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".

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.

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].