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Edelstein M.V.,Smolensk State Medical Academy | Skleenova E.N.,Smolensk State Medical Academy | Shevchenko O.V.,Smolensk State Medical Academy | D'souza J.W.,Smolensk State Medical Academy | And 7 more authors.
The Lancet Infectious Diseases | Year: 2013

Background: Multidrug-resistant and extensively-drug-resistant Pseudomonas aeruginosa are increasing therapeutic challenges worldwide. We did a longitudinal epidemiological and clinical study of extensively-drug-resistant P aeruginosa in Belarus, Kazakhstan, and Russia. Methods: The study was done in three prospectively defined phases: Jan 1, 2002-Dec 31, 2004; Jan 1, 2006-Dec 31, 2007; and Jan 1, 2008-Dec 31, 2010. The first two phases were in Russia only. All consecutive, non-duplicate, nosocomial isolates and case report forms were sent to the coordinating centre (Institute of Antimicrobial Chemotherapy, Smolensk, Russia), where species reidentification, susceptibility testing, and molecular typing of isolates were done. We did susceptibility testing by agar dilution. The presence of metallo-β-lactamase (MBL) genes was established by PCR and sequencing, and class 1 integrons containing MBL gene cassettes were analysed by the PCR restriction fragment length polymorphism approach. Strain relatedness was analysed by multiple loci variable-number tandem-repeat (VNTR) analysis (at six VNTR loci) and multilocus sequence typing. Results: In 2002-04, 628 of 1053 P aeruginosa isolates were insusceptible to carbapenems and 47 (4·5%) possessed MBLs. In 2006-07, 584 of 787 isolates were insusceptible to carbapenems and 160 (20·3%) possessed MBLs. In 2008-10, 1238 of 1643 Russian P aeruginosa isolates were insusceptible to carbapenems and 471 (28·7%) possessed MBLs. Additionally, the 32 P aeruginosa isolates from Belarus and Kazakhstan were all carbapenem insusceptible and all possessed MBLs. More than 96% of MBL-positive P aeruginosa isolates were resistant to all antibiotics except colistin (ie, extensively drug resistant), and, in 2010, 5·9% were resistant to colistin. 685 (96·5%) of 710 MBL-positive P aeruginosa belonged to ST235. blaVIM-2 genes were detected in 707 (99·6%) of 710 MBL-positive isolates. Interpretation: Extensively-drug-resistant ST235 P aeruginosa has rapidly spread throughout Russia and into Belarus and Kazakhstan via clonal dissemination. Increases in the use of colistin will probably result in further spread of ST235 P aeruginosa resistant to all drugs. Funding: HEFC, Ministry of Health of the Russian Federation, Government of the Republic of Belarus, Government of the Republic of Kazakhstan, European Union, Medical Research Council UK-Canada partnership. © 2013 Elsevier Ltd.


Kozyreva V.K.,West Virginia University | Ilina E.N.,Karpov Institute of Physical Chemistry | Malakhova M.V.,Karpov Institute of Physical Chemistry | Carattoli A.,Instituto Superiore Of Sanita | And 4 more authors.
Antimicrobial Agents and Chemotherapy | Year: 2014

In this paper, we present evidence of long-term circulation of cefotaxime-resistant clonally related Salmonella enterica serovar Typhimurium strains over a broad geographic area. The genetic relatedness of 88 isolates collected from multiple outbreaks and sporadic cases of nosocomial salmonellosis in various parts of Russia, Belarus, and Kazakhstan from 1996 to 2009 was established by multilocus tandem-repeat analysis (MLVA) and multilocus sequence typing (MLST). The isolates belong to sequence type 328 (ST328) and produce CTX-M-5 β-lactamase, whose gene is carried by highly related non-self-conjugative but mobilizable plasmids. Resistance to nalidixic acid and low-level resistance to ciprofloxacin is present in 37 (42%) of the isolates and in all cases is determined by various single point mutations in the gyrA gene quinolone resistance-determining region (QRDR). Isolates of the described clonal group exhibit a hypermutable phenotype that probably facilitates independent acquisition of quinolone resistance mutations. Copyright © 2014 American Society for Microbiology. All Rights Reserved.


Sarsekeyeva N.,Karaganda State Medical University | Sarsekeyeva N.,Karaganda Regional Center for the Prevention and Control | Kosherova B.,Karaganda State Medical University
International Journal of General Medicine | Year: 2016

Aim: To evaluate immunological indices in HIV-infected patients with chronic hepatitis C (CHC) who are injecting drug users. Materials and methods: The study examined 38 patients coinfected with HIV and CHC who were injecting drug users and 36 patients with HIV/CHC who were not injecting drug users. In the study of immune status, the relative and absolute numbers of CD3+, CD4+, CD8+, CD16+, and CD20+ cells were determined by means of flow cytofluorometry of “FACSCount” using monoclonal antibodies of the company Becton Dickinson. The level of circulating immune complexes in blood serum was determined by means of precipitation in polyethylene glycol solution. Results: It was found that T-cell immunodeficiency was developing in patients coinfected with HIV and CHC. T-cell immunodeficiency was characterized by a decrease in the number of T-helpers, mainly for injecting drug users. At the same time, patients coinfected with HIV and CHC experienced markedly elevated levels of circulating immune complexes, mainly among injecting drug users. The evaluation of immunogram indices in injecting drug users coinfected with HIV and CHC, depending on the stage of HIV infection, revealed a greater degree of immune-suppression of T-helper cells in clinical stage III. Conclusion: Our comprehensive immunological study of patients coinfected with HIV and CHC revealed a pronounced dysfunction of the immune system. The comparison of the immune system indices in patients with HIV/CHC showed a more pronounced T-cell suppression in injecting drug users than in patients with HIV/CHC but who were not injecting drug users. © 2016 Sarsekeyeva and Kosherova.


The review article discusses the possibilities and evidence base of the use of antithrombotic drugs in common clinical practice. Presents information about the basic clinical trials of the effectiveness of antithrombotic medications (CAPRIE, CURE, VA, RISC, ISIS2, PLATO) in the treatment and secondary prevention of the consequences of atherothrombosis. Also presents the algorithms for prescription of antithrombotic drugs and the principles of rational use of antiplatelet agents.


Mustafin R.,Karaganda State Medical University | Bakirov A.,Karaganda State Medical University
Georgian medical news | Year: 2015

The article presents the functional characteristics of lung tissue in reanimation profile patients with different pathologies with forced ventilation and auxiliary support on the background. The aim of this study was to analyze the dynamics properties of lung tissue in intensive care unit patients with symptoms of severe violations of restrictive lung tissue being on ventilatory support. Results were subjected to analysis of acid-base status and dynamics of the main indicators of the biomechanical properties of the lung in 32 patients with severe concomitant injury (n=21), acute bilateral community-acquired pneumonia (n=7), septic shock (n=4) during the entire period of the respiratory "prosthetics "(before and after the beginning of mechanical ventilation). Using during ventilatory support of patients with initial symptoms of the syndrome of acute lung damage and reduced lung function restrictive positive end-expiratory pressure of 6-10 cm of water column when the conventional (1:2; 1:2.5 at p≤0.05) and invert (2:1 at p≤0,1) ratio inhale/exhale, relatively low tidal volume (6-8 ml/kg) allows increase the compliance of the lung tissue to 11-29%. Increased expiratory time constant has a direct correlation with the value of airway resistance was due not only to the maintenance of optimal parameters for MVV (mechanical voluntary ventilation), but regular lavage of the tracheobronchial tree, which allows to maintain patency of the lower respiratory tract. The main areas during mechanical ventilation of lungs in patients with a sharp decline in restrictive lung function (ARDS, pneumonia), regardless of the reason it was summoned, optimal value is the observance of the positive end-expiratory pressure, the ratio of inhale/exhale (depending on the degree of hypoxemia), to maintain sufficient blood oxygen saturation and partial pressure of oxygen in the blood plasma.


Lyubchenko M.,Karaganda State Medical University | Baziak Y.,Karaganda State Medical University
Georgian medical news | Year: 2015

The aim of the work is to present the results of psychotherapeutic treatment of patients with anxiety disorders in the model of short-term strategic therapy. On the basis of the material the effectiveness of the short-term strategic approach is represented in the treatment of patients with phobic disorders. The apparent non-directive behavior of therapist allows to bypass the internal resistance of the patient. As a result of using the paradoxical prescriptions, phobic manifestations lost or significantly reduced their symptomatic significance. The combination of the neurolinguistic techniques and strategic approach gave to the psychotherapeutic process high effectiveness.


Shusterov Y.,Karaganda State Medical University
Georgian medical news | Year: 2014

Correction of high degree myopia, anisometropia and astigmatism continues to remain one of actual problems of ophthalmology. The purpose of the present work - the analysis of results of application of refractive interlamellar tunnel keratoplasty variants. We develop 6 updatings tunnel keratoplasty. In total in clinic 310 operations from which in 158 cases as a transfer material used a donor cornea, in 63 cases - brephocornea (a fruit cornea) and in 89 cases - hydrogel synthetic implant, modified in low-temperature to gas-discharge plasma are spent. From the specified number of operative interventions, on 86 eyes of operation tunnel keratoplasty have been spent at those patients by whom earlier it has been given up in carrying out eximerlaser corrections, in connection with presence of a "thin", "flat" and "convex" cornea. Maximum refractive effect fell first two weeks after operation. Definitive stabilisation of a refraction occurred on 2-3 month, thus regress of the reached effect made an order of 10-12 %. It is reached refractive effect from 5,5 to 20,0 D. Undercorrection in some cases made to 3,5 D, that spoke very high myopia (more than 20,0 D) degrees. It has been noticed, that refractive effect of operations with ecsplants was above (on the average on 10 %), than at use of a donor cornea, at identical cross-section section of used transfer materials. It spoke that the synthetic material, unlike a donor cornea, kept the form. At all patients substantial increase of visual acuities has been received, and in 75 % it was equal or exceeded visual acuity before operation with the greatest possible correction. Thus, clinical approbation has proved, that the variants of tunnel keratoplasty, are effective ways of high myopia, anisometropia and astigmatism correction. Updating in gaseous plasma is represented in the perspective way of improvement of biocompatibility of synthetic materials.


PubMed | Karaganda State Medical University
Type: Journal Article | Journal: Open access Macedonian journal of medical sciences | Year: 2016

In order to assess womens reproductive health in the Kyzylorda region (the Aral Sea) of Kazakhstan, 1406 women were involved in an integrated clinical-functional and laboratory examination, given regional and environmental ecological factors. The high level of endocrine gynecological pathology is indicated in the examined women. In both examined zones, there is a late menarche over 16 years old, which is 39%. It is indicated a trend towards younger age of menopause onset. Inflammatory diseases of the female genital organs affect a third of the examined women. In the zone of ecological disaster, every fourth woman has fetal losses, cases of spontaneous pregnancy termination and/or non-developing pregnancies in anamnesis, which can be repeated many times.


PubMed | Karaganda State Medical University
Type: Journal Article | Journal: Open access Macedonian journal of medical sciences | Year: 2016

Objective of the study was to evaluate the state of the main indicators of antioxidant status and enzymes of purine metabolism in the germ cells of men living in the zone of ecological catastrophe Aral Sea region.The criterion for inclusion is the stay of an adult in the Aral Sea area is not less than 5 years, employment in occupations with no more than 2 hazard class. Determination of the activity of adenosine deaminase (ADA) was conducted in semen by the method of Nemechek et al., 1993. Determination of the activity of catalase (CAT) was performed according by the method of Korolyuk et al., 1988.Results of the study indicate a change in the activity of catalase and adenosine deaminase, due to increased levels of oxidative stress and the development of the pathological process.According to the results of study, it was put the influence of negative factors of the Aral Sea region in mens sperm of reproductive age gives to disability free-radical processes, that proves changing of ferments of ant oxidative protection Catalase and adenosine deaminase (ADA). This disturbance in mens sperm of reproductive age leading to increased level of oxidative stress and impaired activity of antioxidant enzymes and purine metabolism, responsible for the abnormal transmembrane and intracellular processes, reflecting the degree of imbalance of enzymes.


PubMed | Karaganda State Medical University
Type: Journal Article | Journal: Open access Macedonian journal of medical sciences | Year: 2016

Extreme environmental situation in the Aral crisis has caused a massive chemical pollution of the territory for decades with high doses of pesticides, herbicides. Discharge of industrial waste into the rivers that feed the Aral Sea has lead to the development of various pathological processes in the human body, as well as disruption of reproductive function in young men.To evaluate the performance of molecular cellular changes in the sperm of men under the influence of dust and salt aerosols in Aral Sea region.Clinical and laboratory studies were conducted in men 5 settlements (Aralsk-city, v. Aiteke-Bi, v. Zhalagash, v. Zhusaly, v. Shieli). We have studied male ejaculate obtained after 4-5 days of abstinence, and placed it in a warm tube with a glass stopper. On the investigation proceeded ejaculate within 20-30 minutes after its preparation, during which time he was subjected to liquefaction. Isolation and quantification of ASF, RNA, DNA, and determining the fraction of histones in sperm was performed by the method of Markusheva and Savina.It was found that the value of ASF in the semen of men living in the zone of ecological disaster higher compared with the values of parameters in men living in the area of environmental crisis, and this trend is observed in all age groups. The study of circulating extracellular DNA and RNA in the sperm of men registered their decline with a corresponding increase of acid precursors that can be attributed to the degradation of nucleic acids under the influence of negative factors in the complex area of ecological trouble. Also, according to a study in men residing in the areas of environmental catastrophe at the age of 18-29 years, found an increased content of the H1 histone H2A lower total fraction, H3, H4 - and a sharp increase in histone H2B content - histones.Men living in environmentally disadvantaged areas of Kyzylorda region under the influence of dust and salt aerosols and other toxicants leads to disruption of the reproductive function in men.

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