Our study was carried out to characterize respiratory tract microbiota in patients with “COVID-like pneumonia” in Kazakhstan and analyze differences between COVID-19 positive and negative groups. Sputum samples were collected from hospitalized patients, ≥18 years old, in the three cities in Kazakhstan with the highest COVID-19 burden in July 2020. Isolates were identified by MALDI-TOF MS. Susceptibility testing was performed by disk diffusion. We used SPSS 26 and MedCalc 19 for statistical analysis. Among 209 patients with pneumonia, the median age was 62 years and 55% were male. RT-PCR-confirmed SARS-CoV-2 cases were found in 40% of patients, and 46% had a bacterial co-infection. Co-infection was not associated with SARS-CoV-2 RT-PCR test results, but antibiotic use was. The most frequent bacteria were Klebsiella pneumoniae (23%), Escherichia coli (12%), and Acinetobacter baumannii (11%). Notably, 68% of Klebsiella pneumoniae had phenotypic evidence of extended-spectrum beta-lactamases in disk diffusion assays, 87% of Acinetobacter baumannii exhibited resistance to beta-lactams, and >50% of E. coli strains had evidence of ESBL production and 64% were resistant to fluoroquinolones. Patients with a bacterial co-infection had a higher proportion of severe disease than those without a co-infection. The results reinforce the importance of using appropriate targeted antibiotics and effective infection control practices to prevent the spread of resistant nosocomial infections.

BACKGROUND: At the present time the alternation of the oxidative metabolism is considered as one of the leading pathogenic mechanisms in the development and progression of community-acquired pneumonia (CAP). However the nature and direction of the oxidative protein changes in CAP patient’s blood had been almost unexplored.AIM: To define oxidative and modified proteins in erythrocytes and blood plasma of CAP patients.MATERIAL AND METHODS: Blood plasma and erythrocytes obtained from: 42 patients with moderate severity pneumonia, 12 patients with grave severity pneumonia and 32 healthy volunteers. Content of advanced oxidation protein products, malondialdehyde and reactive carbonyl derivatives were estimated as indicators of the oxidative stress and oxidative damage of proteins.RESULTS: In patients with grave severity the level of oxidative proteins and MDA in erythrocytes exceeded both: control values and similar meanings in CAP patients with moderate severity. The further growth of MDA in this group patients’ blood plasma was observed, but the level of oxidative proteins decreased in comparison with those in CAP patients with moderate severity. CONCLUSION: To sum up, our derived data show, that injury of erythrocytes’ redox-status and blood plasma components plays an essential role in development and progression CAP.

AIM: The purpose of the present research was to study the content of erythropoietin and hepcidin in serum in pregnant women with iron deficiency anaemia and anaemia of chronic inflammation. METHODS: The authors examined 98 pregnant women who were observed in LLP (Regional obstetric-gynaecological centre) in Karaganda. The including criteria for pregnant women in the study was the informed consent of the woman to participate in the study. Exclusion criteria were oncological diseases, HIV-infection, tuberculosis, severe somatic pathology, mental illness, drug addiction. The design of the study was by the legislation of the Republic of Kazakhstan, international ethical norms and normative documents of research organisations, approved by the ethics committee of the Karaganda State Medical University. RESULTS: As a result of the study, it was determined that the content of erythropoietin and hepcidin in pregnant women with anemias of different genesis varies ambiguously. In the main group of pregnant women with IDA, the erythropoietin content rises, and the hepcidin level decreases. In pregnant women with ACI, on the contrary, the level of hepcidin increases, and in one subgroup it is significant. However, in pregnant women and with IDA and anemia of chronic inflammation, there is a subgroup of women in whom erythropoietin is either comparable with hepcidin, or their changes are of opposite nature. CONCLUSION: The authors concluded that the obtained data indicate ambiguous changes in the level of erythropoietin and hepcidin in pregnant women with anaemias of various origins. In all likelihood, there are still unaccounted factors affecting the content of these protein-regulators of iron metabolism, which require further definition and interpretation in anaemia of pregnant women.

High and individual positive end-expiratory pressure (PEEP) during laparoscopic surgery may improve oxygenation and respiratory mechanics. We searched RCTs in PubMed, Cochrane Library, Web of Science, and Google Scholar from from from January 2000 to December 2023 comparing the different intraoperative PEEP (low PEEP (LPEEP): 0–5 mbar; moderate PEEP (MPEEP): 6–9 mbar; high PEEP (HPEEP): >=10 mbar; individualized PEEP (iPEEP): PEEP set by special physiological technique) on arterial oxygenation, respiratory compliance (Cdyn) or driving pressure, mean arterial pressure (MAP), and heart rate (HR) in patients during laparoscopic surgery in reverse Trendelenburg position. We calculated mean differences (MD) with 95% confidence intervals (CI), and predictive intervals (PI) using random-effects models. The Cochrane Bias Risk Assessment Tool was applied. 8 RCTs (n = 425) met the inclusion criteria. HPEEP vs. LPEEP increased PaO2/FiO2 (+ 129.93 [+ 75.20; +184.65] mmHg, p < 0.0001) with high variation of true effect (Chi2 34.92, p < 0.0001; I2 89%). iPEEP vs. LPEEP also increased PaO2/FiO2 + 130.23 [+ 57.18; +203.27] mmHg, p = 0.0005) with high variation of true effect (Chi2 26.95, p < 0.0001; I2 93%). HPEEP vs. LPEEP increased Cdyn (+ 15.06 [5.47; +24.65] ml/mbar, p = 0.002) with high variation of true effect (Chi2 93.16, p < 0.0001; I2 96%). iPEEP vs. LPEEP increased Cdyn (+ 22.46 [+ 8.56; +36.35] ml/mbar, p = 0.002) with high variability of the true effect (Chi2 53.92, p < 0.0001; I2 96%). HPEEP group had higher MAP as compared to LPEEP) + 4.36 [+ 0.36;+8.36], p = 0.03), variability of the true effect was nonsignificant. HR did nit differ between all comparisons. In patients with obesity undergoing surgery in the reverse Trendelenburg position HPEEP and iPEEP may improve oxygenation, decrease driving pressure, and increase dynamic compliance compared to LPEEP with high variation of true effect without relevant hemodynamic compromise. Data with MPEEP comparisons are inconclusive. CRD42023488971; registered December 14, 2023.

COVID-19 vaccines have played a critical role in controlling the COVID-19 pandemic. Although overall considered safe, COVID-19 vaccination has been associated with rare but severe thrombotic events, occurring mainly in the context of adenoviral vectored vaccines. A better understanding of mechanisms underlying vaccine-induced hypercoagulability and prothrombotic state is needed to improve vaccine safety profile. We assessed changes to the biomarkers of endothelial function (endothelin, ET-1), coagulation (thrombomodulin, THBD and plasminogen activator inhibitor, PAI) and platelet activation (platelet activating factor, PAF, and platelet factor 4 IgG antibody, PF4 IgG) within a three-week period after the first (prime) and second (boost) doses of Gam-Covid-Vac, an AdV5/AdV26-vectored COVID-19 vaccine. Blood plasma collected from vaccinees (n = 58) was assayed using ELISA assays. Participants were stratified by prior COVID-19 exposure based on their baseline SARS-CoV-2-specific serology results. We observed a significant post-prime increase in circulating ET-1, with levels sustained after the boost dose compared to baseline. ET-1 elevation following dose 2 was most pronounced in vaccinees without prior COVID-19 exposure. Prior COVID-19 was also associated with a mild increase in post-dose 1 PAI. Vaccination was associated with elevated ET-1 up to day 21 after the second vaccine dose, while no marked alterations to other biomarkers, including PF4 IgG, were seen. A role of persistent endothelial activation following COVID-19 vaccination warrants further investigation.

The present study is a retrospective analysis of the activities of a tertiary stroke center (SC) operating on the basis of Akzhan Clinic in Karaganda Region during the year 2024. The primary objective of this study was to examine the epidemiological features, the structure of stroke morbidity, and the efficacy of thrombolytic therapy (TLT) in patients with ischemic stroke (IS). The study included data from a total of 585 patients, out of which 437 had been hospitalized with acute cerebrovascular disorders, and 104 of these patients had received TLT for IS. The analysis revealed a high level of utilization of TLT (23.8%), which was significantly higher than the average regional and national figures, owing to the efficient organization of prehospital and in‐hospital stages, availability of skilled personnel, and a state‐of‐the‐art technical infrastructure. Additionally, mechanical thrombectomy (MT) was performed in 100 instances, further confirming the high level of adoption of advanced treatment modalities. The proportion of hemorrhagic transformations (7.69%) and mortality (6.7%) was comparable to or lower than international benchmarks. The results demonstrate the high effectiveness of the performance of the SC “Akzhan” and the need for the further expansion of similar facilities in order to improve the accessibility and quality of stroke treatment in Kazakhstan.