Journal of Clinical Medicine of Kazakhstan

J Clin Med Kaz 2018;2(48):9-13 doi:10.23950/1812-2892-JCMK-00549

Authors: Olga Malgazdarova, Bulat Kupenov, Akmaral Moldazhanova, Zhanat Bekzhigitova

Chronic heart failure - symptom complex arising in the outcome of cardiovascular diseases of various etiologies. At the moment heart failure is widespread and has become a pandemic. This fact led to the need to clarify the known mechanisms of pathogenesis and the search for new ways of diagnostics therapy and ultimately to improve methods of monitoring the course of heart failure. The wide diagnostic possibilities of modern medicine did not give a clear understanding of the mechanisms of involvement of the immune system links in the pathogenesis of chronic heart failure. It remains an open question, concluded in the “cytokine theory” of the pathogenesis of chronic heart failure,

J Clin Med Kaz 2018;2(48):22-27 doi:10.23950/1812-2892-JCMK-00563

Authors: Izuchukwu Azuka Okafor, Johnson Okwudili Nweke, Uchenna Somtochukwu Nnamah

Background: Cisplatin, a platinum-based chemotherapy agent, is used in the effective treatment of a wide range of malignant cancers. Resveratrol, a polyphenolic plant-derived compound, has been shown to have several biological effects including protecting the body against several forms of damages. Objective: This study assessed the effects of cisplatin and supplementation with resveratrol on some hematological parameters in Sprague-Dawley rats. Material and Methods: Forty-five adult female Sprague–Dawley rats, grouped into 9, were used for this experimental study. Group 1 served as the control group and received distilled water only. Groups 2 and 9 received Cisplatin only while groups 3, 4, and 5 received different doses of Resveratrol after a single dose of Cisplatin. Groups 6, 7, and 8 received Resveratrol before Cisplatin. Results: At the end of administration, blood samples were collected and different hematological parameters were accessed. Groups 2 and 5 showed a significantly higher Total WBC when compared to the control group (p<0.05). Group 7 showed a significantly higher (p<0.05) neutrophil count compared to both the control group and group 2, but a significant decrease in the lymphocyte count compared to the same groups (p<0.05). Groups 6 and 7 showed a significant reduction in monocyte when compared to the control group (p<0.05). There was no significant difference in the eosinophil count of all treatment groups when compared to the control group and cisplatin groups (p<0.05). Basophil increased significantly in group 7 when compared to the control group and group 2 (p<0.05). More so, a significant decrease in the Haemoglobin (Hb), Packed cell volume (PCV) and Mean corpuscular volume (MCV) level were observed when compared to group 9 (p<0.05). Conclusion: This study showed that cisplatin-induced alteration in some hematological parameters is reversible by treatment with resveratrol. More so, resveratrol supplementation should be incorporated as part of dietary nutrients for patients on cisplatin during chemotherapy.

J Clin Med Kaz 2018;2(48):33-40 doi:10.23950/1812-2892-JCMK-00560

Authors: Lyudmila Khimion, Lilia Tymoshchuk, Mariia Rybytska

Objective: To determine the functional state of the kidneys in patients with the I stage essential hypertension with different total risk of cardiovascular complications and to assess the effect of early medication (angiotensin II receptor blocker) on the dynamics of changes in the functional renal reserve. Material and Methods: This study included 80 patients with the established diagnosis - the I stage essential hypertension of the I-III grade in age from 18 to 60 years (28 women (35 %), the average age is 40,1 (35,0-56,0) years; men - 57 (71%), average age – 40,2 (37,0-53,0) years. A risk factor count was used to assess the overall risk of cardiovascular complications in hypertension. Functional renal reserve and endothelium-independent vasodilation of the brachial artery were defined. Statistical analysis was performed using SPSS Statistics. Results: In patients with high risk, the depleted and decreased functional renal reserve was most often detected, which was 55% of patients. It is also important to note that patients with even a low risk of cardiovascular complications have already had renal damage as a reduced or depleted functional renal reserve. Patients with a low risk of cardiovascular complications who had not started drug treatment on their first visit had a 2.3-fold (95% CI 1,048-4,896) higher relative risk of developing kidney damage in comparison with patients who had started medication therapy without delay. Conclusion: Diagnosis of functional renal reserve in patients with a low risk of developing cardiovascular complications in stage I arterial hypertension is an important component for predicting the further development of kidney damage and timely prevention of its progression. The early onset of drug treatment reduces the relative risk of developing kidney damage by 2.3 times in patients with arterial hypertension

J Clin Med Kaz 2018;2(48):47-51 doi:10.23950/1812-2892-JCMK-00561

Authors: Askar Serikbaev, Almas Dyusupov, Asanali Seitkabylov

Objective: To determine the comparative clinical outcomes and quality of life of patients with ankle fractures with dislocation of the foot using the transarticular fixation technique. Material and methods: 232 patients with closed fractures of the ankles, accompanied by subluxation or dislocation of the foot at the age of 19 to 75 years (mean age - 45.6 ± 2.4 years) were examined. The subjects were divided into 2 groups - the main group (142 patients - 61.2%) and comparisons (90 - 38.8%). In the treatment of patients of the main group, the method of transarticular fixation of the foot to the tibia was used, using a device specially developed for this purpose. The patients of the comparison group underwent an operation of open osteosynthesis with knife plates with screws or a wire loop. Comparison of clinical indices, functional outcomes and quality of life was performed using the FOAS technique. Results: The average for the main group of complications was 11.3%, for the comparison group - 35.6% (χ2 = 19.80, p = 0.002). The use of the technique of transarticular fixation contributed to a decrease in the treatment period by 8.6 days (p> 0.05). Excellent functional results were obtained in the main group by 25.4% more often, although the differences were insignificant. Unsatisfactory results were observed only in the comparison group. Significant differences in quality of life in favor of the main group were determined on the basis of the “pain” scale of the FOAS questionnaire at a 6-month follow-up period (46.7%, p<0.05). On the scale of “sports and recreation” similar differences were revealed in the period of 6 and 9 months. Conclusion: The use of the transarticular fixation method in our study turned out to be expedient and gave better results than open interventions with respect to the clinical course and the quality of life of patients

J Clin Med Kaz 2018; 2(48):56-58 doi:10.23950/1812-2892-JCMK-00547

Authors: Meerim Omurbekova

The article presents the clinical case of utero-placental apoplexy in a patient of 23 years old, who underwent innovative way of bilateral ligation of the uterine vessels according to the algorithm developed by us. Observing this algorithm, it is possible to perform an organ-preserving operation in the Couvelaire uterus.

J Clin Med Kaz 2018;4(50):21-25 doi:10.23950/1812-2892-JCMK-00592

Authors: Rizaldy Taslim Pinzon, Niyata Hananta Karunawan

Ischemic heart disease and stroke are the leading cause of morbidity and mortality worldwide. Ischemic stroke and ischemic heart disease have similar pathophysiological mechanisms and risk factors. Ischemic heart disease patients are associated with increased morbidity and mortality, but the studies describing outcomes of ischemic heart disease in ischemic stroke patients are a lack. This is the first study to correlate ischemic heart disease in ischemic stroke with length of stay and functional outcome by using modified Rankin Scale (mRS). This study aims to compare the clinical outcome of ischemic stroke patients with ischemic heart disease and without ischemic heart disease. Methods: This retrospective cohort study of 200 patients were first incident acute ischemic stroke recorded in the Bethesda Hospital Yogyakarta Stroke Registry (2012-2017). These patients were divided into ischemic stroke patients with ischemic heart disease and ischemic stroke patients without ischemic heart disease. The primary outcomes of the study was in-hospital mortality, disability measured by modified Rankin Scale (mRS), and length of stay. The data were analyzed bivariate followed by the Chi-square test and Mann-Whitney. Results: Data of 200 patients with 100 stroke patients with ischemic heart disease consist of fifty-eight male (58.0%) and eighty-six (86.0%) were more than 50 years old. Compare to 100 stroke patients without ischemic heart disease consist of fifty-eight male (58.0%) and eighty-nine (89.0%) were more than 50 years old. The mortality of stroke patients with ischemic heart disease group is eighteen patients (18.0%), sixty patients (60%) have poor functional outcome (mRS >2) and have length of stay 7.50 (0-40) days. Bivariate analysis showed stroke patients with ischemic heart disease group is significantly associated with higher in-hospital mortality (RR:2.9, 95%CI:1.1–7.3, p<0.019), worse disability (RR:2.6, 95%CI:1.3 –5.1, p<0.005) and prolonged hospital stay (7.50 (0-40) vs 4 (0-14), p<0.001) than in stroke patients without ischemic heart disease group. Conclusion: Ischemic stroke patients with ischemic heart disease is statistically significantly associated with higher in-hospital mortality, worse disability, prolonged hospitalization than in ischemic stroke patients without ischemic heart disease

J Clin Med Kaz 2018;4(50):34-39 doi:10.23950/1812-2892-JCMK-00600

Authors: Alima Almadiyeva, Zhanay Akanov, Venera Almatova, Karlygash Absattarova

Aim: A study was conducted to assess the clinical and economic effectiveness of vildagliptin in adults with type 2 diabetes mellitus (T2DM) with poor glycemic control against the metformin monotherapy. Materials and methods: 280 sources were identified in accordance with the search strategy; 40 sources were subjected to critical analysis, of which 22 full-text publications were included in the present study. Results and discussion: Significant advantages of the use of vildagliptin in combination with metformin in improving glycemic control, regardless of the initial level of glycosylated hemoglobin (HbA1c), age or body mass index (BMI) compared with other dipeptidyl peptidase-4 inhibitors, were found; Combination therapy using 50 mg of vildagliptin and metformin twice daily significantly reduced the mean baseline HbA1c (-0.7 to -0.9%) and fasting blood glucose levels (-1.4 to 0.1 mmol/l) compared with placebo, as well as with other dipeptidyl peptidase-4 inhibitors; this combination also led to the greatest increase in QALYs (0.18 over the life span) among dipeptidyl peptidase-4 inhibitors compared to treatment with a combination of metformin and glimepiride. Thus, the combination of metformin and vildagliptin gives advantages in efficiency and additional mechanisms of action, since it does not increase the risk of hypoglycemia and does not contribute to weight gain. Conclusion: Combination therapy using metmorfin and vildagliptin is more cost-effective, since it does not increase the risk of hypoglycemia and does not lead to increasing weight.

J Clin Med Kaz 2018;3(49):15-23 doi:10.23950/1812-2892-JCMK-00578

Authors: Assem Nogaibayeva, Bagdat Sultanova, Myrzabek Makhmutov

Pathophysiological, pathomorphological and functional changes in the kidneys after left ventricular assist device implantation have not yet been fully understood and represent an actual problem of our time. Changes in renal function following left ventricular assist device implantation have been disclosed in many studies with inconsistent results. Some studies have shown that patients with renal dysfunction after left ventricular assist device implantation had worse outcomes, despite stabilization or even improvement of kidney function during the postoperative period, other studies have shown the progression of chronic kidney disease requiring renal replacement therapy.

J Clin Med Kaz 2018;3(49):28-31 doi:10.23950/1812-2892-JCMK-00581

Authors: Gulbarshin Darisheva, Bolat Saktashev, Aigul Brimova

This article is devoted to the problem of mastopathy in the post-Soviet space. Analysis of clinical observation, literature data shows a different approach in describing this condition, methods of diagnosis and treatment. Often, a purposeful motivational assignment of certain groups of drugs from biologically active food supplements, iodine preparations to the administration of antiestrogens, etc. is often used to correct this condition. This problem requires a careful approach to etymology, diagnosis and principles of conducting similar processes.

J Clin Med Kaz 2018;3(49):35-41 doi:10.23950/1812-2892-JCMK-00584

Authors: Fatma Kulali

Aim: Differentiating benign from malignant vertebral fracture is sometimes difficult in geriatric oncology patients. Accurate diagnosis is necessary for treatment planning. Therefore, we aimed to investigate the role of quantitative evaluation of diffusion-weighted imaging (DWI) at multiple b-values of 200, 400 and 600 s/mm2 in differentiating benign from malignant thoracolumbar vertebral fractures and to determine an optimal b-value. Methods: Forty-four patients with 72 vertebral fractures were enrolled. Magnetic resonance imaging (MRI) findings combined with DWI at b-values of 200, 400 and 600 s/mm2 were evaluated. Apparent diffusion coefficient (ADC) and normalized ADC values were obtained. Radiological and histopathological/follow-up results were compared. Results: Of 72 vertebral fractures, 22 were benign and 50 were malignant. Mean ADC and normalized ADC values of malignant group were lower than benign group’s in all b-values (p<0.05). Despite of no significant difference between ADC values at b-values of 200, 400 and 600 s/mm2 within each group, normalized ADC values were lower at b-value of 200 s/mm2 than those of at 600 s/mm2 in malignant group (p<0.05). Conclusion: MRI combined with DWI is a problem solving modality especially in geriatric oncology patients. Performing DWI at b-value of 200 s/mm2 and estimation of normalized ADC value for optimization of data are recommended.

J Clin Med Kaz 2018; 3(49):46-49 doi:10.23950/1812-2892-JCMK-00580

Authors: Nariman Zhambayev, Ulanbek Zhanbyrbekuly, Yernur Ainayev, Gafur Khairli, Ravil Sherkhanov, Ulan Zhaparov, Aleksey Sushchenko

Aim: Describe a clinical case and compare the difference in treatment methods at pelvic-dystopic kidney. The article describes the clinical case of urolithiasis, in the pelvic - dystopic kidney. The stages of diagnosis and treatment reflected in the article testify to the present possibilities of modern medicine. Recovering the patient is the result of timely, skillfully chosen conservative and operational techniques.

J Clin Med Kaz 2018;4(50):15-20 doi:10.23950/1812-2892-JCMK-00586

Authors: Zarina Babaeva, Yerzhan Uteuliyev, Latina Tekebaeva, Kairat Karibaev

Strokes, being a heterogeneous syndrome, are the result of multifactorial accumulative disorders of the body. The urgency of the problem of cerebral stroke is due to the high level of occurrence and prevalence on a global scale, as well as the consequences. Thus, vascular diseases of the brain vessels occupy the second place in the structure of mortality from diseases of the circulatory system and total mortality of the population. The expected aging of the population, coupled with a decrease in mortality from stroke, creates a predisposition to an increase in the burden of strokes in the form of an increase in the number of victims. In Kazakhstan, as in most countries of the world, ischemic strokes prevail, which are the main cause of disability of the working-age population. Despite certain advances in the treatment of brain catastrophes caused by the introduction of protocols for early diagnosis and the development of algorithms for urgent actions, as well as the development of innovative pharmaceutical approaches, prevention of stroke development remains the most effective approach in all respects - medical, economic, social. Risk factors for stroke can be classified as changeable (modifiable) and not subject to change (non-modifiable, or risk markers). Age, gender and race, ethnicity, genetic predisposition are unchangeable risk factors for both ischemic and hemorrhagic stroke, while hypertension, smoking, diet and physical inactivity are among the most common modifiable risk factors. Stroke prevention mainly focuses on managing variable risk factors. Lifestyles and behavior modification, such as changes in diet or smoking cessation, not only reduce stroke risk, but also reduce the risk of other cardiovascular diseases. Other preventive areas include the identification and treatment of diseases that increase the risk of stroke, such as hypertension, diabetes and atrial fibrillation.

J Clin Med Kaz 2018;4(50):30-33

Authors: Mykola Gryshchenko, Andrey Lutskiy

Aim: To increase the frequency of pregnancy and delivery rate in in vitro fertilization cycles using native and vitrified donor oocytes. Methods: Analyzing the results of in vitro fertilization in 62 patients who had oocyte donation programs. Patients were divided into 2 groups: the 1st group included 27 women who had used vitrified donor oocytes, and the 2nd group - 35 patients to whom the native oocytes of the donor were used in the in vitro fertilization cycle. The obtained oocytes were vitrified according to the standard technique using the Cryotech Vitrification kit. To prepare the endometrium for the transfer of embryos, a preparatory hormonal therapy regimen was used and the embryos were transferred in a modified menstrual cycle. Results: Studies have shown that the application of the vitrification method in assisted reproductive technology programs allows to achieve clinical results that are not inferior and even significantly exceed the effectiveness of treatment in cycles with native donor oocytes in such parameters as clinical pregnancies, implantation rate and labor. Conclusion: Vitrification is an effective method of cryopreservation of oocytes, which allows to preserve the functional properties of the eggs and, after their fertilization, to obtain embryos with high implantation potential.

J Clin Med Kaz 2018;1(47):8-13 doi:10.23950/1812-2892-JCMK-00541

Authors: Saule Abisheva, Nurlan Batpenov, Zhadra Amangeldiyeva, Kanagat Abdiramasheva

The article discusses the problematic issues of cardiovascular pathology in rheumatoid arthritis. The latest data on the influence of traditional risk factors for cardiovascular pathology, autoimmune chronic inflammation, antirheumatic drugs on the development of cardiovascular complications are provided.

J Clin Med Kaz 2018;1(47):18-24 doi:10.23950/1812-2892-JCMK-00542

Authors: Zhenisgul Tlegenova, Gulmira Kudaiberdieva, Bekbolat Zholdin, Ayan Abdrakhmanov

Atrial fibrillation is the most common arrhythmia that physicians face in their clinical practice. Atrial fibrillation is associated with a higher risk of thromboembolic events, all-cause mortality, frequent hospitalizations, decreased quality of life. Early detection of atrial fibrillation is important for optimal management and improvement the prognosis of atrial fibrillation patients. Evidence on new methods of atrial fibrillation screening discussed in this review, allows considering them more accurate than simple pulse palpation.

J Clin Med Kaz 2018;1(47):29-35 doi:10.23950/1812-2892-JCMK-00543

Authors: Ulanbek Zhanbyrbekuly, Jung Kwon Kim, Minyong Kang, Bumsik Tae, Ja Hyun Ku, Hyeon Hoe Kim, Chang Wook Jeong

Objectives: The objectives of the current study were to determine long-term biochemical recurrence rates stratified by adverse pathologic features and to identify predictive factors of biochemical recurrence rates following radical prostatectomy performed by either retropubic prostatectomy or robot-assisted laparoscopic prostatectomy from single tertiary center prostate cancer database. Material and Methods: The Seoul National University Hospital prostate cancer database was queried for all patients treated with radical prostatectomy from 1999 to 2015. Among the 2680 patients who underwent radical prostatectomy, 331 patients with seminal vesicle invasion (pathologic T3bN0-1M0 stage) were identified. The primary endpoint was biochemical recurrence, defined as two consecutive postoperative prostate specific antigen values ≥0.2 ng/ml. Comparative analysis based on adverse pathologic characteristics and operation type was performed. Results: Five and 10-year biochemical recurrence-free survival in the entire cohort was 59.0% and 42.9%. The Kaplan-Meier survival analysis demonstrated 5-year biochemical recurrence free survival rates differences in patients with different lymph node involvement (70.6% vs. 52.4%, log-rank, p=0.01). Variables including age, extracapsular extension, lymph node invasion, surgical margin, perineural invasion, multicentricity and Capra-S score were similar between the groups of patients who underwent either retropubic or robot-assisted laparoscopic radical prostatectomy. The mean prostate specific antigen level, seminal vesicle invasion laterality, tumor volume, and pathologic Gleason score were lower in the cohort of patients who underwent robot-assisted laparoscopic prostatectomy. No statistically significant differences were found in 5-year biochemical recurrence-free survival rates stratified by operation type (58.1% vs. 65%, log-rank, p=0.8), by Capra-S score (72.5% vs. 56.8%, log rank, p=0.1), or by surgical margin status (69.4% vs. 59.3%, log-rank, p=0.8). In univariate and multivariate Cox proportional regression analysis lymph node involvement (p=0.01) was found to be a statistically significant predictor of biochemical recurrence. Conclusion: Patients with positive lymph node involvement have a poor prognosis. Capra-S score was unable to predict biochemical recurrence in patients with pathologic T3b stage prostate cancer. Robot-assisted laparoscopic prostatectomy is comparable to retropubic radical prostatectomy in terms of the biochemical progression of prostate cancer with seminal vesicle invasion.

J Clin Med Kaz 2018;1(47):41-43 doi:10.23950/1812-2892-JCMK-00302

Authors: Kakharman Yesmembetov, Aiymkul Ashimkhanova, Kulpash Kaliaskarova

his clinical case demonstrates a history of 40-year old male with decompensated liver cirrhosis due to hepatitis C (genotype 1). The patient was started on direct acting antiviral therapy with sofosbuvir and simeprevir in order to decrease rate of disease progression. Treatment was associated with marked improvement of patient’s condition and resolving of ascites. Negative viremia was achieved after week 8 of antiviral therapy and the treatment was completed on week 12. However, evaluation on post-treatment week 12 has demonstrated recurrence of hepatitis C virus with sharp increase of liver transaminases of higher than 20 times upper limit normal. Second round of direct acting antiviral agents including ombitasvir, paritaprevir, dasabuvir and ritonavir was started. Negative viremia was achieved on week 4 with consequent demonstration of end of treatment and sustained virological response at 12 weeks post-treatment. This clinical case demonstrates need for personalized approach to antiviral therapy in each patient with modification of the treatment regimen by prolongation or implementing additional antiviral agent, if needed.

J Clin Med Kaz 2018;1(47):49-52 doi:10.23950/1812-2892-JCMK-00536

Authors: Galina Fedotovskikh, Galiya Shaimardanova, Manarbek Askarov, Sapargul Marat, Tatyana Yezhelenko

Objective: To determine the morpho-functional state of bone marrow autologous cells at the ultrastructural level. Material and Methods: For the electron microscopic examination, bone marrow cells taken from patients with autoimmune diseases were fixed in a 2.5% solution of glutaraldehyde with post fixation in a 1% solution of osmium tetroxide, was performed according to the conventional method and enclosed in epon. Ultrathin sections were prepared on a Leica ultramicrotome, contrasted with lead citrate by Reynolds, and examined in an electron microscope called Libra 120 (C. Zeiss). Results: Morpho-functional state of autologous bone marrow cells in severe chronic pathology was characterized by mitochondrial dysfunction and signs of insufficiency of microvesicular secretory function. Conclusion: Precultivation of bone marrow cells of patients with severe autoimmune diseases restored the energetic function of mitochondria, increased the secretory activity of endosomes.