Herald of Almaty State Institute of Advanced Medical Education

6-12

Authors: Markabayeva A.A., Alibayev G.N., Ospanova D.A., Hanna Hopia

Despite the measures taken to organize the treatment of cancer, the quality of the services provided in managing the cancer process may be discredited in the near future due to problems related to various factors. Factors such as population aging and an increase in the number of surviving patients after cancer, as well as a shortage of labor, will affect the entire oncological service. Based on international experience in improving the quality of services provided to the oncological population, it is necessary to take into account the positive results in expanding the workforce with the help of practicing nurses. The role of nursing staff has been and continues to be an integral part of oncological care. From the Middle Ages to the present day, oncological /palliative/ hospice care has developed and, finally, has acquired special significance for nurses specializing in oncological profile. The very essence of nursing is aimed at caring for a person and supporting the family in difficult situations. A nurse practitioner specializing in an oncology profile is a necessary and significant tool in the structure of creating a quality program for the oncology service as a whole. This article examines the various areas of oncological specialization of the nurse, as well as their functional responsibilities on the basis of inpatient, district clinics, palliative care, at home.

21-23

Authors: Baymuratova M.A., Bazarova G.S., Tyesova-Berdalina R.A., Zhumabekova B.T., Abdusalamova Z.S., Aneshova E.E.

Sharp intestinal infections continue to remain the most frequent diseases in children's population; however, in special literature results about allocation of pathogenic serovar are extremely small. The purpose of the real research was to give an assessment to prevalence of intestinal esherichioz with identification of the dominating serovariant of E. coli. Researches were conducted on the basis of children's city infectious diseases hospital of Almaty during 2014-2017. The standard methods and nutrient mediums were applied, according to standard and legal documents RK, definition serogroup escherichias was carried out with use of diagnostic esherichioz sharp intestinal serums (polyvalent, monovalent) by productions of a joint-stock Biomed of I.I. Mechnikov. Conclusions: pathogenic colibacilli of an escherichia were presented in the majority in comparison with the found unconditional pathogens; serogroup distribution by years is presented ambiguously, but in 2017 there was a change dominating serogroup from superiority of the isolates which are not relating to above mentioned, against the background of earlier revealed by E.coli 020, E.coli 0111; the serological structure of esherichioz is presented by seven various serogroup of colibacilli: enteropatogen, enterotoksigen, enterogemorragic, in particular E.coli 020, E.coli 055, E.coli 0111. The received data on circulation various serogroup colibacillus, dictate need of carrying out systematic monitoring for interaction with the hospital epidemiologist of medical institution.

30-33

Authors: Uap Zh.T., Bulegenov T. A., Kamkhen V.B.

Tumors of the brain, despite advances in the diagnosis and treatment of neoplasms in general, are an actual problem due to low patient survival and high disability. The purpose of this study is to study the epidemiological aspects of malignant brain tumors in the East Kazakhstan region of the Republic of Kazakhstan. The received results testify to territorial and gender differences in diseases of cerebral tumors in the EKO.

38-42

Authors: Demidchik L.A., Li V.V., BeynikovaI.V., Klyuev D.A.

Based on the epidemiological picture of ethanol, acetic acid and drug poisoning, the study of the mechanisms of their influence on the body is very relevant. Our knowledge of kidney damage and the development of nephropathy in these cases is limited. It is believed that one of the possible mechanisms for the development of complications in cases of poisoning is oxidative stress. However, markers of oxidative stress in blood cells in toxic nephropathies have been little studied and such an important aspect of oxidative stress as oxidative modification of proteins has not been studied. The aim of our study was to study the intensity of the oxidative modification of red blood cell proteins in patients with exogenous toxic nephropathy. Erythrocytes of the blood were studied in 18 patients with nephropathy caused by acute poisoning with acetic acid, 30 patients with nephropathy caused by acute alcohol poisoning, 20 patients with nephropathy induced by psychotropic drugs and 20 healthy donors. The inten¬sity of the oxidative modification of erythrocyte proteins was estimated by the content of carbonyl derivatives of proteins and membrane-bound hemoglobin (MSH). The data were obtained spectrophotometrically. In all the groups of patients with toxic nephropathies that we studied, regardless of the initiating nephrotoxin, we observed a general trend: a statistically significant increase in the content of carbonyl derivatives of erythrocyte proteins and in different degrees a decrease in MSH relative to the values of the control group. The single trend of changes in the content of carbonyl derivatives of erythrocyte proteins for all the types of exogenous nephropathy we studied is due, in our opinion, to the common points of application of these nephrotoxins in action. Namely, in their general ability to destabilize erythrocyte membranes, to provoke to some extent hemolysis and oxidative stress, due to the release of hemoglobin. Reduced MSH can serve as a compensatory mechanism, however, reflects the hypoen-ergy state of red blood cells, which, together with oxidative stress, hemolysis of some red blood cells, reduces their gas transport function and undoubtedly contributes to the development of tissue hypoxia and progression of kidney damage.

47-52

Authors: Sharipova K.K., Gatin R.F., Aydarbekova A.S., Suleymenov K.G.

This article presents the results of urodynamic research in women of the period of climate. Estrogen deficiency is an established and proven cause of urogenital disorders in menopausal women. The role of estrogen deficiency in the development of imperative urges is associated primarily with ultrastructural changes in the MP, ischemia and atrophic changes in urothelium and other factors [1, 2, 3]. Most patients associate the onset of illness with the onset of menopause. The purpose of the study is to clarify the main factors of urination disorders in women of the menopause period. Materials and methods: The material of the study was the data of an outpatient examination of women of 167 women aged from 46-76 years of menopause, with manifestations of urinary incontinence (NM) for 2016-2018. The study was divided into two groups of women of both groups of the period of menopause and post-menopause, with manifestations of urinary incontinence "sensory" disorders and the second group with pronounced manifestations of OAB. Results and discussion 1.Analysis of urodynamic indicators is one of the main indicators in the diagnosis of imperative disorders. 2.Urodynamic invasive diagnosis should be performed before and after treatment in the presence of imperative violations. 3.The peculiarity of the procedure for the selection of patients is of key importance, since only in this case it is possible to objectively establish not only the condition of the lower urinary tract, but also to evaluate the effectiveness of treatment. 4.From the obtained data it is clear that there is a significant decrease in sphincter resistance and specific strength of the sphincter in women with urinary incontinence compared with a group of women with "sensory impairments" 5.The age indicator in the compared groups of women has a significant difference, it is necessary to recognize the importance of the above indicators as diagnostic criteria for assessing sphincter insufficiency in patients.

59-62

Authors: Sinyavsky Yu.A., Berdygaliyev A.B., Barmak S.T.

Objective: To study the contamination of Salmonella bacteria strains of food products sold in the markets of Almaty. Methods: laboratory studies of food products were carried out in accordance with MU 4.2.2723-10 "Laboratory diagnosis of salmonellosis, the detection of Salmonella in food products and environmental objects". As a result of the study, it was found that in samples of food raw materials sold in the markets of Almaty, the largest share of products unsatisfactory in terms of microbiological indicators is confectionery, in 2nd place is milk and dairy products, and in 3rd place are vegetables and fruits (12 , 2%). The highest proportion of food products contaminated with Salmonella bacteria was confectionery (31.6%), milk and dairy products (26.3%), vegetables and fruits (15.8%). Among the strains of the Salmonella bacterium studied, salmonella of rare groups prevailed.

6-15

Authors: Nurakhmedova I.S., Nurbekova A.A.

General diabetic complications are diabetic retinopathy, nephropathy, and peripheral neuropathy patients. In addition to this, patients often may have another complication - the autonomic nervous system. In particular - cardiac autonomic neuropathy. This complication is caused by metabolic disorders in the sinus node and nerves that regulate the work of the heart and the tone of the bloodvessels. Fundamental factors in the development of cardiac autonomic neuropathy are chronic hyperglycemia and variability of glycemia. In order to identify this complication, five Ewing cardiovascular tests are used. Besides, the disturbance of the sinus node is indicated by changes in the variability of the heart rate according to the daily monitoring of the ECG. Often cardiac autonomic neuropathy remains undiagnosed, although the presence of this complication is prognostically unfavorable and associated with a high risk of death.

21-25

Authors: Berdiyarova G.S., Anockhina S.G., Abentaeva B.A., Dzhumabekov T.A.

The article introduces the results of critical conditions monitoring in the neonatal period. The analysis of the critical children cards at the age from 0 to 28 days of life with a body weight of 1500 gr and more, located in the NICU for the Republic, for 2017. Have been identified the main nosological structures, statistical analysis has been carried out between the number of newborns with a weight of 1500 grams and more for the given period. Revealed accompanying and background pathologies and average timing of the transmission of children according to the critical report. The nosological structure on the first place are states of the perinatal period. Congenital malformations ranked second place, then congenital heart disease, which does not correspond to data on the structure of infant mortality, where the congenital heart disease is larger. The infectious diseases in newborns, including intrauterine infections of unclear etiology, tend to grow and are in third place. The high incidence of intrauterine growth retardation is 40% of cases, it is an unfavorable indicator of maternal health. Monitoring of critical conditions allows timely response to problems in remote regions related to the provision of medical care to newborns: problems in the transportation of a newborn, diagnosis (lack of equipment or specialist, limited range of laboratory studies), therapy (lack of medicines, resuscitation equipment, narrow specialists) its timely and full-fledged submission of necessary information indicating the existing problems. If, according to the critical report, the newborn continues to remain in the critical ranks for 3 days, then the appropriate measures for the provision of medical care should be taken by higher-level hierarchies and by the principle of regionalization: tele-consultations, transfer the newborn at the appropriate levels of regionalization, which will improve the situation morbidity and mortality. Reserves to reduce the mortality of newborns is the resolution of issues of staffing and equipment, improving the quality of prenatal screenings and prenatal consultations in the regions.

31-37

Authors: Aliev M.A., Zhaylaubayeva A.S., Mustafinov D.B., Karavayev V.S., Aglakov B.M., Suleymanova G.E.

Intraoperative neuromonitoring represents an opportunity to observe the state of the the nervous system structures during surgical intervention and to define, reduce and prevent neurological deficits prior to the surgery. Intraoperative neuromonitoring remains important, as the surgeon has no neuronavigation information during the operation to remove tumors/ Moreover, constantly changing structures can reduce the quality of the manipulations performed. Therefore, the neurophysiologist who also participates during the operations on the spinal cord "co-work" with the neurosurgeon closely in order to establish the physiological limits of resection, to prevent mechanical damage to the spinal cord and its ganglia: overstretch, rupture, trauma, detection of damage to the vessels in proper time and thereby preventing potential iatrogenic lesions. 41 operations were performed using Nim Eclipse intraoperative neuromonitoring by Medtronic at the Almaty City Clinical Hospital No. 7, This article describes neuromonitoring methods and good results confirming an obtained effectiveness. A total intravenous anesthesia without myorelaxants was performed according to the international standards of anesthesiologists. A close interaction of neurophysiologists, neurosurgeons, anesthesiologists is required in order to improve postoperative results and reduce the risks of neurologic lesions:

43-46

Authors: Sinyavsky Y. A., Berdygaliyev A. B.

Objective: to assess cognitive or emotional disorders using questionnaires accepted in clinical practice for 100 employees of a lead processing enterprise. Methods: Cognitive or emotional impairment was assessed using the Montreal Cognitive Assessment Scale (MoCA) developed for rapid screening of cognitive impairment in the adult population. The survey was conducted with information consent (in Kazakh and Russian) for an interview. Brief description of the work and the results of the work: As a result of the conducted studies, it was found that 30.1% of employees of enterprises located in the Almaty and Karaganda regions had various psychological and emotional disorders, the reasons for which needed to be studied in more detail, identifying the main hematological indicators and lead content in blood serum. All identified violations require the provision of nutritional support among employees to increase the resistance of their bodies to the unfavorable factor of the working environment.

51-55

Authors: Dosmatova K.R., Temirbayev M.A., Mansurov Z.A., Daulbaev CH.B.

Today, it is important to search for various biocompatible materials of organic origin for using them in medical purposes. Development of such materials actively develops and solves many problems in the field of medicine: Materials for endoprostheses in traumatology and orthopedics, filling materials in dentistry, implants in maxillofacial surgery, medical and cosmetic means in cosmetology and pharmacology. An important direction is the creation of biomaterials based on hydroxyapatite to replace damaged bone tissue, since hydroxyapatite is the main inorganic component of bone and dental tissue in humans and animals. The use of chemically synthesized nanocrystalline hydroxyapatite opens up wide opportunities in case of various tissue defects of bones, as it helps rapid reparative regeneration of the surrounding tissue. This study is devoted to the improvement of existing osteoplastic materials and to a comparative analysis of domestic nanocrystalline hydroxyapatite and its analogues of various origin.

67-75

Authors: Shamsutdinova A.G., Turdalieva B.S., Beltenova A.G., Shalabekova M.T., Kudaibergenova Т.А.

themselves. The calculation of mortality-to-incidence index expands the possibilities for analysis. This index is an indirect indicator for the quality of oncological care, including early diagnosis of diseases, i.e. screening programs. Using the GLOBOCAN 2012 data on incidence and mortality of breast, cervical and prostate cancers, we calculated the r mortality- to-incidence index for a number of countries with different economic development. Ranked incidence and mortality of these cancer types were taken from Global Burden of Cancer 2013. Screening data were extrapolated from various sources of the PubMed database by key words and tabulated for further analysis of the impact of reproductive cancer screening in countries with different income level. The analysis confirmed that in countries where population-based screening is used, the mortality-to-incidence index is low. In Kazakhstan, incidence and mortality of breast, cervical and prostate cancers are in global trend but ranking is closer to developing countries than to the developed ones. The mortality-to-incidence index for breast, cervical and prostate cancers is high Kazakhstan.

6-12

Authors: Urazhanova M.B.

The "dry eye" syndrome is a common disease characterized by a variety of symptoms. According to the definition, «dry eye» is a multifactorial disease, which is accompanied by a disturbance and instability of the tear film and leads to xerosis of the cornea and conjunctiva. More than 1 billion people suffer from the disease worldwide, main risk factors include: age, sex (women are more likely to suffer due to wearing contact lenses), smoking, overusing modern digital technologies, for example: smartphones, computers. Patients may experience discomfort, impaired or blurred vision, dryness, feeling of a foreign body within the eye. All of the above affects the daily life of patients. The mechanism of the development of the disease is associated with impaired stability of the tear film, which is manifested by a change in the composition of the tear film. It should be noted that there are violations of the anterior epithelium of the cornea, which contributes to the formation of pre-cornea ruptures and thus leading to xerosis at the surface of the cornea. With age, cataracts develops, the treatment of which is reflected in the course of the "dry" eye syndrome. At the same time, phacoemulsification and the use of drops for conservative treatment for a long period of time aggravate the deterioration of the cornea. During the operation on the removal of cataracts, anesthetics are applied, which may contain benzalkonium chloride preservative. It contributes to the instability of the tear film and the disruption of mucine production, which is necessary to sustain hydrophilic properties to the epithelium. The impact of the operational light on the cornea during the operation should be considered thoroughly in order to prevent further negative consequences so the use of filters is recommended. A wide range of medications is used to treat this disease, namely tear replacements - "artificial tears". At the present stage, they differ in composition and mechanism of action. Of the greatest efficacy for patients after phacoemulsification were the drugs containing 1% sodium arboxymethylcellosellose. When prescribing these eye drops, the current condition of the ocular surface should be taken into account. Thus, the "dry" eye syndrome is a factorial disease that is characterized by a specific symptom complex. After the operation the "dry" eye syndrome should be treated.

18-22

Authors: Zhumakaeva A.M., Rakhimov K.D., Madiyarov A.E., Adekenov S.M.

Modern diagnostic methods allow timely detection of lesions of regional lymph nodes and determine the most optimal method of therapeutic effect. Reduction or complete disappearance of the volume of tumor tissue allows to increase the indices of disease-free survival of patients with malignant lesion of the breast, and is always an important and urgent topic for oncologists. Reduction or complete disappearance of the tumor tissue allows to increase the rate of relapse-free survival of patients with malignant breast lesions, and is always an important and relevant topic facing oncologists. Therefore, the detection of the pathological process in the regional lymphatic system in patients with breast cancer and the dynamics of its regression activity against the background of preoperative chemotherapy is an urgent task. Preoperative chemotherapy, acts as an" ambulance " in a situation that needs to be urgently corrected and prepared for the next stage of therapeutic effects. In cancer practice, more and more preference is given to combined methods of exposure, as they help to achieve a complete regression of not only regional metastases, but also the tumor itself. We were faced with the task of making a comparative assessment of the regression of the lymph nodes in breast cancer using different modes of preoperative (neoadjuvant) chemotherapy. A retrospective study was performed using archival data from medical records of 93 patients diagnosed with breast cancer who received preoperative chemotherapy. The dependence of the degree of regression of metastatic lymph nodes and the amount of chemotherapy administered is revealed. The highest regression rates of metastatic lymph nodes were observed in patients receiving chemotherapy with three Doxorubicin + Cyclophosphan + Arglabin (73.0 ± 8.1%).

27-32

Authors: Memishev T.Z., Tursynbaev S.E, Smailov A.S., Imirov Ya.A.

The authors analyzed the data of a clinical study of 4714 patients with phlebotrombosis for the period from 2010-2017 in the CCCH in Almaty. For the prevention of PE, 2910 (61.3%) operations were performed. Of these, 1702 (36.1%) patients underwent surgery for acute subclinical vein thrombophlebitis (under local anesthesia). He had a crossectomy. The remaining 1158 (24.5%) patients, with thrombophlebitis of the subcutaneous veins after arresting the inflammatory process, underwent phlebectomy under a delayed anesthetic in a delayed manner. In 131 (85.6%) patients with a flotation thrombus, the following tactics was followed: in a flotation thrombus in the femoral-popliteal segment of 37 patients (28.2%), an emergency seam of the superficial vein vein, resorbed by the filament «Catgut» 3/0-4/0. Moreover, in 94 (71.7%) patients with localization of thrombi in the lumen of the common femoral vein, resorb able suture plication of the external iliac vein was performed. Ileocavalous localization of the floating thrombus was detected in 22 (14.4%) patients who were implanted with a cava filter into the inferior vena cava. The recurring course of PE in six patients also served as the basis for the installation of a cava filter. In addition, indications for an operation «plication» and the installation of cava filters in the lower vena cava was the impossibility or ineffectiveness of conducting adequate anticoagulant therapy. In patients who underwent venation with resorbable sutures «KETGUT» 3/0-4/0 after 3-4 months, ultrasound examination revealed 75 (57.2%) patients with venous vein in the plication area. The authors defined the tactics of surgical treatment of phlebothrombosis and prevention of PE. Because of the operation, mortality from PE was significantly reduced.

37-45

Authors: Alikeyeva E.A., Ismailov Zh.K., Aringazina A.M., Berikova E.A., Dzhazibekova P.M.

Introduction. Despite the successes achieved in the fight against tuberculosis, it remains one of the urgent health problems. Drug-resistant forms of the disease and HIV infection, the control of which is a complex and difficult to manage process, are the driving factors of the epidemiological process of tuberculosis. The search for optimal and effective ways of organizing control of TB / HIV co-infection will help to prevent the death of people living with HIV from tuberculosis, which is currently the main cause of death of PLHIV. The aim of the study was to study the outcomes of treatment for TB/HIV co-infection in low-, medium- and high-risk groups of unfavorable outcome of tuberculosis, depending on the model of medical care. Results of the study: The outcomes of treatment of 223 new TB/HIV cases, registered in 2016, were previously predicted, the risk of occurrence of unfavorable outcomes was predicted. In the study group, which included patients from regions where full integration was carried out and non-governmental organizations were involved, the outcomes among patients with an average and high risk of adverse tuberculosis outcomes were 1.7 times less likely to end poorly (p<0.05). Conclusion: an integrated patient-centered control, consisting in identifying people's needs, and, subsequently, providing assistance aimed at these needs, helps to reduce the number of unfavorable outcomes of the disease, and, as a result, reduce the death rate of people living with HIV from tuberculosis.

53-57

Authors: Shamsutdinova A.G., Turdalieva B.S., Beltenova A.G., Kudaibergenova Т.А.

The study surveyed 386 men of age-specific groups for prostate cancer screening in Almaty to examine the level of awareness on the screening program and informed participation in it. We conducted anonymous survey after the respondents passed PSA-test in the outpatient clinics. Questionnaire included issues on awareness of the screening program, screening test before and after the procedure, information sources, and recommendations for participation in prostate cancer screening. For data processing we used descriptive analysis with calculation of confidence interval. The results revealed (with confidence p <0.001) a low level of awareness on screening in general, its stages, the PSA-test and about where and how to get the test results. The level of this knowledge had improved slightly after men passed the PSA-test. Almost half of respondents received no general information on screening and almost two-third of men indicated a need for additional information. The most popular and preferred information sources were medical personnel, although printed materials as brochures and booklets, the Internet and video clips in public places were also mentioned. The need for information and its availability did not depend on the preferred communication language, i.e. Kazakh or Russian. Low awareness confirms not informed participation in prostate cancer screening and may affect adherence to the program.

62-67

Authors: Ospanova D.A., Altynbekova S.A.

Nursing staff constitutes a significant proportion of health workers and is seen as a valuable resource to meet the growing needs of the population for affordable and quality medical care. Expansion of the list and volumes of medical and social services is carried out at the expense of nurses, for which a system of multilevel education and new nursing specialties have appeared in the framework of modernization of the health care system. The results of some studies have shown better treatment outcomes for nurses with higher education, since it provides better vocational training [20]. Currently in the country, the preparation of bachelors of nursing is carried out on two main programs - academic and applied baccalaureate. The analysis of educational programs shows in academic baccalaureate the time allocated for electives is 15.8% more than applied bachelor's degree. The greatest increase in the number of hours allocated to a component of choice occurred in the basic disciplines of 720 hours, whereas in the applied baccalaureate there are only 270 hours. The number of hours allocated for practical training in academic and applied bachelor's degree averages 49% of the total academic load. Theoretical training includes: classroom activities, student self-study and simulation. In the academic baccalaureate, 53% of the theoretical training load is spent on classroom activities, while in the applied bachelor's degree it is 34%. A big difference is noted in the simulation, in the applied bachelor's degree the time allocated for the simulation is more by 22%. Conclusions: When comparing the two types of training, an extremely small number of hours allocated for studying management and management issues for students of academic baccalaureate was revealed, only on the fourth year there is an elective course "Personnel management. Development of management solutions ", dealing with these issues. In addition, in recent years there has been a decline in interest in studying on the academic bachelor's programs in the specialty "Nursing", which is apparently associated with the formation of a set based on the residual principle, imperfection of educational programs, lack of practical orientation, weak potential of teachers, employment problems of graduates [14] . On applied baccalaureate there are more practical classes that improve basic training in the specialty "Nursing".

6-10

Authors: Djalairova A.Sh. Likhacheva N.E., Lepesova M.M.

The article describes main etiological and risk factors of psycho-speech delays in children. Several classifications scales of psychoverbal delays that are used by child neurologists, speech therapists and psychologists are also outlined, which in turn reflect major stages of speech development in a child, associated with different age periods. There are different psychological scales to assess the child's intellectual areas specified here: adaptive behaviour, social and emotional areas, cognitive, and speech and communications, starting from the age of three, which help in the psychoverbal delays diagnostics. Special attention is given to the correctional work of experts, without which the isolated drug therapy is not efficient. At present, the screening methods have become more important, which enable to diagnose a psychoverbal delay in children before the age of four, thus consequently allow applying correctional methods in combination with the drug therapy at early stages. Main tools used for early diagnostics are also discussed in this review.

17-19

Authors: Kugizbekova A.B., Smagulova I.B., Varushkin E.G.

The paper presents the results of the prevalence of chronic gastroduodenitis among children of different ages. The structure and frequency of concomitant diseases from the gastrointestinal tract was studied. Leading amnestic data: age and sex characteristics, family characteristics and place of residence. The clinical picture and the results of instrumental methods are described.

24-29

Authors: Usupbayev A.Ch., Kurbanaliyev R.M., Kuzebayev R.E.

Actually, the treatment of hypospadias is one of the most complex and unresolved problems in constructive surgery. According to domestic and foreign authors, the frequency of complications in the postoperative period 50% and more. Materials and methods. The work is based on an analysis of the results of the survey and the surgical treatment of 195 patients aged 3 - 31 years for the period 2004 - 2017. Inclusion criterias: boys with a stem, a stem-scrotal and a scrotal form of hypospadias of the urethra. Depending on the choice of plastic material and the type of performed surgery, patients were divided into three groups. In the postoperative period, glumen instillation by the antiseptic solute in the main group of patients was perfomed by the catheter, specially developed by us. Results: In the analysis of complications in these three groups of patients established: in the main group complications occurred 10%; in the second group of patients operated by the Duptay method complications reached 28,5%; in the group of patients operated by the method of Landerer complications reached 24,6%. Conclusion: The operation of buccal urethroplasty with the use of a continuous screw-in suture and the developed neo-urethral instillation catheter allowed us to achieve a positive result of up to 90% in comparison with the method of Duplay (success up to 71,5%) and Landerer (success up to 75,4%).

35-40

Authors: EnsebayevE.Zh., Sharipova K.K., Baigaskinov Zh.K., Sholokh P.I., Abdrakhmanova A.A. Zhanbyrbekuly U.Zh., Ainayev T.M.

This article presents the results studies patients of womens the different age groups with disorders of urination and basic diagnostic methods, taking into account clinical and urodynamic parameters. One of the informative and objective research methods to clarify the behavior of the bladder in the phases of filling and emptying is urodynamic research that allows to simultaneously studying intravesical, intra-abdominal and detrusor pressure. Obstruction of the urination determined by the ratio of pressure and flow reflects detrusor contractility and urethral resistance, but does not allow determining which of the factors is impaired. The clinical significance of urodynamic examination of patients in diagnosis is undeniable. At the heart of urinary dysfunction in women lies a different degree of sphincter insufficiency, therefore the conducted studies of domestic and foreign colleagues showed the objectivity of existing significant differences in the study of the urethral pressure profile in urgent and stressful forms, in particular, the functional length and intraurethral pressure at stress [1, 2]. Purpose of the study: Indices ratio of changes in the volume of filling the bladder to a change in intravesical pressure in the dynamics of the development of "urinary incontinence" and the identification of the relationship and significance of urodynamic indicators in the mechanism of development of this pathology. Materials and methods of research. 81 women aged 18 to 85 years were examined. According to the urodynamic parameters and the clinical picture of the disease, the patients are divided into 4 groups. Women were examined in stages: filling the diaries of urination, a questionnaire was conducted (they were introduced into the study of the questionnaire recommended by the European Association: UDI-6, ICIQ-UI, QOL). The physiological volume of filling the bladder was determined, the extensibility of the bladder wall to a change in the intravesical pressure. Results and discussion: The results obtained allow us to say that the measurement inside the abdominal, detrusor, urethral pressure for various types of incontinence is mandatory; the parameters of the pressure parameters may change with uncoordinated detrusor cuts often manifested by symptoms of the imperative type urinary incontinence. Conclusion Given that detrusor activity may be normal (stable bladder), abnormal (hyperactive urinary bladder disease), urinary incontinence can occur with a decrease in urethral pressure and no detrusor cuts. The correct interpretation of the profile of the uriureurethral pressure depends on the correctness of the performance and measurement of detrusor pressure. If there is a manifestation of instability of the urethra, which is detected with a decrease in urethral pressure, the absence of detrusor reduction should be taken into account that uncoordinated reductions "detrusor hyperactivity" is manifested by increased intra¬abdominal pressure, while the capacity of the bladder does not change.

46-50

Authors: Ramazanova R.M., Begaliyev B.A., Sultangaziev G.Zh., Zholdasova R.Zh.

In this paper, the efficacy of the VD scheme use in patients with newly diagnosed multiple myeloma for the period 2012¬2017, in the department of hemoblastoses of Kazakh Institute of oncology and radiology was evaluated. The effectiveness of treatment was assessed after 4-6 cycles of VD. Objective: To evaluate the efficacy of the VD regimen (bortezomib + dexamethasone) in the first line of multiple myeloma therapy. Methods. The study included 40 patients with newly diagnosed MM who received treatment according to the VD scheme in the department of hemoblastoses of of Kazakh Institute of oncology and radiology from 2012 to 2017. The median age was 59 years (40-81 years). Results. Using the VD scheme in patients with newly diagnosed MM, the overall response rate was 75%. 40.6% of patients complete remission was achieved, in 16.6% of patients was very good partial remission, in 43.3% of patients - partial remission. Progression of the disease on the therapy background according to the VD scheme occurred in 25% of patients. The median time to achieve complete remission was 4 months. The overall survival of patients was 28 months. The transferability of treatment according to the VD scheme was satisfactory regardless of the age of the patients. Among the side effects anemia (42.5), peripheral neuropathy (35.5%), asthenic syndrome (25%), dyspepsia syndrome (22.5%) were observed. The conclusion. The VD scheme has a manageable and predictable toxic profile, is effective and plays an important role in MM therapy as a first line, and leads to a significant increase in the overall survival of patients compared to treatment methods without the use of proteasome inhibitors.

63-69

Authors: Shamsutdinova A.G., Kasymzhanova M.K., Juszkiewicz K.

The diagnosis of a mental disorder bears in itself a social and ethical burden, which is not present in any other clinical medical field. For psychiatric patients, this often results in a decrease in public confidence, infringement of dignity, violation of rights and somatization that significantly affects the quality of patient's life and causes less appeal to psychiatrists, followed by a negative effect on the course and prognosis of the disease. The application of the paternalistic approach in patient-physician relation has its testimony. However, an introduction of a new model of partnership based on patient's right is becoming popular. Taken into consideration a polyprofessional and partnership approaches for the provision of psychiatric care, ethical and moral principles should also be followed by non-medical specialists. The aim of the article is to reveal challenges in psychiatric practice that require separate analysis and conversion into a broad field of scientific research.