1999 to 2014, allowed to extrapolate the obtained models for 2-3 years in advance, in our case - up to 2017. Considering the dynamics peculiarities of esophageal and stomach cancer case rate among the country population, the most relevant method for forecasting is the logarithmic function. Results. According to the results of forecasting, there was some tendency to the growth of esophageal and stomach cancer case rate among the population of Akmola (from 8,900/0000 to 9,650/0000), Almaty (from 5,740/0000 to 6,130/0000) and Kostanay (from 9,450/0000 to 10,590/0000) regions. Based on the forecast of stomach cancer case rate in Zhambyl region, there is a possibility of the growth from 15,00/0000 to 16,00/0000 till the year 2017. In all other regions there was a common tendency to stabilization and decrease in stomach cancer case rate. Nationwide, there is a tendency to the decrease in esophageal cancer (7,90/0000) and stomach cancer (17,00/0000) case rate to the year 2020. Conclusion. In connection with the identification of esophageal and stomach cancer case rate growth in a certain regions of Kazakhstan during mathematical forecasting, there is a viability of further investigations on the detailed study of possible cause and effect relationships of this phenomenon.

J Clin Med Kaz 2016; 2(40):57-59 doi:10.23950/1812-2892-2016-2-57-59

Authors: Akzhunus Orekeshova, Oral Ospanov

The purpose of the study: to evaluate the efficacy of laparoscopic greater curvature gastric plication in the treatment of type 2 diabetes. Methods. The study involved 32 patients suffering from type 2 diabetes and obesity on average 6.87 ± 1.9 years. Results. Participants in a year lost an average weight of 25 kg. Fasting glucose levels dropped significantly within six months after the operation, which correlates with the trend in the weight loss during this period. The average HbA1c for the cohort gradually decreased during the study period from 9.8% to 5.6%. Much of this change occurred during the first six months. Diabetes Remission was achieved in 92% of patients. In patients with remission, hypoglycemic agents were canceled after 4-22 weeks after surgery. Conclusions. Laparoscopic greater curvature gastric plication lowest altering the physiology of the gastrointestinal tract, lowers blood glucose levels in patients suffering from type 2 diabetes and obesity.

J Clin Med Kaz 2016; 1(39):6-11 doi:10.23950/1812-2892-2016-1-6-11

Authors: Yevgen Lisovskyy, Kenzhe Kussainova, Meiram Shakenov, Natalya Lisovska

The cerebral palsy is highly actual issue of pediatrics, causing significant neurological disability. Though the great progress in the neuroscience has been recently achieved, the pathogenesis of cerebral palsyis still poorly understood. In this work we reviewed available experimental and clinical data concerning the role of immunocompetent cells in pathogenesis of cerebral palsy. Maintaining of homeostasis in nervous tissue and its transformation in case of periventricular leukomalacia were analyzed. The reviewed data demonstrate involvement of immune regulatory cells in the formation of nervous tissue imbalance and chronicity of inborn brain damage. The supported opinion, that periventricular leukomalacia is not a static phenomenon, but developing process, encourages us optimism about possibility of its correction. The further study of changes of the nervous and immune systems in cerebral palsy will contribute to creating fundamentally new directions of the specific therapy and individual schemes of rehabilitation.

J Clin Med Kaz 2016; 1(39):16-19 doi:10.23950/1812-2892-2016-1-16-19

Authors: Oksana Ussenova, Dinara Gabdullina, Marina Morenko, Yelena Kovzel

By definition, primary immunodeficiencies are genetically determined diseases, which are fundamental molecular or organic defects associated with impaired immune responses, in this case there is the clinic of infectious and autoimmune diseases, with an increased risk of developing malignancies. Primary immunodeficiency diseases more frequent than previously thought. The lack of clear algorithms and the use of outdated technologies considerably delay diagnosis process, which leads to delays expensive no specific treatment instead of Immunotropic effective therapy. The first episodes of primary immunodeficiencies (PID) are manifested at an early age, but also the primary PID can also occur in adults, the first episode of the disease observed in the 20-30 years of age.

J Clin Med Kaz 2016; 1(39):25-29 doi:10.23950/1812-2892-2016-1-25-29

Authors: Tatyana Ponomarevа

Objective: Assessment of the “animalization” impact on the immunogenicity and viability of EV live plague vaccine. Methods: In this research we have used a vaccine strain of Yersinia pestis EV (a RIEH line), and a strain 231 from the National Depository of highly dangerous microorganisms of the Kazakh Scientific Center of Quarantine and Zoonotic Diseases (KSCQZD). For the cultivation and evaluation of cultural, biochemical properties, as well as phage lysability of the vaccine strain we used Hottinger agar, Hottinger broth, peptone water with 1% glycerol, 1% sucrose, 1% lactose, 1% rhamnose and Andred indicator, a sterile 0.9% sodium chloride, and also plague diagnostic bacteriophages L-413 and Pokrovsky, produced in KSCQZD, and determination of the cell concentration using 10 units standard turbidity. We carried out “animalization” of the vaccine by its intravenous infusion to 5 rabbits weighting from 2 to 2.5 kg, with subsequent (after 3-4 hours) isolation of the vaccine strain culture from rabbit’s internal organs. We evaluated the protective activity in acute experiments of contamination of previously immunized guinea pigs weighing from 250 to 350 g (by a number of survived animals), and immunogenicity by ED50 value for all series of “animalized” and “not animalized” EV vaccine. The viability (percent of live cells) was determined by the number of colonies grown on Hottinger agar compared with the concentration of bacteria marked on an ampoule. As the percentage of viable microbial cells in a series, we accepted the arithmetic mean calculated for the three ampoules of the same series. Results: Indicators of the specific activity of the vaccine series prepared with the inclusion in the process of an “animalization” stage showed their significant growth. Significant increase in the number of surviving after contamination guinea pigs in combination with a significant reduction ED50 indicates that short stay of the vaccine strain in a rabbit body leads to a significant increase in protective activity (immunogenicity) of the finished vaccine. The number of viable cells in the final vaccine increases, too. Conclusions: Short-term (within 3-4 hours) stay of the 2nd generation culture during the process of a live plague vaccine production greatly enhances its immunogenicity (protective activity). The vaccine obtained with the inclusion in its production process of the “animalization” step contains a significantly greater number of viable microbes, as compared to conventional technology without “animalization”

J Clin Med Kaz 2016; 1(39): 37-42 doi:10.23950/1812-2892-2016-1-37-42

Authors: Nikolay Shebrina, Muaviya SN Almaradat, Natalya Kapusnik, Irina Kuzmina

Аim: To determine the effectiveness of the method biorevitalisation cervical correction cervical incompetence (CIN) before the planned pregnancy by restoring physiological sphincter cervix using her replacement excessive muscle connective tissue. Methods. A total of 80 non-pregnant women with CIN, the main group, and 20 healthy women, included in the control group. The main group of patients was divided into two clinical groups: 1 - 40 women with CIN, which pregravid period were treated fillers based on hyaluronic acid, 2 - 40 women with CIN, which before pregnancy CIN treatment was carried out. Glycosaminoglycan biopolymer administered in cervical tissue in an amount of 0.3 ml once, by gradually chipping the entire area of the total volume of the internal os of the drug from 1 to 2 ml. As criterion for the effectiveness of the correction of cervical activity index is proposed to use of neuraminidase in the cervical mucus. Results. Concentrations of all studied biologically active components cervical mucus in patients with CIN after correction method biorevitalisation significantly exceeded the comparable figures recorded in the initial state. carrying out correction of the cervix in women with CIN step pregravid period accompanied by increased content of all carbohydrate components cervical mucus on average 40-45% and reliably maintained for 14 months. Conclusion. Method biorevitalisation cervical hyaluronic acid is effective for correction at step CIN pregravid preparation, contributes to the normalization of structural and functional properties of the cervix.

J Clin Med Kaz 2016; 1(39):47-49 doi:10.23950/1812-2892-2016-1-47-49

Authors: Askar Bakhtiyarov, Gulmira Utepbergenova, Sayra Sagitova

Brain and spine echinococcosis are one of the rare locations echinococcus bubble, which is difficult to diagnose, and can lead to complications (epileptiform seizures, paresis, paralysis). In this article we describe rare cases of echinococcosis fronto-temporal region of the brain to the right of a woman 33 years old with relapsed and hydatid L3 body cysts vertebra with spinal cord compression, complicated lower paraparesis and dysfunction of the pelvic organs in men 49 years old, first identified on MRI lumbar dressed spine. With a view to early diagnosis and to reduce the incidence of echinococcosis need to conduct targeted screening population using blood enzyme-linked immunosorbent assay (ELISA) and instrumental research methods (CT, MRT) of the brain and spine. In order to prevent relapse after patients Echinococcectomy compulsorily appoint protivoretsedivnoe treatment of anthelmintic drugs.