Herald of Almaty State Institute of Advanced Medical Education

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".