Journal of Clinical Medicine of Kazakhstan

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.