Journal of Clinical Medicine of Kazakhstan

J Clin Med Kaz 2014; 3(33):13-16

Authors: Aigul Syzdykova, Assiya Turgambayeva, Temirlan Karibekov

The problem of risk management today is quite relevant. The modern healthcare the issues on risk optimization of both medical and non-medical, absolutely resonates with issues of quality and safety of medical services. One of highlights for increase of safety of delivery of health care is creation of a control system of risks in the system of domestic health care focused on the international standards, but operating in a legal framework of the country.

J Clin Med Kaz 2014; 3(33):22-28

Authors: Almaz Makenjan uulu

The aim: to evaluate the effectiveness of the internal iliac artery ligation to stop severe obstetric hemorrhage and opportunities organ-preserving surgery in critical situations. Methods. In our studies, we analyzed 216 cases of ligation of internal iliac arteries (IIAL) in women with severe obstetric hemorrhage in the provision of emergency obstetric care (EmOC) during the period 2004-2013years in maternity care hospitals of the Kyrgyz Republic. According to the outcome of operations cases were divided into two groups: a) Group 1 - 111 cases, which were finished by hysterectomy followed ligation of internal iliac arteries. b) Group 2 - 105 cases where it was possible to use organ-preserving surgery. Results. Ligation of the internal iliac arteries in women with severe obstetric hemorrhage were allow for preserve uterus: in premature detachment of the placenta - in 69.6% (32 women); Postpartum hemorrhage (hypotonic bleeding) - 58.3% (35 women); traumatic injuries of the uterus - 55.2% of cases (16 women). As a result, hysterectomies were avoided in 48.6% of cases (105 out of 216 woman) during pregnancy and delivery. Conclusion. Ligation of internal iliac arteries is one of the effective methods of stopping the massive obstetric hemorrhage, thus preserving the uterus.

J Clin Med Kaz 2014; 3(33):32-33

Authors: Recep Tunc, Ilknur Albayrak, Abdulkadir Basturk, Sevket Arslan, Adem Kucuk

Systemic lupus erythematosus (SLE), is a systemic autoimmune disease. Hemolytic anemia, leukopenia, lymphopenia, thrombocytopenia are the most common hematologic problems in SLE. Our case was a 19 years old young girl presented with complaints of weakness. She had autoimmune hemolytic anemia and treated successfully with cyclosporine therapy

J Clin Med Kaz 2014; 3(33):39-40

Authors: Adem Kucuk, Ilknur Sahin, Guluzar Kutas Kurt, Ilknur Albayrak, Mehmet Unal, Ali Yavuz Karahan

Paraneoplastic syndrome is a group of signs and symptoms that are not directly associated with tumor metastasis and caused by hormones or cytokines that are produced by a tumor or in reaction to a tumor. Here we presented a lung cancer case with a paraneoplastic dermatomyositis as a clinical evidence.

J Clin Med Kaz 2014; 3(33):44-46

Authors: А.K. Segizbayeva, О.D. Kassymova

Data of results of Astana city Health administration work for 2013 are described in this material.

J Clin Med Kaz 2014;2(32):14-20

Authors: Altyn Aringazina, Manat Kurmanguzhina

Development of transplantation is one of the strategic priorities for the medical industry in the country, but the main obstacle to its development is the shortage of organ donors. The figures of international “waiting lists” are growing steadily and not amenable to control. In Kazakhstan the existing disbalance between the necessity in transplantological services and possibility to use has already achieved the critical level. Practiced lifetime donation is not a solution to this problem for a number of reasons such as: frequent lack of histocompatibility between potential donor and recipient, the donor identification contraindications to surgery, insecurity of the donor in the event of a threat to health, unsuitability of this type of transplantation for transplant individual unpaired organs (heart, lungs, and complex "heart-lung"). In such circumstances to use postmortem donor is a forced measure, which explains public policy adopted in this respect. The limited number of organ donors is the main problem of the countries where transplantation is at the stage of development; along with the level of transplantological issues is closely connected to strength of healthcare system.

J Clin Med Kaz 2014;2(32):26-32

Authors: Natasha Tsoy, Oleg Tsoy

This article summarizes literature data on the immunomodulatory effect of hormones involved in the pathogenesis of acne: testosterone, progesterone, prolactin. Examined the immunological effects in animals and humans, when failure or ultrahigh concentration and under conditions in vitro.

J Clin Med Kaz 2014;2(32):38-42

Authors: Indira Smagulova, Toregeldi Sharmanov

The aim: To evaluate the nutritional value of food kits for pregnant women in Astana. Methods: The sample included 80 of pregnant women aged from 19 to 30 years, the median age is 23 years. Among those interviewed were women, most in the II trimester of pregnancy is - 60.4%, the proportion of women in the III trimester of pregnancy is 39.6%. Studied were followed up in female consultation of Astana. The study of actual nutrition of pregnant women was conducted a questionnaire-polling method, developed at JSC "Kazakh Academy of Nutrition". The method 24-hour food recall (in the last day) was conducted through a survey of pregnant women, reproducing from memory that studied used the food the day before during the previous 24 hours (from the time of awakening until bedtime, making sure from memory that they included snacks and drinks, not even water). Results: This research was revealed an insufficient number of dietary fiber in the diet of pregnant women - about 42.3% of the normal as recommended Kazakh Academy of Nutrition. The main reason for this fact is insufficient consumption of fruits and vegetables that contain dietary known fibers in large quantities. Chemical analysis of the nutrition of pregnant women also showed a deficit and other important indicators: the content from the normal calcium is - 53% for iron - 47.3%, and zinc - 70.9%, folate - 42.1%, riboflavin - 79.2%. Conducted a survey showed that during the third trimester ingestion performed 4-6 times a day 76% of the women surveyed. 38% of women food load is evenly distributed and the intervals between meals were cut for comparison: at the beginning of pregnancy on this principle were fed 25% of women. Conclusions: The average consumption of foods selected for the study group of pregnant women did not match recommended requirements. The food and energy value of food rations did not comply with nutrition on the principles of usefulness, balance, diversity. Outlined above will serve as a justification of the results of research activities aimed at improving the effectiveness of prevention of micronutrient deficiency.

J Clin Med Kaz 2014;2(32):49-53

Authors: Timur Omarov, Venera Omarova, Liliya Omarova, Samal Sarsenova

The aim. To study the course of gastric ulcer with H.pylori in the Candida infection of the gastric mucosa and the impact of antimycotic therapy on the efficiency of ulcer healing. Methods. We have determined the microbial spectrum of large intestine in 30 patients with gastric ulcer with H.pylori. The patients were divided into two groups. The both group took standard anti-Helicobacter pylori therapy and probiotics. The first group also took antimycotic therapy. The identification of clean cultures selection was performed by microbiological computer analyzer “Microtax” of firm “Sy-Lab” (Austria). Results. Before treatment the decrease of Bifidobacterium and Lactobacterium level in concentrations <108 and <106 UFC in 97% of patients and increase the opportunistic flora, especially Candida fungus were found. After treatment, in first group who took fluconazole than other group, in 93% patients, Lactobacterium, E.coli with normal and reduced enzymatic activity come to normal. In 13% of patients Bifidobacterium and Candida keep in high concentration. In second group, the indigenous and facultative microflora come to normal in 76%, but Candida keeps in high concentration in 53%. Conclusions. To include antimycotic preparations to standard therapy for patients with gastric ulcer, Candida infection of the gastric mucosa and its high concentration in feces.

J Clin Med Kaz 2014;2(32):60-64

Authors: Turlybek Tuganbekov, Nurlan Ashimov, Dana Saipiyeva

Vacuum therapy has only recently been introduced for treatment of low extremity ulcers. The traditional way has conventionally been application of continuous negative pressure at -125 mm on patient’s lower body and extremities. However there are evidences suggesting potential advantages of lower value intermittent negative pressures. The article describes the mechanisms and clinical effects of intermittent vacuum therapy. Practical experience of its application in patients with low extremity venous ulcers is demonstrated. This technique has proved being a perspective approach in the treatment of non-healing wounds and ulcers and so requires more profound studying to identify the most suitable therapeutic regimen.

J Clin Med Kaz 2014;2(32):69-72

Authors: Zhannat Sadyrova

The purpose of research was studying the contents brain natriuretic peptide at patients with chronic rheumatic illness of heart, and also its influence on clinic and functional parameters. 28 patients have been surveyed. On the basis of results research it is revealed the increased concentration brain natriuretic peptide at patients with chronic rheumatic illness of heart. The contents of it peptide increased in process of increase of weight of heart failure.

J Clin Med Kaz 2014;2(32):76-77

Authors: Adem Kucuk, İlknur Albayrak, Abdülkadir Basturk, Sevket Arslan

Systemic lupus erythematosis (SLE) is a chronic disease. Antiphospholipid antibodies are detected in laboratuary; and recurrent thrombosis or pregnancy morbidity may be seen in clinic. We presented a man who diagnosed SLE and Antiphospholipid syndrome when investigated because of deep venous thrombosis.

17-19

Authors: Б.А. Каюпов

Для большинства хронических диффузных заболеваний почек свойственно неуклонное прогрессирование патологического процесса, которое постепенно приводит к потере массы функционирующих нефронов, к развитию хронической почечной недостаточности (ХПН), и в итоге - к терминальной почечной недостаточности (ТПН). Протеинурия является прогностическим фактором прогрессирования почечной недостаточности

26-34

Authors: Г.Н. Исмаилова, О.Е. Шлыгина

Выполнен ретроспективный анализ результатов статической сцинтиграфии (СС) почек 53 пациентов, ликвидаторов аварии Чернобыльской АЭС, с артериальной гипертензией (АГ) и радиологической семиотикой хронического пиелонефрита (ХП). СС выполнена на однофотонном эмиссионном компьютерном томографе «GenesysEpic» производства ADAClab. (США). Расчет процента захвата радиофармпреарата (РФП) технемека 99mТс проводился стандартным способом и с введение в формулу расчета процента захвата технемека99mТс коэффициента поправки 99mТс. У всех пациентов определена радиологическая семиотика ХП на разных стадиях с функциональными нарушениями почек. Введение коэффициента поправки 99mТс позволило снизить на 11,9% число ложноположительных результатов в оценке функции почек у больных с ХП и АГ.

43

Authors: Orhan Guliyev, Elgun Heziyev, Shelale Ismayilova, Arzu Ibishova, Mehman Agayev

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46

Authors: В.Х. Алтынова, Н.Б. Нигматуллина, Н.Б. Амреева, М.А. Хван, М.Б. Бамыш

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50

Authors: С.Б. Иманкулов, К.К. Оскенбаева, А.Х. Ибадильдина

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53

Authors: Beyza Algül Durak, Selman Ünverdi, Süleyman Karaköse, Yasemin Gülseren, Eyüp Koç, Emin Çağlar Yetkiner, Galip Aktürk, Murat Duranay

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56

Authors: Р.Ш. Вахитова, М.И. Хасанова, Н.И. Исмагилова, В.А. Дамоцев, Л.Ф. Ахмадуллина, Т.Н. Камалетдинова, Р.М. Газизов

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60

Authors: Г. Рахымжан

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62

Authors: К.Ш. Джеентаев, Р.Р. Калиев

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66

Authors: С.С. Сариева, Н.Ю. Жидких, Е.В. Павлова, С.Б. Абраева, Н.Ю. Богунов

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69

Authors: А.Э. Гайпов, Л.С. Жармуханбет, Г.А. Оразбаев

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72

Authors: Г.Н. Чингаева, А.М. Нугманова, М.Н. Кулкаева, Э.Б. Алимжанова, С.М. Досым, Д.Б. Исмаилова, А.А. Бисекен

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76

Authors: Р.Г. Джуманова, А.К. Турусбекова, Р.Р. Калиев

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79

Authors: А.М. Нугманова, С.А. Диканбаева, Г.Н. Чингаева, С.К. Шабдарова

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85

Authors: Д.В. Жмуров, В.А. Жмуров, В.Г. Яркова, Д.Е. Ковальчук, Т.Г. Задорина

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89

Authors: Suleyman Karakose, Selman Unverdi, Beyza Algul Durak, Arzu Ensari, Eyup Koc, Murat Duranay

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91

Authors: С.Б. Иманкулов, Н.К. Жампеисов, К.К. Оскенбаева

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94

Authors: Г.К. Бахтиярова

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97

Authors: Г.М. Шаймарданова, Г.В. Федотовских, А.П. Савчук, А.К. Смагулова

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100

Authors: Б.А. Абеуова, Н.Б. Нигматуллина, Н.М. Мустапаева, Л.Б. Ибраимова

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104

Authors: Г.Е. Магзумова, А.Э. Гайпов, К.О. Толеп, Т.Б. Джусипов, Б.Е. Абдрахманова

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108

Authors: Т.Л. Бестаева, Ф.У. Дзгоева, М.Ю. Сопоев

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112

Authors: Ebru Uz, Cemaleddin Öztürk, F. Betül Asan, Şükran Erten

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115

Authors: А.Е. Наушабаева, Б.А. Абеуова, Г.Н. Чингаева, К.А. Кабулбаев

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120

Authors: Jamshid Hamdard, Rumeyza Kazancıoğlu, Işın Kılıçaslan, Yasemin Özlük, Murat Alay, Ruhper Çekin, Reha Erkoç, Gauhar Rakhymzhan

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122

Authors: Р.Э. Тожибоев, М.А. Досов, А.Э. Гайпов, Р.Ш. Кульчуков, А.А. Тимченко, А.Т. Бексейтова, М.М. Мартасова, К.М. Саенко, Я.Н. Хакимов

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J Clin Med Kaz 2014;1(31):13-17

Authors: Akmaral Kassimova

In order to understand the pathogenesis of ovarian neoplasms is necessary to study the role of bioactive substances in the mechanisms of regulation "biological behaviour" of the tumor, namely its growth, invasion to surrounding tissues and metastasis. In recent years, researchers has been attracted to study the mechanisms of apoptosis which is programmed and controlled by death of cell with characterized morphological and biochemical features. Apoptosis is an extremely important mechanism for maintaining the homeostasis of multicellular organism, due to multicellular organisms damaged cells are removed, which have completed their course of life, as well as "unwanted" cells without damaging the cellular microenvironment. In recent years, it became well known, that one of the key molecules which trigger apoptosis in a cell is the Fas-receptor. Moreover, Fas is expressed in almost all tissue types, this receptor is also expressed on many tumors, including ovarian cancer. Similarly, well-functioning Fas-system maintains homeostasis of the organism. Loss of functional activity of the Fas-system induces hyperplasia and lymph proliferation.

J Clin Med Kaz 2014;1(31):25-32

Authors: Elena Alypova, Ivan Mironenko, Samal Sarsenova, Irina Yemchenko

The aim. Research purpose is a comparative estimation of “dry” carbonic baths (DCB) and general low-frequency magnetotherapy (GLMT) influence on heart rate variability (HRV) and 24-hour blood pressure (BP) profile measures in elderly patients with isolated systolic arterial hypertension (ISAH). Methods. Analysis of HRV measures has been carried in comparison with 24-hour BP monitoring parameters in 180 patients (middle age 65,8±6,2 years) with ISAH, Grade 1 and 2 in groups: A is control (n=30) drug therapy; B (n=50) is DCB; C (n=50) is GLMT; D (n=50) is a combination of DCB and GLMT. Results. DCB and GLMT monovariant administration gives vegetative correction with the accurate (p<0,05) decrease of LF/HF index and parallel improvement of 24-hour parameters systolic, pulse BP, BP variability, giving way in antihypertensive efficiency to combination of DCB and GLMT which is marked accurate HRV and BP circadian rhythm parameters unidirectional remodelling with advances in 2/3 patients of a target BP level. Conclusion. DCB and GLMT combination gives more expressed corrective synergistic effect on the vegetative system regulation and 24-hour BP profile against monovariant use.

J Clin Med Kaz 2014;1(31):38-44

Authors: Mariya Derbak, Serhiy Tsyapets, Gabriela Tsyapets

The aim: the study of methods of correction at syndrome of cholestasis at patients with chronic hepatitis C (CHC) and type 2 of diabetes mellitus (DM), which for diverse reasons antiviral therapy (AVT) was not got. Methods. In this prospective comparative study was included 98 patients with CHC and type 2 of diabetes mellitus (44 males and 54 famels), middle age 58,5 ± 2,7 years. Depending on the variants of the conducted therapy three groups were formed. The patients of the I group (n=30) got monotherapy of ademetioninom by 800 mg of intravenosis 1 times daily during 10 days, with a further peroral reception 1600 mg in a day, dividing the dose of preparation into two receptions (in the morning and in the evening) 20 days. The reception of ademetionina was repeated on 4-th, 8-th and 12-th months of treatment. To the II group of patients (n=32) monotherapy of UDCA was appointed for 13-15 mg/kg of body wait for the night during 12 months. The third group of patients (n=36) got the combined therapy of UDCA+ademetionin in the higher offered dosages. The course of treatment for all of groups made 12 months. A kind and doses of hypoglycemic therapy remained without changes during all of period of treatment. Results. In all of three groups of patients it is set that diminishing of clinical syndromes is marked in 3 months of treatment: astenovegetative, dispeptic and pain in the right upper quadrant. To the end of supervision these syndromes were saved not more than in one tenth part of patients not dependency upon the type of treatment. More expressive improvement of clinical and laboratory indexes is marked at patients, which accepted ursodeoxycholic acid (UDCA ) and ademetionin on the developed chart by comparison to monotherapy of UDCA or ademetioninom due to positive influence on the syndrome of cholestasis, level of dislipidemi and biochemical indexes of blood serum. Conclusion. Taking into account influence of the combined therapy on the different links of pathogenesis of comorbid pathology, deem it wise to utillize it in treatment of patients with chronic hepatitis C and type 2 of diabetes mellitus.

J Clin Med Kaz 2014;1(31):48-51

Authors: Aziz Ibragimov, Zubayda Matkasimova, Jeniskul Raeva, Barna Parmankulova

Hydatid disease of the heart is a complex disease that has no specific clinical characteristics and symptoms. It can be recognized too late and can also lead to life-threatening complications (embolism great vessels, cardiac hydatid cyst rupture in the pericardial cavity causes the development of hydatid pericarditis with cardiac tamponade). In this article we describe a rare case of echinococcosis of the heart in a child 13 years old, first identified by echocardiography. Particular attention is paid to the improvement and timely diagnosis of echinococcosis of the heart. The most common complaints of patients may be chest pain, fever, palpitations, shortness of breath, ischemic ECG changes, which are not associated with age of patients. In all cases of liver and lungs echinococcos, and especially when multiple and combined organ dissemittions need focused cardiac echography in order to eliminate parasitic heart disease.

J Clin Med Kaz 2014;1(31):55-56

Authors: Elmira Chuvakova, Timur Sarsengaliyev, Boris Tsoy, Karlygash Abdrakhmanova, Abduzhappar Gaipov

Renal arteriovenous malformation (AVM) is a rare and can be complicated with internal ruptures, gross hematuria and sudden death. Multislice computed tomography is the one of the best minimally invasive screening and available diagnostic tool. In this case we present the renal AVM in 63-years male patient. We discussed the genesis of congenital or post-traumatic AVM.

3-5

Authors: Abay Baigenzhin

Dear friends! Scientific-practical journal “Clinical Medicine of Kazakhstan” turns a new page of its activity with the renewed staff, ideas. According to the order #1082 of the Chairman of Committee of Control on Education and Science of the Ministry of Education and Science of the Republic of Kazakhstan (Committee) dated July 10th, 2012, we were once again included into the List of Approved Scientific Journals of Kazakhstan. We opened own site for journal - www.clinmedkaz.org. New web-site of the journal, allows you to submit your publications online and to follow the process editing and accepting, as well as to communicate directly with the editors staff. Our renewed editorial staff and editorial board include leading foreign specialists. This way we hope to be able to raise our academic bar to a whole new, international level, and invite you to be a part of this. Our journal is now indexing in databases - Global Impact Factor, Open Academic Journals Index and International Impact Factor Services. These are one of the largest databases where conducted in-depth quantitative and qualitative analysis to assess the prestige periodical scientific publications in the world. The rating takes into account such factors as peer-review the original article, the quality of scientific and technical review, acceptance and rejection rate of the manuscripts and the periodicity of the publication numbers. In general, the stringent requirements for the selection of articles, high rejection rate of manuscripts are considered one of the important criteria of high peer review quality and prestige of the journal. Our impact factor in the system of Global Impact Factor is 0,542. Now, we conclude contracts with international scientific information platforms, such as the Russian Science Citation Index, Cross Ref, Index Copernicus, DOAJ (Directory of Open Access Journals), Bioline International, SCOPUS. Indexing in such databases will enhance the citation of articles published in our journal. The main purpose of the journal is to be indexed in the ISI Web of Science (Thomson Reuters) and in the PubMed. J Clin Med Kaz is fully committed to the Open Access Initiative and will provide free access to full text of all articles as soon as they are published and available from online system. All of the submitted articles will be considered free of charge. Thus, we go to the international level and strive for excellence. We hope that realization of Editors' plans will attract new readers and authors to the journal and will contribute to the development of scientific approach to problems of clinical medicine based on the principles of evidence-based medicine.

9-13

Authors: Abay Baigenzhin, Galiya Shaimardanova, Nadezhda Popova, Bakhit Zhussipova, Gulziya Ismailova

Existence of circulating tumor cells (CTCs) in blood of cancer patients, testifies about a dissemination of cancer cells to the peripheral blood stream, on the earliest stages of cancer development and very often testifies to an adverse clinical current, especially it is connected with formation of metastases. Besides, these cells can represent the minimum residual disease and quantitative monitoring of CTCs level in time of anti-cancer treatment provides researchers with valuable information. For today the role of epithelial-to-mesenchymal transit (EMT) and mesenchymal-to-epithelial transit (MET) in formation of various subpopulations CTCs, in expansion of cancer aggressive properties. In this article we want to prove the purpose and problems of our scientific research - the cytological molecular analysis of circulating tumour cells have isolated by the size dependent ISET technology (Isolation by size of epithelial tumor cells). To study the cyto-morphological and immunological characteristic, to identify targeted therapy markers and the metastatic response predictors to anti-cancer treatment on viable circulating cancer cells by the RT-PCR method (real-time polymerase chained action). To study of clinical profit from quantitative, immunological and molecular monitoring of CTCs, for elimination minimum residual disease, by application of individual targeted therapy, on the basis cytological molecular analysis of CTCs.

21-28

Authors: Gunay Akbarova

This article is devoted to the study of β-thalassemia, which is one of the most widespread hereditary diseases among the population of the Azerbaijan Republic. The pathology's genetic mechanism, clinical and laboratory manifestations are described. A complete analysis of references in this field since 60s was completed. The causes of this disease and methods of detecting the pathology in Azerbaijan are examined. Research of the β-thalassemia in Azerbaijan was carried out in 40 of the 66 administrative districts of the Republic. The article reviews the main types of β-thalassemia mutations found in Azerbaijan. The most characteristic mutations for the population are β0 - Fs codon 8 (-AA), β0 - IVS-II-1 (G>A), β+ - IVS-I-110 (G>A) and β+ - IVS-I-6 (T>C). The rarest mutations are codon 5 (-CT), -88 (C>A), β+-IVS-I-130 (G>C) and β0-codon 37 (TGG>TGA). The mutation frequencies are listed by administrative districts in Azerbaijan. The possibilities of β-thalassemia manifestation together with abnormal forms of hemoglobin in the Azerbaijan population are traced. The methods of treating, exploring and prevention of β-thalassemia by the general public, charitable organizations, foreign companies and the government of the Azerbaijan Republic are illustrated. Basic prevention methods and the importance of establishing a State register of β-thalassemia cases are reviewed.

37-41

Authors: Natalia Abramova, Natalia Pashkovskaya

The aim of the study. To study the dependence of expression of vascular endothelial growth factor (VEGF) and endothelial cell desquamation intensity in patients with the metabolic syndrome (MS) according to the body mass index and dependence of levels of thyroid hormones on the level of VEGF and content of desquamated endothelial cells in venous blood serum. Methods. We have determined the level of VEGF and desquamated endothelial cells in the serum of venous blood in 68 patients with MS (48 obese and 20 non-obese patients), and indicators reflecting the metabolism of thyroid hormones namely thyroid stimulating hormone (TSH), free triiodothyronine (fT3), free thyroxine (fT4), thyroid-stimulating hormone/free triiodothyronine ratio (TSH/fT3), thyroid stimulating hormone/free thyroxine ratio (TSH/FT4 ), thyroid index (TI), the total thyroid index (TTI), free triiodothyronine/free thyroxine ratio (fT3/fT4). Results. Expression of VEGF as well as the number of desquamated endothelial cells in venous blood serum increased significantly with enhancement of the degree of obesity. Desquamated endothelial cells correlated positively with TSH, TSH/fT3, TSH/fT4 (p <0.05) and negatively with thyroid index, fT3/fT4 (p <0.05). Also we found a positive correlation between the expression of VEGF and TSH, fT4, TSH/fT3, TSH/fT4 (p <0.05) and negative with T3, fT3/fT4 and TTI (p<0.05). Conclusions. Expressoin of vascular endothelial growth factor and endothelial cell desquamation enhances with increasing of the degree of obesity, which are associated with the level of thyroid hormones metabolism and the functioning of the pituitary-thyroid axis.

47-51

Authors: Igor Kutko, Irina Terуshina

The aim of the study – investigation of metabolic active preparation cytoflavin influence on dynamic of nitric oxide (NO) metabolites (nitrates / nitrites) in patients with reccurent depressive disorder (RDD) in the ambulatory conditions. Methods. For aims realisation the clinicalpathopsychologycal, immunologycal and statistical methods were used. To implement the objectives of the study were examined two randomized groups of patients with RDD (F33.0, F33.1, F33.2) - main (98 patients) and comparison (94 patients). Patients of both groups received on-commonly accepted maintenance therapy with antidepressants and antipsychotic on an outpatient basis. In addition, patients of the main group during the treatment yielded an additional cytoflavin. Results. Found that before treatment in patients with RDD levels of NO metabolites - nitrate / nitrite were lower than the corresponding parameters in healthy donors. Violations of nitrogen metabolism indicators were the same type for all three types of RDD gravity, but differed in quantitative traits. The use of modern metabolic active drug cytoflavin in the treatment of patients with RDD contribute to the normalization of NO metabolites - nitrates / nitrites. Conclusion. The use of modern metabolic active drug cytoflavin in the treatment of patients with RDD has pathogenetic base and clinical perspective.

60-65

Authors: Abduzhappar Gaipov, Daniyar Abishev, Saltanat Moldakhmetova, Natalya Kim, Assem Nogaibayeva, Mukhit Dossov, Bolat Bekishev, Adilzhan Albazarov, Nadezhda Popova, Saltanat Tuganbekova

The aim of our pilot study was to determine the relation between the intraoperative parameters and levels of urinary neutrophil gelatinase-associated lipocalin (uNGAL) in patients after cardiac surgery. Methods: Twenty four adult (mean age 55.3±11 years) patients with coronary heart diseases whom planned cardiac surgery were included to study. All patients had initially normal kidney function (GFR > 60 ml/min). Diabetic patients were excluded from the study. Clinical survey included assessment of kidney and heart functions, routine laboratory assays. uNGAL levels were tested at 2nd and 12th hours after conducted cardiac surgery. We investigated association between the intraoperative factors such as extracorporeal circuit (pump on) time, intraoperative blood loss, duration of surgical operation and level of uNGAL. Results: General clinical characteristics of patients were followings: GFR 92±20.6 ml/min, Hb 13.4±1.8 g/dL, WBC 6.9 x103/mm3, left ventricle ejection fraction 53.8±8.4%. All patients received standard surgical and anesthesiological protocols during the cardiac operation. Mean extracorporeal circuit time and duration of operation were 93.2±42.1 and 184±47.1 minutes respectively, intraoperative blood loss calculated 205±47.8 ml. Urine NGAL levels at 2nd and 12th hours after cardiac surgery made up 68.5±90.6 (0.8 - 267.2) ng/ml and 20.4±21 (0.3 - 92.4) ng/ml respectively. Mean staying days in intensive care unit (ICU) were 2.79±6.4 (1 - 32) days. In result of cardiac surgery, two patients developed acute kidney injury (AKI), and one patient died in result of multiorgan dysfunction syndrome. Urine NGAL of 2nd hour positively correlated with extracorporeal circuit time (r=0.625, p=0.001), duration of operation (r=0.576, p=0.003), intraoperative blood loss (r=0.60, p=0.002) and with ICU staying time (r=0.449, p=0.022), whereas there were no correlation of these parameters with serum creatinine levels. Development of AKI were related with extracorporeal circuit time (r=0.436, p=0.033). CONCLUSIONS: Prolongation of extracorporeal circuit time and duration of operation as well as excessive intraoperative blood losses was associated with increased uNGAL levels. Extracorporeal circuit time has an indirect relationship with the risk of AKI in patients after cardiac surgery.