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DEXMEDETOMIDINE FOR REGIONAL ANESTHESIA: AN UMBRELLA REVIEW
(Nazarbayev University School of Medicine, 2024) Dossymbek, Dayana
Objective: To determine the perioperative effect of dexmedetomidine as a pharmacological adjunct to the regional anesthesia in adult surgical patients. Introduction: Dexmedetomidine is an α-sympathomimetic drug, which has a high selectivity and specificity for α2-adrenoceptor of noradrenergic neurons and affects the modulation of pain perception. Multiple systematic reviews and meta-analyses are associated with advantages of administering dexmedetomidine as an adjuvant drug for adult surgical patients with regional anesthesia. Inclusion criteria: In this umbrella analysis, relevant systematic reviews and meta-analyses involving adult patients (older than 18 years) undergoing surgery and receiving preoperative regional anesthesia with dexmedetomidine as an adjuvant drug and published before January 2024 are eligible for inclusion. Methods: 22 relevant articles were screened and 14 of them were excluded after full-text assessment due to failing to meet all inclusion criteria or/and meeting one of the exclusion criteria. The remaining eight studies were critically appraised and primary and secondary outcomes of the articles were assessed.
Results: Perineural administration of dexmedetomidine in brachial plexus block for upper limb surgery prolongs the duration of analgesia compared to local anesthetics alone.
Discussion: Further investigations on the topic would help make umbrella review more comprehensive and result in recommendations of a high statistical value and credibility.
ANALYSIS OF IMMUNIZATION COVERAGE AND INSIGHTS INTO VACCINE ACCEPTANCE IN PARENTS OF CHILDREN AFFECTED WITH CHRONIC DISEASES (FOCUS ON RHEUMATOLOGICAL AND NEPHROLOGICAL PATIENTS)
(Nazarbayev University School of Medicine, 2024) Sardarbek, Dana
Introduction: Patients with chronic conditions are at increased risk of severe complications following infectious diseases due to their immunocompromised state. The rate of vaccine preventable diseases and its complications has declined significantly with high vaccine coverage among certain populations. Although children with chronic diseases have higher susceptibility for severe course of infection, vaccine hesitancy among their legal representatives is still high.
Methods: This cross-sectional study was conducted from April 2022 to September 2023. The study analyses the data from a paper-based survey of 63 parents of chronically ill children.
Results: 36 responses from nephrology department and 27 responses from rheumatology department were collected. Majority of the respondents were married female parents at the age between 30-39 and having university degree. Overall, the survey participants predominantly agree with the statements that claim the importance (61.1% and 74.1%), effectiveness (58.3% and 55.5%) and safety of the vaccination (41.7% and 59.3%) among both nephrology and rheumatology departments, respectively.
Conclusion: Parents are concerned about safety of vaccines for children with chronic diseases who receive specialized therapy. The vaccine coverage is inadequate, with the higher immunization rate among rheumatological patients compared to nephrological patients. While parents of nephrological patients are more vaccine hesitant.
THE INFLUENCE OF ADVANCED MATERNAL AGE ON PREGNANCY COURSE AND OUTCOME IN PATIENTS WITH GLUCOSE METABOLISM DISORDERS IN PREGNANCY
(Nazarbayev University School of Medicine, 2024) Khusain, Arailym
The prevalence of pregnancies in women of advanced age, which is defined to be over 35
years, has increased globally, raising concerns about associated risks such as hypertension,
gestational diabetes (GD), preeclampsia, miscarriage and preterm birth. Even though these risks
are widely recognized, the impact of advanced age on the course and outcome of pregnancy among
women with glucose metabolism disorders (GMDs) is still underexplored. This study aims to
examine the specific impact of advanced maternal age on pregnancy courses and outcomes in
women with GMDs. The clinical records of women with GMDs who gave birth between 2013 and
2017 where retrospectively analyzed. 281 women were divided into three groups by age: <35, 35-
40 and >40 years old. According to the study results, there is a significant association between
advanced maternal age and higher body mass index (BMI), blood pressure (BP) and pre-pregnancy
hypertension in patients with GMDs. Interestingly, fasting glucose levels were lower with
gestational diabetes diagnosed at earlier gestational ages as maternal age increased. Among the
neonatal outcomes, the analysis showed significantly higher incidence of neonatal hypoglycemia
with advancing maternal age, and the frequency of macrosomia was also higher among these
patients. Therefore, early screening and targeted monitoring of women of advanced age with GMDs
is highly recommended to mitigate these risks. Further research is needed to develop
comprehensive management strategies for this high-risk population and to develop a pre-pregnancy
program focused on dietary and lifestyle modifications to improve the pregnancy outcomes in
advanced age pregnancies with GMDs.
SOLUBLE TAM RECEPTORS ARE POTENTIAL REGULATORS OF BLADDER CANCER PROGRESSION
(Nazarbayev University School of Medicine, 2024) Kuantayeva, Akmaral
Bladder cancer cells such as RT112 and T24 cells contain TAM receptors called Axl, Tyro3 and
Mer. These TAM receptors are cleaved and form soluble forms that can have impacts on signaling
pathways. The hypothesis of this dissertation is that soluble TAMs initiate downstream signals that
can be correlated with progression of bladder cancer. Therefore, RT112 and T24 bladder cancer cell
lines were analyzed using cell culture, western blotting, and wound healing assay. These cells
illustrate morphological changes and increased migration after addition of recombinant - TAM
receptors. Moreover, the soluble TAM receptors are found in RT112 and T24 that are biologically
active.
TIO2- AND AG2CO3-BASED PHOTOCATALYSIS FOR REMOVING EMERGING POLLUTANTS FROM WATER
(Nazarbayev University School of Engineering and Digital Sciences, 2024-09-04) Mergenbayeva, Saule
Water plays a vital role as an essential natural resource that supports the development of life and human endeavors. Large volumes of water are consistently polluted with various
pollutants, including emerging pollutants (EPs). EPs are a group of persistent pollutants like pharmaceuticals and personal care products (PPCPs), dyes, and endocrine-disrupting compounds (EDCs). Many of them result from overuse, and their presence can cause serious health issues. However, conventional water treatment technologies are not specifically designed to remove these kinds of pollutants. In this study, advanced oxidation processes (AOPs) utilizing newly developed TiO2 and Ag2CO3-based photocatalysts were applied to remove several model EPs. The catalysts were synthesized using various preparation methods and then characterized to investigate their crystal structure, morphology, elemental
composition, and optical characteristics using XRD, Raman spectroscopy, SEM, TEM, EDS, BET analysis, and UV-Vis DRS spectroscopy. Firstly, TiO2 combined with Ti2O3 (mTiO), calcined at various temperatures, was used to degrade 4-tert-butylphenol (4-tert-BP) under simulated solar light. Among the catalysts, mTiO calcined at 650°C (mTiO-650) achieved the highest degradation and mineralization performance, achieving approximately 90% and 50%, respectively. The phase transformation and surface area of the calcined catalysts played a significant role in enhancing their photocatalytic activity. Additionally, the presence of various anions (NO3−, Cl−, HCO3− and CO32−) and humic acid (HA) in water was evaluated for its effect on 4-tertBP degradation. In addition, potential pathways for the degradation of 4-tert-BP were suggested. This study marks a significant advancement with the successful preparation of mTiO-650 catalyst capable of eliminating of 4-tert-BP in water. Secondly, mono- and co-doped TiO2 catalysts were synthesized using simple impregnation methods. Mono-doped Mo@TiO2 and W@TiO2 improved the adsorption capacity and reduced the energy gap (Eg), while co-doped catalysts, namely CuMo@TiO2 exhibited distinct adsorption properties and slightly enhanced degradation performance. CuMo@TiO2 fully degraded 4-tert-BP under UV light in 60 min and achieved 70% degradation under solar light in 150 min, marking the first application of both mono-doped and co-doped TiO2 catalysts for degrading 4-tert-BP in water, emphasizing their potential in environmental remediation, and introducing a novel pathway for efficient photocatalyst synthesis. Moreover, TiO2 doped with Fe (Fe@TiO2) was successfully synthesized via the wet impregnation method. Surface morphology was analyzed using SEM and TEM, while EDS confirmed the incorporation of Fe into TiO2. Fe@TiO2 demonstrated enhanced light absorption in the 200–365 nm range compared to bare TiO2. The photocatalytic performance of the catalyst was assessed in a continuous flow system for the degradation and mineralization of 4-tert-BP under UV light (254 nm). Fe doping slightly improved the degradation efficiency, with 87% of 4-tert-BP degraded in 60 min, compared to 82% with bare TiO2. Furthermore, Fe@TiO2 catalyst achieved 49.6% mineralization of 4-tert-BP. Additionally, Ag@TiO2 catalysts were also developed for reducing 4-nitrophenol (4-NP) to 4-aminophenol (4-AP), with Ag@TiO2-21 achieving 98.3% 4-NP reduction within 10 min. Moreover, Ag@TiO2-21 displayed strong antibacterial activity, with minimum inhibitory concentration (MIC) values ranging from 0.5 to 1 mg/mL against B. subtilis, E. coli, S. aureus, and P. aeruginosa. This study introduces Ag@TiO2 catalysts for efficient elimination of 4-NP from water, showcasing significant antibacterial activity. This research highlights the potential of Ag@TiO2 catalysts for environmental applications and offers a novel approach to developing effective photocatalysts. Furthermore, TiO2@zeolite (TiO2@Z and TiO2@ZSM) catalysts were tested for the degradation and mineralization of sulfamethoxazole (SMX) under UV (365 nm) light. The TiO2@ZSM1450 catalyst achieved complete SMX degradation within 10 min and mineralized 67% of SMX in 120 min. The effect of anions (NO3−, Cl−, and CO32−) on the photocatalytic performance of the TiO2@ZSM1450 catalyst was also investigated. The study highlights the effectiveness of modifying TiO2 with zeolite for improved photocatalytic performance. Lastly, Ag2CO3 was employed for the photocatalytic degradation of 4-tert-BP, achieving 100% degradation within 60 min under solar light. The effect of key parameters, including 4-tert-BP concentration (2.5–10 mg/L), Ag2CO3 dosage (100–300 mg/L), various light sources, and the presence of different anions, was studied. The re-usability of Ag2CO3 remained effective after three successive experimental runs. This study introduces Ag2CO3 as a novel catalyst for 4-tert-BP elimination in water, emphasizing its potential in environmental applications and offering a new synthesis approach. The results of this Thesis have great significance in advancing water treatment technologies and provide original and novel alternatives for the elimination of EPs in water.