Journal of Clinical Medicine of Kazakhstan

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.