Propedeutics and Problems of Internal Diseases

ORIGINAL PAPER

Propedeutics and Problems of Internal Diseases

Inkar Serdaliyeva, Arailym ABSTRACT
Omirbayeva, Nurgul Background: Internal diseases pose a significant public health concern due to their prev-
alence and impact on premature mortality and disability. This study investigates the role
Nurmanova, Kunsulu
of internal diseases in the morbidity structure of the Republic of Kazakhstan’s population,
Kenzheyeva, Gulmira
focusing on the period from 2019 to 2021. Objective: The primary objective of this study is
Izzatullayeva to assess the prevalence and dynamics of internal diseases among the adult population of
Department of Propedeutics and Internal the Republic of Kazakhstan during 2019-2021. Methods: We conducted a comprehensive
Medicine, Khoja Akhmet Yassawi analysis of medical records from healthcare facilities across the Republic of Kazakhstan
International Kazakh-Turkish University, for the years 2019 to 2021. The study focused on diseases of the cardiovascular system,
Republic of Kazakhstan endocrine system, metabolic disorders, respiratory system, gastrointestinal tract, and
urinary system. Epidemiological indicators, including prevalence rates and morbidity,
Corresponding author: Inkar Serdaliyeva,
Lecturer, Department of Propedeutics and were calculated for each disease category using official population data for the same
Internal Medicine, Khoja Akhmet Yassawi period. Results: Our findings indicate a noteworthy increase in the prevalence rates of
International Kazakh-Turkish University. internal diseases among the adult population of the Republic of Kazakhstan from 2019
Address: 161200, 29 B. Sattarkhanov Ave.,
to 2021. Diseases of the cardiovascular system were the most prevalent, with arterial
Turkestan, Republic of Kazakhstan. Phone: +7
72533 6 38 48. E-mail address: inserdaliyeva@ hypertension and coronary heart disease being particularly pressing concerns. Diabetes
yahoo.com. ORCID ID: https://orcid.org/0009- mellitus and thyroid abnormalities were the most common endocrine organ diseases.
0000-6516-2308 Among respiratory diseases, bronchitis had the highest prevalence, followed by tracheitis,
bronchial asthma, and pneumonia. Additionally, the prevalence of gastrointestinal tract
diseases increased by 3% over two years. Conclusion: This study underscores the urgent
doi: 10.5455/aim.2023.31.287-291
need for effective prevention and management of internal diseases in the Republic of
ACTA INFORM MED. 2023, 31(4): 287-291
Kazakhstan. The increasing prevalence rates across all leading categories of diseases
Received: JUL 25, 2023 highlight significant public health concerns.
Accepted: SEP 04, 2023
Keywords: diseases of the internal organs, diseases of the organs and systems,
prevalence rate, regular medical check-up, medical research.

1. BACKGROUND accordance with current standards and

Diabetes). Health is the universal American, European and domestic pro-
value of humanity. The human body is tocols for the delivery of health care (1-
a single functional unit, in which the 4). The introductory course in the study
activities of individual parts are inter- of internal diseases is propedeutics, the
connected and interdependent. There- study of which provides the basis of the
fore, the perversion of the function of knowledge that will be used in the pro-
one organ or system is necessarily re- cess of detailed study of all diseases.
flected in the functions of other organs The study of internal diseases is closely
and systems that lead to the develop- related to many basic sciences – gen-
ment of internal diseases. Internal dis- eral pathology, physiology, biochem-
© 2023 Inkar Serdaliyeva, Arailym Omirbayeva, eases belong to the section of clinical istry, microbiology, pharmacology and
Nurgul Nurmanova, Kunsulu Kenzheyeva, Gulmira medicine, the study of which gives us epidemiology. The knowledge of these
Izzatullayeva
modern ideas about diseases of internal subjects is necessary for the enhanced
This is an Open Access article distributed under the
terms of the Creative Commons Attribution Non-
organs, their epidemiology and eti- development of medical judgment.
Commercial License (http://creativecommons.org/ ology, pathogenesis, classification, clin- In recent times, medicine has light
licenses/by-nc/./) which permits unrestricted non- ical picture, diagnostics and differential years away from: new information tech-
commercial use, distribution, and reproduction in any
medium, provided the original work is properly cited. diagnosis, prophylaxis and treatment in nologies have started to be applied, it al-

ORIGINAL PAPER / ACTA INFORM MED. 2023, 31(4): 287-291 287

Propedeutics and Problems of Internal Diseases

lowing not only to obtain the latest knowledge and exchange Through the use of official data of the Republic of Kazakh-
of information, but also to efficiently systematize it (5-7). stan on the population living in this territory in 2019-2021,
Today, the main task of internal medicine is to recognize the the main epidemiological characteristics were calculated:
disease and its treatment. Among the constellations of in- prevalence rate (ratio of absolute number of cases to popula-
ternal diseases, diseases of the cardiovascular system are first tion multiplied by 100 000 persons) and morbidity (ratio of
in line (8-9). The cardiac pathology is the major cause of death the absolute number of newly diagnosed cases to the popula-
in the population. Each person in his/her life is necessarily tion multiplied by 100 000 persons). The size of the popula-
faced with cardiovascular disorders. The age-related changes tion corresponded to the number of people living in the ter-
in organs and tissues, metabolism disorders lead to hyperto- ritory of the Republic of Kazakhstan in 2019-2021, of both
nicity, myocardial hypertrophy, infarctions, blood strokes, sexes, of all ages.
cardiac decompensation, arterial sclerosis and reduces life The epidemiological indicators were calculated for indi-
and causes a number of restrictions leading to mortality and vidual diseases of the internal organs. The pathology of the
disability (10-13). internal organs was divided into groups of diseases by system,
The endocrine pathology is an equally pressing problem according to the International Statistical Classification of
of internal diseases (14). The endocrinologists consider that Diseases and Related Health Problems (ICD-10)). In the fu-
human health is governed by various hormones produced by ture, the dynamics of these parameters were evaluated with
the glands of internal secretion (15;16). The state of health the help of statistical methods.
and quality of people life depends on carry out a task by the The electronic database was created using Microsoft Excel
glands of internal secretion. The respiratory diseases also are electronic worksheet of the Microsoft Office XP application
among the leading in the world in prevalence rate and mor- package (Copyright© Microsoft Corp. 1993-2007). With
tality, and represent a heavy social and financial burden on the help of the functions of this program the material was
the country’s economy (17;18). In advanced countries, acute grouped, samples were formed, summary tables were created.
and chronic bronchitis, bronchial asthma (BA), pneumonia The statistical processing of the study results was carried out
associated with COVID-19, chronic obstructive pulmonary using StatSoft STATISTICA 6.1.
disease are the most common cause of temporary disability The following methods of analysis were used in statistical
and are amongst the 5 groups of diseases, which is the leading data processing: 1. Descriptive statistics (statistical estima-
cause of population mortality. tion of distributional parameters). The mean, median, stan-
The gastro-intestinal tract diseases have significant eco- dard error, standard deviation, asymmetry and excesses co-
nomic and social consequences (19). The health of the diges- efficients were calculated for quantitative indicators. The ab-
tive system depends largely on the lifestyle. In the rhythm solute and relative risks, standard errors of relative risks and
of the city human does not have time to eat correctly and to confidence intervals were calculated for qualitative features.
monitor what foods he/she eats. And the pernicious influence Prior to the data analysis, the distribution of the quantitative
of harmful habits affects the digestive system in consequence features was checked against the normal probability law: 1)
of which, already at a young age, many people are acquainted the construction of the distribution histograms and verifica-
with such disease as gastritis. Every person is prone to urinary tion of their conformity with the Gaussian distribution curve,
system diseases. Cystitis is the most commonly among uri- 2) the Shapiro-Wilk test was used (testing the hypothesis that
nary system diseases. The pyelonephritis and urinary disease the distribution of the test topic in the general population cor-
take a second place. In some cases, the disease may be asymp- responds to the normal probability law).
tomatic in a hidden form, and requires detailed diagnosis and The dynamics in morbidity and prevalence of these diseases
treatment (20). in general internal pathologies was analyzed with using Abso-
lute Increase (ICR) and Growth Rate (GDP). Linear regres-
2. BOBJECTIVE sion models were used to estimate prevalence and morbidity,
Therefore, the aim of the study is to examine the role of in- the slope angle of the regression line was calculated (k coeffi-
ternal diseases in the overall incidence of the inhabitants of cient; the incidence and morbidity dynamics) with the help
the Republic of Kazakhstan. of Student’s t-test the statistical significance of the difference
k from zero was assessed: the presence of the dynamics was
3. MATERIAL AND METHODS considered statistically significant at p<0.05.
A statistical analysis of medical documentation of medical
institutions of the Republic of Kazakhstan was conducted in 4. RESULTS AND DISCUSSION
the period from 2019-2021. The most common diseases of the In the process of research were established that diseases
internal organs, which lead to high rates of mortality and dis- of the internal organs play a leading role in the formation
ability, were selected for statistical processing. These diseases of mortality, disability and general morbidity of the inhabi-
included: diseases of the cardiovascular system, diseases of tants of the Republic of Kazakhstan. The most common pa-
the endocrine system and metabolism disorders, respiratory thology of the internal organs include diseases of the cardio-
diseases, diseases of the gastro-intestinal tract and the uri- vascular system, diseases of the endocrine system, diseases of
nary system. Data on the number of patients with previously the respiratory system, diseases of the organs of the digestive
diagnosed or newly diagnosed diseases of internal organs are system and diseases of the urinary system. The cardiovascular
taken from form № 12 “Information about the number of dis- disease is the largest social and medical problem among all in-
eases registered in patients living in the medical organiza- ternal diseases; it is the leading cause of mortality in the world.
tion’s service area” for 2019-2021. The most common pathologies are considered ischemic heart

288 ORIGINAL PAPER / ACTA INFORM MED. 2023, 31(4): 287-291

 Propedeutics and Problems of Internal Diseases

disease (disease of blood vessels supplying the heart muscle), Kazakhstan with complaints of cardiac pathology did not
diseases of the cerebral vessels (disease of blood vessels sup- seek medical attention. And only 24% of citizens visited out-
plying the brain) and peripheral arteries (blood vessel disease patient-and-polyclinic institutions after the appearance of the
supplying blood to the hands and feet), rheumatic carditis, ar- first symptoms of the disease. The combination of the above
terial hypertension, blood strokes, infarctions, valvular heart factors affects the frequency of the population seeks med-
diseases and more. ical attention and, consequently, the extent to which internal
Every year about 1.5 mln cases of cardiovascular diseases diseases are detected. Endocrine pathology is an equally
are registered in the Republic of Kazakhstan, including more pressing problem of internal diseases. The endocrine system
than 100 ths cases that were detected for the first time. The pa- is one of the most important systems in the human body; the
thology of the cardiovascular system (CVS) is the first among normal growth, development and functioning of the body are
adults in Kazakhstan (51.4 %) and the third among primary impossible without its coordinated work. Endocrine organ
morbidity (9.2%). Arterial hypertension (PAH) (39.8%), cor- dysfunction leads to the development of various pathologies.
onary heart disease (CHD) (31.4%) and cerebrovascular pa- The most common endocrine organ diseases identified in Ka-
thology (14.9%) predominate in the disease structure of the zakhstan were diabetes mellitus (39.5%) and thyroid gland
cardiovascular system. The prevalence of CVS is 53,3; 39,2 (36.2%).
and 14.9 %, respectively. The most rapid increase in the prevalence rate of endocrine
Analysis of the dynamics of the prevalence of CVS dis- diseases was observed during 2019-2021. From thyroid gland
eases in the population of Kazakhstan showed that during pathology, hypothyroidism was detected in 64.2%, thyroid-
2019-2021 this indicator increased by 125.4 cases per 10 ths itis – 56.8%, nodular goiter – 47.7% of residents of Kazakh-
of adults. (from 6980.4 to 7105.8). The dynamic changes in stan. During the study period, there is a tendency to increase
the incidence of CVS are due to the high prevalence of CHD, the prevalence rate of type II diabetes mellitus, in contrast to
which increased by 45.5 cases from 2650 to 2695.5 cases per the decrease in the detection rate of insulin dependent dia-
10 ths of adults. Arterial hypertension (PAH) is one of the betes mellitus (62.6% against 46.7%). The DM is character-
most common abnormalities of CVS. In addition, PAH is a ized by a large number of vascular events. Timely detection
risk factor for other diseases of the internal organs. In indi- and high-quality regular medical check-up of patients with
viduals with high BP, 3-4 times more likely to develop CHD DM reduces the risk of developing events of this pathology.
and 6 times more likely to develop brain circulation disor- The proportion of DM patients with vascular events of var-
ders. Therefore, timely detection of patients with PAH and ef- ious localizations remains high – 38.2% (2019 – 30.6%). The
fective control of blood pressure are important areas of sec- DM is not only a medical problem but also a social problem,
ondary prevention of diseases of CVS, prevention of prema- because it affects various organs and systems, often resulting
ture mortality and disability of the population. in disability. In 2021, the proportion of diseases of the endo-
As a result of preventive examinations, the organization of crine system in the structure of primary disability of the adult
health days in the region has led to an increase in the rate of population of Kazakhstan was 5.6%, of which 78.2% was at-
detection of PAH among the population. During 2019-2022 tributable to the DM as a cause of permanent disability. The
the prevalence of PAH among the adult population of Ka- reducing trend in the frequency of primary registration of
zakhstan has been stable at 31.5%, which corresponds to data DM (from 67% to 45.5%) is a cause for concern. The type II
from special epidemiological studies of the scientific centre. diabetes mellitus represents 94.5% of all first diagnosed cases
The trend towards a decrease in the prevalence of cerebro- of DM in Kazakhstan. There was a delay in the detection of
vascular pathology (by 3%, from 560 to 546.9 per 10 ths of DM –one in five (20.7%) of the first cases of DM is diagnosed
adults) has been determined. In the same way, it can be ex- at a stage of the disease where sequelae have already devel-
plain the tendency to decrease the frequency of strokes and oped.
stabilize the frequency of acute myocardial infarctions during Due to unhealthy lifestyle in 37% of residents of Kazakh-
2019-2021. stan, metabolic syndrome (MS) was detected. The prevalence
In order to reduce mortality and disability, patients with rate of this syndrome is 18% in people over 30, 34% over 30
cardiovascular diseases are subject to periodic health exam- and 44% over 50. Obesity is the leading risk factor for MS
ination. Only 36.4% of patients with this pathology were over- development. According to our results, the prevalence rate
come by periodic health examination, 62.6 % of whom had of obesity among the population of Kazakhstan was 34%,
PAH, 57.5% had CHD, and 49.4% had cerebrovascular pa- among men 20.2 % and among women 43.5%. The second
thology. These indicators show that there are significant dis- most common risk factor was metabolic imbalance, 58.3%
advantages in the organization of regular medical check-up (hypercholesteremia and hypertriglyceridemia). The pres-
of patients with CVS pathology and the necessity of outpa- ence in patients MS arterial hypertension closes the triple –
tient care improvement for these patients. During 2019-2021 50%. Therefore, our research has shown that one of the main
we have detected a reducing trend in the number of primary risk factors for the development of MS is overweight.
registrations of CVS diseases (from 54.3 to 49.8%), due to in- Among the constellation of internal diseases, diseases of
adequate organization of preventive measures in the region. the respiratory system occupy a leading place in the struc-
The frequency of patients’ visits to outpatient-and-polyclinic ture of general morbidity, to which WHO constantly draws
institutions is significantly affected by the patient’s subjective attention. According to WHO, approximately 600 mln people
attitude towards his/her state of health, as well as the level of worldwide suffer from respiratory diseases. In Kazakhstan,
organization and availability of medical care. the prevalence rate of chronic obstructive pulmonary disease
According to anamnestic data, only 34.2% of residents of amount to 14.2% among smokers, 3.3% are non-smokers, and

ORIGINAL PAPER / ACTA INFORM MED. 2023, 31(4): 287-291 289

Propedeutics and Problems of Internal Diseases

6.9% are people who have not smoked before. It is known that stress, diabetes mellitus, excessive use of effervescent bever-
4-6% of men and 1-2% of women suffer. The pulmonary dis- ages and coffee, low physical activity, infectious affect of the
ease is the fifth leading cause of mortality, it is being noted the body.
increase of this disease. The prevalence rate of diseases of the gastro-intestinal tract
The most common respiratory diseases in Kazakhstan increased in 2 years by 3 % – from 2856.8 to 2913.7 cases per
are bronchitis (71.8%), tracheitis (54.1%), bronchial asthma 10 ths of the adult population of Kazakhstan. In this class
(47.4%), pneumonia (44.1%). Acute bronchitis (58.2%) is of diseases, cholecystitis and cholangitis (28.6%), pancreas
prevalent in the structure of bronchitis diseases, as opposed gland disease (17.2%), stomach and duodenal ulcer (7.5%)
to chronic bronchitis – 32.8% of cases. Bronchial asthma is accounted for the largest proportion. The fastest rate during
one of the most common chronic bronchopulmonary no- 2019-2021 the prevalence rate of pancreatic diseases has in-
sology, which is often found in conditions of the primary creased (by 14.9% – from 459.8 to 533 per 10 ths of adults).
medical assistance delivery. It is the local practitioner are the Only half of the patients with gastrointestinal pathology
first to whom patients seek medical attention with a certain (52.1 per cent) were found under regular medical check-up
range of respiratory symptoms and who can suspect and diag- in 2019-2021, including 85.5% with stomach ulcers and du-
nose chronic diseases such as BA, chronic obstructive pulmo- odenal ulcers, 48% with cholecystitis, 74.9% with hepatic cir-
nary disease (COPD), pneumonia. The overall incidence of rhosis, 70.2% with chronic hepatitis, 51% with pancreas gland
chronic obstructive pulmonary disease (COPD) among the pathology. Intestinal canal pathology in the form of irritable
adult population of the Republic of Kazakhstan is 56%, ex- bowel syndrome was found in 40.5% of residents of Kazakh-
cept but a growth rate of 17.9% over three years (2019-2022). stan.
COPD is the only therapeutic disease mortality from which For the period 2019-2021. There is a reducing trend in the
has not decreased, despite preventive and curative measures. frequency of primary detection of almost all the clinical en-
There was a significant increase in the incidence of pneu- tity that form this class of diseases, with the exception of pan-
monia against the background of the COVID-19 pandemic in creas gland pathologies, the incidence of which has remained
2020-2021 – 3.5 times compared to 2019 (1676.15 per 100 ths almost unchanged. The final pathology of the internal organs
of the population), including the viral pneumonia - 65 times are diseases of the urinary system. The increase in the level of
(783.08 per 100 ths of the population). Pneumonia accounted this pathology occurs under conditions of reduced quality of
for 41,7% in the structure of mortality from respiratory dis- life and ecological disadvantage of the studied region. Among
eases in the Republic of Kazakhstan in 2019-2021; mortality the most common diseases of the urinary system are urinary
was 21.5 per 100 ths of the population. COVID-19 is also tract infections (UTI). UTI is a collective term that combines
reason of the high mortality rate. Early detection of respira- all infectious and inflammatory diseases of the organs of the
tory system pathologies is the prevention of the development urinary system (cystitis, pyelonephritis, urethritis).
of serious complications such as oncology. The prevalence rate of cystitis in the Republic of Kazakh-
According to the forecasts of experts of the World Health stan is 498 cases per 100 ths of the population. Statistics show
Organization, diseases of the digestive organs will occupy that one in two women has experienced this problem at least
one of the leading places in the structure of morbidity of the once in her life. The incidence of cystitis in adult men is very
population on a par with cardiovascular pathology in XXI low - 6-7 episodes per year for 10 ths of men aged 25-55 years.
century (7). Symptoms of gastro-intestinal tract diseases are Among the infectious kidney damage, there is pyelonephritis.
very common and have significant economic and social con- The prevalence rate of which is 390-450 cases per 100 ths of
sequences. It is estimated that 10.5% of the population in Ka- the population. In 73% of cases, pyelonephritis develops be-
zakhstan suffer from gastro-intestinal tract diseases, with fore the age of 40, and women are 2-5 times more likely to
prevalence rate reaching 34% among persons aged 65 and have the disease than men. The incidence of the disease is
older. At the same time, there is a grading of sexual differences gradually equalizing between men and women at age 60.
in the frequency of gallstone disease, gastric ulcers and duo- The development of urinary stone disease is possibly
denal ulcers; there is a widening of the age boundaries of the against the background of general disorders in the human
formation of pathology of the digestive organs; there is a clear body. The leading triad of clinical symptoms of this disease is
trend towards an increase in the incidence of pathology of the lumbar pain (72%), urination abnormalities (67.9%) and renal
upper gastrointestinal. Kazakhstan has a high mortality rate colic - an attack of violent and severe lumbar pain. Hypercal-
from this pathology (7.6 %), which is predominant in both the ciuria (an excessive amount of calcium in urine caused by os-
EU and CIS countries; in particular, mortality from hepatic teoporosis – removal of calcium from the bones), chronic in-
diseases related to alcohol abuse is 5 times higher than in the fectious and inflammatory processes in the urinary tract, uro-
EU (19). dynamics disorders (urine stagnation in the urinary bladder)
Symptoms of gastro-intestinal tract diseases are very di- and inadequate fluid intake lead to urolithiasis (another term
verse and depend on affected organ. Common symptoms as- urinary stone disease). The incidence of urinary diseases has
sociated with digestive system pathologies include: abdom- increased almost 1,5 times over the past two years. Only 34%
inal pain of varying intensity and localization, absence of of patients with the urinary system pathology were exposed
appetite, regurgitation and epigastric burning, sicchasia and to regular medical check-up in 2018-2021. This shows that
vomiting, weight loss, bowel disorders, general weakness, gas- there are significant disadvantages in the organization of reg-
eous distention. The main causes that provoke the develop- ular medical check-up of patients with diseases of the urinary
ment of pathologies of the gastro-intestinal tract: overweight, system.
smoking, alcohol abuse, unhealthy diet and diet violation,

290 ORIGINAL PAPER / ACTA INFORM MED. 2023, 31(4): 287-291

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