M. Abdykassymova, K. Abzaliyev, Ghazwan Butrous, S. Abzaliyeva, A. Kurmanova, R. Bitemirova, D. Sundetova, U. Sagalbayeva, A. Bugibayeva, N. Baizhigitova, A. Kenzhebaeva, М. Baurzhan
An analysis of the current state of the problem of studying biomarkers of human cardiovascular ageing was carried out based on an analysis of international experience. Ageing is an inevitable, constantly progressive systemic process, which is a significant risk factor for the development of most common chronic human diseases, including cardiovascular diseases. Therefore, studying markers of early cardiovascular ageing is a logical goal for developing measures to prevent the development of cardiovascular disease and toimprove the quality of life and prolong active longevity. the intensive care unit. The application of a multidisciplinary approach to diagnose and treat a life-threatening complication as tracheal rupture in a short time allowed us to stabilize the patient’s condition and avoid the development of further complications.
Keywords
biomarkers of ageing, predictors of cardiovascular ageing, theories of ageing, regulation of ageing, longevity
Background. Pulmonary complications are the second most common complication after cardiac surgery with cardiopulmonary bypass. Pulmonary atelectasis can occur from various intraoperative causes such as prolonged operation, time of anaesthesia more than 3-4 hours, use of a thoracic artery, use of cardiopulmonary bypass during surgery, lack of ventilation, haemotransfusion of 4 or more units of packed red blood cells in the perioperative period. Impact of mechanical venatilation during cardiopulmonary bypass still unknown.
Methods. Prospective, randomised study at one centre. Adult patients undergoing cardiac surgery with a pump by sternotomy for coronary artery disease were included. Patients were randomised into two groups – one group receiving mechanical ventilation and one group receiving no ventilation during cardiopulmonary bypass. The main endpoint was PaO2/FiO2 as a marker for the quality of ventilation and perfusion measured. Secondary endpoints were postoperative pulmonary complications such as atelectasis and prolonged mechanical ventilation of more than 72 hours.
Results. 190 consecutive patients were included, 92 and 98 in each group. No significant difference was found in the PaO2/FiO2 ratio in the groups, p=0.591. A significant difference was found in the number of atelectasis during ultrasound investigation of the lungs in the non-ventilated group, p = 0.0001.
Conclusion. On-pump cardiac surgery without mechanical ventilation can lead to atelectasis of the lungs.
Background. Currently, in Kazakhstan, the issue of chronic heart failure is becoming increasingly relevant, with high mortality from the terminal stage of chronic heart failure, especially in patients with III-IV functional class. Heart transplantation represents the "gold" standard of surgical treatment for terminal chronic heart failure, but endomyocardial biopsy, used for monitoring the transplanted heart, is an invasive and inconvenient procedure. Aim of this study is to generate data which can aid in more precise antibody-mediated rejection diagnosis, assisting in distinguishing between antibody-mediated rejectionand acute cellular rejection and helping us determine the appropriate treatment strategy Materials and
Methods. This article explores the potential of safe and accurate monitoring of acute transplant rejection using circulating donor-derived cell-free DNA(dd-cfDNA). The study included 40 patients who underwent heart transplantation.
Results. It was found that 60% of them had a repeat operation, while 40% had a primary one. Various cardiomyopathies, predominantly dilated and ischemic, were the cause of terminal chronic heart failure. The donor-derived cell-free DNA method demonstrates potential in differentiating T-cell-mediated and antibody-mediated rejection, with different patterns donor-derived cell-free DNA elevation. These differences have high clinical significance for diagnosis and treatment tactics.
Conclusion. Despite the prospects of using donor-derived cell-free DNA, further research is needed to establish threshold values and confirm its effectiveness in clinical practice.
Keywords
Chronic heart failure, Heart Transplantation, Endomyocardial Biopsy, donor-derived cell-free DNA
Background. In most cases, the reduction in pain and clinical manifestations is associated with a decrease in the size of the hernia or its resorption, which is the natural process of reduction or complete disappearance of the hernia without the need for surgical intervention. Currently, there are several intensive physical therapy methods that influence the process of hernia resorption, making conservative treatment preferable.
Materials and methods. At the «Expert Neuro» clinic, as part of a prospective observational study from 2023 to 2024, 30 patients with a confirmed diagnosis of “herniated intervertebral discs of the lumbar spine” were analyzed based on the results of magnetic resonance imaging. The main group of patients received conservative treatment using modern high-intensity physiotherapy methods, the control group received classical methods of conservative treatment.
Results. According to magnetic resonance of the spine, 3 patients developed resorption of a herniated intervertebral disc. In all patients, radiculopathy symptoms improved after 1 month and lower back pain symptoms improved after 2 to 3 months.
Conclusion. According to our clinical experience and relevant literature, sequestered disc herniations have a high rate of resorption. Pathophysiological processes of inflammation and regeneration are the main mechanisms of this phenomenon. Conservative management of such patients in the absence of definitive surgical indications should not be underestimated.
Background. DiGeorge syndrome is a rare congenital disease associated with a deletion of chromosome 22q11.2, which is characterized by the occurrence of various anomalies, such as hypo/aplasia of the thymus and parathyroid glands, which leads to T-cell immunodeficiency and hypoparathyroidism; this syndrome is also characterized by congenital heart disease (tetralogy of Fallot), anomalies in the development of craniofacial structures are observed, in the form of non-fusion of the hard palate and upper lip (cleft palate and cleft lip).
Results. This article will examine a clinical case of DiGeorge syndrome in a child, with the classic triad characteristic of this condition (immunodeficiency, hypoparathyroidism and congenital heart disease). The patient underwent the first stage of correction of a combined heart defect against the background of constant (monthly) immunocorrection. Due to the COVID-19 pandemic, our patient was unable to receive scheduled hospitalization for blood replacement and immunocorrective therapy in a timely manner. The key to increasing the survival rate of patients with DiGeorge syndrome is prenatal screening, timely correction of the anomaly and immunoreplacement therapy, which are actively used in foreign countries. Also, incomplete treatment of DiGeorge syndrome can subsequently lead to various other manifestations, such as autoimmune diseases, infectious diseases, etc.
Conclusion. The prognosis of DiGeorge syndrome is that this disease has various clinical manifestations, is combined with other variants of the anomaly that are incompatible with life and lead to delayed psychomotor development and have an unfavorable prognosis.
Keywords
DiGeorge syndrome, thymic hypo/aplasia, tetralogy of Fallot, thymus transplantation
A 46-year-old woman, withheight 161 cm and weight 75 kg, underwent endoscopic resection of the esophagus with reconstruction of the gastrointestinal tract with a gastric tube (McKeown procedure). During the surgery a tracheal injury with a rupture of the membranous part revealed, which was considered as a complication regarding a double-lumen endotracheal tube installation. Clinically, the rupture remained asymptomatic during two hours of single-lung ventilation of the left lung and was visualized during the thoracoscopic stage of the surgery. The tracheal rupture was promptly repaired. In the postoperative period, the patient required prolonged lung ventilation through a laryngeal mask. Frequentbronchial fibroscopy was performed to verify the condition of the tracheal suture, its continuity, and to provide tracheobronchial sanitation in the intensive care unit. The application of a multidisciplinary approach to diagnose and treat a life-threatening complication as tracheal rupture in a short time allowed us to stabilize the patient’s condition and avoid the development of further complications.
