Kazakstannyn Klinikalyk Medicinasy最新文献

{"title":"Identifying potential risk factors associated with gastrointestinal tract cancers: &amp;nbsp;A case-control study in Turkey","authors":"Sonay Goktas, Elif Gezginci","doi":"10.23950/jcmk/13691","DOIUrl":"https://doi.org/10.23950/jcmk/13691","url":null,"abstract":"<b>Objective: </b>Gastrointestinal cancers have different risk factors. However, it was clearly thought that the risk factors of these cancers should be determined by a case-control studies. The study aims to determine the potential risk factors associated with gastrointestinal cancers with a case-control study design.<br /> <b>Material and methods:</b> This case-control study was conducted with a total of 620 people applied to Department of General Surgery of two hospital in Turkey. The case group consisted of 310 patients diagnosed with gastrointestinal tract cancers. The control group consisted of 310 subjects without any history of cancer including gastrointestinal cancers. The data were collected with the Patient Identification Form including socio-demographic characteristics, and risk factors for gastrointestinal tract cancers.<br /> <b>Results:</b> The mean age of the case and control groups were 58.9±12.9 and 50.0±10.0, respectively. Although there was statistically significant differences in several factors compared, multivariate analysis identified male gender (OR=1.729, p=0.02), higher age (OR=1.068, p&amp;lt;0.001), low body mass index (OR=1.110, p&amp;lt;0.001), high number of children (OR=1.563, p&amp;lt;0.001), cancer history in the family (OR=4.444, p&amp;lt;0.001) and the presence of other chronic diseases (OR=6.314, p&amp;lt;0.001) as risk factors. Mostly vegetable consumption (OR=2.923, p&amp;lt;0.001) was also found to be a lower risk factor for gastrointestinal cancers.<br /> <b>Conclusion:</b> According to this study; age, gender, body mass index, number of children, family history of cancer, chronic diseases were among risk factors for gastrointestinal tract cancers. Vegetable consumption was an important factor to decrease gastrointestinal cancers.","PeriodicalId":32426,"journal":{"name":"Kazakstannyn Klinikalyk Medicinasy","volume":"31 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136262890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of corticosteroid use in septic shock on secondary infection frequency, microorganism species, morbidity, and mortality","authors":"Duygu Kayar Calili, Seval Izdes, Levent Ozturk","doi":"10.23950/jcmk/13690","DOIUrl":"https://doi.org/10.23950/jcmk/13690","url":null,"abstract":"<b>Aim:</b> We aimed to examine the effect of corticosteroid treatment in vasopressor-refractory septic shock on secondary infections, microorganism species, survival, and length of hospital stay.<br /> <b>Material and methods: </b>In this observational study, the records of 108 septic shock patients admitted to the intensive care unit (ICU) were reviewed.<i> </i>Patients were divided into two groups: the corticosteroid group (Group S, n=60) and the non-corticosteroid group (Group S-0, n=48). The results of three cultures [blood, endotracheal aspirate (eta), urine, wound] taken after ICU admission were recorded. The groups were compared in terms of demographic characteristics, culture growth rates and microorganisms, length of hospital stay, and survival rates.<br /> <b>Results:</b> The hospital (p=0.043) and ICU stay (p=0.035) were longer in Group S. There was no significant difference between the groups in terms of survival (p&amp;gt;0.05). The growth rate of the first urine culture was significantly higher in Group S-0 than in Group S (p=0.018), but there was no difference in terms of microorganism species (p&amp;gt;0.05). There was no significant difference in growth rates and microorganism species in blood, eta and wound cultures (p&amp;gt;0.05), but increase in growth rates were observed in the 2nd and 3rd eta and, wound cultures compared to first culture in Group S (p&amp;lt;0.05).<br /> <b>Conclusion:</b> There was no difference between the patients who received and did not receive corticosteroid treatment in septic shock in terms of culture growth rates, growing microorganism species and mortality; however, the frequency of growth in eta and wound cultures increased and the length of hospital stay was longer in patients who received corticosteroids.","PeriodicalId":32426,"journal":{"name":"Kazakstannyn Klinikalyk Medicinasy","volume":"54 5","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136261961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unraveling the interplay: Exploring the relationship between children's obesity, sleep disorders, depressive symptoms, and age dynamics","authors":"Betül Orhan Kiliç, Eda Çakmak","doi":"10.23950/jcmk/13761","DOIUrl":"https://doi.org/10.23950/jcmk/13761","url":null,"abstract":"<b>Objective: </b>This study explores the relationships between sleep disorders, depressive symptoms, and obesity among children of different ages.<br /> <b>Material and methods: </b>The data for this study were collected from 163 Turkish children aged 7 to 10 and 11 to 15 years (mean age=9.4, SD=1.9) who were attending well-child visits. Parents completed an online questionnaire on sociodemographic data, while children completed the Children Depression Inventory and The Children's Sleep Habits Questionnaire.<br /> <b>Results: </b>The regression model for the 7-10 years group included sleep resistance, sleep onset delay, nighttime awakenings, and daytime sleepiness, and explained 33.8% of the variance in Children Depression Inventory scores (R²=0.338, F=9.779, p&amp;lt;0.001). For the 11-15 age group, the regression model included obesity status, Children's Sleep Habits Questionnaire scores, sleep onset delay, sleep-related anxiety, and sleep-disordered breathing, and explained 80.3% of the variance in Children Depression Inventory scores (R²=0.803, F=28.489, p&amp;lt;0.001).<br /> <b>Conclusion: </b>Overall, the results of this study emphasize the significance of addressing sleep disorders, obesity, and depressive symptoms in children, particularly in adolescents, to promote better mental health outcomes.","PeriodicalId":32426,"journal":{"name":"Kazakstannyn Klinikalyk Medicinasy","volume":"212 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136317030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intracardiac foreign bodies: Diagnosis and management","authors":"Valeh Memmedov, Anar Emrah, Ziya Shahaliyev, Javid Ibrahimov","doi":"10.23950/jcmk/13764","DOIUrl":"https://doi.org/10.23950/jcmk/13764","url":null,"abstract":"<b>Introduction:<i> </i></b>As a result of gunshot wounds due to a bullet or shrapnel entering the system of arteries or veins, direct wounds of the heart or vascular structures, as well as embolisms may occur. After entering one of the systemic veins, the bullet or shrapnel can enter the right heart or the pulmonary artery. Shrapnel embolism is a rare condition, usually asymptomatic and is detected accidentally during routine examinations. Due to the fact that the intensity of occurrence of this type of cases is quite rare, it was decided to present such clinical cases.<br /> <b>Material and methods:<i> </i></b>This article reports about 3 patients with intracardiac foreign body. All 3 patients took part in the battles during the Second Karabakh War and were hospitalized as a result of shrapnel wounds received in different parts of the body. In each of the patients, the lesion area was different, but as a result of venous migration, the movement of a foreign body (metal fragment) in the heart cavity was noted. In two patients, the foreign body was removed by open surgery (connection to a heart-lung machine) due to the presence of symptoms, but one patient was under observation due to the absence of symptoms.<br /> <b>Results:<i> </i></b>Bullet or shrapnel embolism is a very rare complication of gunshot wounds, occurring in about 0.3% of cases. These emboli often cause antegrade migration into the arterial system. However, in about 20% of cases, migration into the venous system can also occur. Venous embolism often results in foreign body migration into the right heart or the pulmonary artery. The diagnosis in these cases is often established by chance, but in some cases, arrhythmias and valve defects can occur due to exposure to a foreign body. The identification of such cases depends on the symptoms. A foreign body can be removed by an open method, as well as by invasive methods. In some cases, it is possible to keep the foreign body under control when it does not cause any symptoms.<br /> In the clinical cases we mentioned, we also mentioned the management of cases of foreign bodies entering the venous system from peripheral zones of penetration.","PeriodicalId":32426,"journal":{"name":"Kazakstannyn Klinikalyk Medicinasy","volume":"120 2","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136262873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How fixation affects the results of lymph node immunophenotyping by flow cytometry","authors":"Dana Yerpasheva, Vadim Kemaykin, Gulzhanat Zhunis, Zhasulan Aisyn, Ivan Vorobjev","doi":"10.23950/jcmk/13762","DOIUrl":"https://doi.org/10.23950/jcmk/13762","url":null,"abstract":"<b>Aim: </b>Flow cytometric diagnosis of lymphoma and leukemia is of high clinical and research importance. However, performing flow cytometry analysis on the day of biopsy might be of challenge due to several reasons, including late sample delivery, problems of preparing the reliable panel for immunophenotyping based on other diagnostic studies, etc. This problem could be partially solved if cell suspension could be fixed and stained on another day or after several days after standard FFPE (formalin-fixed and paraffin-embedded) procedure.<br /> <b>Material and methods: </b>Addressing this issue, we compared staining of live lymphocytes in suspension obtained from lymph node biopsies and same specimens fixed using 2-4%-paraformaldehyde, 1-3%-glyoxal, and 0.1-1% glutaraldehyde with subsequent immunostaining on the next day or later.<br /> <b>Results: </b>Staining after fixation could be partially representative only after paraformaldehyde fixation for 20 min and subsequent storage of cell suspension in phosphate-buffer saline within not more than 3 days. Probes stained after fixation always shows lower stain index compared to staining of live cells.<br /> <b>Conclusion:</b> Staining after fixation cannot be used for determining of the percentage of CD45-positive cells and for testing B-cell lymphomas since antigens against light chains of IgG cannot be properly detected in fixed specimens.","PeriodicalId":32426,"journal":{"name":"Kazakstannyn Klinikalyk Medicinasy","volume":"223 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136262280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Сase report of syphilitic hepatitis","authors":"Aibar Aginbay, Saule Khamzina, Ruslan Zhambulayev, Natalya Baromyko, Sanzhar Shalekenov","doi":"10.23950/jcmk/13757","DOIUrl":"https://doi.org/10.23950/jcmk/13757","url":null,"abstract":"Syphilitic hepatitis is a rare clinical presentation of syphilis and is easily misdiagnosed. However, clinical and histopathologic manifestations of Syphilitic Hepatitis can imitate other infectious and non-infectious diseases, and the diagnosis should be considered in patients with abnormal liver function tests. We present an unusual case of syphilitic hepatitis presenting with jaundice and abdominal bloating after treatment with benzylpenicillin, liver enzymes, and mucocutaneous findings improved.","PeriodicalId":32426,"journal":{"name":"Kazakstannyn Klinikalyk Medicinasy","volume":"129 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136262466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A retrospective CT based comparative analysis of available screw pathways to determine optimal iliac screw trajectory","authors":"Atul Sareen, Anuradha Sharma, Jatin Prakash, Hitesh Lal, Ashish Bansal, Ashish Jaiman","doi":"10.23950/jcmk/13756","DOIUrl":"https://doi.org/10.23950/jcmk/13756","url":null,"abstract":"<b>Introduction:</b> The lumbo-sacral stabilization using iliac screw is gaining popularity in such cases of long multi segment lumbar constructs. Iliac screws help to achieve strong spinopelvic fixation, augments and protects sacral screws. However, there is a great variability found in literature for iliac screw fixation in terms of trajectory, screw length and screw diameter. Also, to the best of our knowledge, there is lacunae in current literature regarding the optimal pathway, screw length and screw diameter in the Indian population. Hence, we planned the study with the aim to analyze the available screw pathways to determine optimal iliac screw trajectory, screw length and diameter for the Indian population.<br /> <b>Material and methods:</b> This was a tertiary center-based retrospective study. One hundred pelvic CT scans of patients in 18-70 years age, who underwent abdominal CT on Siemens 256-slice dual source CT scanner for various indications were evaluated. Subsequently, 4 iliac screw trajectories were assessed by connecting the points given below using double oblique reformats on which the lengths and narrowest zones of these trajectories were measured. Path A: Posterior Superior Iliac Spine (PSIS) to Anterior Superior Iliac Spine (AIIS); Path B: point between PSIS and posterior inferior iliac spine (PIIS) to Anterior Inferior iliac spine&amp;nbsp; (AIIS); Path C: iliac crest intersection point (CLIC) point to Upper acetabulum; Path D: CLIC point to acetabular center.<br /> [p1]&amp;nbsp;<b>[a2]&amp;nbsp;Results:</b> Statistically significant difference was found in the lengths of various pathways. Path A (PSIS to AIIS) was found to be the longest (mean 13 cm). The second longest path in our study was path C (CLIC point to Upper acetabulum). The narrowest widths of each path were not found to have any statistically significant difference.<br /> <b>Conclusion:</b> Iliac screw fixation is of paramount importance for lumbosacral stabilization. Of the studied paths, trajectory from posterior-superior iliac spine to Antero-inferior iliac spine has the longest passage length and is the most optimal path for the Indian population. In case additional screws are required, the trajectory from CLIC point to Upper acetabulum provides the second largest screw passage.","PeriodicalId":32426,"journal":{"name":"Kazakstannyn Klinikalyk Medicinasy","volume":"151 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136262111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Worsening air pollution an unfamiliar cause of low vitamin D levels: A systematic literature review","authors":"Jai Aditya Jhamb, Sanjiv Rampal, Ashish Jaiman, Ajantha Sinniah, Jia Bei Tong, Aryaman Jaiman","doi":"10.23950/jcmk/13760","DOIUrl":"https://doi.org/10.23950/jcmk/13760","url":null,"abstract":"Air pollution is widely recognized as a future biohazard, yet its direct effects on human health, particularly in relation to bone health and vitamin D levels, are inadequately understood. While the detrimental impact on respiratory and cardiovascular health is well-documented, the correlation with vitamin D deficiency remains weak.<br /> To explore the relationship between air pollution and vitamin D levels, an extensive search of scientific literature was conducted. This comprehensive search encompassed databases such as PubMed, Cochrane Library, and DOAJ, while also examining the bibliographies of relevant articles. The inclusion criteria focused on studies that specifically investigated the association between air pollution and vitamin D levels, while excluding systematic reviews, case reports, editor's letters, and studies lacking pertinent explanations or causative factors. Each included study underwent rigorous evaluation of its methodological quality, with data extraction performed to assess the reliability and robustness of the evidence for each research question.<br /> The majority of studies have consistently demonstrated a negative correlation between ambient air pollution and vitamin D levels in humans. Several mechanisms have been proposed to explain this relationship, including reduced exposure to sunlight due to increased air pollution, production of reactive oxygen particles, and inflammation leading to decreased vitamin D synthesis. Moreover, certain pollutants, such as particulate matter and nitrogen dioxide, have been found to have a more pronounced impact on vitamin D levels. Variables such as age, gender, season, and geographical location may also influence the association between air pollution and vitamin D levels. Lifestyle factors, including indoor confinement and pre-existing vitamin D deficiency, may exacerbate the detrimental effects of air pollution.<br /> In conclusion, air pollution detrimentally affects vitamin D levels primarily through increased body inflammation and the generation of free radicals. The presence of elevated levels of particulate matter and nitrogen dioxide further compounds this effect. Additionally, decreased cutaneous production of activated vitamin D, resulting from reduced ultraviolet B radiation penetration due to decreased Air Quality Index, contributes to the negative impact. Studies suggest that the intake of exogenous vitamin D supplements and adherence to a calcium-rich diet may confer benefits to individuals residing in highly polluted areas. To address this issue, public health policies should emphasize outdoor exposure to sunlight, promote healthy dietary choices, and reduce overall exposure to pollutants.","PeriodicalId":32426,"journal":{"name":"Kazakstannyn Klinikalyk Medicinasy","volume":"16 5","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136316683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Conventional videolaryngoscope versus 3D printed videolaryngoscope","authors":"Kamil Varlık Erel, Nagehan Ümit Karacan","doi":"10.23950/jcmk/13765","DOIUrl":"https://doi.org/10.23950/jcmk/13765","url":null,"abstract":"<b>Background and objectives:</b> In patients with Covid-19, using a video laryngoscope as an alternative to direct laryngoscopy is recommended to protect the intubator from infection and reduce intubation failures due to personal protective equipment. The cost of video laryngoscopes limits their availability in all healthcare institutions. The present study aimed to compare the efficacy and safety of 3D printed video laryngoscope and conventional video laryngoscope on intubation.<br /> <b>Material and methods:</b> 30 ASA I-II patients who were not considered to have a difficult airway were included in the study after obtaining the ethics committee approval from Adnan Menderes University Clinical Research Ethics Committee. Patients were randomly divided into two groups, group 1 and group 2. After the induction of anesthesia under standard monitoring, the Cormack Lehane score was recorded by direct laryngoscopy in all patients. Patients in group 1 were intubated with a 3D-printed video laryngoscope. In contrast, patients in group 2 were intubated with a conventional video laryngoscope (STORZ C-mac videolaryngoscope). Intubation time, number of attempts, and hemodynamic values of patients with early postoperative complications were recorded. The data were recorded and statistically evaluated.<br /> <b>Results:</b> There were no significant differences between the groups regarding demographic data, BMI, and hemodynamic data. The Cormack Lehane score was calculated as 1.6±0.51 in group 1 and 1.4±0.51 in group 2 (p=0.38). Intubation times of the groups were 32.6±18 s and 27.06±11.37 s, respectively (p=0.4). The number of intubation attempts was 1.2±0.63 in group 1 and 1±0.01 in group 2 (p=0.31). The image quality of the camera by the intubator, intubation conditions, and intubation satisfaction was similar in the two groups.<br /> <b>Conclusion:</b><b> </b>Comparing a 3D-printed videolaryngoscope with a conventional videolaryngoscope, no differences were observed in intubation times, number of intubation attempts, hemodynamic changes, and early postoperative complications. Intubation satisfaction values by the practitioner were found to be similar. It was concluded that the 3D-printed videolaryngoscope, which is cost-effective and easy to access, can be used instead of conventional videolaryngoscope in patients with a normal airway.","PeriodicalId":32426,"journal":{"name":"Kazakstannyn Klinikalyk Medicinasy","volume":"129 2","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136262107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determining incontinence awareness, attitude, and frequency in female students enrolled in the Faculty of Health Sciences","authors":"Ayşe Çuvadar, Suzan Onur","doi":"10.23950/jcmk/13758","DOIUrl":"https://doi.org/10.23950/jcmk/13758","url":null,"abstract":"<b>Aim: </b>This study was conducted to determine urinary incontinence awareness, attitude, and frequency among female students studying at a faculty of health sciences.<br /> <b>Material and methods: </b>This cross-sectional study was conducted with 458 female students enrolled in a university's faculty of health sciences between February 2023 and April 2023. The data of the study were collected using a \"Personal Information Form\" and an \"Incontinence Awareness and Attitude Scale\" prepared by the researchers. Descriptive statistics, independent t-test, and ANOVA test were used to evaluate the data.<br /> <b>Results</b>: The mean age of the students was 21.17±1.70, and only 2% had been diagnosed with urinary incontinence during their lifetime. The mean scores of the students in the sub-dimensions of incontinence awareness were found as follows: factors affecting acceptance of incontinence as a health problem 32.98±5.13, health motivation 7.15±2.51, coping with urinary incontinence 17.25±5.77, limitation 10.54±3.38, and fear of urinary leakage 11.47±4.34.<br /> <b>Conclusion: </b>The mean score of female students on the urinary incontinence awareness scale, factors preventing acceptance of incontinence as a health problem, coping with urinary incontinence, health motivation, and limitation sub-dimensions were found to be at a good level.","PeriodicalId":32426,"journal":{"name":"Kazakstannyn Klinikalyk Medicinasy","volume":"129 4","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136262114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}