Journal of Clinical Medicine of Kazakhstan

J Clin Med Kaz 2019;2(52):23-29 doi:10.23950/1812-2892-JCMK-00677

Authors: Ainur Doszhan, Roza Bektayeva, Aiman Galiyeva, Kapura Adrissova

Aim: To determine the IL-6, IL-8, TNF-α and fecal calprotectin levels in different phases of the disease and correlate their values with the clinical and endoscopic data in patients with inflammatory bowel diseases. Methods: 41 patients with IBD were selected: 78% with ulcerative colitis and 22% with Crohn's disease, 39% women and 61% men, mean age 35,3±1,9. Ulcerative colitis: acute current – 12,5%, chronic continuous – 6,25%, chronic relapsing – 62,5%, rarely relapsing – 12,5%, often relapsing – 6,25%. Minimal activity – 15,6%, moderate activity – 84,4%. Crohn's disease depending on the Crohn's Disease Activity Index (CDAI): mild disease and minimal activity – 55,6%, moderate severity and moderate activity – 44,4%. Results: IL-6 was increased to 20,56±5,51 pg/ml at ulcerative colitis, to 18,64±4,70 pg/ml at Crohn's disease; IL-8 – 79,38±15,37 pg/ml at ulcerative colitis and 82,49±34,81 pg/ml at Crohn's disease; TNF-α – 28,70±3,24 pg/ml and 32,32±6,92 pg/ml, respectively. Depending on the extent of the lesion: for IL-6 at E2 – 23,91±14,64 pg/ml and at E3 – 20,54±5,61 pg/ml; for IL-8 at E2 – 60,95±14,60 pg/ml and at E3 – 97,31±24,10 pg/ml. Conclusion: The results of the study have demonstrated an increase in the concentrations of IL-6, IL-8 and TNF-α in patients with ulcerative colitis and Crohn's disease, significantly exceeding the reference values. With increased activity of the inflammatory process, a significant raise in IL-6, IL-8 and TNF-α level was observed. Determining the level of fecal calprotectin depending on the location of the lesion and the activity of the process confirmed its importance in assessing the extent of lesions of the colon and diagnosing the activity of ulcerative colitis and Crohn's disease in different phases of the disease.

J Clin Med Kaz 2019;2(52):6-9 doi:10.23950/1812-2892-JCMK-00674

Authors: Dana Taizhanova, Roza Bodaubay

One of the most important achievements of medical science is the development and implementation of endovascular methods for treating ischemic heart disease, the volume of which is progressively increasing in relation to other methods of myocardial revascularization. As a result of data from various researchers, the mechanism for the development of coronary artery restenosis in patients with coronary artery disease undergoing endovascular interventions can be an inflammatory reaction, smooth muscle hyperplasia, formation of a wall clot and its organization, as well as the effect of an angiotensin-converting enzyme that activates angiotensin-II, an inducer and inhibits the activity of bradykinin, which inhibits cell growth. Recent studies of molecular and cellular mechanisms of restenosis in models of vascular damage in animals, as well as histological studies of human coronary arteries, have shown that the basis for the development of restenosis is the activation of migration and proliferation of vascular cells under the influence of growth factors caused by damage, which is a manifestation of angiogenesis and leads to neointima hyperplasia and neoadvention, narrowing the lumen of arteries. However, today there is no single point of view regarding the role of vascular growth factors in the development of the restenotic process, the number of studies highlighting the dynamics of the concentration of vascular growth factors in response to balloon expansion or implantation of coronary stents, and their possible role in the neointima formation and the restenosis development.

J Clin Med Kaz 2019;2(52):23-29 doi:10.23950/1812-2892-JCMK-00677

Authors: Ainur Doszhan, Roza Bektayeva, Aiman Galiyeva, Kapura Adrissova

Aim: To determine the IL-6, IL-8, TNF-α and fecal calprotectin levels in different phases of the disease and correlate their values with the clinical and endoscopic data in patients with inflammatory bowel diseases. Methods: 41 patients with IBD were selected: 78% with ulcerative colitis and 22% with Crohn's disease, 39% women and 61% men, mean age 35,3±1,9. Ulcerative colitis: acute current – 12,5%, chronic continuous – 6,25%, chronic relapsing – 62,5%, rarely relapsing – 12,5%, often relapsing – 6,25%. Minimal activity – 15,6%, moderate activity – 84,4%. Crohn's disease depending on the Crohn's Disease Activity Index (CDAI): mild disease and minimal activity – 55,6%, moderate severity and moderate activity – 44,4%. Results: IL-6 was increased to 20,56±5,51 pg/ml at ulcerative colitis, to 18,64±4,70 pg/ml at Crohn's disease; IL-8 – 79,38±15,37 pg/ml at ulcerative colitis and 82,49±34,81 pg/ml at Crohn's disease; TNF-α – 28,70±3,24 pg/ml and 32,32±6,92 pg/ml, respectively. Depending on the extent of the lesion: for IL-6 at E2 – 23,91±14,64 pg/ml and at E3 – 20,54±5,61 pg/ml; for IL-8 at E2 – 60,95±14,60 pg/ml and at E3 – 97,31±24,10 pg/ml. Conclusion: The results of the study have demonstrated an increase in the concentrations of IL-6, IL-8 and TNF-α in patients with ulcerative colitis and Crohn's disease, significantly exceeding the reference values. With increased activity of the inflammatory process, a significant raise in IL-6, IL-8 and TNF-α level was observed. Determining the level of fecal calprotectin depending on the location of the lesion and the activity of the process confirmed its importance in assessing the extent of lesions of the colon and diagnosing the activity of ulcerative colitis and Crohn's disease in different phases of the disease.

J Clin Med Kaz 2019;2(52):37-41 doi:10.23950/1812-2892-JCMK-00676

Authors: Rizaldy Taslim Pinzon, Fransiscus Buwana

Background: Atrial fibrillation increases the risk of stroke and is associated with poor stroke outcomes. The primary concern of this study was to compare the clinical outcome of ischemic stroke patients with atrial fibrillation and without atrial fibrillation. Methods: This was a retrospective cohort study using secondary data from electronic medical record and electronic stroke registry of Bethesda Hospital Yogyakarta, Indonesia. The data was collected from 2017-2018. The presence of atrial fibrillation at stroke onset and during the acute phase was confirmed by a standard electrocardiogram. The primary outcomes of the study was in-hospital mortality, disability measured by modified Rankin Scale (mRS), and length of stay. We used SPSS 20 with significance level 0,05. Results: Among 1688 patients with ischemic stroke, 45(2,67%) had atrial fibrillation. 51,11% of patients with AF were males and 82,22% aged above 60 years. The mortality of stroke patients with atrial fibrillation group is eighteen patients (40.0%), thirty seven patients (84.4%) have poor functional outcome (mRS≥2) and have length of stay 6 (0-41) days. Bivariate analysis showed stroke patients with atrial fibrillation group is significantly associated with higher in-hospital mortality (RR: 2.11; 95% CI: 1.09-2.22; p: 0.001), worse disability (RR: 2.09; 95% CI: 1.92-2.32; p: 0.001) and prolonged hospital stay (6 (0-41) vs 4 (0-14), p:0.001) than in stroke patients without atrial fibrillation group. Conclusion: Atrial fibrillation is associated with stroke outcomes. Careful cardiac evaluation and appropriate treatment are needed to improve the poor outcomes in patients with ischemic stroke and atrial fibrillation.

J Clin Med Kaz 2019;2(52):50-58 doi:10.23950/1812-2892-JCMK-00684

Authors: Talgat Uskenbayev, Altay Kerimkulov, Adilbek Mukazhanov, Meiram Mamlin, Rimbay Kaliyev

Objective: The aim of this study is to present our initial implementation experience in peritoneal carcinomatosis treatment and the technical details of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the light of current literature. Material and methods: Data of 7 consecutive patients who were treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis in the National Research Center for Oncology and Transplantology, between October 2016 and December 2018 were retrospectively reviewed. Treatment indication and management were evaluated at the multidisciplinary oncology council. All patients underwent cytoreductive surgery and hyperthermic intraperitoneal chemotherapy with the aim of complete cytoreduction. Patients with unresectable disease and/or palliative surgery were excluded from analysis. Perioperative complications were classified according to Clavien-Dindo classification, and hyperthermic intraperitoneal chemotherapy-related side effects were identified using National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) criteria. Demographic, clinical and histopathological data of the patients were analyzed. Results: The mean age was 47 (30-62). Three patients were female. The origin of peritoneal carcinomatosis was colorectal cancer in 3 patients, ovarian cancer in 2 patients and pseudomyxoma peritonei in 2 patients. The mean Peritoneal Carcinomatosis Index was 17 (3-32), with a mean operative time of 517 (366-710) minutes. Perioperative morbidity and mortality were observed in 2 (28,5%) and one patient (14.2%), respectively. During a mean follow up of 9,6 (3-26) months, overall and disease-free survival rates were 85,7% and 83,3%, respectively. One patient with colorectal cancer (after 12 months) had retro-abdominal recurrence. The remaining patients are being followed-up without any recurrence. Conclusion: Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy have favorable results in the treatment of patients with peritoneal carcinomatosis. Compatible with the literature, surgical outcomes of the presented series are encouraging for this treatment modality. Careful perioperative evaluation, proper patient selection and multidisciplinary approach are essential for success in curative treatment of peritoneal carcinomatosis.

J Clin Med Kaz 2019; 2(52):68-71 doi:10.23950/1812-2892-JCMK-00682

Authors: Rakhima Mekenbayeva, Anar Sarsembayeva, Bahytzhan Nurkeyev, Zhazira Kursanova, Nigina Mekenbayeva, Arman Akseitov

The Fallot’s tetrad is a common congenital heart disease that requires radical surgical correction. Without treatment, Fallot’s tetrad quickly leads to progressive right ventricular hypertrophy due to the increased resistance caused by a narrowing of the pulmonary trunk, which leads to heart failure and dilatation of the heart cavities. The Fallot’s tetrad mortality rate reaches 35% in the first year of life and 50% in the first three years of life. By the age of 40, only 5% of patients with Fallot’s tetrad survive. A unique feature of this clinical case is the natural life expectancy of a patient with congenital heart disease of Fallot’s tetrad: not operated, with a large defect in the perimembranous part of the interatrial septum, in the advanced stage of progressive chronic heart failure with the development of pulmonary hypertension, right dilatation and left heart atrial, tricuspids, insufficiency of the II degree, decrease in global systolic function of the left ventricle. The patient was offered surgical treatment, explained the postoperative risks, which were assessed as high. The patient refused surgery, after which it was recommended inpatient treatment aimed at correcting chronic heart failure at the place of residence.

J Clin Med Kaz 2019;1(51):8-11 doi:10.23950/1812-2892-JCMK-00657

Authors: Dinara Amanzholova, Valentina Sirota

Contemporary diagnostics methods can suspect the presence of tumors in mammary gland of minimal size. The current world trend in the treatment of breast cancer, especially early breast cancer, is the use of organ conserving treatment as a method that improves patient’s quality of life with preserving mammary glands. This study systematizes results of recent researches which studied long-term results of treatment after radical mastectomy and breast conserving surgery.

J Clin Med Kaz 2019;1(51):16-20 doi:10.23950/1812-2892-JCMK-00664

Authors: Mereke Maratkyzy, Aruna Kosybaeva, Naylya Kabildina, Anelya Beisenaeva

Views on the role of extracellular neutrophilic traps in oncology vary greatly. On the one hand, there is evidence of the anticarcinogenic properties of neutrophil networks associated with the direct destruction of tumor cells and stimulation of the immune system. Cytotoxicity towards tumor cells is manifested by trap components (myeloperoxidase, proteinases and histones), while DNA strands are considered as a kind of tool for capturing tumor cells and limiting their further spread.

J Clin Med Kaz 2019;1(51):27-31 doi:10.23950/1812-2892-JCMK-00659

Authors: Hülya Nazik, Mehmet Kamil Mülayim, Derya Korkut Saridağ, Perihan Öztürk

Objective: Psoriasis is a chronic inflammatory skin disease with a complex etiopathogenesis including genetic predisposition, immune dysfunction and environmental factors. Chronic inflammation leads to the development of vascular and metabolic disorders. The bioimpedance method is an easy and useful method for evaluating of body composition. In this study, it was aimed to investigate body composition, demographic, clinical and laboratory data in patients with psoriasis and to compare them with healthy controls. Material and Methods: Sociodemographic characteristics of the participants, duration of disease, concomitant systemic diseases, family history of psoriasis, presence of psoriatic arthritis and current treatments were questioned. Body composition of the participants was determined by Tanita Body Composition Analyzer type BC-418 (Tokyo, Japan), and in blood samples glucose, total cholesterol, HDL, LDL, triglyceride and insulin levels were determined by autoanalysers. Results: HOMA-IR, triglyceride, BMI, metabolic age and fat percentage were significantly higher in the psoriasis group, whereas the control group had higher body density, lean mass, mineral percentage and total body fluid. In this study, it was found that as the insulin resistance, BMI and fat ratio increased, the severity of the disease increased in patients with psoriasis. Also BMI increased in patients with longer disease duration. Topical and conventional therapies had no significant effect on laboratory and body composition parameters. Conclusion: In the light of the data obtained in this study, it was concluded that some metabolic markers and body composition parameters were negatively affected in patients with psoriasis and were associated with disease severity.

J Clin Med Kaz 2019;1(51):37-43 doi:10.23950/1812-2892-JCMK-00666

Authors: Safiye Sanem Dereli Bulut, Fuad Nurili, Hadi Sasani, Omer Aras, Yasar Bukte

Objective: To evaluate T2-weighted BLADE tecnique for evaluating intra-abdominal organs and lesions, especially the gastrointestinal wall and pathologies, and to compare the findings with HASTE. Material and Methods: Sixty patients (mean age: 47.2 years, range 19-88) (32 males, 28 females) referred to our institution for upper abdominal Magnetic Resonance Imaging (MRI) examinations with various indications between January 2015 and May 2015 were included in our study. All examinations were performed on a 1.5 Tesla MR device and no anti-peristaltic drug was administered. Images were retrospectively and independently evaluated by two radiologists. A qualitative evaluation was performed to assess images regarding the presence of artifacts and diagnostic quality, the anatomical detail of the upper abdominal organs and structures (contour sharpness, contrast of tissue, parenchyma and internal wall structure) and any present pathologies and lesions in the organs (lesion contour sharpness and size, internal structure properties, morphological characteristics). A quantitative evaluation was performed to calculate the contrast-to-muscle ratios (CMR) of the internal organs and lesions. The distribution of the variables was statistically checked by Kolmogorov Smirnov test. Paired-samples t- test was used for quantitative data. Results: BLADE was significantly associated with reduced artifacts (p <0.0001) and increased image quality compared with HASTE. The highest agreement between both observers was that motion artifacts were reduced (Gwet's AC2 = 0.94). In addition, observers agreed that the parenchymal structure of the upper abdominal solid organs and the anatomic details of the stomach wall structure were better with BLADE (Gwet's AC2 = 0.87). In most cases, both observers preferred BLADE (p <0.0001) for evaluating images and lesion morphology. Conclusion: In upper abdominal MRI examination, artifacts, especially movement artifacts, were significantly reduced by BLADE, yielding more valuable data for the evaluation of the gastrointestinal system wall structure and its pathologies, especially considering the organs near to the diaphragm and retroperitoneal organs as well as vascular structures.

J Clin Med Kaz 2019;1(51):50-55 doi:10.23950/1812-2892-JCMK-00662

Authors: Saule Urazalina, Aisulu Musagalieva, Assel Issabekova, Kulzida Koshumbayeva, Bagdat Akhit

Aim: To conduct a one-stage multicenter study in South-Kazakhstan Region to obtain baseline prevalence of comorbidity of chronic noninfectious diseases and their risk factors. Material and methods: 1400 persons at the age of 18-69, living in the South-Kazakhstan region. Epidemiological part consisted of: interviewing, physical examination and laboratory tests. For statistical analysis were used MSAccess and SPSS22.0. computer programs. Results: 12.7% of respondents in South-Kazakhstan region smoke, which statistically significantly less than number of nonsmoking (87.3%; p<0.01) ones. The number of alcohol drinkers is 28.4%, which also less than number of nondrinkers (71.6%; p<0.01). The 48.3% of people included in the study had physical inactivity, while 51.7% had sufficient physical activity. More than half of respondents had abdominal obesity (67.9%), which higher than number of people without obesity (32.1%; p<0.01). The 72.1% had chronic noninfectious diseases (1009 of 1400). Comorbidity with two diseases – 48.2% (676 of 1400). Most common disease was arterial hypertension (45.9%: 464 of 1009). Less common – chronic kidney disease (2.4%:24 of 1009). The most common comorbidity – arterial hypertension and diabetes mellitus (72.3%). The less common – obesity and chronic obstructive pulmonary diseases (2.3%). Conclusions: 1. The most common risk factors of chronic noninfectious diseases in South-Kazakhstan region are improper diet, obesity, physical inactivity. 2. The frequency of chronic noninfectious diseases in South-Kazakhstan region was 72.1%. And the most common disease was arterial hypertension. 3. The most common comorbidity – combination diabetes mellitus with arterial hypertension while the less common – combination obesity with chronic obstructive pulmonary disease.

J Clin Med Kaz 2019; 1(51):61-64 doi:10.23950/1812-2892-JCMK-00660

Authors: Akylbek Tussupkaliyev, Svetlana Tuitebayeva, Andrey Gaiday, Ulbolsyn Kairbaeva

To date, in order to better understand the mechanisms for the development of terminal states associated with pregnancy, and to correctly assess the allowable costs in the organization of observation and intensive treatment, it is increasingly taking into account and analyzing not only deaths, but also cases of successful elimination from a critical condition, so called “near-miss cases”. The given clinical case can be attributed to those. We observed a case of a positive outcome with an embolism of amniotic fluid of the lightning form, accompanied by cardiopulmonary shock with a double cardiac arrest, DIC - syndrome, postresuscitation disease. As practice shows, one of the most effective opportunities to shorten the way to success, is to use the experience of those, who have already traveled this