Assessment of Adipokines, CXCL16 Chemokine Levels in Patients With Rheumatoid Arthritis Combined With Metabolic Syndrome.

OBJECTIVE: Rheumatoid arthritis (RA), which is a chronic systemic inflammatory disease, is associated with accelerated atherosclerosis and an increased risk of cardiovascular disease (CVD), but the causal factors have yet to be completely elucidated. The studies show that the prevalence of metabolic syndrome (MtS) was significantly higher in RA patients compared to the population. In RA and MetS inflammation and atherosclerosis are closely linked. The level of chemokines and adipokines, which may play a role in the development of atherogenesis in RA with MetS patients is currently unknown. In this study, we investigated the level of chemokine C-X-C motif chemokine ligand 16 (CXCL16) and adipokine in RA with MetS patients and assessed the association of biomarkers with clinical and biochemical activity scores of RA and components of MetS. METHODS: Blood serum of 298 people (48-patients with RA and MetS, 82-with RA without MetS, 105-with MetS, 63-control group without both RA and MetS) was tested for (CXCL16), Resistin, Leptin and Fibroblast Growth Factor 21 (FGF21) levels by fluorescent antibody technique. Statistical analysis was performed using SPSS version 18.0. RESULTS: The biomarker study showed the highest level in the RA with MetS patient group; but as compared with the RA group the differences were insignificant. CXCL16 (Me = 426.2 pg/ml (Q25-75 250.5-527.6), resistin (Me = 8685.4 pg/ml (Q25-75 6480.8-13 629.1), and FGF21 (Me = 443.6 pg/ml (Q25-75 772.9-916.3) proved to be significantly augmented in RA with MetS patients group, and in RA without MetS patients group (Me = 312.7 (Q25-75 199.4-517.7) pg/ml; Me = 8265.3 (Q25-75 5779.7-13 340.5) pg/ml; Me = 412.4 (Q25-75 300.4-497.4) pg/ml, respectively) as compared with MetS patients group (Me = 189.4 (Q25-75 130.3-280.6) pg/ml; Me = 5364.8 (Q25-75 2368.9-10 160.9) pg/ml; Me = 133.2 (Q25-75 76.2-268.6) pg/ml, respectively; P = <.001). Leptin level in all groups was higher than in the control group, but there were no differences between groups. The correlation analysis found a positive relationship between the leptin level and the waist circumference (rs = 0.39; P = .007) in the RA with MetS patients, the association of biomarkers with DAS28 score and ESR did not have any statistical significance. Conclusions: The augmented chemokine, resistin and FGF21 in the RA with MetS patients proves the systemic inflammation which is the basis of RA; the augmented leptin is linked to the abdominal obesity. These data are somewhat of an explanation of the increased risk of the CVD development in RA with MetS people. A differentiated specification can be useful to assess the cardiovascular risk of patients and justify prompt personalized treatment.

Water Supply Challenges in Rural Areas: A Case Study from Central Kazakhstan.

Rural water supplies have traditionally been overshadowed by urban ones. That must now change, as the Sustainable Development Goals calls for water for all. The objective of the paper is to assess the current access to and the perceived water quality in villages with various types of water supply. The survey was carried out during July⁻December 2017 in four villages in central Kazakhstan. Overall, 1369 randomly selected households were interviewed. The results revealed that even though villagers were provided with tap water, significant numbers used alternative sources. There were three reasons for this situation: residents' doubts regarding the tap water quality; use of other sources out of habit; and availability of cheaper or free sources. Another problem concerned the volume of water consumption, which dropped sharply with decreased quality or inconvenience of sources used by households. Moreover, people gave a poor estimate to the quality and reliability of water from wells, open sources and tankered water. The paper suggests that as well decentralization of water management as monitoring of both water supply and water use are essential measures. There must be a tailor-made approach to each village for achieving the Sustainable Development Goal of providing rural Kazakhstan with safe water.

Transforming medical education in Kazakhstan: Successful case of internationalization from Karaganda State Medical University.

BACKGROUND: Medical education in Kazakhstan has been literally transformed in the past 10 years. Kazakhstan inherited the Soviet-time discipline-based teacher-centered system of education when no decisions could be made independently. The curriculum was mostly governed in a traditional way, with lectures being the core, little use of e-learning tools, and assessment through oral exams and multiple-choice questions. Most of the universities still preserve the subject-based curriculum with elements of integrated learning. METHODS: Being the most active member of International Space Education, Karaganda State Medical University (KSMU) took the initiative to adapt the full integrated curriculum mostly based on problem-based, team-based learning, and use of virtual patient cases. The given approach was chosen because of active involvement of our University in nine Tempus and Erasmus+projects including reforming of Public Health and Nursing curriculum, human resources development, active learning, credit mobility, and move towards autonomy of medical schools. RESULTS: KSMU became the coordinator of two of these projects, taking its active position in internationalization of medical education. We actively use technology-based medical education, pro-actively adapting deliberate practice in acquiring essential practical skills, for which KSMU was recognized by an ASPIRE-to-Excellence Award in simulation. CONCLUSIONS: Kazakhstan hopes to become the leader in medical education in Central Asia and suggests other Universities in the area to adopt its approach to internationalization of medical education.

The Study of Cellular and Molecular Physiological Characteristics of Sperm in Men Living in the Aral Sea Region.

BACKGROUND: 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. AIM: 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. MATERIAL AND METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

The Health Status of the Reproductive System in Women Living In the Aral Sea Region.

In order to assess women's 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.

Disturbance of Antioxidant Enzymes and Purine Metabolism in the Ejaculate of Men Living in Disadvantaged Areas of Kyzylorda Region.

AIM: 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. METHODS: 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: 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. CONCLUSIONS: According to the results of study, it was put the influence of negative factors of the Aral Sea region in men's 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 men's 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.