Journal of Clinical Medicine of Kazakhstan

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.).