Herald of Almaty State Institute of Advanced Medical Education

21-27

Authors: Eshnazarov K.E., Park Jin Oh, Yulda A.G.

The research objective consists in the analysis of dynamics of publications about an artroplastika of a coxofemoral and knee joint in Pub Med, EBSCO Health MedLine and the Science Direct database over the last 10 years. Methods: PubMed, EBSCO Health MedLine and Science Direct of the database were used with function of advanced search to receive result. Numbers of the publication of an hip arthroplasty and knee arthroplastyare defined separately for each database with use of advanced search in the following terms searching: "an arthroplastica of knee and coxofemoral joints" in "endoprosthesis replacement of knee and coxofemoral joints" from January 1, 2005 till December 31, 2014. n= an arithmetic average publication number in the database was defined and the ratio of publications of an artroplastika of a coxofemoral and knee joint is analysed. The incidence of endoprosthesis replacement or the hip arthroplastyjoint published in Pub Med in 10 years made 17939 which increased with 1,354 to 2,772 during the period from 2005 to 2014. EBSCO Health Medline published 17,783 cases which also increased with 1,342 to 2,235 in a year between 2005 and 2014. In ScienceDirect 29,970 cases are published, grew with 1,857 to 3,600 for the same period. Arithmetic average the publication about an arthroplastica of a coxofemoral joint increased from 1,518 to 2702 cases a year between 2005 and 2014 whereas the number of the publication about an arthroplastica of a knee joint grew from 1136 to 2771. The percentage ratio shows that growth rates of publications of a knee joint (10%) was quicker, than a coxofemoral joint (7%) within 10 years. Conclusion: the number of publications about a knee joint sharply increased over the last 10 years, showing increase in interest in researches of problems of a knee joint.

32-38

Authors: Abzaliev K.B., Tuleutaev R.M., Omgarbaev K., Saydalin D.

Lln National Scientific Center of Surgery named after A.N. Syzganov (Almaty, Kazakhstan) from 2000 till 2016 63 patients underwent plastic repair of the mitral valve with use of Carpantiers ring. There were discussed direct results and complications of the near postoperational period of the reconstructive and plastic operations on mitral valve with use of the Carpantiers prosthetic ring. It has been shown that in use of soft half ring in 12 (19%) cases the tachyarrhythmia and AV-blockages were taken place. Use of the Carpantiers basic rigid by the way in 1 (1,6%) case it was a reason of lethal outcome. Use of the soft synthetic half ring is indicated in the II types of the mitral valve insufficiency of a rheumatic etiology. It is not recommended to be used in mitral valve insufficiency of I and III types of the degenerative and congenital origin. Analysis of the course of an early postoperational period after operation on mitral valve has shown the considerably smaller percent of complications and lethal outcome in this group (1,58 and 4,76%) compared to prosthetic repair.

43-49

Authors: Baymuratova G.A., Tyessova-Berdalina R.A.

The purpose of our work was to carry out the analysis of results of studying of microbic structure of various biosubstratea, which are taken away from different age groups of patients with nonspecific diseases of the top airways. We have studied microflorea. We have established etiologichen significant thresholds detectability of representatives of conditionally pathogenic microorganismus to a research of a mucous back wall of a throat, a phlegm in-group of patients with chronic somatic diseases. The range of representatives of microflorea of a mucous back wall of a throat, a phlegm, at pathologies of respiratory system was various as it is qualitative, and quantitatively with considerable variability of the leading etiopatogen by years. So, in a phlegm for the 20-year period the pneumococcus has yielded the leading position to golden staphylococcus which share has grown by 4,8 times and has made 35,8 % of cases, that is growth of the etiologichesky importance of conditionally pathogenic microorganisms is revealed.

55-58

Authors: Umeshov A.U., Kusainov A.Z., Kuatbekov D.Zh.

The intestinal invagination remains to one of the most frequent and terrible pathologies at babies. Results of treatment of 255 children with an intestines invagination are given in article, 69 of which are operated in the Center of children's emergency medical service of Almaty over the last 5 years. For treatment of this disease conservative and operational methods are used. Application of a conservative method is admissible only in the conditions of a specialized children's surgical hospital and the surgeon having experience of clinic-radiological diagnostics and expeditious treatment of an invagination at children. 69 children of various age were operated with different terms of receipt, at the same time localization of an intestinal invagination in each case was unique. The uncertainty with diagnosis and assessment of activity of intestines at a conservative dezinvagination puts doctors in a difficult situation and is reflected in time rendering the emergency surgical help to the child, leading to delay with surgery. If operation is performed right after the address, then the forecast for the child improves. The delay with surgical intervention can lead to irreversible changes of a wall of the taken root gut. In article the attention to the most informative objective methods of inspection of patients, modern methods of early tool diagnostics is focused. Thus article can be of considerable interest for a wide range of doctors: for children's surgeons, pediatricians, gastroenterologists concerning timely diagnostics.

66-70

Authors: Atezhanov D.O.

The goal in a comparative perspective to examine the level of dental health of preschool children.Determination of the level of the dental health of children as described and dental status of the indices, trampled in dentistry. In 61 children with somatic pathology (comparison group) and 110 children with persistent infection (study group) identification of active infection dynamics in the Institute of Scientific Laboratory B. Atchabarova Kazakh National Medical University. Indicators of dental status and oral health level in children with somatic diseases and infections will reveal more profound changes. They have revealed high intensity and decompensated form of caries flow with systemic hypoplasia poor hygienic condition of the oral cavity. Dental health status of children of preschool age somatic pathology was 63,6 ± 0,54 % upon accession persistent infection - 51,6±0,74 % of apparently healthy - 85,1 ±0,554 % (acceptable rate - 81,4 %). This data is used for planning and general dental treatment and preventive measures in children with somatic diseases and infection.

75-79

Authors: Kusainova F.A., Nurumbetova Zh.Zh., Baymuhanbetova Zh.N., Aliyeva Zh.S.

This work provides the retrospective analysis with a missed abortion 130 woman aged 21 to 48, on the basis of Operative Gynaecology Department of the Institute for Reproductive Medicine for the period from January to December 2015 y. The histological results analysis of the ovum elements, combined with curettage of the uterus. Foregoing signs are characteristic at undeveloping pregnancy began in a gestational term 5-6 weeks: at 81 (62,3 %) woman had not complaints, 34 (26,1 %) women are marked by scanty with blood excretions from genital tracts, 23 (17,6%) patients aching cramping pain in the lower abdomen. Woman of the anamnesis with undeveloping pregnancy, it does not eliminated the risk of re-undeveloping pregnancy.

84-86

Authors: Mukasheva G.M., Azizov Y.Zh., Tleugabulova G.A., Kim V.B.

There are the results of the study of the effectiveness of high-tech radiotherapy at the linear accelerator Clinac-100 in patients with esophageal cancer compared with patients who has received standard remote gamma therapy in the unit Teragam. The study was conducted based on a retrospective analysis of 30 medical histories (KazNSIOR) patients with esophageal cancer (ICD-10 by C15) between the ages of 29 to 83 years. By comparative analysis, it was revealed that the effectiveness of 3D conformal radiation therapy is higher than that conventionally distant gamma therapy. Besides tolerability of irradiation after treatment on the linear accelerator, was much better, due to the maximum protection of healthy tissues and organs by multileaf collimator.

14-18

Authors: Moidimova N.K., Turdumambetova G.K.

Objective: to study the possibility of ultrasound diagnosis in determining the qualitative and quantitative components of tuberculous pleurisy. Materials andMethods: The study involved 147 patients newly diagnosed with exudative pleurisy of tuberculous etiology and 90 patients with non-specific etiology of pleural lesions in age from 18-65 years old of both sexes in the outpatient diagnostic department of the National Centre of the Kyrgyz Republic ТВ (NTSF MOH). A comparison of the heterogeneity of the pleural fluid, pleural severity overlays, the thickness of the affected pleura, pleural overlays and fibrin strands. Results: echogenic features of tuberculous pleurisy: heterogeneous pleural fluid was determined in 86,3%±2,85% of cases (p<0.001); pleural overlay to 66,7%±3,4% cases (p<0.001); the thickness of the pleura (almost 2/3 of patients) in 76,3%±3,2% of cases (p<0.05); Overlay thickness (4 mm, 8 mm) - in 75,5%±3,3% of cases (p<0.001); fibrin strands were often thick at 80,5 %±2,2 % of patients (p<0,001). These results allow us to recommend the criteria for the early detection of tuberculous pleurisy doctors diagnosticians primary health care level.

25-28

Authors: Abdurazakov U.A., Abdurazakov A.U.

Habitual dislocation of a shoulder results from an insufficient and short-term immobilization after traumatic dislocation. According to literature, the frequency of development of instability of a shoulder joint after primary dislocation of a shoulder at persons of young age from 16 to 30 years makes up to 67%, and at persons 40 years - to 38% are more senior. The first repeated dislocation arises within half a year, further the frequency of dislocations grows and reaches 8-10 in a year, arise when performing usual movements (raising of hands, assignment aside and even in a dream). The reasons of habitual dislocation of a shoulder are existence of specific anatomic features of a shoulder joint - a big spherical head of a humeral bone, a poorly concave articulate hollow of a shovel of the small size, the extensive extensible capsule of a joint, weakness of muscles of a humeral belt. At patients secondary, deep violations in nervously - the muscular device of a humeral belt develop: bone changes in area of the affected joint, the joint cavity increases, articulate surfaces change, muscles atrophy. Treatment of habitual dislocation of a shoulder only quick. The absolute indication to quick treatments - presence at the patient 2-3 recurrence of dislocation within one year. About 300 ways of expeditious treatment are known, however any of them in pure form wasn't widely adopted. The combination of various ways is most often used. We developed a new way of expeditious treatment of a shoulder joint, in article postoperative maintaining and results of treatment of 33 patients is described. The offered way differs in simplicity of performance and efficiency of restoration lost functions of the top extremity that allows to recommence sports activities, to increase quality of life.This article describes a method of surgical treatment of shoulder anterior instability, postoperative management and the results of treatment of 33 patients. The proposed method is simple to perform and efficiency.

33-36

Authors: Zholdasov P.A., Baymukhanbetova Zh.N., Nurumbetova Zh.Zh.

Symptoms of chronic endometritis consist of menstrual and fertility dysfunctions. The existence of an inflammatory focus in the pelvic area leads to disruption of the menstrual cycle, heavy or scanty menses, amenorrhea, intermenstrual spotting and abdominal pain. Fertility problems are one of the main complaints of patients with chronic endometritis. The article describes the results of a retrospective analysis in 154 women aged 23-47 years with infertility diagnosis associated with a preliminary diagnosis of «сһгопіс endometritis.)) Having identified hysteroscopic picture of chronic endometritis it was compared with histological findings. On the basis of the data obtained it was found that visual endometrial changes were confirmed in 28.5 % of cases obtained from hysteroscopic investigations at the operative gynecology department at the Institute of Reproductive Medicine (IRM) from 1 January 2015 to 31 December 2015.

42-45

Authors: Akimov O.Ye., Mischenko A.V., Kostenko V.O.

The study was conducted on 52 adult Wistar rats for 30 days to examine the effect of combined nitrate and fluoride intoxication on the generation of superoxide anion radical («О?-), the functioning of enzymatic antioxidant systems, integrated indicator of antioxidant protection and indicators of lipid peroxidation (LPO) in rat gastric mucosa. Analysis of the results allowed us to establish a synergistic effect of fluoride and nitrate toxicity on processes of lipid peroxidation. The impact on the generation of »02- and antioxidant system has a complex interaction.

51-57

Authors: Sarmuldayeva Sh.K., Rozahimova G., Djexembekov A., Yerbulatova S.T., Umarova A.D., Lisenkov

То carry out the analysis of anamnesis, clinical and laboratory data according to the clinical history of women with HELLP syndrome. The article contains the data of clinical history from the archives of The Municipal Prenatal Centre. The clinical, biochemical, and static methods have been applied in the research. The anamnesis data has been presented in the medical history: age, birth parity, pregnancy period, percentage of severe preeclampsia, labor method, newborn state, cases of maternal mortality, EGZ, clinical (A/D, symptoms) and laboratory (blood picture, urine picture, level of ALT.AST.bilirubin, coagulation)data in development from the moment of checking in to the days when there was a normal state of lab analysis.According to our analysis of HELLP syndrome, mostly women of early reproductive age, in iparous term of 29-35 weeks. The main symptoms were hypertension 75%, nausea 66%, 55% general swelling, vomiting 41%, 33% decrease in diuresis. The normal analysis ofliver ferments, direct bilirubin has been noticed in average on the 4th day. Proteinuria tended to decrease averagely on the 3rd day.Timely and correct diagnosis and complex intensive therapy made it possible to ensure the best outcome in 10(83,3%) patients.

67-71

Authors: Turgumbayeva A.A., Ustenova G.O., Rakhimov K.D., Beltenova A.G., Esetova K.U., Samara A.

The objects of study were samples of C02- extract, obtained from the flowers of safflower (Carthamustinc-torius L), and collected in the flowering stage. Dried plant material (safflower flowers) collected in the summer, subjected to treatment and disposal of mechanical impurities, drying and then grinding to hyperfine state. Harvesting plants was made on theterritory of Almaty region. Theoretical and experimental composition was developed and ointments technology conforming to the Pharmacopeia Republicof Kazakhstan. The composition of ointments presented ingredients: sunflower oil, T-2 and peppermint oil, purified water. From the obtained sample C02-extract ointment developed. The resulting samples of C02-extract were moving, volatile Cinnamon, with a pleasant characteristic odor. From the obtained sample CCyextract ointment developed. Developed laboratory regulations antimicrobial, anti-inflammatory phytopreparation based on medicinal plants.

79-83

Authors: Myzdoubaeva B.T.

Short evolution of definitions of sepsis is considered, definition of the basic concepts concerning sepsis, an infection is presented. The syndrome of the system inflammatory answer as the adaptive response of an organism to damage which subsequently, under certain conditions can lead to development of sepsis, the terms, which are used, only for path о anatomical diagnosis of sepsis is considered. New definitions of sepsis and septic shock, taking into account organ dysfunction which were reconsidered in 2016 by doctors of the American and European school of intensive therapy are presented. Definitions of sepsis in the clear and concrete form applied in routine practice by doctors were changed. Sepsis - the term making broad sense is applied at health workers to unclear process where there are no unambiguous criteria: biological, visualization or laboratory indicators therefore, the pragmatic compromise was accepted. New definition received the name Sepsis-3, after the first and second definitions of sepsis of 1991 and 2001.

13-15

Authors: Abdurazakov U.A.1, Abdurazakov A.U.1, Tazhiev Zh. A.1

In article, results of studying of influence of an implant for a nailing of diaphyseal fractures of clavicle on environmental fabrics after implantation and an assessment of safety by its path of carrying out the implantation test are given in a preclinical stage at the experimental animals. The new original clamp for a nailing is offered. This clamp consists of a core of various standard sizes with a diameter of 3 mm, from 95 to 115 mm long and nuts f/3 made of stainless steel of medical brand (12X18H10T). Distinctiveness of a core is its triangular section throughout. Animals were observed by 12 weeks. The final assessment about compatibility of bones of mammals and the fabrics surrounding them with the studied exemplar was given based on a complex assessment of data of a patomorfologiya, dynamics of body weight, an adhesion of operational wounds, the behavioural reactions given outer inspection. As a result of the conducted pilot research of "in vivo" the negative impact of the implanted clamp for a clavicle nailing on an organism of laboratory animals is not revealed, we will combine with tissues of mammals at the long-lived implantation.

20-24

Authors: Karzhaubaeva M.A.1, Isabekova A.A.1

Admission diagnosis: Myoclonus epilepsy with extrapyramid syndrome, Rassmusen encephalitis. Complains on admission: attacks of twitching (shoulders, arms) over the right - against the dystonic attacks, without loss of consciousness, short term, lasting about 15-25 seconds, for 20 minutes 54 polymorphic paroxysms, general weakness and lethargy. The analysis of literary data shows, that virological and immunological methods of investigation in vivo and post-mortem proved that virus of measles is most often plays the role of a pathogen. On MRI find the picture of encephalitis with the presence of gliosis knots in the hemispheres of cerebrum, brainstem and cerebellum. It should be noted that KT did not expose changes in the brain before 1 year from the beginning of clinical display. MRI can show the damage of white substance already in 4 months after appearance of the first symptoms. On an electro-encephalography expose high-peak periodic slow waves, with mioclonya. In a cerebro-spinal liquid a cytosis is within the limits of norm. The level of gamma-globulins rises in blood. In blood and cerebro-spinal liquid the titles of antibodies are enhance able to the virus of measles. Subacute sclerosing panencephalitis rapidly progressed and led to fatal outcomes for a child. The introduction of measles vaccination reduces the incidence by 90%.

29-32

Authors: Kuttykuzhanova G.G., Tanyrbergenova A.G.

Among all immunobiological preparations, intravenous immunoglobulinsare the only approved for use in children. They are used to correct impaired anti-infectious resistance. Quite often, it requires their use with the aim of immune replacement therapy in patients with sepsis or severe bacterial and viral infection. In such cases, need not only replacement therapy, also adjuvant treatment of bacterial infections. For these purposes, Pentaglobin is the only drug and it can be used in newborns. Pentaglobin contains antibodies of class IgG and is enriched with antibodies of the IgM and IgA.The concentration of IgM class antibodies in Pentaglobin is higher about 5 times than in human plasma, so a high concentration of these antibodies in conjunction with antibiotics increases the efficiency of therapy for severe bacterial infections. Using Pentaglobin significantly reduces the risk of death, rather than the use of standard antibodies.The authors also shared their experiences on usage of Pentaglobin in infectious diseases in children. They treated 36 children with severe infectious pathologies: extensive pneumonia, sepsis, purulent meningitis, acute intestinal infections, from HIV to AIDS stage, Epstein-Barr virus infection. Because of this preparation showed that the survival of children who were receiving Pentaglobin 1.5 times higher than in the control group, also it decreased hospital stay for about 4-5 days.

38-43

Authors: Sarmuldaeva Sh.K., Nugmanova J.M., Imangalieva N.M., Abdikarimova R.B., Lejebokova E.A.

The Caesarean section though wild spread is a completed one characterized with high level of post-operative complications - 3.3-54.4 %. One of the problem is bleeding. Antifibrinolytic preparation is powerful source in treatment of obstetric bleedings. One of this preparations is tranexamic acid (trenaksa). It is a synthetic derivative of the amino acid lysine that exerts its antifibrinolytic effect through the reversible blockade of the lysine binding sites on plasminogen molecules. То evaluate efficiency and safety use of tranexamic acid (trenaksa) in prevention of bleeding on cesarean section of women experienced one caesarian section before.difference in blood loss was stated in both groups undergoing this study. Under use of gravimetric method and method of Moor blood loss in research group was less than in control group. Estimation of blood loss by Nelson was higher in research group compared with control group, but difference index was subtle. Side effects and complications were not revealed in both groups. Antifibrinolytic treatment with tranexamic acid (Trenaksa) evidently decreases blood loss. There were no side effects and complications in use of tranexamic acid (trenaksa). Tranexamic acid treatment (trenaksa) is safe and can be recommended in wide obstetric practice.

48-54

Authors: Tesova-Berdalina R.A., Myrzagulova Zh. U., Baymuratova M.A.

Infectious diseases dominate in structure of illnesses of children's age, making - 70% in structure of all case rate and 80 % in structure of child mortality. Thanks to bacterination in the 20th century the case rate was sharply reduced by infections: as smallpox, diphtheria, whooping cough, tetanus, poliomyelitis, measles and others. On the magisteris of the analysis of data of our master research, it is possible to draw the following conclusions: despite the carried-out scheduled maintenance of the district doctor, number of refusals of bacterination and medical contraindications to bacterination continues to grow. The control system of electron document flow becomes an obligatory component of informatization of healthcare institutions. The automated program of management (APU) framed by us allowed to optimize process of immunoprophylaxis of the children's population at the out-patient level of an out-patient department in the form of a transparence and efficiency of use of operating time: Economy of operating time since one working day up to 30 seconds, on formation of lists of children on medical contraindications and refusals of bacterination; Reduction till 10 seconds since 2 working days, on drawing up the list of necessary quantity of the purchased vaccines for a year; Decrease till 15 seconds (5 hours were spent) of planning of bacterination for a month.

60-64

Authors: Pozdnyakova A.P., Ashirbekov G.K., Adilgireyuly Z., Kabdulina S.S.

The comparative analysis of quality of life at inhabitants is carried out and. Акай, the item Toretam of Karmakshynsky district, adjacent to the area of failure of the Proton-M launch vehicle in 2013 at the Baikonur spaceport, and the settlement of comparison of Ayteke6nKazalynsky district of the Kyzylorda region, according to poll. As material data of social and hygienic poll of 300 persons from settlements of supervision (150 residents of the aul of Akay and 150 - the settlement of Toretam) and 200 residents of the settlement of comparison of Ayteke6n aged from 18 till 75 years served. It is established that, by an integral assessment, quality of life in all three analyzed settlements satisfactory: the inferior «quality of life» at respondents from and. Акай - 2,61±0,05 points, the best - at respondents from the item of Ayteke6n - 2,74±0,04 and average position is held by the item Toretam - 2,70±0,04. Distinctions between the village Akay and the settlement of comparison of Ayteke6n statistically are significant.

71-76

Authors: Erkinylu A.

In this paper the use of Results of diagnosis and treatment of 287 patients with gastro intestinal bleeding. Endoscopic examination performed in all patients admitted to the hospital with gastro intestinal bleeding. 120 (100%) patients of the main group performed endoscopic hemostasis. In 9 (7.5%) patients developed recurrent bleeding. Of these, 3 (2.5 %) patients in spite of the extended complex of therapeutic measures could not prevent death. In 6 (5 %) patients in connection with non-performance of endoscopic and conservative treatment, surgical treatment, after the control endoscopic examination were discharged with positive treatment outcomes. In 92.5 % of cases, endoscopic hemostasis was satisfactory results where achieved final hemostasis. In the control group was 167 (100%) patients, 106 (63.5%) cases conservative treatment performed, on 61 (36.5 %) patients were surgical treatment. In the control group, 64 (38 %) patients had an episode of rebleeding and in 31 (18.5%) cases were fatal. Conclusions: Endoscopic hemostasis in 92.5 % of cases gives a satisfactory result in the gastro intestinal bleeding. In patients with a high risk of recurrent gastrointestinal bleeding, it is advisable to perform a dynamic EFGDS 6-8 hours preventive endoscopic hemostasis pathological focus.

17-21

Authors: Ahmetova L.M.

This article presents a brief history of bronchial asthma, statistical data on the incidence in different countries, particularly bronchial asthma in children population of Almaty. Elucidated and the main factors of the above nosology. Statistical data on the incidence, prevalence and epidemiology of the disease, provide an analysis of the incidence of asthma among children in Almaty (0-14) and find out the main factors that influence the occurrence of this disease in allergic diseases of high incidence structure identified in Almaty. Over the past 5 years in Kazakhstan has been an increase in patients with bronchial asthma by 18.9%. Treatment of asthma in the Republic of Kazakhstan is conducted in accordance with international recommendations and national RC programs. Patients with bronchial asthma in the Republic of Kazakhstan in accordance with the order of Ministry of Health of the Republic of Kazakhstan № 786 of 04.11. 2011, amended in 2012 by order of the Ministry of Health of the Republic of Kazakhstan №347 from 18.05.2012 of the year, provided the necessary drugs. Bronchial asthma is an urgent problem in the service of Pediatrics. In most cases of asthmaasthma, effects persist for many years. The most severe forms of asthma significantly affect the quality of life of the patient and his family. About 15-20% of cases hereinafter tends to the formation of chronic obstructive pulmonary disease and subsequent disability. There is a high increase in asthma, especially among children. Today, in developed countries, the disease becomes an epidemic. According to WHO, in the world suffer from asthma around 300 million people. According to official statistics in the Republic of Kazakhstan for the past 5 years, the first place on the prevalence of diseases of the respiratory organs, which include diseases such as pneumonia, chronic bronchitis and unspecified emphysema, bronchial asthma. Of particular importance in all consensus documents in the management of patients with allergic diseases is attached to prevention system. Under the prevention of asthma is understood as a warning of disease occurrence (primary prevention) and prevention of relapse in those who already suffer from asthma (secondary prevention).

28-31

Authors: Ahan R.A., Umeshow A.

Relevance of a problem of strokes of a brain at children of early age gains extreme sharpness in connection with the increasing frequency of developing of this pathology, a suspense of many questions of diagnostics and treatment. Sharp violations of brain blood circulation on hemorrhagic type is a prerogative only of people of advanced age, but the statistics notes considerable rejuvenation of this pathological state and increase in its cases at children of early age. In this paper - levels of prevalence of a hemorrhagic stroke, the main mechanisms of pathogenesis, feature of a clinical current and outcomes of a stroke at children of early age of Almaty are studied. The analysis with use of medical documentation of the Center of children's emergency medical service in made.

38-46

Authors: Lepessova M.M., Ushakova T.S., Myrzaliyeva B.D.

Spinal muscular amyotrophy type 1 (SMA), Werdnig-Hoffmann infantile spinal amyotrophy) is inherited in an autosomal - recessive manner. Responsible for the development of the disease genes are localized in the region of chromosome 5q12.2-q13.3. There are 4 gene in this zone, damage of which causes the development of the disease or determines its severity. The most common SMN gene mutation, a deletion introduced in the 7th or 8th exon in the homozygous state. SMA type 1 is one of many diseases, causing the symptom «floppy baby». «Gold standard» diagnosis of SMA is a genetic method. Genetic diagnosis is to determine the deletion of exons 7 and / or 8 SMN1 gene. Among the methods used electrophysiological methods such as needle electromyography. Children with this disorder may keep their head, but never turn over or sit. The first in the pathological process involved the proximal muscles of the lower extremities, the process has spread upward. SMA type 1 must be differentiated from other diseases that cause a syndrome «floppy baby»: structural myopathies, neonatal myasthenia gravis, metabolic myopathy, storage disorders, atonic form of cerebral palsy, Marfan syndrome. This article provides a brief overview on the topic. Discussion on the clinical case of a child with genetically unconfirmed diagnosis of spinal muscular amyotrophy, but with the presence of characteristic clinical picture and pathognomonic for the SMA results of additional methods. During examination of the child was carried out differential diagnosis of SMA type 1 with other diseases that give similar clinical picture.

53-56

Authors: Lepessova M.M., Fedyanina Y.A., Akhmetova D.A.

Difficulties in the diagnosis of tuberous sclerosis complex associated with the polymorphism of clinical manifestations specific to this disease. We presented the article on the example of clinical case raised an important question about the diagnostic criteria for tuberous sclerosis complex, required for correct clinical diagnosis, and modern views on the subject. We present the definition of new data on the mechanisms of pathogenesis of tuberous sclerosis and major mutations in genes TSC1 and the TSC2, localized in the chromosomes 9 and 16, respectively, underlying the disease. Dysfunction of genes TSC1 and TSC2 leads to morphological changes of neurons and neurotransmitter disorders, which are also described in the article. We also examined the functions of proteins and hamartintuberin, as part of the natural antitumor systems. Here are described the controversial issues of the reliability criteria of tuberous sclerosis complex given the variety of clinical manifestations. It is noted that the classical triad of signs in the form of seizures, mental retardation, and «adenoma sebaceum», is today considered obsolete. It was revealed that diagnosis of epilepsy, mental retardation and autism should not be exhibited as major diagnosis and related diagnosis. For clarity, the clinical signs of tuberous sclerosis complex presented in the form of a table. There was presented clinical case of the patient Т., five-year-old boy with a diagnosis of tuberous sclerosis complex. There was displayed the data history, somatic and neurological status, indicating the considered nosology. It was carried out a genetic screening and identified family history of tuberous sclerosis in the family. This article contains information instrumental methods (electroencephalography, echocardiography, computed tomography and magnetic resonance imaging of the brain). It has been clearly presented morphological changes in the brain in the form of cortical Tuber on the example of magnetic resonance imaging, patient T. In conclusion, summarizes the clinical and diagnostic criteria to establish a definite diagnosis of tuberous sclerosis.

61-63

Authors: Rakhimbekova D.K., Duisen A.T.

In the article presented the dynamic of the main indicators of the polyclinic help organization on the example of one policlinic in the conditions of stage-by-stage realization of the Republic of Kazakhstan state programs in the health protection field.

69-72

Authors: Aknazarov A.S., Amidova M.B., Dusekova T.P., Kononbayeva S.N., Rashitova N.A., Sultanova A.K., Hamzina A.N., Amankulova Z.S.

The aim of the article is to reveal the most significant risk factors that lead to suicidal thinking in children. The objects of study are the pupils of the school number 30 in Almaty. One of the first aims of the work were create questionnaires for children in two age categories, together with the school psychologist. During the development of the questionnaires reviewed and processed for a better understanding of each question for the child, but at the same time excluded those that some way could hint at the main essence of this article. Age category of pupils divided into 5-8 and 9-11 according to the education system. Key words: suicides, suicidalbehavior.

78-83

Authors: Khussainova K.N.

In this article results of introduction of the new, progressive technologies reducing environmental pollution are brightly shown. On the oil and gas field studied by us introduction of new, nature protection technologies, such as "A super green torch", progressive technology for collecting excess gas, methanol regeneration installation, the compressor of gases of aeration, system of intra-field pipelines, the return pumping excess and sour gases has begun. Also data of monitoring researches of quality of atmospheric air are provided in article. By the conducted researches it is established that the periods of increase of pollution of the air basin of settlements, adjacent to the field, have two peaks which are connected with an intensification of production of hydrocarbonic raw materials. However these negative ecological moments significantly differ. In 1990. in connection with sharp increase in production of hydrocarbonic raw materials, and also low efficiency of gas-cleaning device, air pollution has considerably increased. And the second period was characterized by slight increase of concentration of dioxide of nitrogen only in two next settlements, and concentration of other chemicals, in the atmosphere of the studied settlements didn't exceed limits of the corresponding sanitary standards, despite essential increase in volume of extraction of gas condensate any more. Results of studying of incidence of local population are given in article. In general true incidence of the population of the region of inspection in 1995 in comparison with 1991 has increased by 1,31 times. In 1998 there was a decrease in the general incidence of the population by 1,1 times in comparison with 1995. In 2002 on some classes there was an incidence lowering of the level. Results of the comparative analysis of incidence of the population of the region studied by us give the chance to come to a conclusion that decrease in concentration of the polluting substances for the studied period, can lead to decrease in indicators of incidence on some classes, for example - respiratory organs, eyes and its appendages, and also skin and hypodermic

92-95

Authors: Mahambetova G.T., Shaimardanova R.R.

The given article discusses the importance of teaching Professional English within the framework of postgraduate medical continuing education. Language competency is an essential element of profile training of high-qualified specialists. Methods and materials of the investigation are an interview, sociological observation of 97 undergraduates and residents of Kazakh Medical University of continuing education. Most residents and undergraduates see a practical necessity of learning English and treat it seriously. However, the majority of them have difficulties in learning Professional English, as there are some reasons of objective and subjective character: the lack of time and a low level of basic knowledge of the language.