Background: Acute pancreatitis is a major issue in surgical practice, with high complications and mortality rates. It severely affects patient quality of life and places a significant economic strain on healthcare systems, making its study crucial for public health. This study aims to analyze trends in acute pancreatitis incidence in the Akmola region from 2009 to 2022.
Materials and methods: The study is based on a retrospective analysis of data from the Ministry of Health of the Republic of Kazakhstan according to the International Classification of Diseases-10 code: K85. Methods of health statistics and time series analysis were used to assess the dynamics of morbidity.
Results: There was an increase in the total number of hospitalizations from 865 cases in 2009 to 1.061 in 2022. The percentage of surgical interventions decreased from 5.7% to 4.2%, while the share of conservative treatment increased to 95.8%. The mortality rate among operated patients was 20.4% in 2019 and increased to 33.3% in 2022. The incidence of hospitalization increased from 117.1 per 100000 population in 2009 to 144.6 per 100000 population in 2022, with a decrease in the rate of late visits from 42.6 to 36.1 per 100000 population, respectively.
Conclusion. The study highlights the need to improve medical approaches to acute pancreatitis in the Akmola region. The results indicate the critical importance of early diagnosis and timely hospitalization to reduce complications and mortality. Additional research is needed to develop more effective clinical protocols.
Gastrointestinal bleeding (GIB) remains a significant cause of hospitalization and mortality worldwide, including in Kazakhstan. This retrospective study analyzes the incidence, treatment outcomes, and mortality of GIB in the Republic of Kazakhstan over a 10-year period (2014–2023) using data from 101,703 patients across 254 medical institutions. The study differentiates between non-variceal and variceal GIB, highlighting a 24.5% increase in non-variceal cases and a 45.1% increase in variceal cases due to higher rates of acute ulcerative lesions and liver cirrhosis, respectively. Men were disproportionately affected, accounting for 69.3% of cases, with the highest incidence in the 18-59 age group. Despite a 27.8% increase in GIB cases, overall mortality decreased from 7.8% in 2014 to 5.0% in 2023, largely due to advances in endoscopic hemostasis and critical care management. The mortality rate for non-variceal GIB decreased to 3.0%, while variceal GIB decreased from 23.8% to 13.6%. The results underscore the need for improved prevention, especially in high-risk populations using NSAIDs and anticoagulants, and in those with chronic conditions such as liver disease.
B.B. Baimakhanov, А.А. Shokebayev, K.M. Kanatov, D. Baiguissova, A. Abilseit, A. Kalibekova, A. Markelova, Y. Kalshabay, A. Mukhamedzhanova, N.Т. Orynbassar, T.A. Nazar
Background. The sensitivity and specificity of multislice computed tomography is of great importance in the detection of gastric and esophageal cancer, and also expands the possibilities of preoperative staging using computed tomography.
Materials and methods. A retrospective study at the A.N. Syzganov National Scientific Center of Surgery from 2022 to 2024, included 121 patients: 48 females (39.6%), 73 males (60.3%), with an average age of 60 years. Sensitivity, specificity were calculated to assess diagnostic accuracy. Esophageal and gastric cancer staging via computed tomography was done using the TNM classification and compared with esophagogastroduodenoscopy, pathohistological examination results.
Results. The sensitivity of computed tomography was 96.49%, the specificity was 85.71%. Esophagogastroduodenoscopy showed a sensitivity of 79.75%, specificity of 95.24%.
Conclusion. Computed tomography is highly informative, sensitive in detecting esophageal and gastric cancer, with superior diagnostic accuracy compared to esophagogastroduodenoscopy. Given the detection of esophageal and gastric cancer at T2 and T3 stages, along with the presence of distant metastases in some patients, implementing protocols for early diagnosis is advisable.
Kidney cancer with inferior vena cava thrombosis represents a complex condition that requires meticulous surgical treatment. The most common malignant kidney tumor in adults is renal cell carcinoma. The incidence of renal cell carcinoma has increased recently due to the enhanced resolution of imaging techniques. Most cases are discovered incidentally. Renal cell carcinoma's ability to spread to vascular systems without developing metastases is a significant feature. Venous involvement can manifest as a tumor thrombus in the renal vein on the affected side, potentially extending to the right atrium or the inferior vena cava. The risk of having a tumor thrombus in the renal vein or inferior vena cava ranges from 2-10%, with the right side being more frequently affected. The level of tumor thrombus extension can reach the hepatic veins and even the right atrium. This condition thus requires a multidisciplinary approach and a rational surgical strategy, focusing on achieving favorable outcomes in such complex cases.
In this clinical case, stenosis of a renal artery of transplant was detected in time by angiography using dynamic Doppler ultrasound control. The chosen treatment method allowed the restoration of arterial patency and thus renal graft function in the shortest possible time and with minimal trauma. However, due to the high risk of restenosis in the plastic area, continuous dynamic ultrasound monitoring and monitoring of the patient's creatinine level are required. The purpose of this presentation is to present a case of early detection of a postoperative complication by Doppler ultrasound, which made it possible to prevent vascular dysfunction, often leading to loss of the renal graft. Materials and
Methods. In this article, we report a case of timely detection of renal artery stenosis by ultrasound in a patient, followed by confirmation by angiography and restoration of renal artery and graft function by endovascular balloon angioplasty. All major hemodynamic changes in Doppler ultrasound parameters characteristic of renal artery stenosis are described in this article.
Results. Dynamic Doppler ultrasound monitoring and angiography allowed early detection of the described complication of renal transplantation. The optimal choice of treatment tactics allowed the restoration of arterial patency and renal graft function in the shortest possible time, thus preventing graft rejection.
Conclusion. Our clinical case demonstrates the importance of the monitor in the assessment of renal perfusion. The outcome of kidney transplantation largely depends on the successful resolution of these issues, which determines the relevance.
Keywords
kidney transplant, complication, stenosis, survival, restoration of function, angioplasty, Dopplerography of kidney vessels, anastomosis
Background. In adult living donor liver transplantation with the right lobe, the venous outflow of the anterior sector is typically restored during the procedure to form a neo-middle hepatic vein. Restoring the middle hepatic vein for the drainage of the anterior sector is critically important for achieving optimal graft function. Various conduits are used for this reconstruction, such as synthetic and biological grafts (e.g., the recipient's portal vein, vessels from a deceased donor, and modified great saphenous vein). However, the selection of the best option remains a topic of discussion. This study evaluates the effectiveness of using biological and synthetic grafts for MHV reconstruction.
Materials and methods. A retrospective analysis of outcomes was conducted in patients who underwent transplantation of a modified right liver lobe due to end-stage liver disease from 2011 to 2024.
Results. A transplantation of modified right liver lobes was performed on 80 patients. In 69 cases, the reconstruction of the hepatic veins was carried out using a biological graft, while in 11 cases, a synthetic graft was used. Statistically significant differences were noted in mortality and the postoperative period. No significant differences were found in the frequency of intraoperative complications.
Conclusion. Our study demonstrates that the use of a biological graft for the reconstruction of the hepatic veins of segments 5 and 8 is more effective than the application of a vascular prosthesis.
Background. Chronic heart failure is a major global health issue. As a complication of most cardiovascular diseases, it affects 4% of the population. Heart transplantation is the gold standard in the treatment of patients with end-stage heart failure. Objective of the study was to evaluate early and long-term outcomes of heart transplants performed at the Heart Center University Medical Center (Heart Center) over a 10-year period.
Materials and methods. Cross-sectional study was conducted from 2012 to 2022, 86 orthotopic heart transplants were performed at the Heart Center. The analysis of the obtained results was conducted retrospectively.
Results. From August 2012 to December 2022, 114 patients were on the waiting list for heart transplantation. Of these, 86 (75.4%) patients underwent transplantation; 10 (8.7%) patients were excluded. Among the 86 patients, 49 (56.9%) had previously undergone cardiac surgery. Of these, 42 (48.8%) had a left ventricular assist device implanted earlier, 3 (3.4%) had a fully artificial heart, and 2 (2.5%) were on temporary mechanical support (central veno-arterial Extracorporeal membrane oxygenation). Hospital mortality was 8 (9.3%) recipients. In 2.7% of cases, the cause of death was an acute cerebrovascular accident on the second day post-surgery. Postoperative renal dysfunction was noted in 28 (32.5%) patients. An analysis of all performed heart transplantation cases showed a 30-day survival rate of 94%, a 1-year survival rate of 84.3%, and a 5-year survival rate of 64.7%.
Conclusion. In the hospital period and the first 6 months after heart transplantation, infectious-septic complications were predominant, whereas in later periods, rejection reactions were more common.
Trauma remains one of the leading causes of mortality worldwide, particularly among the young population. A significant number of people die within the first 48 hours due to acute cardiovascular pathology. Cardiac injury is a significant predictor of adverse outcomes following multiple trauma, associated with poor prognosis and prolonged hospitalization. Systemic elevation of cardiac troponin levels is linked to survival, the severity of trauma, and catecholamine consumption in patients after multiple trauma. Clinical signs of the so-called "commotio cordis" include arrhythmias, such as ventricular fibrillation and sudden cardiac arrest, as well as wall motion abnormalities. In trauma patients with inadequate hypotension and a lack of adequate response to fluid therapy, the possibility of cardiac injury should be considered. Therefore, a combination of electrocardiography, echocardiography, and the systemic determination of cardiomyocyte injury markers, such as troponin, appears to be an appropriate diagnostic method for identifying cardiac dysfunction after trauma. However, the mechanisms of post-traumatic cardiac dysfunction continue to be actively studied. The aim of this review is to discuss cardiac injury following trauma, focusing on the mechanisms of post-traumatic cardiac dysfunction related to inflammation and complement activation. The review illustrates the causal relationship between cardiac dysfunction and blunt chest trauma, multiple trauma, and hemorrhagic shock.
Background. Obesity has turned into a worldwide epidemic with increasing prevalence that is associated with excess mortality and morbidity. Obesity is a risk factor for many diseases including cardiovascular disease, the leading cause of death worldwide. Aim of the study was conducted to evaluate the association of obesity with dyslipidemia and hypertension among patients with low, medium and high risk of developing cardiovascular diseases
Materials and methods. Cross-sectional study was conducted at the tertiary hospital in Astana, Kazakhstan. In total 216 participants included in this study.
Results. Student’s t test was performed to elicit association between body mass index and lipid panel analysis such as cholesterol, triglycerides, low-density lipoprotein and high-density lipoprotein, where all p values found to be <0.0001. Consequently, there is a statistically significant association, and increased body mass indexis linked with higher lipids in the body.Obesity increases risk of atherosclerosis 2.81 times in comparison those who have a normal body mass index. Obesity increases risk of coronary angioplasty with stenting 1.91 times in comparison those who did not undergo stenting procedure.
Conclusion. Atherogenic dyslipidemia is extremely common in obesity, both in the presence and in the absence of severe insulin resistance, and is probably the main factor in the increased risk of cardiovascular diseases in these people
A stroke is an emergency medical condition, commonly referred to as a cerebrovascular accident, occurs when the blood supply to the brain is interrupted, depriving brain tissue of oxygen and essential nutrients. This interruption can lead to rapid neurological impairment and, if not treated promptly, permanent brain damage or even death. Stroke is primarily categorized into two types: ischemic, resulting from arterial blockage, and hemorrhagic, caused by a ruptured blood vessel. Conditions such as acute cerebral circulatory disorder, atherosclerosis, and carotid artery stenosis are strongly associated with an increased stroke risk. Understanding these underlying factors is crucial for effective prevention, early detection, and management of stroke. Globally, stroke ranks as the second lead in cause of disability and mortality, disproportion at early affecting low-and-middle - income countries. Efforts in stroke prevention emphasizes the significance of early detection, management, promoting healthy lifestyles, and implementing legislative measures. The healthcare costs associated with stroke are substantial and projected to grow significantly. Socioeconomic factors and adverse working conditions also influence stroke incidence. Advancements in surgical revascularization techniques, such as carotid endarterectomy and stenting, have demonstrated efficacy in reducing stroke risk. Continuous research and development of optimal treatment strategies and monitoring protocols are essential for improving stroke outcomes and mitigating its global burden.
Background. Pulmonary vein isolation is the cornerstone of catheter-based treatment for atrial fibrillation. Cryoballoon ablation offers an effective and reproducible method for pulmonary vein isolation, yet recurrence of arrhythmias remains a challenge. Despite advances in catheter technologies, the role of altered pulmonary vein anatomy as a factor for atrial fibrillation recurrence is poorly studied. Materials and
Methods. This prospective study included 465 patients with paroxysmal atrial fibrillation who underwent cryoballoon ablation. Pulmonary vein and left atrial anatomy were evaluated using multislice computed tomography. Patients were followed for 24–48 months to assess atrial fibrillation recurrence and anatomical risk factors. Cox proportional hazard modeling and Kaplan-Meier analysis were used to evaluate predictors of arrhythmia recurrence.
Results. Complete Pulmonary vein isolation was achieved in all patients. During follow-up, 38% of patients experienced atrial fibrillation recurrence. Patients with altered pulmonary vein anatomy, particularly a left common pulmonary vein and additional pulmonary veins, showed a higher rate of recurrence. Cox regression analysis identified left atrial volume index >50 mL/m² and pathological pulmonary vein anatomy as independent risk factors for atrial fibrillation recurrence.
Conclusion. Altered pulmonary vein anatomy is a significant risk factor for atrial fibrillation recurrence following cryoballoon ablation. Comprehensive imaging of the left atrial and pulmonary vein using multislice computed tomography can improve patient selection, reducing the recurrence risk and improving long-term outcomes.
Relevance. Atrial fibrillation (AF) is the most common arrhythmia, which negatively affects the quality of life and significantly increases the risk of thrombosis, strokes and cardiovascular diseases. The pathogenesis of AF is a complex and multifactorial process in which inflammatory and immune mechanisms play an important role. In recent years, special attention has been paid to interleukins, cytokines that regulate the immune response, which may influence the development and maintenance of AF. The study of the role of interleukins in the pathogenesis of AF may provide new perspectives for understanding the mechanisms of the occurrence of this arrhythmia and the development of effective methods of its prevention and treatment. The study aimed to evaluate the influence of interleukins on the pathogenesis of atrial fibrillation and to identify possible mechanisms of their action.
Methods. data concerning the role of interleukins in the pathogenesis of atrial fibrillation were analyzed during the analysis of scientific publications. A systematization of existing studies, including both clinical and experimental data that show a link between the levels of interleukins (IL-1, IL-6, IL-17 and others) and the development of AF was performed. Search methods included analyzing publications in PubMed, Scopus and Web of Science databases over the last ten years and using keywords related to interleukins and AF.
Results. The results indicate that interleukins such as IL-1, IL-6, IL-17 and IL-18 play a significant role in the inflammatory processes associated with AF. Elevated levels of IL-6 correlate with worsening cardiac function and an increased likelihood of developing AF. In addition, IL-1 may contribute to myocardial remodeling, which is a key factor in the pathogenesis of AF. Other interleukins, such as IL-17, are also associated with inflammatory processes affecting cardiac electrical stability. Accumulating evidence suggests that interleukins can affect cellular hypertrophy and fibrosis, leading to changes in cardiac structure and contributing to the development of AF. The inclusion of interleukins in risk prediction models for the development of AF may improve preventive strategies and individualize the treatment of patients at risk.
Conclusion. the analysis shows that interleukins play a key role in the pathogenesis of atrial fibrillation by participating in inflammatory processes and abnormalities in cardiac electrophysiology. Further studies are needed to clarify their mechanisms of action and to develop new therapeutic strategies aimed at reducing interleukin levels and improving the prognosis of patients with AF.
: the aim of this study is to analyze the current advances of CT perfusion in the diagnosis of liver disease. Liver fibrosis is a characteristic feature of chronic liver disease and is confirmed by liver biopsy, which is an invasive method. Morphologic parameters of cirrhosis are evaluated by conventional imaging techniques such as ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI). Additional studies of new imaging modalities are needed for earlier diagnosis, surveillance and accurate treatment, CT perfusion has several advantages by examining the arterial and venous blood flow of the liver, which gives a more complete picture of early functional changes in the liver. Despite the advantages of this method, the results of postprocessing in different stages of fibrosis and etiology of its development are not fully understood.
