Journal of Clinical Medicine of Kazakhstan

J Clin Med Kaz 2015;1(35):11-14

Authors: Tuba Tülay Koca, Aydın Arslan

Juvenile idiopathic arthritis (JIA) is the most common inflammatory disease in childhood. JIA is subdivided into six categories, all of which differ in etiological factors, clinical phenotype, prognosis, laboratory tests and response to therapy. To start appropriate treatment in patients with JIA and to inform patients correctly, it is essential to know the individual prognosis. This emphasizes the need for research on novel and more accurate biomarkers to assess disease acitivity. A biomarker comprises small samples from the patient such as blood, urine and saliva, obtained by non-invasive techniques. These serum biomarkers such as S100 proteins (S100A12,S1008/9), myelin related proteins (MRP8/14), single nucleotide polymorphism (SNPs) and newly vectra DA have been suggested for the prediction of disease course and relapse risk. İn this review we summarize the biomarkers for JIA.

J Clin Med Kaz 2015;1(35):21-25

Authors: Arystan Seidalin, Adilzhan Albazarov, Rahim Tojiboyev, Saule Nurakaeva, Ayana Sygay, Vladimir Dikolayev

The aim: Assessment of a surgical treatment modality for patients with an obstructive hypertrophic cardiomyopathy. Materials and methods: From 2013 to 2014 year cardiac surgery department of National Scientific Medical Center (Astana, Kazakhstan) performed 14 procedures for correction of an obstructive cardiomyopathy. Morrow procedure in isolated form or in combination with correction of other cardiac pathology had been utilized. Isolated form of Morrow procedure was used in 3 patients (21.4%), in other 11 cases in combination with coronary artery bypass surgery (CABG) – 3 (21,4%); CABG with mitral valve repair – 6 (42,8%); David procedure – 1 and a section of the myocardium muscular bridge – 1 case. Results: early and long-term results of surgical correction of an obstructive cardiomyopathy are presented. The average pressure gradient was 13.9 + 6 mm Hg (prior to operation of 79.7+61.3 mm Hg). Average thickness of the interventricular septum after myomectomy was 13,7 + 3,3 mm (prior to surgery 23.1+3.2 mm). In cases when correction of valve pathology was performed simultaneously, function of valves by echocardiographic control was also estimated (size of gradient and regurgitation). Satisfactory clinical results were obtained in 12 patients. Two patients died in early postoperative period. Conclusions: we recommend expanded myomectomy techniques, as opposed to classical Morow procedure. Our department experience with these procedures shows that this approach leads to considerable clinical improvements in the patients with obstruction of the left ventricular outflow tract.

J Clin Med Kaz 2015;1(35):30-33

Authors: Berik Koichubekov, Anuar Shaikhin

The aim of this study was to demonstrate effectiveness of biofeedback in the correction of mental and emotional state in patients with metabolic syndrome. Methods. 31 volunteer patients with metabolic syndrome between the ages of 18 to 45 years of Regional Clinical Hospital of Karaganda were selected to participate in the study. Biofeedback sessions conducted on software-hardware complex "Morskiye glubiny." Evaluation of psycho-emotional state was carried out on five grounds and carried out prior to the study, in the middle and after the last session. For comparison of dependent groups was used nonparametric Wilcoxon U-test. Results. Analysis of the data showed a statistically significant reduction in the main indicators of mental and emotional stress, such as mental stress, asthenic condition, trait anxiety, and reactive anxiety. Conclusion. The study and the data show the effectiveness of biofeedback method for the correction of mental and emotional stress in patients with metabolic syndrome.

J Clin Med Kaz 2015;1(35):40-44

Authors: Assel Matalipova, Leonid Karp, Tatyana Potapchuk, Bakhyt Seisebayeva

The objective of the research is to identify problems/issues related to the professional development of the doctors in rural healthcare service. Materials and methods. The combined research approach has been applied as the design of the Research, which included a quantitative collection of the statistical data and qualitative characteristics expressed in obtaining personal opinion of the doctors about the problems existing in the area of professional development. A social survey has been conducted (anonymously filled questionnaires) among the rural doctors on the Northern Kazakhstan (Akmola and North Kazakhstan Oblast). “Survey on Studying Professional Development of the Healthcare Personnel in Rural Healthcare” consisted of 48 questions of open-end and closed questions. With the help of a mechanical random (non-repeated) sampling 175 doctors from central district (rayon) hospitals have been selected. The selection of the observation unit from among the general population has been carried out by applying the random number table. Considering the total number of the rural doctors in two oblasts the selected sampling plays only a representative role. The statistical tools included calculation of extensive indicators (indicators of distribution). For comparing statistical significance of the group a fitting criteria (chi-square) has been applied. Results. The Research identified that the majority of the doctors have a desire to enhance and further develop their professional skills; a great number of the surveyed respondents (86,7%) would love to upgrade their professional level. The doctors, who have attended refresher courses/trainings, were able, upon return to work, apply in practice the knowledge they have acquired, and this contributed to the enhancement of their professional skills. The survey on the frequency/periodicity of the post-graduate education have shown that over half (54,2%) of the responding doctors consider that training (further development) of the doctors once in five years would be feasible. For that purpose the majority of the responding doctors (40,6%) wish to be trained/to develop their professional skills at the Medical University, 36,5% - at the Oblast Center where the specialists from the capital would be invited too, 22,9% prefer to travel to another region. It was recorded that many forms of the professional development (participation in international conferences and workshops, trainings at the leading national and international clinics) are not available to the major part of the employees. Conclusion. The analysis of the ways of professional development, in general, revealed satisfaction of the doctors in rural healthcare service in the context of the subject matter. The majority of the doctors strive towards professional growth and development, which shows the existing potential. Almost half of the responding doctors (56,0%) were able to apply in practice the acquired knowledge, which has enhanced their practical skills as well.

J Clin Med Kaz 2015;1(35):51-54

Authors: Doszhanova G., Abduldayeva A., Maulenkul T., Beketay G.

The aim - to assess the health status of older people, depending on their age and gender identity. The health status of the elderly was studied based on the assessment of the physical condition and adaptive capacity. Materials and Methods: We used materials of primary and secondary sources on the following methods: information - analytical, content analysis, ratios, comparison indications, indications of visuality, statistical and causative - consecutive methods. The study group included 133 people aged 60-89 years, including men-50.4% and women - 49.6% living in Astana. Out of them elderly - 74.4% of people, senile age - 25.6% of people with an average age - 71 years. Elderly men accounted for - 42%, senile - 9% among older women, this figure was 33% and 16% of senile age women, respectively. Results: The index of the physical condition in older men and women was 0.432 ± 0.02 and 0.419 ± 0.01 in men and women of senile age, the figure was 0.205 ± 2.19 and 0.362 ± 1.16. The range of index values of physical condition in older men corresponds to below-average level of physical condition in older women it is equal to the average level. People of senile age the range of the index of physical condition in men and women corresponds to a low and below the average level. Group III health is observed in male and female of elderly and senile age, as well as in elderly women with lower adaptive capacity of 3.49 points (poor adaptation), and Group IV the lowest health is observed in senile age men, whose adaptive capacity is above 3. 5 points (failure of adaptation). Conclusion: Analyzing the results obtained it may be noted overvoltage regulation systems, accompanied by a change in the level of inadequate functioning of the main systems of the body and the presence of pathological diseases in elderly and senile decompensation, which is more pronounced, manifested in men than in women that lead to the disruption of adaptation.

J Clin Med Kaz 2015;1(35):59-61

Authors: Tuba Tülay Koca

Joint hypermobility is a connective tissue disorder commonly seen in childhood and adolescence. The Beighton hypermobilty score is an easy and practical method to determine joint laxity and hypermobility. Some major and minor criteria based on symptoms and objective signs (arthralgia, back pain, spondylosis, spondylolysis/lystesis, dislocation/subluxation, scoliosis, soft tissue rheumatism, marfanoid habitus, skin hyperextensibility, ocular symptoms, varicose veins, hernia, uterine/rectal prolapse) have been determined for diagnosis of benign hypermobility syndrome. A 13 year-old female presented with long-standing complaints of anterior knee pain which increased at night in particular, also pain and stiffness in her pain. She was of thin and tall phenotype. İn her medical history, frequent ankle sprains were reported. İn her physical examination determined dropping eyelids, myofascial tender points in the trapezius muscle, hyperextensible elbows, wrists, thumbs, metacarpophalangeal and knee joints and moisture on palmar aspect of the hands. Laboratory parameters and conventional radiographic observations were normal. In benign hypermobility syndrome, clumsiness, motor retardation, poor coordination, recurrent joint sprains and limited school-based activities may be seen in the history and examination. Delayed diagnosis may lead to poor control of pain, limitations in home-life, schooling and daily activities. We recommend to patient to use joint protective methods, to make modifications in daily life, to avoid heavy physical activities and use pain-relief medication.

J Clin Med Kaz 2015;1(35):66-68

Authors: Aigul Abdrakhmanova, Vitaliy Koikov, Banu Khandillayeva

The article analyzes the staffing of health facilities and analysis of the current state of training for the health care organizations universities in the Republic of Kazakhstan. The main problem of Health: imbalance and low-skilled personnel, which is largely a consequence of the imperfect system of training organizations Medical Education. The solution to this problem requires a revision of state standards of medical education at the undergraduate, internship and residency with clearly defined deliverables: list of knowledge skills that graduates should possess medical graduates.

J Clin Med Kaz 2015; 4(38):12-16

Authors: Ilya Belyayev

This review dedicated to one of relevance problems of modern medicine. In this article are descripted clinical, epidemiological characteristics of pneumococcal infection. Role of pneumococcal infection in prevalence of diseases was over-viewed in childhood and adult. Importance of multicenter study of antimicrobial resistance of Streptococcus pneumonia was marked.

J Clin Med Kaz 2015; 4(38):21-24

Authors: Kakharman Yesmembetov, Nurgul Yesmembetova

1/3 of patients with chronic hepatitis C develop liver cirrhosis in 20 to 30 years’ time in the absense of effective antiviral therapy. By eradicating HCV, antiviral therapy with interferon allows to stop further progression of the liver disease, thereby reducing the risk of decompensation, hepatocellular carcinoma and liver-related death. Priority in starting antiviral therapy in chronic hepatitis C cases should be given to patients with fibrosis stages 3-4 (by METAVIR), with the highest risk of liver-related complications. However, need of antiviral therapy in patients with HCV-induced cirrhosis is restricted by lower efficasy and a high risk of side effects. Randomised studies show, that antiviral therapy of patients with genotype 2/3 HCV-induced cirrhosis with interferon is as effective as in ones with chronic hepatitis, this way allowing it for all patients in stages A-B by Child score. Antiviral therapy of patients with decompensated liver cirrhosis, especially those with genotype 1 HCV, should be carefully weighed against the low efficasy and high risk of, in some cases life-threatening, side effects. Thus, antiviral therapy of patients with sub- and decompensated HCV-induced liver cirrhosis with interferon should be restricted to clinical centres, able to adequately address possible complications (variceal bleeding, ascitis, anemia, severe infection, hepatic encephalopathy, hepatorenal and hepatopulmonary syndrome) and perform TIPS and liver transplantation.

J Clin Med Kaz 2015; 4(38):30-36

Authors: Igor Mashchenko, Alexander Gudaryan, Sergey Shandyba

The aim of our research is to improve the efficiency of reconstructive treatment of generalized periodontitis at the patients with diabetes mellitus type 2 by using various types of autologous platelet rich fibrin, HELBO-system and correction therapy of local immunity. Methods. Clinical and laboratory studies of 48 patients with generalized periodontitis with diabetes mellitus type 2 after flap operations with the usage of different types of autologous platelet rich fibrin. Results. In patients of the main group full recovery of bone occurred more than 75% of the area of the bone defect (83.3% of cases), partial - in 16.6% of patients. In the comparison group full regeneration of bone after 12 months after surgical treatment was observed in 66.7% of patients, partial - in 33.3% of patients. Conclusions. In order to optimize the recovery of periodontal bone defects at patients with diabetes mellitus type 2 can be used surgical technique involving the use of autologous injection platelet rich fibrin (i-PRF) in combination with autologous platelets rich fibrin membranes (a-PRF).

J Clin Med Kaz 2015; 4(38):42-45

Authors: Andrey Semenenko

Objective: To investigate the dynamics of NSE during treatment of isoosmolar 0.9% NaCl solution and the hyperosmolar mannitol solution in acute ischemic stroke. Methods: It was studied 15 patients with acute ischemic stroke. The investigated isoosmolar 0.9% Nacl solution and the solution hyperosmolar mannitol administered intravenously in a conventionally effective dose (defined in the experiment) directly upon confirmation of the diagnosis of acute ischemic stroke and further every day, every 12 hours for 7 days. A control group were patients treated with infusion therapy only 0.9% NaCl solution, the comparison group were patients treated with 0.9% NaCl solution + mannitol. Blood sampling was conducted for determination of specific marker of cerebral ischemia the neuron-specific enolase (1st, 4th and 7th day of stroke). Results: Treatment of patients with acute ischemic stroke with mannitol was accompanied by the dynamic growth of the test marker of neurodestruction from 17 to 23 nm / ml in all periods of observation with a statistically significant increase in the activity of NSE on the seventh day of stroke. A similar picture is viewed in the group with 0.9% NaCl solution. Conclusion: infusion therapy with isoosmolar 0.9% NaCl solution + hyperosmolar mannitol with standard therapy was accompanied by a dynamic growth of NSE in patients with acute cerebrovascular accident on ischemic type as in the control group.

J Clin Med Kaz 2015; 4(38):50-55

Authors: Igor Mashchenko, Alexander Gudaryan, Sergey Shirinkin

The purpose of the study. The purpose is to study the clinical, etiologic and pathogenetic features of occurrence of dental periimplantitis and to develop on this basis the optimal treatment regimen for this disease. Methods. Was performed clinical and laboratory tests of 61 patients with dental periimplantitis I-II severity after directed bone regeneration with local correction of immunological disorders and biocidal function of the oral mucosa. Results. Was proposedthe new conceptual approach to the pathogenetic, therapeutic and surgical treatment of dental periimplantitis, which made it possible to increase the number of positive immediate and late results of 27.8% and 23.3%, respectively. Conclusions. It was found that forecasting outcomes reconstructive dental treatment periimplantitis possible on the basis of changes in the content of the oral fluid sIgA levels and IL-1β. Сomplex therapy of patients with dental periimplantitis produced persistent clinical and laboratory recovery in 94 % of patients; in conventional lechenii in 71.1% of patients.

J Clin Med Kaz 2015; 4(38):60-64

Authors: Anna Krylova

Aim of the study. To investigate the efficacy of chondroitin sulfate in treatment of osteoarthritis and hyperuricemia and its effects on the dynamics ofthe inflammatory process, purine, carbohydrate and lipid metabolism markers. Materials and methods. In this study was included 32 patients with hyperuricemia and osteoarthritis (26 women and 6 men), aged 35-75 years. Estimated dynamics of VAS, indices Lequesne, WOMAC, uric acid, IL-1β, IGF-1, NO, general clinical indicators. Statistical analysis was performed using SPSS Statistics. Results. The study found a significant reduction in pain by VAS, indices WOMAC, Lequesne after 6 months of treatment. Any dynamics of laboratory tests – levels of serum glucose, markers of lipid metabolism, markers of liver function,serum creatininewere not observed. After 6 months of treatment, we obtained significant decreasedlevels of IL-1, NO, CRP and significant increasedlevel ofIGF-1. Increased uric acid levels were found. Conclusion. The use ofchondroitin sulfate avian origin (chondroitin-4-sulfate, 72%) in the treatment of patients with osteoarthritis has pathogenetic base and clinical perspective, but it should be taken into account its effect on uric acid levels and in the futureshould be planed a differentiated approach to the treatment of patients with osteoarthritis and hyperuricemia.

J Clin Med Kaz 2015; 4(38):74-78

Authors: Anatoliy Kolos, Lyazzat Saidildina, Kazhibay Askerov, Zhaksylyk Dzhieshev, Aigul Aitbayeva, Mariya Gerassimova

Pulmonary arteriovenous shunts Vascular malformations, due to which there is an abnormal connection between the arteries and veins of the lung. The result is reset in the venous blood channel, resulting in varying degrees of hypoxia. The most dangerous complication of arteriovenous aneurysm is a massive pulmonary hemorrhage, which occurs suddenly due to rupture of the bronchial vascular plexus, directly related to the aneurysm. The article presents the clinical case studies of particular interest to clinicians dealing with the problems of Pulmonology and Thoracic Surgery.

J Clin Med Kaz 2015; 4(38):83-85

Authors: Gaukhar Bakhtiyarova, Mehtap Tınazlı, Deniz Granit, Sabiha Gökçen Asvaroğlu

Black Hairy Tongue (BHT) is a hereditary benign condition which is characterized by the appaerance of abnormally hypertrophied and elongated pilliform papilla on dorsal surface of tongue. Its exact pathogenesis is unknown; however, there is significant involvement of secondary papillary cells producing hairy-type keratin. Known predisposing factors include smoking, consumption of excessive coffee / black tea, bad oral hygiene, trigeminal neuralgia, poverty, xesrostomia, drugs and alcohol. Hairy tongue is especially seen in those who smoke intensively in high prevalance; however our case is associated with excessive alcohol consumption. As means of treatment, we made suggestions such as alcohol abstinence, mouthwash with antiseptic solution, frequent hygienic care, tooth brushing as his treatment.

J Clin Med Kaz 2015; 3(37):9-13

Authors: Aigul Baizhumanova

The review is devoted to modern methods of voice rehabilitation in patients with laryngeal paralysis. The effectiveness of therapy depends on the age, cause and nature of the lesion. The main task of rehabilitation is used to activate the muscular apparatus of the larynx and compensatory mechanisms to achieve complete closure of the vocal cords during phonation.The author notes a number of advantages and disadvantages of each method.

J Clin Med Kaz 2015; 3(37):19-25

Authors: Alexander Gudaryan, Igor Samoilenko

Study purpose: Improving the effectiveness of rehabilitation in patients with generalized periodontitis during preoperative preparations for dental implantation, by improving methods of antimicrobial therapy and correction of immunological and biochemical disturbance. Research methods: Clinical, microbiological (PCR), immunological and biochemical studies in 42 patients generalized parodontitis, selected to conduct dental implantation. In the main group (32 patients) the preoperative preparation was carried out on the developed technique using Photodynamic therapy, immunomodulator IL-2 recombinant (ronkoleukin) and antioxidant mexidol. In the control group (31 patients) passed on the preoperative preparation and traditional generally accepted the plan. Results. In the main group of mild inflmmatory-infectious process in periodontal tissues and resistant (not less than one year) clinicoradiological remission, normalization of studied immunological and biochemical indices reached 93.8% of cases. In the comparison group, a positive result of treatment observed at 74.4% of the patients. Conclusions: developed and proven method combined preparations for dental implantation of patients with generalized periodontitis by clinical studies demonstrated advantage over existing traditional, due to optimization of sanation of periodontal tissues, as well as correction of immunological and biochemical irregularities identifid in such patients.

J Clin Med Kaz 2015; 3(37):32-36

Authors: Yernar Tursynbet, Mazhit Shaidarov, Andrey Dubitskiy

Aim: Evaluation of the efficacy of the emergency medical care response system is necessary to make management decisions on how to improve the timely provision of medical assistance to the victims in road accidents. To evaluate the effectiveness of the current system of organization for prehospital emergency medical assistance to the victims of road accidents in regions of Kazakhstan. Methods: Cases of emergency medical care that occurred during 2012-2013 year were selected. Cases included road accidents that resulted in traumatic injuries of varying degrees of severity in three regions of Kazakhstan. The volume and type of medical diagnostic and transport activities were recorded. Results: In 27.3% of studied regions, the extension of service area that provided access to the offices of emergency medical care exceeded 75 km. Six of the 11 districts had less than 80% of the staff dedicated to the ambulance service. In 49.2% of cases the reports about road accident came to the dispatcher service of ambulance were delayed by as much as 10 minutes after the accident. Conclusion: The research findings show the necessity to make management decisions to improve emergency ambulatory medical care to victims of road accidents.

J Clin Med Kaz 2015; 3(37):43-46

Authors: Pavel Kravchun, Valentina Delevskaya

The Aim: To investigate the effect of spironolactone on echocardiograhic parameters of the heart in patients with arterial hypertension combined with chronic obstructive pulmonary disease. Methods: A total of 80 patients, 41 patients, who received the basic therapy of arterial hypertension and chronic obstructive pulmonary disease (controls), and 39 patients, who additionally received spironolactone in a dose of 50 mg for 3 months, were included in the study. All the patients underwent spirometry and echocardiography before and after the treatment. Results. The obtained results showed, that addition of spironolactone to the basic treatment of patients with arterial hypertension and chronic obstructive pulmonary disease led to the reduction of the left ventricular myocardial wall thickness, left ventricular myocardial mass and its dimensions (P < 0.05), the increase of its contractility along with decrease of pulmonary hypertension (P < 0.05). Conclusion. Еру use of spironolactone in the basic treatment of patients with arterial hypertension and chronic obstructive pulmonary disease results in positive changes of structural and functional characteristics of the left ventricle of myocardium, prevents further adverse remodeling of the cardiovascular system and the progression of cardiac dysfunction.

J Clin Med Kaz 2015; 3(37):52-56

Authors: Arystan Seidalin, Marat Aripov, Adilzhan Albazarov, Alexey Smolenskiy, Vladimir Dikolayev, Timur Sarsengaliyev, Saule Nurakaeva, Sabitkhan Pernekhanov

Surgical treatment of patients with aortic aneurism dissection type I according to DeBakey classification still remains a challenge for surgeons and represents still unresolved problem in respect of a choice of ideal strategy. The best results in treatment of this pathology are reached by multidisciplinary approach with use of a hybrid method. This message shows successful application of a hybrid method in treatment of the aortic aneurism dissection type I according to DeBakey classification.

J Clin Med Kaz 2015; 2(36):11-14

Authors: Suyindyk Imankulov, Abay Baigenzhin, Turlybek Tuganbekov, Nurlan Zhampeissov

Duration of chronicity, serious injury of internals, defect in quality of living, mortality puts echinococcosis in the rank of socially dangerous helminthosis of the human being. Predominantly widespread in many regions of the Planet Echinococcus granulosus is passed from animals to a man that leads to loss of health, ability to work. Echinococcosis causes essential economic damage and poses a problem for healthcare. The article deals with the problem of echinococcosis. State of echinococcosis morbidity over the past few decades is represented in the article. Modern understanding of etiology, epidemiology, pathogenesis and clinics is revealed. Up-to-date capabilities of echinococcosis diagnostics and treatment are presented, including HIFU - therapy.

J Clin Med Kaz 2015; 1(35):23-29

Authors: Halyna Koval, Maria Ivanchuk

The aim of this study: а determination of cytokines informative for predicting and diagnostics of the presence of endometriosis in women with infertility. Methods: The main groups of 65 women with infertility associated with endometriosis have been researched as well as control group of 40 women with infertility of tubal genesis. The pre-defined levels of several cytokines (IL-2, INF-γ, TNF-α, IL-6, IL-10, TGF-β, IL-17, IL-1β, IL-12, IL-18) in serum and peritoneal fluid. Identification of immunological markers informative for predicting and diagnostics of the presence of endometriosis in women with infertility was conducted using mathematical models for informative by Kulbaka, Valdivsky sequential analysis, cluster analysis and linear separation method of convex hulls. The indices for prediction were selected according to Uilkokson-Mann-Whitney criterion and have showed probable differences (p<0.05) between the groups of patients with the presence and absence of endometriosis. Results: the cytokines of peritoneal fluid has bigger value, than the cytokines of serum for predicting and diagnostics of the presence of endometriosis. But bigger practical value has the cytokines of serum, because collecting of peritoneal fluid is more invasions. The highest informative for endometriosis prediction was demonstrated by interleukin 6 and tumor necrosis factor-α cytokines. Conclusion: IL-6 and TNF-α of serum can be used as immunological markers for predicting and diagnostics of the presence of endometriosis in women with infertility.

J Clin Med Kaz 2015; 2(36): 34-38

Authors: Tuba Tülay KOCA

Multiple Myeloma (MM) is a malignant proliferation of plasma cells producing monoclonal proteins. MM may manifest as skeletal pain, pathological fractures, fatigue, anemia, infection, hypocalsemia, spinal cord compression or renal failure. Proliferating plasma cells are responsible for these clinical symptoms. Seronegative erosive poly/olygoarthritis may be observed in patients with MM and other monoclonal gammopathies concurrently at the time of diagnosis, after the diagnosis or occasionally before it. The patient admitted to hospital in May 2012 with the complaint of fatigue, polyarthralgia, limitation of hand joints’ movements. Her physical examination revealed flexion contractures in elbows, fingers, knee, feet joints bilaterally. Laboratory examination revealed a sedimentation rate of 106 mm/h; rheumatoid factor(RF), C-reactive protein(CRP) and anti-cyclic citrullinated peptide(anti-CCP) was negative and anti nuclear antibody(ANA) tested by immunfluorescence technique was positive. The patient is considered and followed up as an inflammatory arthritis developed in MM process. The joint involvements were symmetric, erosive pattern and seronegative tested. The diseases with monoclonal gammopathies may lead to erosive polyarthritis or olygoarthritis so we should investigate the immunopathogenesis of arthritis process.

J Clin Med Kaz 2015; 2(36):44-46

Authors: Mehtap Tinazli, Ufuk Gencalp, Deniz Granit, Gaukhar Bakhtıyarova, Tumay Sozen

Scleroderma (systemic sclerosis; Ssc) is a chronic, idiopathic autoimmune/inflamatory disease that is characterised with fibrosis of skin, blood vessels and visceral organs of the body, particularly gastrointestinal system, heart and kidneys. Because it is rare and clinically heterogen, the pathogenesis of the disease is still not completely clarified. Characteristics of Ssc's pathogenesis include triade of vasculopathy, immune activation and fibrosis. There is an increased risk of malignancy of internal organs and tissues which are affected from fibrosis. Patients have increased frequency of skin, lung, esophagus, breast cancer and lymphoma. Recent studies that particularly focus on vascular pathology and lung involvement provided benefits on morbidity and mortality and increased interest to the disease. The aim of this case report is to point at the vital consequences of scleroderma coexisting with malignity.

J Clin Med Kaz 2015; 2(36):51-53

Authors: Roza Shakiyeva, Aigul Abduldayeva, Erbolat Dalenov, Gulnur Doszhanova, Zh Bizhanova, N Degemerzanova

The aim of this work was to obtain epidemiological data on the prevalence of osteoporosis among individuals older than 40 years of Astana using ultrasound densitometry. Methods: The study involved 93 people, including 17 (18.3%) men and 76 (81.7%) of women aged 40-90 years. Selective cross-sectional screening study mechanical properties of bone tissue in Astana residents was conducted by ultrasound densitometry at the heel bone (densitometer SONOST 3000, South Korea). On the basis of a questionnaire specially designed questionnaire and measurement of T-score was calculated 10-year absolute risk of low-energy fractures of the respondents using a computer program FRAX TM tool. Results: According to the ultrasound densitometry of the calcaneus NCM prevalence among residents of Astana is 83.3%, OP - 20.4%, which generally coincides with data elsewhere in the country. The urban population of Astana is a high degree of risk of fracture macrobiotic low, medium and high risk of fracture were 46.2% of the population, while the nationwide rate is 26.7%. According to the ultrasound densitometry women are more prone to Astana OP - 22.4% of respondents than men - 11.8% of respondents. Persons Kazakh nationality are more susceptible to reduce the t-test in comparison with the Russian nationality. Conclusions: The data about the peculiarities of the prevalence of osteoporosis among the residents of Astana over 40 years allow health authorities to take measures for prevention and early detection of disease study.

J Clin Med Kaz 2014;4(34):10-19

Authors: Gulziya Ismailova, Bakytgul Yermekbayeva, Bakhit Zhussupova, Aliya Iskakova, Zharilkasin Esmagambetov, Galiya Shaimardanova, Raushan Kumisbekova

Breast Cancer one of the most widespread cancer form in the world, and from the scientific point of view one of the most studied cancer types. The success of breast cancer treatment depends on staging of the disease, family history, and also HER2 characteristics. The analysis of qualitative characteristics of breast cancer diagnostics, staging and treatment will allow reduce recurrence risk of breast cancer using required standard treatment.

J Clin Med Kaz 2014;4(34):25-29

Authors: Zhanna Serikova, Saule Abisheva

The article is a review of the literature on a research of effectiveness of the education programs for patients with rheumatoid arthritis. The review included randomized controlled trials, systematic reviews and meta-analyzes. Various methods of teaching patients with rheumatoid arthritis, a comparative study of teaching methods, problem-based learning, the use of printed material such as leaflets, booklets, mental maps, multimedia resources, assessment tools for needs of patients with rheumatoid arthritis were used in obtaining the information. Volume 4, Number 34 (2014)

J Clin Med Kaz 2014;4(34):34-39

Authors: Valentina Delevskaya

The aim: To study the changes in connective tissue metabolism at progression of bronchoobstruction in patients with chronic obstructive pulmonary disease in combination with arterial hypertension and to determine the character of their correlations with parameters of respiratory function. Methods: We investigated the level of serum chondroitin sulfates, glycoproteins, glycosaminoglycans and their fractional composition in 62 patients with chronic obstructive pulmonary disease of II and III degree of severity of airflow limitation with concomitant arterial hypertension. Results: The patients had elevated serum levels of chondroitin sulfates, chondroitin-6-sulfates, glycoproteins and reduced levels of dermatan / chondroitin-4-sulfates and keratan- / heparan sulphates. While progression from II to III degree of severity of airflow limitation, along with increased levels of glycoproteins the patients had chondroitin-6-sulfates and chondroitin-4-sulfates increase and heparan sulphate decrease, that may indicate impaired synthesis of the latter type of glycosaminoglycans and expressed extracellular matrix degradation processes. Study revealed moderate and strong correlations between parameters of respiratory function, chondroitin-6-sulfates, heparan sulfates and glycoproteins may indicate their involvement in the pathogenesis of bronchial obstruction in chronic obstructive pulmonary disease and arterial hypertension. Conclusion: Serum levels of chondroitin-6-sulfates, glycoproteins and heparan sulfates may be used in predicting bronchoobstruction progression in patients with chronic obstructive pulmonary disease and arterial hypertension. Volume 4, Number 34 (2014)

J Clin Med Kaz 2014;4(34):46-48

Authors: Rikhsi Sabirova, Munojat Kulmanova

The aim. To study cytokines in experimental hepatitis depending on the timing of study. Methods. Experiments were carried on 60 white male rats weighing 100-120 g. Heliotrinic hepatitis (HH) was reproduced by oral injection of heliotrin solution, acidified with hydrochloric acid (pH 7.0) at the rate of 50 mg / kg (5 mg heliotrin per 100g) weight once a week for 42 days. Then animals were decapitated on the 60th, 90th and 120th days of the experiment. Interleukin (IL-1b, IL-2, IL-6) and tumor necrosis factor-alpha (TNF-α) were determined on ELISA analyzer of «Stat-Fax» (USA) firm using a set of test kits produced by LTD «Cytokine» (St. Petersburg). Results. In the dynamics of the development experimental heliotrinic hepatitis set of induction of cytokines IL-1b, IL-2, IL-6, the most increase these cytokines in comparison with intact animals was on the 90th day of the experiment. Conclusion. Immune dysfunction plays an important role in progression of pathophysiological processes, in course, severity and outcome of the disease in heliotrinic hepatitis. Volume 4, Number 34 (2014)

J Clin Med Kaz 2014;4(34):54-57

Authors: Timur Omarov, Liliya Omarova

The aim. To study the influence of intestinal Candidiasis on immune status and severity of clinical implications in patients with nonspecific ulcerative colitis. Methods. The patients with nonspecific ulcerative colitis (NUC) infected by Intestinal Candidiasis, were divided into 2 groups depending on the severity. The first group – 15 patients with moderate NUC severety, the second - 15 patients with mild severity. The state of the immune status, depending on the severity of nonspecific ulcerative colitis was studied. Cell-bound immunity was assessed by uniform method, the main classes of immunoglobulins (G, A, M) by radial immunodiffusion according to Mancini. The identification of gram-positive cocci and Gram-negative rods pure cultures was performed by microbiological computer analyzer “Microtax” of firm “Sy-Lab” (Austria). Results. A significant decrease in the number of To lymphocytes, the increase of immunoregulatory index Tx/Ts by reducing the amount of Tc and functional activity of Tx, reduction of killer suppressor T- lymphocytes in the peripheral blood, increase in CIC, decrease in В19+ and increase in IgG and decrease in IgA and IgM were identified in patients with moderate NUC severity infected by Candidiasis. In 89 % of patients with NUC colonic bacteria associated not only with a significant reduction of obligate bifidobacteria, but also with active growth of opportunistic bacteria. More marked impairment of microbial spectrum was observed in first group. Conclusions. In patients with moderate NUC severity on the background of a violation of the microbial spectrum of the large intestine showed significant changes in cell-bound and humoral immunity and led to worse clinical severity. Volume 4, Number 34 (2014)

J Clin Med Kaz 2014;4(34):61-65

Authors: Tuba Tulay Koca, Aydın Arslan

Spinal meningioma is a benign tumor, with a slow but severe course of symptoms, demonstrating different neurological deficits according to the anatomic region. Diagnosis is generally made with magnetic resonance imaging (MRI). A 74-year-old female presented with chronic atypical low back pain spreading bilaterally to the thighs and progressive difficulties in walking with a history of onset after surgery for gallbladder stones. There was no neurological deficit in the physical examination. MRI revealed a spinal intramedullary mass at T8-9 level, 1.5 cm in size. Laminectomy and instrumentation were applied. Post-operative histopathological examination reported the case as ‘psammomatous’ and ‘meningothelial’ Grade I. The lower back pain and difficulty in walking improved rapidly postoperatively. The aim of this paper was to emphasise the importance of early investigation with MRI and differential diagnosis of spinal tumors in patients presenting with complaints of persistent atypical low back pain and sciatica. Volume 4, Number 34 (2014)

J Clin Med Kaz 2014;4(34):70-74

Authors: Sahipzhamal Idrissova, Galiya Shaimardanova, Saltanat Abdraimova, Karlygash Kuzembayeva, Assem Tuleyeva

This article is a clinical report about supervision of 2 patients with Konovalov-Wilson’s disease, Hepatolenticular degeneration. The disease started when they were young; in one of the cases patient was diagnosed incorrectly as Myasthenia and was observed for quite a long time. In both cases there was no evidence of positive family history. Both patients have a diverse severe damage of the liver. In one of the cases cirrhosis led to severe coagulopathy with marked decrease in coagulation factors, platelets and increased bleeding time of the hemostasis system with decreasing the level of platelets, lengthening of indicators of coagulogram was diagnosed. Both patients have a severe damage of nervous system with combination of extrapyramidal and cerebellar signs. Cognitive function was affected as well creating diverse presentation of symptoms. Volume 4, Number 34 (2014)

J Clin Med Kaz 2014;4(34):77-79

Authors: Aigul Syzdykova

The main factor, which defines the level of patient risk of fall in hospitals is age. The highest risk is among people older than 60 years. This is due to age related loss of muscle strength, reduced coordination and impaired vision. Volume 4, Number 34 (2014)