Herald of Almaty State Institute of Advanced Medical Education

6-11

Authors: Stabayeva L. M.

The proposed review of the literature is devoted to sarcoidosis of the lungs - granulomatous inflammatory disease, one of the topical problems of modern medicine, manifested by the defeat of various organs and systems, variable flow and lesion of relatively Sarcoidosis is a systemic granulomatous lung disease of unknown origin, affecting people of any age, mostly young people. The disease is extremely heterogeneous with an unpredictable clinical course. Various phenotypes have been identified: acute syndrome can be distinguished from subacute and chronic variants. About 20% of patients progress chronically and fibrosis of the lung can develop.manifestations of this disease are manifold. The article describes what issues have been little studied in this pathology.

18-21

Authors: Zhumakaeva A.M., OmarovaI.M., Sirota V.B., RakhimovK.D., Zhumakaeva S.S., Eleshov D.Z.

In the Republic of Kazakhstan, as in the whole world, breast cancer has the leading positions. In Karaganda region, breast cancer is 15.7% in the structure of all malignant neoplasms and 53.6% among tumors of the reproductive system of the female population. The high incidence of breast cancer falls on the able-bodied age, which demonstrates the particular urgency of this problem and dictates the need for its investigation. According to world statistics, the main age, which accounts for the peak incidence, is 45-59 years. The incidence of breast cancer is not the same depending on the national characteristics, and it often occurs in women of those nationalities, which traditionally have a limited birth rate. The study of the epidemiological features of breast cancer in Karaganda region is topical and of great interest since there are significant age differences. The purpose of this research is to study the epidemiological features of breast cancer in women of different ages in Karaganda region. Materials and methods: a retrospective epidemiological analysis of the data of patients diagnosed with breast cancer for the period 2012-2016 was conducted. Results: the main indicators of the incidence of breast cancer during the observation period in the region fall on the age of 50-59 years.

26-31

Authors: Zetov A.Sh.

The study showed that there is a need for the use of surgical treatment methods in addition to antituberculosis therapy, taking into account antibacterial sensitivity. Results of the surgical treatment of 277 patients with multidrug-resistant pulmonary tuberculosis (TB) are described. The aim of the study was evaluate the significance of surgical treatment of the patients with multidrug-resistant pulmonary TB. Application of surgery allowed obtaining positive results in 98.0% of patients with TB on the background of chemotherapy with second-line drugs. Long-term results showed a lower frequency of TB relapses in the operated patients receiving second-line anti-TB drugs.

41-45

Authors: Athezhanov D.O., Zamuraeva A.U.

In children, against the background of somatic pathology and persistent infection, the hygiene of an oral cavity worsens leading to the development of hypoplasia of the teeth, which further contributes to the development of caries. The treatment of caries of the permanent teeth in children is mainly focuses on the development and formation of the teeth and their roots. Broad fissures, observed during the formation of the molars, can be considered as markers for potential caries development. In these cases, tactics of sealing of the fissures takes place. On the other hand, in cases when initial forms of caries already present, either restoration of the tooth enamel or sealing of a carious cavity is required. In the Republic of Kazakhstan a dentifrice InnoDent™ with a unique formula of BioSmart Institute with the participation of the leading biotechnological concern Bachem AG (Bubendorf, Switzerland) was developed. The dentifrice has two forms: InnoDent™ Junior and InnoDent™ Repair. In literature, there are only a few research articles on clinical application of this new domestic dentifrice InnoDent™ in the treatment of initial caries at the stage of a white spot. However, this dentifrice was not applied in the treatment of initial caries at children with somatic pathologies. Our clinical experience of application of InnoDent™ in the treatment of initial caries in children with somatic pathologies showed stabilization of pathological processes and restoration of the enamel of the second teeth within the first three months. The beneficial effects allowed recommending extension of clinical use of dentifrice InnoDent™ for the restoration of the tooth enamel at early stages of the caries development.

50-53

Authors: Temirbayev M., \Pivovarov S\, Rukhin A., Seredavina T., Suchkova N.

This article presents data on the use of electron-paramagnetic resonance in the Q-band to obtain an informative signal from tooth enamel as EPR dosimetry for tooth enamel. For this purpose, a crystal or dental enamel plate with a cross section of less than 1.5 x 2 mm can be used. The task of sampling dental enamel with a cross section of less than 1.5 x 2 mm. without tooth extraction was successfully solved in the treatment and prosthetics of patients. Then it was necessary to solve methodological problems with regard to the optimal conditions for recording and analyzing spectral in the Q-band. In addition, a plate of 1.4 mg of tooth enamel from the teeth of a fossil rhinoceros with a large radiation signal was used, which was explained by natural background radiation of about 0.9 Gy for 1000 years for monitoring [1].

58-68

Authors: Akhmetova Zh.K., Ospanova DA, Sarmuldaeva Sh.K., Laktionova M.V .

In this paper, active methods of teaching in obstetric-gynecological practice are proposed for consideration, and a patent search is carried out on this topic. Objective: to analyze the use of active teaching methods in obstetric and gynecological practice according to scientific literature over the past 10 years. Materials and methods of research: 95 questions were found and analyzed in accessible literature with the use of international databases on the basis of the query on the given topic with the keywords: modern active teaching methods, simulators, obstetrics and gynecology, including 7 large randomized controlled trials, 5 systematic reviews and 1 meta analysis. Results of the study and their discussion: Applied computer technologies are becoming increasingly important for increasing the effectiveness of training specialists, in particular interactive computer simulators. Innovative virtual simulators are able to simulate not only the real kind of surgical instruments, but also the elastic properties of many intra-abdominal organs, large vessels with modeling of fine textural features of the cavities of the human body, objects of operation. Before the surgeon is allowed to independently perform laparoscopic interventions, he should perfectly practice the practical skills on the simulator and confirm (certify) the acquired level. Thus, based on the results of the analysis of the modern approach in the training of a obstetrician-gynecologist, the following conclusions can be drawn: I.The optimal form of teaching practical skills are classes in interdisciplinary simulation or phantom centers with the interaction of students of different specialties in providing obstetric and gynecological care for the simultaneous development of teamwork skills and reducing medical errors. 2. The application of active teaching methods in medical education increases the development of clear and rapid solutions, improves teamwork; develops high communication skills; increases the thinking ability for self-improvement in the course of the whole life, the reproduction of the acquired knowledge after, the transfer of theoretical knowledge into practical skills.

6-16

Authors: Akanova A.A., Akanova K.K.

The last century has seen a significant rise in life expectancy at birth among developed countries as people, on average, are living longer compared to prior generations. Longer life has also led to corresponding increases in chronic, neurological impairments such as Parkinson disease (PD). PD has been identified as the second most prevalent age-related neurodegenerative disease in the world. There are over 5 million people estimated to have the PD world-wide, constituting 1 % of the world's population of those 60 years and older. Global prevalence of PD is 60-187 cases for 100,000. The majority of people develop the clinical symptoms of PD over 60 years of age, with those over 80 accounting for 95 % of all cases. With an expected increase of 2.1 billion people over the age of 60 world-wide by 2050 and thus there will come a corresponding increase of people with PD and an ever-growing challenge to more effectively diagnosis, treat and manage symptoms while maintaining an optimal quality of life of those affected. Despite the great amount of research, the pathological mechanisms behind PD-associated selective dopaminergic neurodegeneration still remain largely unknown. Therefore, this article aims to review the current theories of P

23-32

Authors: Omertayeva D.E., Vazenmiller D.V., Aitisheva L.B.

The purpose of the literature review is the analysis of the information obtained in the study of lipid peroxidation (LPO) in pregnant women with preeclampsia. The objectives of this survey are to study the activity floors according to the number accumulated peroxidation products and antioxidant system activity in pregnantwomen with physiological pregnancy, preeclampsia of varying severity, to assess the influence of gender on the course of gestosis in pregnant women, to compare the activity of the gender in pregnant women with gestosis of different degree of severity, pregnant women with normally proceeding pregnancy, non-pregnant women. Study group the study of gender were pregnant women with physiological pregnancy, preeclampsia mild and severe degree (preeclampsia), non-pregnant women. Despite numerous studies, no consensus of the results, on the one hand some authors in their studies do not find significant differences of LPO processes in the examined groups of pregnant women [6, 13], most researchers still find statically significant increase in LPO products and the decrease of antioxidant activity in pregnant women with preeclampsia in comparison to pregnant women with physiological pregnancy. After analysis of the studied literature, we can conclude that the degree of severity of preeclampsia in pregnant women varies depending on the intensity of oxidative modification of lipids and buffer capacity of the antioxidant system. Thus the development of preeclampsia there is an imbalance between formation of free radicals and capabilities of the antioxidant system, which in turn exacerbates the preeclampsia pregnant women. The progression of preeclampsia, the increase of oxidative stress is the depletion of the antioxidant defense system, the accumulation of peroxidation products in both plasma and in erythrocytes, which turn leads to decrease in the osmotic resistance of erythrocytes, hemolysis and further progression of hypoxia.

42-47

Authors: Mirzabayev M.Zh., Dusembekov E.K., Aliev M.A.

Aim of the work is to determine the informative value of cerebral bloodflow indicators in the diagnosis of intracranial pressure dynamics and the ways of its correction. 80 patients with severe brain contusion who were treated at the central city hospital №7 for the 2016-2017 were examined. Average age of the patients was 35±2,4 years (54 and 28 for men and women respectively). All patients underwent a complex of neurological and instrumental examination (craniography, CTG, etc.). The cerebral blood flow was examined by the TKDG method on the Affiniti 70 G apparatus (Philips).These investigations were carried out on the 1-4-7 days after the trauma, 53 patients underwent surgery, 27 patients were treated conservatively. A lethal outcome was observed in the 15 operated patients. All patients underwent symptomatic and "step-by-step aggressive" dehydration therapy.Changes in cerebral blood flow during craniocerebral trauma are one of the main factors determining the dynamics of intracranial hypertension, while the staging of these changes persists in a relatively clear time frame. Traumatic brain damage and adverse outcome are directly related to the onset and duration of angiospasm.

55-58

Authors: Tuleutaev R.M., Abzaliev K.B., Oshakbayev A.. Taimanova R.S., Rakishev B.A.. Ibragimov T.Yu.

At the National Scientific center of Surgery named after A.N.Syzganov 13 patients with paroxysmal and long persistent form of atrial fibrillation (AF) had thoracoscopic radiofrequency ablation of pulmonary veins performed. Patients with long persisted form of atrial fibrillation-10, with paroxysmal atrial fibrillation -1, average duration of atrial fibrillations- 4,2 y(3 months, 20 years); average size of the left atrium 4,3+0,9 sm; 5 patients had primary catheter ablation performed. All patients had they sinus rhythm restored during the operation and was maintained until the discharge. In 1 patient, atrial fibrillation (arrhythmogenic cardiomyopathy, left ventricular ejection fraction of 36%) after 30 days, atrial flutter was noted, for which a successful radiofrequency ablation of the right cava-cuspidal isthmus was performed, one patient had a recurrence of atrial fibrillation after 6 months from the operation. Thoracoscopic radiofrequency ablation of pulmonary veins is a promising method for the treatment of isolated atrial fibrillation, accompanied by a high efficacy of 90.9% during the year, and against the backdrop of ineffective catheter ablation, as well as it is characterized by a low risk of complications and fast recovery period.This method of treatment can be combined with catheter ablation of the left and / or the right isthmus, which in turn, requires further research.

64-67

Authors: A.Mullen, К. Abzaliyev, Ghazwan Butrous

Pulmonary arterial hypertension (PAH) in children with congenital left-to-right shunt (APAH - CHD) is a very common complication. The question of the indications forthe cardiac surgery repair of the left-to-right shunt is controversial and has no one solution. In Scientific Centre of Paediatric and Paediatric Surgery (SCP and PS) of the Ministry of Health of the Republic of Kazakhstan since 2011 department of the cardiac surgery and intervention cardiology treats over 120 children with APAH - CHD. The most part of the patients is older 6-month-old.However, the guidelines for ventricular septal defect (VSD), patent ductus arteriosus (PDA) and atrial septal defect (ASD) are not define the precise moment of the surgery repair. Early terms for these types of CHD agreed to be under 2 years old.Aforementioned, we studied the evidence of Echocardiography parameters in predicting PH in children with congenital left-to-right shunting on the early age. For that we took the Echo reports of 26 children from 60 to 186 days of life with congenital left-to-right shunting, under suspicious of being complicated with pulmonary arterial hypertension. For the main objective of our study we assessed the volume overload with measure of Qp/Qs index, peak and mean velocity and pressure gradients of the tricuspid regurgitation (TR) and on the pulmonary artery (PA) systolic flow. Size of the aorta (Ao) and PA.16 children (group 1) were operated at the age of 11.5±4.2 months old, while other 10 (group 2) were operated at the age of 3.6±1.3 years old. 19 children were with VSD, and 8 with PDA. Children with the high EDI and Qp/Qs ratio show more tendency for developing PAH in postoperative period.

77-85

Authors: Khairusheva D.A., Beltenova A.G.

Professional burnout is a syndrome that develops against the backdrop of chronic stress and leads to the exhaustion of emotional, energetic and personal resources of the working person. Solid body of research showed that medical workers are at the greatest risk of professional burnout. Burnout begins to form in the medical school, continues throughout the residence period, and finally spills out in the daily life of practicing doctors. Therefore, this review aims at describing problems of professional burnout of medical workers. At the time being, the problem of professional "burnout" of the clinicians represents a very actual problem. The aim of this review is to generalize the manifestations and to establish causative relationships of professional burnout among medical workers of various specialties and institutions. Summary. Rejuvenation, increasing frequency of various manifestations and socially significant consequences of the manifestation of professional burnout in medical workers underlies a need to develop effective methods of prevention and correction of this condition. Provision of self-care of own physical and psychological well-being is a professional duty of the specialist.

91-94

Authors: Tankibayeva N.U., Muravleva L.E., Ahmet Kiziltung

This article focuses on main problems that young scientists face while preparing final qualification works in the system of postgraduate education. Different variants of technological approaches for determining the research topic and authoring ways of solving scientific problems are determined. Several opportunities for the choice of technology, preparation and presentation of scientific research topics while writing medical and biological theses on the magistracy and doctoral studies are considered. Criteria for scientific knowledge evaluation, ways of effective organization of research the, typical examples of errors and stereotyped opinions during the preparation of dissertations are described.

6-10

Authors: Temirbayev M.A.

This publication is devoted to the 80 anniversary since the birth of the prominent Kazakh scientist, MD, Professor Aldashev A.A. AldashevAhmet A. was born on September 4, 1937 in the village of Small of Enbekshilderydistrict of the Kokshetau (nowadays Akmola) region doctor of medical sciences (1973), professor (1978), the honored worker of science of Kazakhstan (1988), the winner of the State award PK (2001), the academic of Academy of preventive medicine (1996). Since 1967, I worked at research institute of regional pathology (Almaty) as the head of department, the deputy director; in 1973-1975, I combined duties of the chief physician of republican clinical hospital. Since 1975 - the deputy director of the Kazakhstan branch of Institute of food of the USSR Academy of Medical Sciences and the head of the laboratory of vitaminology. In 1980-1982 the director of this institution. From 1982 to 2001 the director of the Almaty state institute of improvement of doctors. The main scientific research of Ahmet A. is devoted to problems of preventive medicine, influence of an extreme environment (highlands, the desert, etc.) on a human body and adaptations to them. Author of six popular scientific books. It is awarded with the awards "Parasat", "Badge of Honour".

17-20

Authors: Umeshov A.U., Zhumadildayev R.S., Bismanova A.Zh.

In this article considered some materials of own observation on rehabilitations sick people in to investigational groups (main and control). 30 children entered the main group, which at sharp period of burned traumas and at postoperative's period for the reason of immobilization and prezentive maintenances of retraction transplants was used device for fixation the finger. About 30 children were used traditional method to immobilizations as cyst- gupsum (longet).We noted one fact of the significant reduction changes. The current method as children's burned traumas of treatment wet -air environment is merited recognition as the most prospective method which flows not only without complications, also considerably decrease the development of flexion contracture and formation of children's cosmetic defects. That was determined by pacients catamnesis with burn-cyst in 2 years after treatment.

25-30

Authors: Baymuratova M.A., Tyesova-Berdalina R.A.

Level of prevalence of intestinal candidiasis among patients with clinically established diagnosis sharp intestinal infections for optimization of allocation of mushrooms of the sort Candida.spp is studied. The analysis of incidence of sharp intestinal infections in RK revealed positive dynamics - decrease by 1,6 times during 2010-2014. Results on Almaty region where in 2013 intestinal infections made 53,3%, 2014-42,3% of cases that exceeded more than twice republican indicators were of the greatest interest. Incidence of the intestinal infections caused by Cryptococcus mushrooms of the sort Candida.spp. as an ethiopatogen in structure of sharp intestinal infection, for the studied period, varied from 2,64-3,36% that is rather guarding indicator. The analysis of the received results of a research of patients with sharp intestinal infections of an unspecified etiology for 2014 showed that the most vulnerable group on occurrence frequency as an etiopatogen the Cryptococcus of mushrooms of the sort Candida spp. turned out, persons aged from 25 up to 29 years (24 %) and also age groups from the 20-24th (15,1 %) and 30-34lt (15,1 %). Complex epidemiological assessment allowed to reveal number the Candida of intestinal infections that made 32,02 % (237) which were followed by atypical clinic in 21,5% cases. Clinic-epidemiological interpretation of sharp intestinal infection showed that opportunistic microorganisms in etiological structure made 48 %, among the diarrheas registered with functional and intestinal infection of not specified etiology, the ethioimplication the Cryptococcus of mushrooms of the sort Candida.spp was found, in 32 % of cases, from which 82 % Albicans caused by S. Thus, by results of our researches need of inclusion in an algorithm of diagnostics of sharp intestinal infection and normative legal acts of RK search the Cryptococcusof mushrooms of the sort Candida spp is established, in the studied samples of patients, as obligatory component when determining the activator which is clinically installed sharp intestinal infection.

37-41

Authors: Mambetov J.S., Makhmudov A.M.

Main objective of the real research was assessment of efficiency of the medicines Levokarnitin and Osteo-Vit in a metaphylactic of anurolithic disease in combination with osteoporosis. Patients with display of os¬teoporosis and osteopenia, the bones of a forearm and a calcaneal bone diagnosed based onX-ray absorp¬tiometry entered selection. Clinical study was conducted in 128 patients with urolithiasis with different localiza¬tion and different amount of concrements (from single-sided and bilateral to multiple, including coral). In 60 patients with urolithiasis, concurrent osteoporosis and osteopenia took place, depending on which, taking into account the introduction of the developed alternative conservative treatment method, two comparative clinical groups were identified. In the present publication proves that in the treatment of urolithiasis in combination with osteoporosis and osteopenia, complex conservative treatment is needed, including drugs that improve uro- and hemodynamics in the affected kidney, normalize urinary pH, have reparative activity against bone tissue and contribute to suppression of bone destruction processes Osteoclasts. These are the medicines Levocarnitin and Osteo-Vitcontaining in its composition, vitamins of groups D and B.

48-53

Authors: Taymanova R.S., Aringazina A.M., Medeubekov U.Sh., Abzaliyev K.B.

Level of satisfaction with medical care becomes an important structural component of complex assessment of activity of health care in recent years. 457 questionnaires of patients of cardiac offices and office of intervention cardiology from 2014 for 2016 were analyzed. More than 50% (n=256) of respondents were residents. Bulk (71,1 %, n=325) respondents people of working-age (18-60 years). The satisfaction of respondents with quality, the rendered services in a hospital remains high more than 95 % (n=445), however in dynamics decrease is noted: in 2014 treatment satisfaction of 100% (n=121) of patients, in 2015 97,2% (n=141), in 2016 95,8% (n=183) of respondents. In an incomplete measure 4 respondents (2,8%) and in 2016 8 respondents (4,2%) are satisfied with quality of services in 2015. The answer "No" was not noted by any patient. Quality of medical care estimated on 5 points 88,4% (n=107), 89,6% (n=130) and 86,7% (n=169) of respondents in 2014, 2015 and 2016 respectively. On 4 points estimated 11,6% (n=14) in 2014, 10,4% (n=15) in 2015, 13,3% (n=22) in 2016. Estimates lower than 4 points were not observed.

60-66

Authors: Aldasheva M.A.

The problem of complicated caries treatment for primary and permanent immature teeth among the children and teenagers in Republic of Kazakhstan is under consideration in the article. The author presents the summary of the modern vital and nonvital methods of pulp therapy. The treatment procedures for pulpitis and periodontitis with use of safe and effective methods and means are described. For the purpose of improvement the treatment efficiency and quality the author recommends to optimize the existing in Republic diagnostics and treatment clinical guidelines for pulp diseases in pedodontics practice.

76-81

Authors: Baymuratova M.A., Tyesova-Berdalina R.A., Adurbekova Zh.B.

The social and hygienic importance of traumatism is defined by extensive damage, which is caused to health of the person and his family and also production and society in general. The traumatism is one of the main reasons for disabilities in all branches of production. Therefore, decrease in its level has a direct bearing on reduction of labor losses [1-4]. In the address of the CEO of World Health Organization (10/22/2006) it was emphasized that accidents in the industry, the traumatism which is their result gives daily dangers having more widespread character, manifestations of individual or collective violence to 3,5 million deaths annually. Medical expenses and loss of efficiency are estimated at 500 billion US dollars a year [5]. By estimates of the International Labour Organization (ILO), annually from the accidents and diseases connected with work 2,34 million people perish. The vast majority of them - about 2,02 million - dies of various occupational diseases. From 6300, daily taking place fatal cases connected with work 5500 come because of occupational diseases [6].

6-13

Authors: Trusheva K.S., Toktarbayeva A.A., Baybolova M.K., Aytkulov M.S.

THE DATA ON THE POSSIBILITY OF ELECTRICAL CARDIOVERSION IN PATIENTS WITH ATRIAL FIBRILLATION. IN THIS ARTICLE THE POROKSIZMALNOY OF ATRIAL FIBRILLATION AS WELL AS EFFICIENCY AND FEATURE NON-DRUG TREATMENT OF ATRIAL FIBRILLATION. THE AMERICAN ASSOCIATION OF CARDIOLOGISTS, THE COMMITTEE OF EXPERTS ON THE TREATMENT OF PATIENTS WITH ATRIAL FIBRILLATION, RECOMMENDS THE CLASSIFICATION OF ATRIAL FIBRILLATION IN THREE MODELS: PAROXYSMAL ATRIAL FIBRILLATION, PERMANENT ATRIAL FIBRILLATION, PERMANENT ATRIAL FIBRILLATION, WHICH PERSISTS FOR ONE YEAR. DIFFERENT MODELS OF ATRIAL FIBRILLATION REQUIRE DIFFERENT TREATMENT TACTICS.ELECTRICAL CARDIOVERSION IS AN ELECTRIC DISCHARGE WITH DIRECT CURRENT, SYNCHRONIZED WITH THE ACTIVITY OF THE HEART. THE RISK OF ELECTRICAL CARDIOVERSION IS LOWER THAN THE RISK OF MEDICAL CARDIOVERSION. SURGICAL METHODS IN THE TREATMENT OF AF ARE NOT OFTEN USED. SUCH AS, OPERATIONS OF SURGICAL ISOLATION OF THE ATRIA. PACING IS SHOWN IN BRADY AND TACHY-BRADY FORMS OF AF (IE SSSU AND WITH AV BLOCKADES). THE LAST 20 YEARS CAN BE CALLED AN ELECTROPHYSIOLOGICAL PERIOD IN CLINICAL ARRHYTHMOLOGY. RADIOFREQUENCY CATHETER DESTRUCTION (ABLATION) - THE EXCITATION IS INTERRUPTED BY A "VICIOUS CIRCLE". THE METHOD DOES NOT DIFFER FROM THE "LABYRINTH" METHOD, BUT IT IS MORE ACCESSIBLE, THEREFORE IT IS GIVEN PREFERENCE IN RECENT YEARS. INTERVENTIONAL METHODS IN THE TREATMENT OF AF (TRANSVENOUS CATHETER RADIOFREQUENCY ABLATION) ARE NOW FINDING MORE AND MORE SUPPORTERS. THIS PROCEDURE IS HIGHLY EFFECTIVE, BUT IT IS VERY COMPLICATED TECHNICALLY AND LABORIOUSLY.

22-28

Authors: Satubaldyeva A.D., Bazagazukuzu G., Nasurbekova D.K.

ARTERIAL HYPERTENSION IS ONE OF THE MOST COMMON DISEASES AMONG THE ELDERLY. RISE IN BLOOD PRESSURE AT ANY AGE, ESPECIALLY IN THE ELDERLY TARGET ORGANISMS HEART, BRAIN, HEART, BLOOD VESSELS, KIDNEYS AND BODY DAMAGE IS A RISK FACTOR. THE MAJORITY OF PATIENTS WITH ARTERIAL HYPERTENSION KARD?OMEGAL?YA, BRAIN CIRCULATORY DISORDERS, COMPLICATIONS SUCH AS KIDNEY FAILURE DEVELOPS. 74 FROM 65 ARTERIAL HYPERTENSION CARDIOVASCULAR DEATH AMONG MEN BETWEEN THE AGES OF 4 TIMES, 2 TIMES HIGHER AMONG WOMEN. HYPERTENSION IN THE ELDERLY, A PANEL OF LEADING ACADEMIC PHYSICIANS COMPREHENSIVELY REVIEWS ALL ASPECTS OF THIS PROBLEM USING THE MOST CURRENT CLINICAL DATA. THEREFORE, THESE PATIENTS REQUIRE SPECIAL KNOWLEDGE AND TAKING INTO ACCOUNT ADDITIONAL DISEASES, DRUG THERAPY SHOULD BE VERY CAREFUL. THIS ARTICLE FEATURES A VARIETY OF HYPERTENSION IN OLDER AGE. HYPERTENSION IN THE ELDERLY AND THOSE SPECIFIC DIAGNOSIS, TREATMENT AND COMPLICATIONS SHOULD BE FOCUSING ON THE MOST.

33-37

Authors: Shakirov S.S., Mambetov Zh. S., Kolesnishenko I. V.

In this article it is considered an echomorphological verification of changes in a prostate gland at patients with chronic prostatitis at ultrasonography. The purpose of work was the comparative research and studying of ultrasonic parameters of a prostate gland at patients with various clinical forms of chronic prostatitis. Examination is conducted to 360 patients of able-bodied and reproductive age, suffering from infiltrative and proliferative, kongestivny, kalkulezny forms of chronic prostatitis. It is revealed that depending on localization an echo -pathological process in a prostate gland various clinical symptoms are revealed. At localization of concrements in a periuretralny zone dizurichesky frustration, in the central area - an anogenitalny syndrome, in a peripheral zone - a syndrome of pelvic pain prevailed, at the mixed pathology clinical symptoms were polymorphic. The overwhelming nature of sexual violations took place at all forms of chronic prostatitis and was characterized by frustration of a potentiality in the form of fear of failures of sexual intercourse, weakness of an erection and an orgasm that in 76% of cases caused psychostressful reaction of the sexual partner to sexual intercourse. And, even for men of 20-40 years it was expressed by psychomotor reaction of the sexual partner that fixed an oppressed depression of the patient before sexual intercourse. We consider that it is clinically expedient to consider ultrasonic signs taking into account the working classification of chronic prostatitises developed in clinic to which infiltrative and proliferative, stagnant changes and existence of kaltsinat in a prostate gland parenchyma are peculiar, for the purpose of more exact an echo - morphological verification of pathological process in a prostate gland. Timely ultrasonic diagnostics taking into account clinical forms of a disease as the main low-invasive method of a research gains the medical and social importance in view of decline in quality of life because of sexual frustration and stressful reactions from men. Ultrasonography gives essential help in identification of pathological changes in a prostate gland and in dynamic control of the carried-out conservative treatment at chronic prostatitises.

47-52

Authors: Baymuratova M.A., Tyessova-Berdalina R.A., Abdusalamova Z.S., Zhakanova G.A., Ibraimova A.A.

The purpose of our research was studying of a specific variety of microflora mucous vaginas of pregnant women and women after the delivery. Object of a research were smears with mucous the cervical channel. The research was conducted by well-known techniques, we also studied an antibiotikogramma, the list 6 the disks taken in hand entered: drugs of half-yen group and also drugs of azolum group. The analysis of our three-year researches taped that the leading role of an etiopatogenum of a candidosis infection belongs C.albicans - 58,8 % as originators of urogenital infections in both categories surveyed (among pregnant women, women after the delivery) that allows to think of current situation of high risk of disturbance of genesial health of women in general. And also allowed to draw conclusions that use of a mycologic method in SOP (Standard of the operational procedure), allows to standardize microbiological researches among pregnant women and women after the delivery, providing thereby the early diagnostics referred on well-timed correction and conservation of health of women. Studying of etiological structure of a candidosis infection allowed to tap the leading gynecologic strain of Candida albicans. It is necessary to notice that clinical isolates of yeast-like mushrooms of the sort Candida spp. concerning half-yen group (Nistatinum and Amphotericinum) of antimicotic drugs showed the high level of sensitivity to Nistatinum of 97,8% and Amphotericinum In 90,1 %. At the same time for practical health care very important observation is the sensitivity found by us to Clotrimazolum in 75,8 % (n=69), a ketakenazol - 50,5 % (n=46) which will allow clinicians to use these drugs in obstetrical institutions, without ignoring, obligatory statement of an antimikotikogramma concerning originators of a candidosis infection among women of genesial age.

58-65

Authors: Kusainova F.A., Zhusupova N.S., Nurumbetova Zh.Zh., Alyeva Zh.S., Davletbayeva A.P.

THE ARTICLE PRESENTS THE RESULTS OF HYSTOLOGIC INVESTIGATION OF ENDOMETRIUM EVACUATED AND REMOVAL OF FOCI OF HYPERPLASIA AND AIMING REMOVAL UNDER HYSTEROSCOPIC CONTROL FROM 55 WOMEN AGED 22-57 (AVERAGE 39.5), FOR THE PERIOD FROM JANUARY 2015 TO SEPTEMBER 2015 BASES OF OPERATIVE GYNECOLOGY IRM.WHEN CARRYING OUT ULTRASOUND IN ALL PATIENTS WERE FOUND TO HAVE SONOGRAPHIC SIGNS OF ENDOMETRIAL HYPERPLASTIC PROCESSES. DIFFUSE ENDOMETRIAL HYPERPLASIA - 31 (56,3 %), FOCAL ENDOMETRIAL HYPERPLASIA - 20 (36,3), POLOVIP HYPERPLASIA - 2 (3.6 PERCENT).HAVING IDENTIFIED HYSTEROSCOPIC RESEARCH OF ENDOMETRIAL HYPERPLASTIC PROCESSES IT WAS COMPARE WITH HISTOLOGICAL FINDING: CHRONIC ENDOMETRITIS - 3 (5,4 %), FOCAL ENDOMETRIAL HYPERPLASIA WITH CHRONIC ENDOMETRITIS - 5 (9,09%), DIFFUSE ENDOMETRIAL HYPERPLASIA WITH CHRONIC ENDOMETRITIS - 14 (25,45%), GLANDS POLIP ENDOMETRIAL HYPERPLASIA WITH CHRONIC ENDOMETRITIS - 14 (16,36%), SIMPLE ENDOMETRIAL HYPERPLASTIC - 10(18,18%), COMPLICATED WITH ATYPICAL ENDOMETRIAL HYPERPLASTIC - 1 (1,8%), FIBROSIS POLIP ENDOMETRIAL HYPERPLASTIC WITH CHRONIC ENDOMETRITIS - 2 (12,7%). ON THE BASIS OF THE DATA OBTAINED FROM HYSTEROSCOPIC RESEARCH WITH HISTOLOGICAL RESULTS NOT CONFIRMED 3,85%, WERE CONFIRMED 96,1 %.

72-76

Authors: Tulebaeva A, Mullen A., Sharipova M.

INVOLVEMENT IN THE PATHOLOGICAL PROCESS OF THE CARDIOVASCULAR SYSTEM IS DESCRIBED FOR ALL TYPES OF MPS.TO CONDUCT A STUDY OF THE AORTIC ROOT IN CHILDREN WITH MPS TYPESL, II, IVA AND VI.TRANSTHORACIC ECHOCARDIOGRAPHY ASSESSMENT OF THE MORPHOLOGY OF THE HEART AND GREAT ARTERIES.RESULTS:AMONG THE CHILDREN WE OBSERVED, THERE WERE 8 CHILDREN WITH MPS I TYPE (25 %), 14 BOYS WITH MPS TYPE II (43.7 %), 4 CHILDREN WITH MPS TYPE IVA (12.5 %) AND 6 CHILDREN WITH MPS TYPE VI (18.7 %). ACCORDING TO THE DATA OF THE ECHOCARDIOGRAM, THE MEAN VALUE OF THE AORTIC ROOT WAS 16.7±6.4 MM. THE SIGNIFICANT DILATION OF THE AORTIC VALVE (Z-SCORE 3.0 AND 3.6) AND ESPECIALLY THE VALSALVA SINUS (Z-SCORE 3.2 AND 4.3) IS A SPECIFIC FEATURE IN BOTH CLINICAL CASES. WITH A CAREFUL EXAMINATION OF THE SINUS VALSALVA MORPHOLOGY IN THE FIRST PATIENT, WE FOUND AN ANEURYSM OF THE RIGHT CORONARY SINUS, WHICH IS A RARE CONGENITAL PATHOLOGY. IN THE SECOND PATIENT, THE SINUS OF VALSALVA WAS SIGNIFICANTLY ENLARGED, BUT WITHOUT AN ANEURYSMAL COMPONENT. MILD AORTIC REGURGITATION WITH DOPPLER ECHOCARDIOGRAPHY (PHT 720 MSEC) WAS REGISTERED IN-PATIENT M. IN-PATIENT P., REGURGITATION WAS MODERATE, WHICH WAS INDICATED BY THE PHT INDEX OF 460 MSEC. IN ADDITION, THE PEAK PRESSURE GRADIENT ON THE AORTIC VALVE WAS 27.8 MM HG, INDICATING A MILD STENOTIC COMPONENT. WE NOTE A LOW INCIDENCE OF AORTIC ROOT DAMAGE IN CHILDREN WITH MPS IN THE REPUBLIC OF KAZAKHSTAN. HOWEVER, IT IS NECESSARY TO TAKE INTO ACCOUNT THE INTERNATIONAL EXPERIENCE OF MAINTAINING THIS CATEGORY OF PATIENTS AND THE EXTREME UNPREDICTABILITY OF THE COURSE OF AN ANEURYSM OF THE SINUS OF VALSALVA IN CONDITIONS OF ACCUMULATION DISEASE.

83-85

Authors: Aksakalova S.K.

IN THE COMPLEX REHABILITATION IN A SPECIAL CATEGORY OF PATIENTS, THE USE OF PHYSICAL THERAPY AND SPA TREATMENTS IN CERTAIN SCHEMES COMBINATIONS ALLOWED TO DETERMINE THE EFFECTIVENESS OF THIS TECHNIQUE. IMPLEMENTATION CERTAIN COMBINATIONS OF ELECTROTHERAPY IN CONJUNCTION WITH WATER PROCEDURES IN PATIENTS IN THE PRESENCE OF THE MAIN AND CONCOMITANT DISEASES WITH A POSITIVE BOTTOM LINE.

96-99

Authors: Smailova F.K., Berdygul M., Tashaev AA., Bekbatyrov S., Egemberdy A., Kaltai N., Sultan A., Tanashkyzy A.

THE ARTICLE INCLUDES THE METHODS OF INTERNSHIP TRAINING IN INTERNAL DISEASES, WHICH FORMS AND CONSOLIDATES THEORETICAL KNOWLEDGE, PRACTICAL SKILLS AND INTERESTS IN MAKING RESEARCHES OF INTERNS. THE INNOVATIONAL METHODS ARE DIRECTED TO COMPETENCE-ORIENTED EDUCATION OF INTERNS-THERAPISTS, AND ACCORDING TO THE STUDENTS CONSIDERATION THOSE METHODS GIVE DEEPER COMPREHENSION IN ABSORPTION STUDYING MATERIALS. THIS IS VERY IMPORTANTE FOR MEDICAL SPECIALISTS, WHO ARE REQUIRED TO IMPROVE THEIR PROFESSIONAL LEVEL IN ACCORDANCE WITH MODERN TECHNOLOGIES AND INNOVATIONS.