Vol. 3 No. 3 (2015): VESTNIK of KSMA

Tuberculosis is widespread among health workers in the Kyrgyz Republic. A significant number of tuberculosis cases among health workers detected mainly at an annual medical examination. The incidence of tuberculosis among health workers in the Kyrgyz Republic in 2014 amounted to 107.85 per 100 thousand populations. The situation on the incidence of tuberculosis among health workers, especially among health care workers at risk, is not stable and requires strengthening the work on its early detection and prevention.

A survey of 389 students was conducted in order to assess student’s knowledge about humanity and involvement of the institute of higher medical education in the process of upbringing humanity. Insufficient level of student’s knowledge about humanity, ethics and moral and insufficient involvement of teachers in the process of education for humanity to the future doctors was identified.

The epidemiological data on the disease neurooncological treatment in the National Hospital of the Ministry of Health of the Kyrgyz Republic. By analyzing archival material 895 patients in the period from 2012 to 2014. According to the results of histological postoperative biomaterial research method to establish the form of a neoplastic process and its localization in the nervous system. In addition, the pathological process is supported by the data MRI studies of neuro-oncological patients.

An article presents the results of a study of suicide risk factors among the 1434 students of the General Medicine Department of the Kyrgyz State Medical Academy. A questionnaire of suicide risk in T. N. Razuvayeva’s modification was applied. A comparative analysis revealed the higher level of suicide risk among second year university students. The study identified the major factors provoking the suicide risk among students.

The results of the study of the clinical features in infested toxocariasis patients. Determined the leading symptom in adults and children for serological tests for the diagnosis.

The article presents the results of a study on perceptions of the second and fifth year medical students of a patient experiencing mental disorder, psychiatrist, and psychotropic drug. An original questionnaire developed by the staff of the Department of Psychiatry of the KSMA was used as a research instrument. The study revealed the double „portraits“ of the patient with a mental disorder, psychotropic drug and the psychiatrist. The findings show that the undergraduate education in psychiatry only slightly changes the positive perception of the fifth year students of mental health services. The results indicate the need of further change and improvement of an academic curriculum on psychiatry at the different levels of education.

Assessment of quality of care during implementation of new guidelines is relevant and necessary.
Objective: to determine the medical and social effectiveness of new guideline implementation in type 2 diabetes management.
Materials and methods. The study involved 173 patients with type 2 diabetes (ages 55,13±0,61 years, 112 women and 61 men) who, depending on the specialty of the doctor were divided into 2 groups: 1st – managed by primary care physicians, 2nd - by endocrinologist. The survey and study of HbA1c level, fasting glucose, lipid profile were conducted to assess the medical and social effectiveness. Effectiveness was assessed using coefficients. Statistical analysis was performed using Excel 2007, SPSS, Statistica 6.0.
Results. The low treatment satisfaction and poor quality of life were determined in patients in general, and diabetes provided additional significant adverse impact. Quality of life, treatment satisfaction, and the degree of diabetes control were independent of doctor specialty, but depended on the type of therapy. Patients on insulintherapy had significantly higher levels of HbA1c and cholesterol LDL; the quality of life was assessed higher, although the impact of diabetes on quality of life were more significant than in patients on the tablets. In addition, there was a correlation between the weighted average impact of diabetes on quality of life and the duration of diabetes (r= -0,32, p <0,001), as well as treatment satisfaction and quality of life (r= - 0,20, p <0,05).
Conclusion. No significant differences between the groups of patients who were managed by primary care physicians and by endocrinologist were found, indicating that primary care physicians provide sufficient level of quality of diabetes care. Integral efficiency coefficient was higher in primary care physicians, that may be caused by management of patients with more mild diabetes.

Over the past years the research of the effectiveness of chemoradiotherapy patients with cervical cancer has taken place, by using the radiomodifying properties of some cytotoxic drugs, their ability to enhance radiation damage and reduce the radioresistance of cancer. The research on usage of cytotoxic drugs in radiomodifying doses during radiotherapy of patients with cervical cancer was conducted in the Department of chemotherapy of National Center of Oncology. Combined radiotherapy among 52 patients with locally advanced cervical cancer in combination with “Ftorafur” as radiomodifier showed sufficiently high efficiency of this method. Objective effect amounted to 78.9% (with 36.6% complete remission).

In majority of women with hyperplastic processes endometrium has severe and medium- severe course, passes by high fregnency of diseases of cardiovascular system hypertensive disases – 27,4%, IHD – 14,3%, thyroid glands -27,4% and hepato –billiary system -17,9%. Marked metabolic disturbances are observed in 53,5% of women.

The purpose of research is the study of effect combination of amlodipini and lisinoprili on the rate of blood pressure and carbohydrate and lipid metabolizms in postmenopausal women with essential hypertension (EH).The study included 34 postmenopausal women with essential hypertension who are at a dispensary in FMC №7 in Bishkek. On the background of a month course at a dose of 5 mg of the amlodipini and 10 mg of the lizinoprili in the day systolic pressure and diastolic pressure were decreased according to the Riva Rocci Korotkoff method for blood pressure measurement. Daily dose of 5 mg amlodipini and 10 mg lizinoprili does not affect carbohydrate and lipid metabolizms in postmenopausal women with essential hypertension.

36 infants were born in asphyxia and receive treatment in the newborns resuscitation unit of maternity hospital of the national centre of welfare of motherhood and childhood were under supervision. It is proved that some of the risk factors of the mother lead to the development of asphyxia in full term newborns.

We are studied the clinical course of 41 children (25 boys and 16 girls) under the age of 3 years with acute obstructive bronchitis in the family clinic number 54, Yunus-Abad district of Tashkent, and studied the highlighted factors contributing to the emergence of both, and exacerbate the severity of the disease in young children on an outpatient basis. This study has allowed to carry presence ante- and perinatal pathology, deficiency states, impaired physical development and ecological community in terms of passive smoking to the risk factors and the severity of acute obstructive bronchitis in infants. Therefore, treatment of children with acute obstructive bronchitis should be comprehensive and aimed at addressing the identified risk factors and associated pathological conditions of other organs and systems of the child’s body, to carry out further adaptation measures.

Aim: evaluation of relationship between serum leptin and insulin resistance (IR) in the group of ethnic Kyrgyzes.
Material and methods: ethnic Kyrgyzes, native inhabitants of Kyrgyz Republic, older than 30 years were included in this study. All patients undergone survey included complaints and anamnesis; general investigation with measurements of blood pressure, anthropometric parameters (height, weight, waist (WC) and hip circumference (HC)). Body mass index (BMI) was calculated as: BMI= weight (kg) / height (м)2. Abdominal obesity was established at WC≥102cm in male and WC≥88cm in female. BMI≥30кг/м2 was assessed as obesity. Laboratory investigations included analysis of plasma glucose (fasting), serum insulin and leptin. IR index HOMA was calculated by formula: НОМА=serum insulin (μIU/ml) х plasma glucose (mmol/l) /22,5. Values of index HOMA≥2,77 were assessed as IR. Results: 322 ethnic Kyrgyzes (145 males, 177 females) at age 30-70 years (51,7 ± 9,6). were included in this study. All patients were stratified by 4 groups accordingly leptin quartiles (male: <2,2; 2,2-4,2; 4,3-6,34; >6,34нг/мл; female: <8,05; 8,05-13,4; 13,5-19,09; >19,09ng/ml). Patients from upper quartiles had higher levels of BMI, WC and serum glucose, compare with lower quartiles. The IR frequency was higher in patients from 3rd and 4th quartiles, than 1st and 2nd quartiles (p<0,0001 – both sexes). In male and female patients serum leptin significantly correlated with glucose (p<0,01), index НОМА (p<0,0001) and IR (p<0,0001).
Conclusion: serum leptin associated with IR in group of ethnic Kyrgyzes.

Purpose of the research: analysis of renal function when chronic obstructive pulmonary disease under low mountains conditions.
Material and methods: 82 patients with chronic obstructive pulmonary disease of different of varying severity, as well as 10 healthy persons were examined. The mean age was 60.53+15.48 years old. In addition to general clinical examination the respiratory function and indicators of renal function, which included the calculation of glomerular filtration rate, proteinuria, leukocyturia, hematuria, total protein and serum creatinine were assessed to all patients.
Results: Significant change in renal function that correlate with the degree of bronchial obstruction is observed with patients, who have chronic obstructive pulmonary disease.

To investigate the relationship of arterial stiffness, primarily augmentation index, with the severity of cardiovascular remodeling.
Material and methods: The study involved 155 patients with EH aged 30-70 years. A physical examination, determination of biochemical parameters: glucose and creatinine and blood lipid (LDL, HDL and triglycerides), duplex scanning of carotid arteries, echocardiography, determination of arterial stiffness by pulse wave contour analysis.
Results: A relationship between the atherosclerosis carotid artery and arterial stiffness in patients with EH, particularly with the indicators AIx 75 and AIx, which are integral indicators of the impact of arterial stiffness in the central BP. At the same time the relationship AIx and other indicators of arterial stiffness with the presence of LVH by us has not been revealed.

Obstructive sleep apnea-hypopnea syndrome (OSA) in Kyrgyzstan remains one of the main health and social problems, as hitherto neglected patients suffering from this serious respiratory illness. This paper presents the results on the prevalence of obstructive sleep apnea / hypopnea in Kyrgyzstan, as well as assess the possibility of using computer monitoring of pulseoximetry as a screening method for the diagnosis of sleep apnea in a practical health care. As a result of the special questionnaires and computer pulseoximetry screening prevalence of OSA in Kyrgyzstan was high and amounted to 10.8%, and pulseoximetry monitoring computer showed high efficiency as a method of diagnosis of breathing during sleep, since all identified with symptoms of natives of Kyrgyzstan, in the future using modern printing portable diagnostic systems OSA diagnosis was verified. Consequently, the use of special questionnaires and the use of pulseoximetry montoring allow to conduct an effective examination to detect sleep-disordered breathing (SDB).

Research of 268 3-6-year-old children, inhabitants of Bishkek, full-term, with signs of intrauterine growth retardation at a birth is carried out – 140 children with hypotrophic variant and 128 children with hypoplastic variant. It is defined, that in investigated groups there is a considerable number of cases of nutrient status disorder which reaches at hypotrophic variant of 28,6% at I degree and 25,8% at II degree, and at hypoplastic variant – 53,3% and 37,0% accordingly. It is noticed, that among 2-year-old children with signs of IUGR at a birth, irrespective of a clinical variant and severity level, children with disharmonious and sharply disharmonious physical development prevail. Microsomatic somatotype of physical development is most often registered.

The study screening survey was conducted in 140 patients with COPD aged 19 to 79 years. COPD patients are determined by many factors, and reduced depending on age, sex, length of illness, number of social factors: place of residence, kind of professional activity, the number of family members, the level of housing and health care.

Comprehensive clinical study modes of respiratory support and respiratory activation of the patient’s relevant now. Patient care, connected to a ventilator is extremely difficult, at any stage of mechanical ventilation to technical glitches and errors, joining secondary complications.

In patients with virus – bacterial pneumonia of the main (n=20) and control (n=20)groups it is registered serious disease accompanied by the formation of acute respiratory distress-syndrome from the first and second day, pneumonia, marked toxic syndrome, toxic nephritis, hepatitis, encephalopathy, septic shock and other complications. The most marked n is registered in patients taking the optimal treatment (including darnase surfactant inhalation, highly frequent artificial lung ventilation , high doses of glucocorticoids)

Patients with high myopia up to 10,0D - 9 patients, (18 eyes) and above 10,0D - 21 patients, (42 eyes) conducted and antioxidant therapy. Before and after treatment were determined by indicators of lipid peroxidation in tears: hydro peroxide lipids (HPL), neutral lipids (NL) diene ketones (DK) and oxidative index (OI).There is a significant decrease in performance HPL and the NL in both groups after treatment. Thus, if the pre-treatment of patients with myopia above 10,0D figures of HPL and NL were - 0,89 ± 0,22 and 1,67 ± 0,12, after treatment 0,76 ± 0,13 and 1,62 ± 0,13. The significant decrease in OI after treatment was found among patients with myopia up to 10,0D in both periods of observation. Thus, an antioxidant therapy significantly improves metabolic processes among patients with high complicated myopia. The duration of the therapeutic effect after treatment in patients ascertained for six months.

The article presents an analysis of the known risk factors for a peptic ulcer developing. The gastro-intestinal tract diseases is a significant social problem for the population of Ukraine, the solution of which requires further study of the development of early diagnosis, treatment and prevention of these diseases, especially at the primary health care level and a General Practitioners-Family Medicine Doctor. Based on the analysis of data that suggest that a peptic ulcer is a polyetiological disease, and for its developing is not necessary to isolate the cause of the impact factor, and the sum of the factors in their interaction are present. The family history should be seen as a predisposing background against which the actions are implemented by others, usually several etiological factors.

In model experiments on the infection of 179 guinea pigs a virulent strain of Y. pestis was shown that pre-immunization with a live animal plague vaccine EV in combination with immunomodulators(polyoxidonium or Betaleukin) substantially increases its immunogenic (increased titers of specific antibodies) and a protective activity (increased number of surviving sea pigs), compared to immunization with the living, plague vaccine EV. Introduction Betaleukin no vaccine does not protect guinea pigs against plague infection

The article describes the experience of treating 80 patients with alveolitis. The most effective drug has proved to Collapan in granules, closing the hole a cut flap folds of transition, as well as exposure of blue light which together provides reliable consolidation blood clot prevented from entering the well of micro-organisms and food debris. Studies have shown that 98.5% of patients of the main group by the end of the first day after the start of treatment was completely docked pain, redness and swelling of the mucous membrane in the hole “causal” tooth is greatly reduced.

We observed in BSRCTO from 2012 to 2014 there were 35 patients with recurrent dislocation of the shoulder. The range of patients is 17 to 62 years. All patients underwent surgical treatment of established methods, developed a method prevents recurrence of shoulder dislocation, as well as allowing early recovery of function of the operated joint. Short- and long-term results were studied on a scale of UCLA.

Paper presents a surgical treatment method of first toe valgus deformity. The developed method eliminates valgus deformity of the big toe, improves anatomical and functional results of treatment and also restores ability to work. Results of treatment were evaluated in 48 patients during the period from two months to one year. The age range is from 44 to 71 years old. Treatment results of 32 patients were regarged as good. 14 patients achieved satisfying treatment results. Unsatisfactory results and disease relapse were not observed.

This paper presents algorithm of diagnosis and tactics of surgical treatment funnel-shaped deformation thorax I and II degree in children and adolescents using the method NASS. The operation is performed under the supervision of torakoskopa. Patients range from 7 to 16 years. All patients were studied early and late results of treatment. Good results were obtained in 9 patients, 4 satisfactory, unsatisfactory results and disease recurrence not observed.

In Bishkek Research Center of Traumatology and Orthopaedics in the period from 2009 to 2012. underwent surgical treatment in 42 patients and degenerative-dystrophic lesions of the lumbar spine in combination titanium cage hybrid with autokostnoy plasticity. Of all treated patients , women accounted for 20 patients (46.5%) , and 22 - male (53.5 %). Long-term results in 33 patients monitored . In 28 ( 84.8 % ) patients reported complete regression of pain symptoms , in 4 ( 12.1% ) patients after the operation moderate pain after a long walk , and in 1 ( 3 % ), pain when changing position and walking. Method anterior fusion of titanium cages in degenerative diseases of the spine can achieve a positive result with minimum damage.

Degenerative diseases of the spine in the structure of the neurological disease is 52%, of which 81% are located in the lumbosacral region. The study group included 41 patients who were operated in the period from 2005 to 2014. Among them, 21 men and 20 women, aged 18 to 75 years old, the average age was 38 years.

This paper presents review of the materials of the 1st Congress of general practitioners and family doctors of Kyrgyzstan that involved leaders of family medicine from 15 countries, including – for the first time in the history of family medicine of our country – representatives of the World organization of family doctors – WONCA: President Michael Kidd (Australia), President Elect Amanda Howe (Great Britain) and President of WONCA Europe Jacobus Metsemakers (Netherlands). The Congress raised discussion of the peculiarities of organization of family medicine, training of medical professionals and scientific research in the field of family medicine in the CIS countries and also future cooperation between WONCA and Associations of family doctors of CIS countries. The Congress became the first event held in the CIS ever that discussed challenges and opportunities of family medicine with involvement of the world leaders and leading experts of the Central Asia and CIS experts while shaping possible directions for future cooperation.