Pulmonary Service of the MCH of the PAA of the RK

The concept of the Medical Centre Hospital of the President’s Affairs Administration of the Republic of Kazakhstan (MCH of the PAA of the RK) is based on the determination that man must be in the focus of attention and contemplates the creation of maximally favourable conditions for the high-quality service of patients in accordance with the requirements of international standards.

MCH of the PAA of the RK is the next generation hospital. The high level of professional training of its specialists in the leading clinics of Europe, USA, Japan. South Korea, and Israel, their great research and clinical potential, availability of the state-of-the-art high tech diagnostic and treatment equipment in the Hospital allow making diagnostic and treatment of the most complex diseases of bronchopulmonary system at the whole new level: from COPD, bronchial asthma, and pneumonic fevers to hardly diagnosticable Interstitial lung diseases, such as sarcoidosis, idiopathic pulmonary fibrosis, alveolar proteinosis, lymphangioleiomyomatosis, cholesterol thesaurismosis, idiopathic pulmonary hemosiderosis , lung vasculitis, and pulmonary involvement in cases of systemic diseases of connective tissue.

Introduction of the high tech diagnostic equipment into the clinical process has considerably enhanced our capabilities of making diagnostics and differential diagnostics of tumors, lymphoproliferative diseases of lungs, tuberculosis, and pulmonary vascular diseases.

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Unique possibilities of the 256-slice computed tomography scanner allow reducing twice the time of lungs examination thus reducing the patient’s radiation exposure by 4 times. At the same time is it possible to scan lungs actually within 1 second in patients with severe respiratory disturbance associated with the reduсed capability of respiratory manoeuvres. With the use of this equipment we conduct examinations of the speed and volume of pulmonary blood flow and perfusion.

1.5 and 3-tesla magnetic resonance computed tomography scanners ensure making the whole new level diagnostics of pathologic processes in the interpleural space and adjacent lungs’ segments without any radiation exposure of patients with heart and lungs diseases.

One of promising directions in the diagnostics of parenchymatous tissue and blood-stream of lungs in the MCH is lungs scintigraphy conducted with the use of the single-photon emission computerized tomography scanner using technetium, the radiopharmaceutical agent with an average lifetime.

Considerably enhanced are our capabilities of detecting pulmonary tumors, lymphoproliferative diseases of lungs with the use of positron-emission tomography with i.v. administration of 18 FDG ultra short-lived radioactive tracer.

The arsenal of the Hospital includes the electrical impedance tomography scanner, which allows, in the conditions of the intensive therapy unit, making topical diagnostic of a lung tissue damage area in patients with severe impairment of the respiratory system, or in cases of respiratory distress syndrome.

The Hospital has established a high-capacity prosectorium, which allows making diagnostics of various anatomic variants of interstitial and oncological diseases of bronchopulmonary system. For this purpose, biopsy sampling from lung or intrathoracic lymph node tissue and mucous membrane of bronchus is conducted with the use of minimally invasive video assisted transbronchial and transthoracic approach and archiving of results.

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Establishment of the state-of-the-art Sleep Laboratory fitted with the high-tech expert class equipment enabled us to detect sleep-disordered breathing in patients suffering from snoring, the basic clinical symptoms of which include snore, slowing down of breathing and apnoeic episodes that result in both acute and chronic oxygen deficit and materially increase the risk of development of arterial hypertension, cardiac arrhythmia, infarction, cerebrovascular incident, and sudden death during sleep.

Conducting of respiratory monitoring, polysomnography test within the framework of an integrated examination program in patients with sleep apnea allows detecting the most severe respiratory disturbances with considerable decrease in blood saturation.

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According to results of tests, specialists of the Sleep Laboratory can select a CPAP therapy program with the use of the high-tech equipment. The application of CPAP therapy in patients with obstructive sleep apnea syndrome is the efficient preventive treatment of acute cardiovascular problems, sudden death in sleep and leads to actual improvement of the life quality of patients.

A substantial aid for the diagnostics and treatment of patients with respiratory system disorders is provided by the clinical diagnostic and microbiological laboratory. The laboratory conducts a large number of biochemical, immunological, and сytological tests of various biological media that allow specifying the genesis and intensity of inflammatory changes and monitoring the effectiveness of treatment being conducted. Tests are made with the use of unique high-tech expert class devices. The capabilities of the microbiological laboratory allow identifying etiologic agent within the short period, as early as on the 3rd or 4th day, monitoring of respiratory tract microflora with a high level of evidence, conducting timely appropriate etiotropic therapy of non-specific bacterial or mycotic infections.

The therapeutic potential of the MCH includes all modern methods to control any pathologic processes of the bronchopulmonary system, such as medications and physical impact methods: all types of electro and magnetotherapy, atmotherapy in the conditions of halochamber, balneo, baro and cryotherapy, massages, acupuncture, well-equipped exercise therapy halls, kinetotherapy, etc.

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The diagnostics and treatment of patients with respiratory diseases is conducted under the supervision and advisory support of the Doctor of medical science and two pulmonologists of the highest qualification grade.

The medical aid for patients with bronchopulmonary system diseases is provided as outpatient care, in the conditions of the day patient facility, and as inpatient care in Internal Medicine Department No. 1, as well as in the conditions of other Internal Medicine Departments of the Hospital. It is important that the pulmonary care is accessible not only for the group of government employees attached to the MCH of the PAA of the RK, but also for any citizen of the Republic of Kazakhstan on contractual or commercial basis. In certain cases specified and approved by the Order of the MHC of the RK, the said medical aid may be provided at public expense through the portal.

The efficient and reasonable use of the available equipment based on the principles of evidentiary medicine in accordance with the requirements of international standards will allow improving of diagnostics and conducting of appropriate treatment of various diseases, in particular serious diseases of the bronchopulmonary system at early stages of pathologic process development. Such approach ensures the attainment of positive effect in the treatment of bronchopulmonary diseases, helps to prevent the development of complications, slow down the rates of disease progression, improve the quality of life of our patients, and determine a favourable disease prognosis.

Пульмонологическая служба БМЦ УДП РК ROZA BAKENOVA

Chief Therapist of the Medical Centre Hospital of the President’s Affairs Administration of the Republic of Kazakhstan, Deputy Chairperson of the Research and Clinical Council of the MC of the PAA of the RK, Doctor of Medical Science, pulmonologist, therapist of the highest qualification grade.

Graduated from Karaganda State Medical Institute in the specialty of General medicine. Worked as therapist in the municipal and regional hospitals of Karaganda, Chief of the pulmonary and internal medicine departments.

Therapist of the highest qualification grade from 1990. Passed clinical residency training in general medicine at Karaganda State Medical Institute, upheld the Master’s Thesis in specialty 14.00.43 — Pulmonology in 1995. Worked as teaching assistant and from 1998 as associate professor of the Chair of Propaedeutics of Internal Diseases of the KSMA. Held the position of the chief part-time pulmonologist of the Department of Healthcare of Karaganda region. In 2000 was awarded the academic rank of associate professor on the basis of decision of the Higher Attestation Commission of the RK.

From 2004 employed as the Chief of the Department of Internal Medicine of the RSE NRMC, leading research associate of the Internal Medicine Centre of the NRMC, Academic secretary of the NRMC. Passed training in the faculties of continuing medical education in the areas of internal medicine, pulmonology, emergency care, functional and X-ray diagnostics in Kazakhstan, Russia, Austria, Germany, and Spain, under the training program of the European Respiratory Society school.

Passed doctoral training in the specialty of Internal diseases at the National Research Medical Centre. In 2010 successfully upheld the Doctor’s of medical science thesis on subject “Interstitial lung diseases: clinical-pathogenetic description and predictors of pulmonary fibrosis progression.” Results of research were several times reported at congresses of the European Respiratory Society in Berlin (Germany, 2008), Vienna (Austria, 1997, 2009), Barcelona (Spain, 2010), in international forums of the CIS countries (Almaty, Astana, Moscow, Saint-Petersburg, Tashkent, Bishkek, Kazan, and Yekaterinburg).

Engaged in the diagnostics and treatment of respiratory system diseases — interstitial lung diseases including idiopathic pulmonary fibrosis, various anatomical variants of idiopathic interstitial pneumonia, lymphangioleiomyomatosis, cholesterol thesaurismosis, alveolar proteinosis, sarcoidosis, exogenous allergic alveolitis, pulmonary involvement in cases of systemic diseases of connective tissue, bronchial asthma, COPD, pneumonias, lung vasculitis, multiple bronchiectasis, bronchopulmonary dysplasiae. Working with the National Research Medical Centre, Medical Centre Hospital of the President’s Affairs Administration of the Republic of Kazakhstan, a number of institutions of Astana, Karaganda, she has developed and introduced diagnostic and treatment procedures of interstitial lung diseases, other chronic diseases of bronchopulmonary system, and pneumonias. With her participation, methods of video-assisted thoracoscopy and needle biopsy of lungs, anatomical verification of various clinicopathologic variants of interstitial lung diseases were introduced in the pathomorphological division of the NRMC, pathomorphological departments of the Regional Clinical Hospital and the Regional Diagnostic Centre of Karaganda, the Chair of pathoanatomy and forensic medicine of Karaganda State Medical University. Bakenova R.A. has 142 publications including those in several foreign periodicals with a nonzero impact factor. From 2009 worked as Academic secretary of NRMC JSC, leading research associate of the respiratory diseases laboratory. From 2012 is employed as the Chief Therapist of the Medical Centre Hospital of the President’s Affairs Administration of the Republic of Kazakhstan, consulting physician of a number of healthcare organizations of Astana, provides advisory assistance to patients with serious diseases of the respiratory system in various regions of the RK.

Bakenova R.A. takes part in the development of the National clinical guidelines of diagnostics and treatment, prevention of diseases of the respiratory system.

Bakenova R.A. is one of founders of the Euro-Asian Respiratory Society and the first General Secretary of that Society. At present, she is presidium member of the Euroasian Respiratory Society, Association of Pulmonologists of Central Asia, GOLD member of the European Respiratory Society, and member of the work group for interstitial lung diseases of the European Respiratory Society (ERS), member of the Russian Respiratory Society and the Russian Association of Rheumatologists, and the Association of Therapists of the RK.

In addition to the clinical activity, Bakenova R.A. gave a set of lectures in topical matters of pulmonology for resident physicians, internship doctors, and medical students in advanced training courses for doctors in the research and education centre of the NRMC, MCH of the PAA of the RK, and Astana Medical University. At the present time Bakenova R.A., apart from treatment and advisory activity with the MCH of the PAA of the RK, provides expert support in the work of expert groups of the Medical and pharmaceutical activity control committee and continues the research activity within the framework of joint projects with Karaganda State Medical University.

Awards: in 2006 received the award “For Excellence in Healthcare of the Republic of Kazakhstan”; in 2015 awarded with the Badge of the Ministry of Healthcare of the RK.