Vol. 4 No. 4 (2017): VESTNIK of KSMA

Resume. This paper presents research data on the prevalence and molecular epidemiology of gram-negative non-fermenting bacteria (PHOB), which produce carbapenemase molecular class D and metallo-β-lactamase in Almaty (Kazakhstan) in the period of 2015-2016. The proportion of isolates PHOB in the common etiological pattern of surgical infections is 14.5%. The predominant species were P. aeruginosa and A. baumannii. 33.3% of isolates of A. baumannii revealed the presence of genes acquired carbapenemase of molecular class-D (OXA-23). A. baumannii isolates were absolutely resistant to piperacillin (100%), ceftazidime (100%), cefepime (100%), gentamycin (100%), ciprofloxacin (100%), levofloxacin (100%). The most active of the carbapenems: imipenem (66,7% of sensitive isolates), meropenem (55,6%); of the aminoglycosides: tobramycin (77,8%). 20% of P. aeruginosa isolates revealed production of metallo-β-lactamase (MBL) VIM-2 type. Most isolates of P. aeruginosa were also insensitive to fluoroquinolones: ciprofloxacin (80%) and levofloxacin (50%), aminoglycosides: gentamycin (50%) and tobramycin (80%), cephalosporins: ceftazidime (60%) and cefepime (40%).

Resume. Pyperydin new derivatives locally anaesthesing activity investigation results and also Emparative characteristics of activity with traditional locally anaesthesing preparations are given in this article.

Summary. Medical students of different courses were investigated for S. aureus bearing 301 S. aureus strains were isolated from 463 students. The strains were tested for pathogenic characteristics. Heamolytic properties were revealed at 301 strains (100%), lecitinase – 301 (100%), DNA – ase 301 – (100%), Hyaluronidase – 301 – (100%), ALA – 273 – (90,7%), AIA – 301 – (100%). S. aureus bearing was confirmed with expressed pathogenis characteristic.

Resume. This article presents the etiological structure and the results of the evaluation of antibiotic susceptibility of strains of gram-negative bacteria isolated from patients of the purulent surgery departments. In the etiologic structure of purulent infections, gram-negative bacteria collectively take a leading role (57,8%, n=128). The overall percentage of members of the Enterobacteriaceae family was 33.6%, PGOB - 21.1%. The predominant species were E. coli, K. pneumoniae, P. aeruginosa and A. baumannii.

The most active drugs against E. coli were carbapenems and amikacin (91.7 - 100% and 75,0% of sensitive strains, respectively); 42,7 - 62.5% of strains were sensitive to tobramycin and gentamicin. Resistance of III – IV generations of E. coli to cephalosporins in 54,2% of cases were due to production of beta-lactamase extended spectrum (ESBL) TEM1, CTX – M1 and OXA types.

K. pneumoniae was totally resistant (100%) to all groups of the studied antibiotics, except carbapenems and amikacin. 40% of strains were sensitive to ertapenem, 20% to meropenem and 40% to amikacin. During PCR detection, 60% of the K. pneumoniae isolates were producers of blaTEM1 and blaOXA.

Carbapenems showed high activity against isolated strains of P. aeruginosa: imipenem (87,5%), meropenem (75%); of the aminoglycoside - amikacin (75% of strains were sensitive); of the quinolones – levofloxacin (50%). 25% of strains resistant to cephalosporins of III-IV generations carried ТЕМ1 genes responsible for the ESBL production of molecular class A. A nosocomial P. aeruginosa strain was registered, that is absolutely resistant to all groups of antibiotics that carries the gene MBL VIM-2.

All A. baumannii strains were completely resistant (100%) to all groups of the studied antibiotics, except carbapenems and tobramycin (from 55.6 – 66.7% and 77,8% of sensitive strains). Along with insensitivity to cephalosporins of III – IV generations, 3 isolates of A. baumannii (genotypic detection of which, found genes of acquired carbapenemase class D (OXA-23) showed resistance to carbapenems (Meropenem and imipenem). 2 isolates carried genes ТЕМ1 responsible for the production of ESBL molecular class A.

Resume. This article dedicated analysis morfofunctional condition adrenal glands male, who died from incompatible with life mechanical injury. 23 cases of sectional materials using morphological, morphmetric analysis of adrenal glands revealed weight perameters and morphometric characteristics of different zones of the cortical substance.
It is established that the weight parameters of the contralateral adrenal, the area of the nuclei of the glomerular, fascicular and reticular zones of the cortical substance of the right and left adrenal glands do not have significant statistical differences, allowing you to use death from incompatible with life injury in the capacity «initial» in the realization research study.

Resume: Forecast (forecasting) – the process of evaluation how many certain medical goods (medicines, testkits, reagents and et.,) will be required for HIV programme or antiretroviral therapy (ART) to provide universal coverage for population with medical services (treatment, prevention, examination and etc.) in the certain period of time in future. Forecasting is used to decrease uncertainties in planning, avoid overstock and expiration of shelf life, and shortage of life saving medicines and interactions in drug supply management.

Resume. Infusions are liquid dosage form that represents aqueous recovery from medical plants. Infusions are used in both official and folk medicine. Aqueous recovery from medical plants remains popular nowadays as well. Therefore, we developed summer-fir (Artemisia viridis) infusion preparation technique taking into account all the new XII RF edition requirements of Global Fund.

Resume. The purpose of this study is to investigate histopathological changes of the vessels of the pulmonary circulation in patients with COPD at high altitude. Used histological, morphometric and electron microscopic methods. The results of the study: in patients with COPD at high altitude conditions revealed pronounced changes in the structures outside and intraorgan arteries segmental features and a heavy defeat of the alveolar capillaries, accompanied by loss of surface gas exchange, a significant thickening of the intermediate space of the AGB, desquamation of the alveolar lining that may contribute to a significant degree the weighting of the course of COPD in a high altitude.

Resume. The article presents an analysis of the main normative and legal acts on the safety and quality of drinking water in the Kyrgyz Republic, as well as regulatory documents, the directives of the European Union, the World Health Organization and other countries. The article considers principles and procedures for harmonization of national standards with international requirements and rules that are aimed at protecting human health and creating a safe living environment.

Resume: In this paper the tasks are set for the preparation of a fully developed personality, capable not only of absorbing a large amount of knowledge, but also possessing certain professional skills are presented. Increasing the training load, increasing the flow of information, solves the problem of the effectiveness of education, but this worsens the physical and mental well-being of schoolchildren.

Resume: The article gives a review of literature on nutrition problems also it includes meaning of rational and balanced nutrition in preserving and strengthening the health of adolescent cadets studying in specialized educational institutions of Ministry of Defence

Summary. The monitoring and assessment of infection control in dental institutions of the republic, with developed assessment tool. Consistent and efficient monitoring possible to calculate the percentage of actual operating results for the prevention of infections associated with medical and dental care recommendations.

Abstract. Goal. The study of short QT syndrome(CLC), Wolff-Parkinson-White syndrome (WPW), Early Ventricular Repolarization Syndrome (EVRS), Brugada syndrome, as well as the detection of their combination with other disorders of rhythm and conductivity. Materials and methods. The study analyzed the data of 24-hour ECG monitoring in 824 patients, age range is from 9 to 87 years old, out of which are 339 males and 485 females, examined during 2016. The most frequently recorded was EVRS, permanent form – in 60 patients, and temporary form - in 121 patients. The potentials were recorded from 10 electrodes during 24 hours.
Results and their discussion. Having interpreted the data of 24-hour ECG monitoring, the specified syndromes were revealed in 215 (26%) out of the examined patients.
The permanent form of CLC was revealed in 13 patients, temporary form in 11 patients, WPW syndrome - in 8 patients, Brugada syndrome was revealed in three patients. The detection of combined disorder of rhythm ad conductivity in the abovementioned patients would help to provide duly consultative and medical assistance. 

Abstract: Objectives: Critical analysis of the efficacy and safety of "hepatoprotectors" in terms of evidence-based medicine. Materials and methods: journals, meta-analyzes of RCT, Cochrane Database of syst. rev. Results: What a perfect hepatoprotectors so far does not exist. Prove to have different degrees of efficacy of UDCA, EFL, amino acid preparations. Silymarin preparations should be considered as gepatoprotectors with suspected, but unproven efficacy, which can be used under certain conditions.

Summary. The purpose of this scientific review was to analyze the socioeconomic and pathogenetic mechanisms of the emergence of nephrocerebral interrelations in chronic renal and cerebrovascular diseases.

Summary: objective of the work was diagnosis and prevention of alveococcosis by taking expedition.1246 residents were inspected, 82 accidents of nodal mass in liver were detected, 33 with another diseases of liver were detected. 8 patients directed to operative treatment (swift treatment) (masses are more then 30 mm), 15 patients directed to CAT scan, magnetic-resonance imaging with round of chemo prescribing. 58 patients received ultrasonic examinations in 1, 3, 6, 12 month period. Epidemiological data’s has approved a need of early diagnosis and detection accidents of alveococcosis. Early diagnostics are very effective and with using sonogram and Katsoni test.

Resume: This paper presents a multivariate analysis of laparoscopic treatment of 297 patients with gallstone disease, based on the use of multi-modal program Fast track surgery (FTS) «quickest way to surgery». FTS program covers all phases of perioperative care. The age of patients ranged from 25 to 75 years, women were 253 (85.2%), 44 men (14.8%), with disease duration from 6 months to 5 years. In 37 (12.4%) had comorbidities. All patients underwent laparoscopic cholecystectomy. Complications occurred in 6 (2%) patients. Deathswere not. Conversion was observed in 7 (2.3%). Mean hospital stay was 3.9±0.92 bed days. Using the program contributed to early rehabilitation, quality of life, decrease hospital stay and reducing material costs for treatment.

Abstract: the auditory tube is part of a complex anatomical functional system, which even today is not completely explained. It plays a crucial role in the understanding of the pathogenesis of chronic middle ear infections and possible therapeutic interventions-particularly in infants.

Summary. In parallel randomized study presents the results of the impact of antibiotiсs on the adhesion formation of the abdominal cavity. An experimental survey was conducted on 80 outbred rats. In four experimental groups were used: Kanamycin, Ceftriaxone, Metronidazole and Ciprofloxacin.

Summary. Spontaneous hemothorax (SG) is a subcategory of hemothorax, which includes the accumulation of blood in the pleural cavity without the relationship to injury or other causes. The clinical picture of the SG includes chest pain and dyspnea, which can be life-threatening when hemodynamic instability and hypovolemic shock occur. In comparison with other forms of hemothorax, the description of SG is much less common in the scientific literature. The literature review is performed to identify and summarize all the potential causes of this clinical condition.

Summary: bullous keratopathy or endothelial-epithelial corneal dystrophy is one of the leading diseases of the cornea. It produces studies and determine the effectiveness of the treatment of deep lamellar keratoplasty combined with crosslinking with bullous keratopathy. It noted the prospects and effectiveness of the proposed method in this disease in the absence of high-quality donor material.

Summary. The article presents a case of expert practice, on examination of the defects of medical care in the form of leaving a foreign body (gauze) in the uterine cavity, complicated by complete ingrowth of a foreign body in the endometrium and hysterectomy.

Summary. The article reflects the structure and the frequency of death from "alcoholic cardiomyopathy" and morphological validity of the diagnosis based on the Republican Centre of Forensic Medicine for years 2012- 2014-2015. It was found that the diagnosis of "Alcoholic cardiomyopathy" in 2012 exhibited in 12.4% of cases, in 2014 – 9.82% and 2015-9.96% of casesof all forensic investigations of corpses, males accounted for 428 (77.81%) cases, 122 female (22.18%) cases. By age mortality prevalent in the age group from 31 to 69 years. Most number of deaths occur in autumn and winter. Alcoholemia degree in men ranged from mild to severe, women-from mild to severe. The main criteria for the diagnosis of "alcoholic cardiomyopathy," were: weight of the heart, the color of the myocardium (cooked meat), steatosis, myocardial flaccidity, enlargement of the heart cavities.

Summary. The study of the state of fetoplacental system in women with obesity of different degree in the process of gestation. It is shown that in obese women during pregnancy develops FNV, associated with the violation of the fruit-placental circulation and Morphogenesis of fetal macrosomia by type and malnutrition. his conclusion is confirmed by changes of qualitative characteristics of fetal CTG dynamics indicators ultrasound. Pathogenetic significance in causing beremennyhs have ESF obesity have reduced the level of placental laktogena and estriol (1.4 and 1.8 times) at the II and III degree obesity combined with hypercholesterolemia and hypertriglyceridemia, hyperinsulinemia, insulin resistance.

Summary: In women with inflammatory diseases of the reproductive system in the first trimester of pregnancy, the most common complications were early toxicosis and the threat of spontaneous miscarriage. The course of the second trimester of pregnancy was most often complicated by the development of the threat of abortion and hypertensive pregnancy disorders, mainly in the form of pre-eclampsia mild. In the third trimester of pregnancy, the most common complication was the threat of premature birth, fetoplacental insufficiency, delayed intrauterine development of the fetus.

Summary: In laboring women with inflammatory diseases of the reproductive system, the pathological preliminar period and primary weakness of labor activity, prenatal outflow of amniotic fluid (3.8 times), intrauterine hypoxia of the fetus (in 3.1), hypertensive disorders in childbirth (2,3 times). Dense attachment of the placenta and premature detachment of the placenta were observed only in patients with inflammatory diseases. In the postpartum period, they often met a lohiometer (2.6 times), a subinvolution of the uterus (3.3 times), endometritis (3.4 times).

Summary: An analysis of 150 case histories of patients with measles and morbilliform diseases were hospitalized in the Republic clinical infection hospital for the period 2014-2016. The patients were divided into three groups: group 1 with a diagnosis of measles, 2nd – with the diagnosis of rubella and 3rd – acute respiratory viral infections + allergic dermatitis. Clinical and laboratory differences between these groups were found. Registered unjustified appointment of antibiotic, infusion and hormonal therapy in patients with morbilliform diseases due to unavailability of rapid diagnosis in the early stages of the disease.

Summary: The analysis of 36 case histories of infants who were treated in 2016 with the diagnosis Flexner dysentery in the intestinal department of Republic clinical infection Disease hospital was made. The leading etiologic factor was Flexner's dysentery 2a (66.7%), where the main pathway of infection was alimentary way (75%). Due to the fact that the premorbid background in children was mostly not burdened, the disease occurred in the majority (94.0%) of patients in a moderate form and all children received antibacterial therapy. All observed children were discharged on 4.2 ± 1.4 days of treatment with improvement to avoid intrahospital superinfection and with the recommendation to continue therapy with probiotics at home.

Summary: The administration of the appetite stimulant for children with disorders of nutritional status was analyzed. It was found that the use of pediatric syrup of Cyproheptadine in a short 2-week period improves the body weight parameters corresponding to the nutritional disturbance according to the criterion of "underweight".

Resume: The results of a retrospective analysis of 115 stories of disease in children with severe form of Hepatitis A Virus (HAV) infection with edema-ascites syndrome. All patients were treated in Republic clinical infectious disease hospital in the period 2010-2014. The age structure of patients was dominated by children older than 4 years. Mostly acute form of disease were developed among children from 4 to 7 years (P<0,05). Mainly patients with HAV infection hospitalized in the icteric period of disease with edema-ascites syndrome, which is not typical in clinical picture. In most cases (91,3%) ascites syndrome was detected by ultrasound. Only in 8,7% of cases ascites syndrome was detected by physical examination. In 3,5% of cases was development of disseminated intravascular coagulation (DIC) syndrome, which contributed to the adverse outcome.

Summary. The article covers a special medical tactics in diagnosis and treatment of parafunction masticatory muscles, is a clinical example with the result of treatment.

Resume: The article presents a comparative analysis between the district and city dental clinic of Osh region and Osh city, the results of dental orthopedic treatment of teeth crown defects and dentition, depending on thedesign features of dentures. The study was conducted according to the archival materials of all dental clinics in Osh province and Osh city of the Kyrgyz Republic. In general, 6519 outpatient cards of dental patients were studied. The result of the research revealed a low percentage of manufactured modern constructions of tooth artificial limbs in district dental clinics than in urban clinics of Osh.

The resume: The article presents an experience of curing and prevention sequels after extraction of teeth with using Decasan which based the materials of department of Maxillo-Facial Surgery of the Kyrgyz Republic Health Service Ministry’s National Hospital.

Resume. As known, the blood services play a leading role and are responsible for adequate, quality and safe blood supply and clinical use.
The management of blood services in KR has been evaluated and found it’s not completely capable to provide with blood and its components with necessary quality and level of product safety.
Further perspectives of blood services development in the country should be based on international best practices analysis, implementation of information technologies, improvements in blood processing, production and storage. Contemporary laboratory testing procedures are of great importance.
Best management includes also safe utilization and sterilization procedures, monitoring, specialist training, as well as advancements in blood clinical use.

Resume. Blood transfusion safety, quality and access to donor blood are the most health care key problems in Central Asia.
In transfusion medicine two components are of importance: infection and immunological safety of blood and its components and safe use of blood products.

The study acted upon the assessment of current standing and performance of blood services in Kyrgyz Republic considering contemporary blood banking technologies that are aimed towards to quality, safety and access to blood use in clinical settings.              The study has showed that present situation with blood services in KR do not completely allow to address blood quality, safety and accessibility concerns and requires to implement with no further delays necessary upgrading measures through all phases of “transfusion” chain, starting from donor motivation down to clinical use of blood products. 

Summary. Publication of textbooks and practical books in English must be submitted to General methodicalm system, because of it’s promote to standardization of educational programs of morphological disciplines. Teaching of this disciplines to English-speaking students in medical universities of Kyrgyzstan must be identical in form and content.