K. Abzaliyev

https://orcid.org/0000-0003-

Articles found: 38

  • Bile Duct Atresia. Literature Review (Issue № 3, 2025)

    Biliary atresia, Z.U. diagnosis, Bakhytzhan Shirtayev, Kurbanov Doniyor, Azadbekova Zarnigora, Subhash Gupta
    2025-09-30
    96–114
    Abstract

    Biliary atresia is a rare but severe congenital disease characterized by progressive obstruction of the extrahepatic and intrahepatic bile ducts and leading to cholestasis, fibrosis and cirrhosis of the liver in newborns. Epidemiological data demonstrate the variability of prevalence in different regions, which indicates the possible influence of genetic and environmental factors. The pathogenesis of the disease remains the subject of active study and includes the interaction of immune, viral and molecular mechanisms leading to damage to the bile ducts. Clinical diagnosis is difficult due to non-specific symptoms such as jaundice, light feces, and dark urine, which makes early detection critical to improve outcomes. Surgical intervention, known as Kasai surgery, remains the main treatment method and is aimed at restoring bile outflow, however, a significant proportion of patients eventually require liver transplantation. Current research focuses on the search for biomarkers for early diagnosis, the study of molecular targets, and the development of innovative therapeutic approaches, including immunomodulation and cellular technologies. The literature data emphasize the need for an integrated approach to disease management and further scientific research to improve clinical outcomes.

    Keywords

    Biliary atresia, diagnosis, screening, cytomegalovirus, portoenterostomy, Kasai, liver, transplantation, immunology, immunosuppression

  • Cardiorespiratory Fitness And Its Role In Managing Atrial Fibrillation. A Literature Review (Issue № 3, 2025)

    A. Beisenbayeva, M. Bekbossynova, F. Bekmetova, U. Aleushinova, A. Abdrakhmanov, Ayan Abdrakhmanov
    2025-09-30
    84–95
    Abstract

    Background. Atrial Fibrillation is a prevalent cardiac arrhythmia associated with irregular heartbeats, posing significant health risks. The purpose of the study is literature review seeks to explore the intricate relationship between cardiorespiratory endurance and Atrial Fibrillation, shedding light on how cardiorespiratory parameters can serve as essential markers for assessing physical activity levels.

    Materials and methods. The search was conducted using electronic databases, particularly PubMed, Google Scholar, and Scopus. Titles and abstracts of identified studies were screened for relevance, and full-text articles were reviewed for eligibility. The following keywords were used in the search: atrial fibrillation, cardiorespiratory fitness, maximal oxygen consumption, cardiovascular mortality. The search depth is 25 years.

    Results. Physical activity adherence lowers overall and cardiovascular mortality in Atrial Fibrillation patients. Tailored exercise regimens alleviate Atrial Fibrillation symptoms, improve heart rate control, and enhance well-being. Standardizing cardiorespiratory testing protocols is crucial for consistent comparisons. Various testing methods, including treadmill protocols and cycle ergometers, offer insights into Cardiorespiratory fitness. Differences between treadmill and cycle ergometer outcomes warrant careful interpretation. Normative values vary across populations, influenced by physical activity, geography, genetics, and testing modalities.

    Conclusions. Integrating cardiorespiratory testing into AF management enhances diagnosis and personalized interventions, contributing to a nuanced approach in addressing this prevalent cardiac condition.

    Keywords

    Atrial fibrillation, Cardiorespiratory fitness, Maximal oxygen consumption, Cardiovascular mortality, Ventilatory anaerobic threshold

  • Six-Minute Walk Test As A Tool For Assessing Physical Activity In Patients With Heart Failure (Issue № 3, 2025)

    S. Bekbossynova Makhabbat, R. Kushugulova Almagul, K. Jetybayeva Saltanat, T. Tauekelova Ainur, S. Duisenbina Zhadyra, Aida Zholdybaeva
    2025-09-30
    64–72
    Abstract

    Background. Heart failure is one of the most significant medical problems of our time, which is associated with the increase in the prevalence of the disease over the past decade. The six-minute walk test is a simple, accessible, and informative tool for assessing the physical activity of patients with heart failure. The test results correlate with peak oxygen consumption and can be used to monitor the effectiveness of rehabilitation programs. The aim of the study is to evaluate the effectiveness of the six-minute walk test as a tool for measuring the level of physical activity and functional status in patients with heart failure, and to determine its correlation with clinical indicators and quality of life in this category of patients.

    Materials and methods. In this study, conducted on the basis of the UMC "Heart Center" Astana, Kazakhstan, private institution "National Laboratory Astana", data of patients with heart failure of class I-IV according to a special classification were analyzed. The main objective of the study was to evaluate the effectiveness of the test as a tool for monitoring physical activity and functional status of patients.

    Results. The results showed that the test is a reliable method for assessing the dynamics of physical capabilities and can be used to individualize rehabilitation programs.

    Conclusion. The 6MWT remains an important component of clinical practice, helping to optimize functional outcomes and improve the quality of life of patients with heart failure.

    Keywords

    functional status, quality of life, cardiac rehabilitation, physical activity, six-minute walk test (6MWT), heart failure

  • Periodontitis As A Possible Cause Of Chronic Heart Failure (Issue № 3, 2025)

    Dana Yessimgalikyzy, R. Aipov Baurzhan, R. Kassiyet Nurlan, Aldanysh Zhumazhan, T. Taukelova Ainur, K. Saltanat, Islambek Laiskanov, Aliya Sailybayeva, S. Bekbosynova Makhabbat, R. Kushugulova Almagul
    2025-09-30
    56–63
    Abstract

    Background. The objective of this study was to investigate the prevalence of periodontitis in patients with chronic heart failure, as well as to characterize the microbiological profile of periodontitis across different chronic heart failure phenotypes. The objective is to analyze the link between oral health and heart disease.

    Materials and Methods. A cohort of 98 chronic heart failure patients (mean age 62.22 ± 8.62 years, 69 men) was assessed through comprehensive cardiological and periodontal examinations. Patients were categorized into heart failure with reduced ejection fraction, mildly reduced ejection fraction, and preserved ejection fraction. Periodontal parameters, including probing pocket depth, clinical attachment loss, and bleeding on probing were evaluated. Microbiological and statistical analyses were conducted.

    Results. Severe periodontitis (Stage C) was identified in 30% of patients, while 48% had moderate periodontitis (Stage B). Patients with chronic heart failure with reduced ejection fraction exhibited the highest prevalence of severe periodontitis, with a significant correlation between increased probing pocket depth and reduced ejection fraction. Candida species abundance was associated with lower ejection fraction (p≤0.0Y) and advanced periodontitis (p≤0.0X). Elevated NT-proBNP levels (1121.00–7611.00 pg/mL) correlated with Streptococcus mitis prevalence, while C-reactive protein levels (up to 2.35 mg/dL) were highest in patients with Klebsiella pneumoniae.

    Conclusion. The study highlights a strong association between periodontal disease, microbial dysbiosis, and CHF. Findings suggest that oral microbial imbalances, particularly involving Candida, Streptococcus mitis, and Klebsiella pneumoniae, contribute to systemic inflammation and cardiovascular complications.

    Keywords

    dental health surveys, gingiva pathology, heart failure, inflammation, periodontal index

  • Features Of Risk Factors For The Development Of Atherosclerosis-Associated Cardiovascular Diseases In The Kazakhstani Population. Ethnonational Aspect (Issue № 3, 2025)

    Makhabbat Bekbossynova, Tatyana Ivanova-Razumova, Aliya Sailybayeva, Management Board, Kamila Akzholova
    2025-09-30
    43–55
    Abstract

    Background. Atherosclerosis-associated cardiovascular diseases exhibit significant ethnic and regional variability in risk factors. Kazakhstan’s high cardiovascular disease mortality rates necessitate population-specific profiling, particularly given urban-rural disparities and lifestyle differences unique to Central Asia.

    Methods. This cross-sectional study (2023–2024) analyzed 368 Kazakhstani adults stratified by European Atherosclerosis Society risk tiers: low (n=67), high (n=127), and very high risk (very high-risk group, n=174). Assessments included lipid profiles (low density lipoprotein, high density lipoprotein, and apolipoprotein B to apolipoprotein A ratio), lifestyle factors (smoking, diet, physical activity), and residence (urban/rural). Statistical analyses employed multiclass logistic regression (MNLogit) with FDR-adjusted p-values.

    Results. Age (OR=8.01, 95% CI:4.40–14.58, p<0.001), male sex (OR=3.27, CI:1.82–5.88), and smoking (OR=7.19, CI:1.52–34.15) were strongly associated with very high-risk group. Rural residents faced 2.6-fold higher very high-risk group odds (CI:1.52–5.68, p=0.002) versus urban counterparts. Protective effects emerged for physical activity (OR=0.03, CI:0.004–0.32) and female sex (High-Density Lipoprotein: +8.1 mg/dL vs. males, p<0.001). No alcohol association was observed (p=0.836).

    Conclusion. A thorough study of the gender aspect of the development of atherosclerotic pathology is required. Physical activity has a strong protective effect. It is interesting that, according to the comparative analysis of binary variables, rural residents have a higher risk of developing atherosclerosis.

    Keywords

    preventive cardiology, lipid metabolism, urban-rural disparities, Kazakhstan, cardiovascular risk factors, atherosclerosis

  • The Radicality Of Pituitary Adenoma Removal In The Republic Of Kazakhstan (Issue № 3, 2025)

    A. 0XVWDɐQ+, A. Doskaliyev, A. Yelyubayev, A. Teltayev
    2025-09-30
    32–36
    Abstract

    Background. Pituitary adenoma is a common tumor of the chiasmosellar region. By hormonal activity, pituitary adenoma’s are classified as somatotropinomas, non-functioning, prolactinomas, corticotropinomas, and mixed types. Treatment tactics vary by type. Objective: To assess radicality of removal of different pituitary adenoma types in patients operated.

    Materials and methods. Retrospective analysis of 929 patients (721 — endoscopic transnasal approach) treated at JSC "National Centre for Neurosurgery" between 2010–2022. Clinical data and magnetic resonance imaging findings were evaluated.

    Results. Significant differences in “Extent of Resection” were found among pituitary adenoma types. The highest rate of total resection occurred in mixed tumors compared to prolactinomas (76.5% vs 50%). Subtotal removal was seen in 23.5% of mixed tumors, none had partial resection. Prolactinomas showed total removal in 50%, subtotal in 41.9%, partial in 8.1%. Conservative resection of prolactinomas is linked to their high sensitivity to medical therapy, enabling full recovery with dopamine agonists postoperatively. More radical removal of mixed pituitary adenoma’s is justified by their aggressive behavior and relative drug resistance.

    Conclusion. Extent of resection correlates with pituitary adenoma type. Lower radicality in prolactinomas reflects their benign course and responsiveness to drugs, whereas mixed pituitary adenoma’s require aggressive surgery due to severe hormonal disturbances. Greater radicality should be pursued when possible while preserving quality of life. The transnasal endoscopic approach remains the safest and most effective surgical method for pituitary adenoma’s in Kazakhstan, as confirmed by high total resection rates and low postoperative complications.

    Keywords

    pituitary adenoma, transnasal, endoscopic surgery, Kazakhstan, neurosurgery

  • Improving The Organization Of Early Diagnosis Of Manifestations Of Microangiopathy To Prevent The Risk Of Complications (Issue № 3, 2025)

    B. Sandybek Alibek, I. Akhmetov Ualikhan, B. Popova Tatyana
    2025-09-30
    25–31
    Abstract

    Background. Microangiopathy is a heterogeneous group of pathological conditions characterized by damage to small-caliber blood vessels, leading to impaired microcirculation and subsequent disruption of trophic, gas exchange, detoxification, and immune functions. It frequently develops in diabetes mellitus, arterial hypertension, systemic autoimmune, infectious, and neurodegenerative diseases. Untimely detection of microangiopathic changes significantly increases the risk of severe complications such as diabetic retinopathy, nephropathy, neuropathy, cognitive impairment, stroke, and dementia.

    Material and methods. A retrospective analysis was conducted using brain magnetic resonance imaging data obtained on a 1.5 Tesla General Electric scanner at Clinical Hospital No. 5 in Almaty from 2022 to 2024. Patient records were evaluated for the presence and severity of microangiopathic changes according to the Fazekas scale.

    Results. Among 1,814 patients who underwent brain magnetic resonance, pathological changes were detected in 58% of cases, of which 79% were of a microangiopathic nature. Early-stage changes (Fazekas 1) accounted for 57% of cases, suggesting that detection often occurs before severe structural damage develops. Advanced microangiopathy (Fazekas 2–3) was observed in the remaining cases, indicating the need for closer clinical monitoring and targeted intervention.

    Conclusion. The findings demonstrate the high prevalence of microangiopathy among patients undergoing brain magnetic resonance in Almaty. Early detection through neuroimaging provides an opportunity for timely preventive and therapeutic measures, potentially reducing the risk of severe neurological complications and improving patient outcomes.

    Keywords

    —

  • Clinical And Prognostic Significance Of Intra-Abdominal Pressure In Choosing A Surgical Strategy For Gastroschisis In Newborns (Issue № 3, 2025)

    N. Bissaliyev Bauyrzhan, A. Tsap Natalya, V. Sarsenova Valentina, B. Tussupkaliev Assylbek, T. Baubekov Zhenysbek, Z. Abdullayeva Gulzhamal, V. Li Dmitriy, Nurbakyt Zh. Zhaksybayeva
    2025-09-30
    18–24
    Abstract

    Background. Gastroschisis is a congenital defect of the anterior abdominal wall in newborns, characterized by the evisceration of bowel loops without a protective sac. Timely and appropriate abdominal wall closure is essential for favorable outcomes.

    Objective: To evaluate the clinical and prognostic significance of intra-abdominal pressure monitoring for determining the optimal surgical strategy in newborns with gastroschisis.

    Materials and Methods. A retrospective cohort study was conducted on 32 newborns with gastroschisis treated in two tertiary centers in Kazakhstan and Russia from 2015 to 2025. Patients were allocated into two groups based on intraoperative intra-abdominal pressure values: Group 1 (n=21) underwent primary fascial closure using the Elective Delayed Midgut Reduction technique; Group 2 (n=11) received staged silo-assisted closure. intra-abdominal pressure was measured intravesically, and a threshold of 22–24 cm H₂O was used to guide the surgical decision. Clinical outcomes included duration of mechanical ventilation, total parenteral nutrition, ICU stay, hospital stay, complication rate, and mortality. Statistical analysis was performed using the Mann–Whitney U test (p < 0.05).

    Results. Group 1 had significantly better outcomes, including shorter durations of mechanical ventilation (6 vs. 13 days, p = 0.01), ICU stay (12 vs. 20 days, p = 0.01), parenteral nutrition (14 vs. 22 days, p = 0.04), and lower mortality (4.8% vs. 27.3%, p = 0.03). Group 2 showed a higher complication rate, especially adhesive obstruction and sepsis.

    Conclusion. Intraoperative intra-abdominal pressure measurement is a valuable tool for guiding surgical strategy in gastroschisis. An individualized approach based on physiological parameters improves safety and outcomes in neonatal surgical care.

    Keywords

    gastroschisis, intra-abdominal pressure, infant, newborn, surgical wound closure, abdominal compartment syndrom

  • Acute Liver Failure On The Background Of Chronic Liver Disease Due To Hepatitis Virus Reactivation (Issue № 3, 2025)

    Bolatbek Baimakhanov, Shokan Kaniyev, Maxat Doskhanov, Almagul Jumabaeva, Zhambyl Ospan, Milliyenium Maulen, Ainur Aftandilkyzy, Magzhan Tursynbay
    2025-09-30
    4–9
    Abstract

    Today, hepatitis B virus-associated acute liver failure remains the leading cause of liver failure (44% mortality in Asia and 41% in the United States). Studies show that among patients with hepatitis B-associated cirrhosis, acute liver failure develops in 10-20% of cases. Acute liver failure on chronic liver disease is a potentially reversible syndrome that occurs in patients with cirrhosis or chronic liver disease and is characterized by acute decompensation, organ failure, and high short-term mortality. Chronic hepatitis B virus infection is a leading cause of liver morbidity and mortality worldwide. When we talk about hepatitis B, there is a high risk of developing super infection hepatitis D, since hepatitis D remains infectious and can reactivate at very low titers that are not detected using modern analysis methods if HBsAg remains in the blood serum. The interaction of these viruses leads to accelerated progression of fibrosis and cirrhosis of the liver, which significantly increases the risk of developing acute liver failure against the background of chronic.

    In our case, a patient diagnosed with liver cirrhosis as a result of viral hepatitis B with delta agent, class C according to Child–Pugh–Turcotte, MELD-36 points, the patient developed a severe form of acute renal failure, which required emergency intervention, so he was not included in the waiting list for a transplant from a cadaveric donor. His wife became the donor, which is an example of living donation, which provides higher chances of successful recovery due to a shorter waiting time and a lower risk of graft rejection. Timely examination of the donor and recipient, as well as prompt liver transplantation, contributed to a favorable outcome of the disease.

    Keywords

    viralre activation, acute-on-chronic liver failure, liver transplantation

  • Relationship between age-related hypogonadism and symptoms of depression in Kazakh men (Issue № 2, 2025)

    M.* Akkaliyev, D. Berikuly, A. Zhunuspekova, M. Kuderbaev, R. Bazarbekov, M. Imanbayev, S. Bukharieva
    2025-06-30
    59–66
    Abstract

    The study is aimed at determining the relationship between age-related testosterone decline and depression in overweight Kazakh men.

    Materials and methods. In total, 417 men of Kazakh nationality, residents of Semey, Abay region, took part in the case-control study. Of these, 135 men had signs of hypogonadism, and 282 men in the control group had no signs of hypogonadism, which is detected by the Ageing Male Screening "questionnaire for age-related symptoms of depression.

    Results. There is a pronounced correlation between clinically manifest hypogonadism and depression in the studied patient population (rs = 0.766, p<0.001). The level of testosterone is inversely proportional to the severity of depression, i.e., its lower level correlates with more severe depression (rs = -0.402, p < 0.001) of total. Similarly, a trend is observed in the free testosterone-depression correlation (rs = -0.210, p < 0.001), while there is no correlation between signs of depression and the bioavailable testosterone fraction.

    Conclusion. Men naturally protect themselves against depressive disorders with testosterone, but this protection disappears as soon as it drops. Thus, the way the bioavailable testosterone fraction affects depression levels in older men needs further research. Men with age-related hypogonadism and depression who attend an erectile dysfunction clinic form a distinct subgroup of patients. Such a category is to be carefully differentiated by the etiology of depressive disorder and erectile dysfunction.

    Keywords

    age-related hypogonadism, depression, Kazakh men, Beck rating scale, testosterone

  • Social efficiency of introduction of atherosclerosis screening program in Kazakhstan. Systematic review (Issue № 1, 2025)

    M. Bekbossynova, S. Duisekova, A. Zeinoldina, G. Daniyarova, K. Akzholova
    2025-03-31
    72–87
    Abstract

    Background. Atherosclerosis, a major cause of cardiovascular disease, has a significant impact on morbidity and mortality in Kazakhstan. The increasing burden of this disease, combined with a high prevalence of dyslipidemia, underscores the importance of effective screening to reduce associated health risks. The aim of this study is to evaluate the social efficiency of implementing a nationwide atherosclerosis screening program in Kazakhstan and to assess its potential to improve public health outcomes and reduce mortality from cardiovascular disease.

    Methods. A literature review was conducted, and global screening approaches and protocols for atherosclerosis and cardiovascular disease were analyzed for their applicability in the local context.

    Results. Results suggest that targeted and cascade screening programs, particularly those focused on high-risk individuals and familial hypercholesterolemia, are effective in reducing disease incidence and mortality. Implementation of similar protocols in Kazakhstan could improve early detection, allowing for preventive interventions and treatment. The study concludes that a structured, government-sponsored screening program would not only save lives but also provide substantial economic benefits by reducing long-term health care costs associated with cardiovascular complications.

    Conclusion. Screening is the convenient and economically efficient way to prevent atherosclerosis, and its effectiveness is demonstrated by worldwide practice and the history of early disease prevention. However, the effectiveness and social value of screening need to be demonstrated before it can be incorporated into medical practice. If established as a regular practice, widespread population screening could dramatically reduce cardiovascular disease, the leading cause of death worldwide.

    Keywords

    atherosclerosis, dyslipidemia, cardiovascular diseases, lipid profile, screening

  • Survival analysis and characteristics of pancreatic adenocarcinoma based on msct data of 216 cases (Issue № 1, 2025)

    D. Baiguissova, Y. Akhmetov, B. Duisenbayeva, A. Mukhamejanova,, G. Battalova, Y. Kalshabay, A. Kabidenov, A.,, M. Doskhanov Sadykova
    2025-03-31
    46–53
    Abstract

    Background. Pancreatic adenocarcinoma is an aggressive cancer with a poor prognosis and increasing global incidence. Early diagnosis is challenging, as it is often detected at advanced stages. Imaging, particularly contrast-enhanced Multispiral Computed Tomography, plays a crucial role in diagnosing, assessing resectability, and monitoring treatment response. This study aimed to analyze Pancreatic adenocarcinoma characteristics, including tumor location, metastasis, resectability, and postoperative outcomes, using Multispiral Computed Tomography. Methods A retrospective review of 216 Pancreatic adenocarcinoma cases from 20222024 was conducted. All patients underwent bolus contrast-enhanced Multispiral Computed Tomography, and diagnoses were confirmed by histology. Key patient parameters analyzed included age, gender, tumor location, metastases, and surgical outcomes. Results The group comprised 50.9% women and 49.1% men. The majority of tumors were located in the pancreas head (72.2%), followed by the body (13.9%), tail (3.7%), and multiple sites (10.2%) (p<0.05). Metastases were observed in 50% of patients, with the liver being the most common site (p<0.05). Radical surgery was performed in 41 patients (19%), while 66 patients (30.5%) underwent palliative procedures. The mean life expectancy among deceased patients was without surgery 110 days, after radical resections 247 days, after palliative interventions 118 days. Conclusion Pancreatic adenocarcinoma remains a highly fatal disease, particularly at advanced stages. Metastasis significantly worsens prognosis, reducing survival rates. Tumor location influences prognosis, with body and tail tumors having better outcomes. Surgery improves survival, and early diagnosis is critical. Contrast-enhanced Computed Tomography is essential for evaluating pancreatic tumors but should be complemented with other diagnostic methods for enhanced accuracy.

    Keywords

    Pancreatic Adenocarcinoma, Metastases, Survival, Surgical Treatment, Computed Tomography

  • Evaluation of ultrasonic dissection technology in reducing post-mastectomy syndrome rates (Issue № 1, 2025)

    N.M. Dzhantemirova, M.S. Mauletbaev, D.N. Akhmedin, A.T. Bekisheva, A.K. Makishev
    2025-03-31
    37–45
    Abstract

    Background. Post-mastectomy syndrome, characterized by chronic pain, lymphedema, and functional impairment, remains a significant complication following breast cancer surgery. This study evaluates the efficacy of ultrasonic dissection technology in reducing morbidity associated with post-mastectomy syndrome compared with conventional electrocautery during axillary lymph node dissection.

    Methods. A prospective study enrolled 53 female patients (aged 29–81 years) undergoing Madden technique mastectomy, stratified into ultrasonic dissection technology (n=25) and electrocautery (n=28) groups. Primary outcomes included operative duration, intraoperative blood loss, drainage metrics, and 30-day complication rates. Both groups exhibited comparable demographics, with high body mass index prevalence (64% overweight/obese) but balanced intergroup distribution.

    Results. Ultrasonic dissection technology’s cavitational mechanism preserved neurovascular and lymphatic structures, potentially mitigating long-term lymphedema risks. Despite equivalent short-term complication rates, ultrasonic dissection technology enhanced operative efficiency without compromising safety. The ultrasonic dissection technology cohort demonstrated a statistically significant reduction in operative time, p<0.001, attributed to streamlined hemostasis and reduced instrument swaps. Significant differences were observed in drainage volume, blood loss anddrainage duration (p<0.001), overall postoperative complications. Conclusions. Ultrasonic dissection technology represents a promising advancement in oncologic surgery, offering faster procedures and economic advantages while maintaining safety. This study underscores ultrasonic dissection technology’s potential to refine surgical precision and improve postoperative recovery trajectories in breast cancer care.

    Keywords

    mastectomy, ultrasonic devices, axillary lymphadenectomy

  • Correlation between apolipoprotein b/a1 and the risk of metabolic-related fatty liver disease depending on the lipid profile (Issue № 1, 2025)

    M. Bekbossynova, G. Myrzakhmetova, S. Seitkasym, A. Sailybaeva, S. Khamitov, G. Daniyarova, K. Akzholova
    2025-03-31
    29–36
    Abstract

    Background. The aim of this study was to investigate the relationship between the Apolipoprotein B/Apolipoprotein A1 ratio and the risk of metabolically associated fatty liver disease, considering lipid profile variations and determine whether the Apolipoprotein B/Apolipoprotein A1 ratio can serve as an independent predictor of metabolically associated fatty liver disease and its associated cardiovascular risks.

    Methods. A total of 377 patients diagnosed with cardiovascular disease and coexisting metabolically associated fatty liver disease were stratified into high-risk and very high-risk groups based on established clinical and imaging criteria. Lipid profiles, Apolipoprotein B, and Apolipoprotein A1 levels were measured, and their associations with cardiovascular and metabolic parameters were analyzed using correlation and regression models.

    Results. The findings reveal a strong positive correlation between Apolipoprotein B levels and atherogenic lipid markers such as low-density lipoproteins cholesterol and total cholesterol, as well as a moderate correlation with triglycerides. In contrast, Apolipoprotein A1 demonstrated a strong positive association with high-density lipoproteins cholesterol and an inverse correlation with metabolic indicators such as Hemoglobin A1c and glucose, suggesting a potential protective role. The Apolipoprotein B/Apolipoprotein A1 ratio emerged as a more accurate predictor of cardiovascular and metabolic risk than traditional lipid ratios. Furthermore, the Apolipoprotein B/Apolipoprotein A1 ratio was significantly associated with the presence and severity of metabolically associated fatty liver disease, reinforcing its potential utility as a biomarker for metabolic liver disease.

    Conclusion. This study highlights the clinical relevance of incorporating apolipoprotein measurements into the routine assessment of individuals at risk for metabolic and cardiovascular disease.

    Keywords

    Apolipoprotein B, Apolipoprotein A1, metabolic-associated fatty liver disease, cardiovascular disease, lipid metabolism, dyslipidemia, risk assessment

  • Fatty liver disease after pancreatoduodenectomy and total pancreatectomy (Issue № 1, 2025)

    S. Tileuov, A. Dzhumabekov, B. Baimakhanov, M. Doskhanov, S. Kaniyev, J. Ospan, Y. Yenin, M. Tursynbai
    2025-03-31
    20–28
    Abstract

    Pancreatoduodenectomy is the only treatment method for patients with pancreatic head and periampullary region tumors. It is known that some long-lived patients develop exocrine pancreatic insufficiency after surgery. One of the consequences of exocrine pancreatic insufficiency is fatty liver disease, which has been reported to occur in 7.8% to 40.0% of patients after pancreatoduodenectomy. We reported two clinical cases of patients who underwent pancreatoduodenectomy and total pancreatectomy for pancreatic head cancer and intraductal papillary mucinous neoplasm of the main pancreatic duct. After surgery, they developed rapidly progressive fatty liver disease with no history of liver disease, leading to death from liver failure 20 days and 3 months after surgery. Severe malnutrition caused by exocrine pancreatic insufficiency, postoperative eating disorders, and exacerbation of diabetes mellitus were the main factors contributing to the rapid deterioration of the condition. This clinical case highlights the possibility of developing life-threatening fatty liver disease with severe fibrosis after pancreatoduodenectomy and total pancreatectomy. Careful monitoring of liver status, regular nutritional assessment of patients, prophylactic replacement of pancreatic enzymes, and ensuring adequate nutrition are important.

    Keywords

    pancreatoduodenectomy, fatty liver disease, pancreatic cancer, liver failure, exocrine pancreatic insufficiency

  • Clinical case of monostotic fibrous dysplasia in a child (Issue № 1, 2025)

    D. Autalipov, A. Bekpan, N. Sagandykova, M.. Baurzhan
    2025-03-31
    14–19
    Abstract

    Fibrous dysplasia is a rare tumor-like condition characterized by the replacement of normal bone with fibrous tissue, with an etiology of uncertain origin. Diagnosis relies on clinical and radiological data, with biopsies used in doubtful cases. The aim of our study is to demonstrate our experience in working with a rare pathology such as fibrous dysplasia of the pterygoid process. We report a clinical case of isolated fibrous dysplasia affecting the pterygoid process of the left sphenoid bone, treated in the Pediatric Head and Neck Surgery Department of the University Medical Center, Astana, Kazakhstan. The patient, a 15-year-old girl, presented with a diagnosis of fibrous osteodysplasia of the left pterygoid process of the sphenoid bone. As a result of surgical treatment, we did not observe an increase in the tumor during a 3-year follow-up. Diagnosis of some tumors, such as fibrous dysplasia, is difficult and requires modern diagnostic methods. The presence of fibrous dysplasia in the sphenoid bone is a caustic pathology, which makes this clinical case unique. In this case, we used transnasal endoscopic approaches, which demonstrated the effectiveness of the treatment.

    Keywords

    fibrous dysplasia, tumor-like process, children, histiocytosis, bone tissue lesion

  • Genetic determinants of tacrolimus metabolism associated with CYP3A5 in kidney transplantation: a literature review (Issue № 1, 2025)

    A. Aubakirova, I. Madadov, B. Rgebayev, V. Kumar, M. Doskhanov
    2025-03-31
    4–13
    Abstract

    Background. Kidney transplantation is the most effective treatment for end-stage chronic kidney disease, improving quality of life and reducing mortality compared with dialysis. The success of transplantation depends on HLA compatibility, immune sensitization, immune status and immunosuppressive therapy. Tacrolimus, a key immunosuppressant, prevents graft rejection by suppressing T-cell activity and is metabolized by CYP3A4 and CYP3A5 enzymes. CYP3A5 gene polymorphisms influence enzyme activity and tacrolimus metabolism.

    Methods. The review analyzed 46 of 141 publications from PubMed, MEDLINE, Embase, Scopus, and Cochrane Library databases that met the inclusion criteria and focused on the role of CYP3A5 gene polymorphisms in tacrolimus metabolism in renal transplant patients.

    Results. CYP3A5 gene polymorphisms significantly affect tacrolimus pharmacokinetics. Carriers of the *1 allele (expressers) demonstrated accelerated metabolism requiring higher doses, while patients with the *3/*3 genotype (non-expressers) exhibited slower metabolism, allowing for reduced doses but increasing the risk of toxicity, including nephrotoxicity. An analysis of 46 publications and randomized studies confirmed that CYP3A5 genotyping enables personalized tacrolimus dosing. For expressers, genotyping facilitated faster achievement of therapeutic concentrations, while for non-expressers, it reduced the risk of toxic effects. However, long-term differences in clinical outcomes between groups with and without genotyping remain statistically insignificant, emphasizing the need for larger-scale studies to validate the efficacy of this approach.

    Conclusion. CYP3A5 polymorphisms play a key role in the personalization of immunosuppressive therapy. Genotyping optimizes tacrolimus dosing and reduces the risk of rejection and toxicity. Integration of pharmacogenetic testing into clinical practice may improve transplantation outcomes.

    Keywords

    tacrolimus, CYP3A5 gene, kidney transplantation, immunosuppression, genotyping

  • A new perspective on diagnosis: the potential of CT perfusion in chronic liver disease (literature review) (Issue № 3, 2024)

    G. Battalova, D. Baiguissova, E. Kalshabay, A. Mukhamejanova, A. Mukanova, D. Nagimova, A. Kabidenov, B. Abzhaparova, B. Baimakhanov
    2024-09-30
    98–107
    Abstract

    : 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.

    Keywords

    CT perfusion, liver fibrosis, liver cirrhosis, computed tomography, liver elastometry

  • The role of interleukins in the pathogenesis of atrial fibrillation: literature review (Issue № 3, 2024)

    A.T. Aubakirova, A.K. Baimbetov, A.V. Sapunov, I.A. Yakupova, K.A. Bizhanov, L.E. Rizabekova, N.J. Bigeldiev
    2024-09-30
    90–97
    Abstract

    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.

    Keywords

    atrial fibrillation, interleukins, inflammation, pathogenesis, cardiovascular diseases, IL-1, IL-6, IL-17

  • The influence of pulmonary vein anatomy on outcomes after ablation of paroxysmal atrial fibrillation (Issue № 3, 2024)

    A. Baimbetov, A. Jukenova, A. Ualiyeva, K. Bizhanov, A. Sapunov, N. Bigeldiyev, K. Yakupova, N. Okhabekov, Zh. Meirambay
    2024-09-30
    82–89
    Abstract

    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.

    Keywords

    Atrial fibrillation, cryoballoon ablation, pulmonary vein anatomy, recurrence, pulmonary vein isolation, multislice computed tomography

  • Myocardial dysfunction in polytrauma (Issue № 3, 2024)

    M.S. Bekbossynova, A.N. Batpen, M.A. Mukarov, Z.M. Shaktybek, M.M. Sugralimova, B.M. Mamasaliev, M.K. Lukbanov, P. S. Kanabekova, A.I. Kozhakhmetova
    2024-09-30
    54–64
    Abstract

    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.

    Keywords

    trauma, myocardial dysfunction, immunology

  • The effectiveness of the functioning of reconstructed hepatic veins using various types of materials in transplantation of the right lobe of the liver from a living donor (Issue № 3, 2024)

    Z.R. Ospan, M.О. Doskhanov, B.B. Baimakhanov, S.A. Kaniyev, M.S. Nagasbekov, S.T. Tileuov, M.U. Suierkulov
    2024-09-30
    38–45
    Abstract

    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.

    Keywords

    Living donor liver transplantation, Hepatic vein, Vascular graft, Venous reconstruction models

  • Surgical management of renal cell carcinoma with inferior vena cava thrombosis: a clinical case (Issue № 3, 2024)

    B.B. Baimakhanov, I.K. Madadov, E.B. Belgibaev, E. S. Nabiev, B.G. Rgebayev, N. T. Saduakas, D. Akhmetov
    2024-09-30
    26–32
    Abstract

    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.

    Keywords

    renal cell carcinoma, inferior vena cava, thrombus, nephrectomy

  • Diagnostic accuracy of multispiral computed tomography in detecting and staging of esophageal and gastric cancer (Issue № 3, 2024)

    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
    2024-09-30
    19–25
    Abstract

    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.

    Keywords

    esophageal cancer, gastric cancer, adenocarcinoma, multispiral computed tomography, biopsy, histology

  • Results of gastrointestinal bleeding treatment in the republic of kazakhstan over 10 years (Issue № 3, 2024)

    O.T. Ibekenov, A. E. Ayupov, A.N. Zhuraeva, B.B. Baimakhanov, S.А. Kaniyev, M.O. Doskhanov, A.O. Ibekenova, A. Ibekenova
    2024-09-30
    10–18
    Abstract

    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.

    Keywords

    gastrointestinal bleeding, incidence, mortality

  • Acute pancreatitis in akmola region according to emergency surgery (Issue № 3, 2024)

    N.S. Igissin, S.A. Ayaganov, R.S. Moldagali, D.K. Turebaev, A.M. Jexenova, S.K. Muratbekova, K.R. Rustemova, G.S. Igissinova, Z.A. Bilyalova, Zh.B. Telmanova, A.G. Nugumanova
    2024-09-30
    4–9
    Abstract

    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.

    Keywords

    acute pancreatitis, hospitalization, surgical intervention, conservative therapy, mortality, morbidity, late diagnosis, trends

  • CT and MRI referral practices under mandatory social health insurance (Issue № 4, 2024)

    D. Baiguissova, A. Sadykova, M.A. Baimuratova, A.R. Ryskulova, Ye. Kalshabay, A.N. Mukhamejanova, G. Battalova, A. Kabidenov, S.A. Kaniev
    2024-12-31
    57–65
    Abstract

    Background. Modern imaging techniques, such as computed tomography (CT) and magnetic resonance imaging (MRI), are vital for diagnosing and monitoring diseases. Despite their value, challenges include high costs, radiation risks, and limited accessibility. Effective use requires collaboration between general practitioners (GPs) and radiologists. Misguided referrals burden healthcare systems, while underuse delays diagnoses. Objective. This study assesses GPs’ awareness of CT/MRI indications, examines challenges in referrals under the mandatory social health insurance framework, and analyzes radiologists’ views on unjustified referrals.

    Methods. Two surveys were conducted: one among 108 radiologists in Almaty and Astana and another among 163 GPs in Almaty and the Almaty region. Questionnaires included closed and open-ended questions, and responses were analyzed to identify barriers and optimize diagnostic processes.

    Results. Among radiologists, 56.5% reported more than five unjustified referrals per month, with CT being the most overused modality (80.6%). Reasons included GPs’ lack of knowledge about indications (66.7%) and patient pressure (67.6%). GPs cited limited mandatory social health insurance framework quotas (29.3%) and long waiting times (19.9%) as significant barriers. Both groups emphasized the need for clear clinical guidelines, enhanced education, and better interprofessional communication.

    Conclusion: Systemic improvements in radiology services are necessary. Key recommendations include developing national clinical guidelines, educating GPs on CT/ MRI indications, and streamlining administrative processes. These measures will reduce unjustified imaging, improve resource use, and enhance patient care.

    Keywords

    radiology, CT, MRI, general practitioners, mandatory social health insurance

  • Thrombosis of mechanical valve prosthesis: a case report (Issue № 4, 2024)

    B.A. Rakishev, A.B. Kudaibergen, U.E. Imammyrzayev, R.S. Taimanova, A.D. Temirkhanov, S.A. Kaniyev
    2024-12-31
    19–24
    Abstract

    Mitral valve prosthesis thrombosis is a rare but life-threatening complication associated with mechanical heart valves. It requires timely diagnosis and prompt intervention to prevent severe morbidity and mortality. We report the case with hemoptysis, severe dyspnea, and fever, two years after mechanical mitral valve replacement with a St. Jude Medical prosthesis. Despite consistent anticoagulation therapy, recent transition from warfarin to low-molecular-weight heparin during hospitalization for pneumonia may have contributed to prosthetic thrombosis. Echocardiography revealed significant mitral valve dysfunction with a mean pressure gradient of 45 mmHg and evidence of thrombus formation. Emergency surgery confirmed total prosthetic valve thrombosis and necessitated thrombectomy and replacement with a new mechanical valve. Postoperative recovery was uneventful, with improved hemodynamics and resolution of pulmonary edema. This case highlights the complexities of managing mechanical valve thrombosis in patients with multiple risk factors, including anticoagulation changes, atrial fibrillation, and recurrent pulmonary infections. The surgical approach remains the gold standard for treatment, though emerging evidence supports the potential role of thrombolysis in select cases. In conclusion, mitral valve prosthesis thrombosis represents a significant challenge requiring multidisciplinary management and strict anticoagulation monitoring, and the importance of developing standardized protocols for early diagnosis, anticoagulation management, and surgical intervention.

    Keywords

    Dysfunction of a mechanical prosthesis, prosthetic thrombosis, pulmonary edema, anticoagulant therapy

  • Stepwise application of aortic wall autoplasty (Issue № 4, 2024)

    K.N. Kuatbekov, A.E. Tugambaev, A.V. Mishin, A.M. Nurbekov
    2024-12-31
    12–18
    Abstract

    This paper describes the effective management of successive early postoperative complications, using aortic wall autoplasty, VAC-system, with completion of combined sterno-osteosynthesis in one cardiac surgical patient. The paper presents a clinical case of management of postoperative complications in a 67-year-old patient after aortic valve replacement and three-vessel myocardial revascularization by applying a combined and step-by-step approach for each complication: 1. In case of surgical bleeding - formation of flap plasty of the damaged aortic wall with autopericardium by in situ fixation method; 2. In case of profuse bleeding - application of VAC-system; 3. In case of high risk of sternum divergence - its closure by preferential rheosteosynthesis with tie-fixation devices. The described methods of control, carried an individual approach and the choice of the optimal method of their application, which requires knowledge of the entire arsenal of relevant and effective ways of emergency elimination of complications. In our case, unfortunately, against the background of successful one-stage treatment of all complications, the outcome was unfavorable, due to the exhaustion of compensatory mechanisms of the body against the background of severe combined acquired cardiac pathology. Autopericardium plasty by the method of fixation on the stem created additional protection of the aortic bleeding zone, and further installation of the VAC-system successfully stopped the uncontrollable non-surgical bleeding that was festering. Clamp-buckle osteosynthesis, which we applied as a standard in reoperations, contributed to more active intensive care in intensive care with improved repair of the sternum.

    Keywords

    bleeding, vacuum system, thoracoplasty, case report, cardiac surgery

  • Diagnosis and modern treatment methods for hepatic hemangioma (literature review) (Issue № 4, 2023)

    B.B. Baimakhanov, G. Oryngali, Zh.S. Suiindik, A.K. Kydyrbaeva., Y. Y. Barakhan, D.S. Abilkaiyr, Sh.A. Narynbay, А.М. Tolegenova, O.T. Ibekenov, Sh.А. Kaniyev
    2023-12-22
    Abstract

    Background. Hepatic hemangioma is the most common form among benign liver tumors. The vast majority is asymptomatic, usually detected accidentally during screening. A thorough study is required to distinguish it from other local liver pathologies, therefore, in the review paper below we have analyzed important issues during the diagnosis and treatment of liver hemangioma in international experience. The aim of this study differentiation of modern methods of diagnosis and treatment of liver hemangioma in clinical practice..

    Material and methods. In the review work, a literature review of randomized, meta-analyses, clinical trials and international clinical recommendations in English and Russian, published only from January 2010 to August 2023 in bibliographic and other electronic medical databases such as PubMed, Scopus, Web of Science, GoogleScholarship, Springer, rare clinical cases were carried out. Criteria for inclusion in the study: 1) full-text research published in the database; 2) research in English or Russian; 3) research carried out or published in the last 2010-2023 years. Conclusions. As the most common benign liver tumor, the incidence of hepatic hemangioma during autopsy is from 0.4 to 20%. Most hepatic hemangiomas are asymptomatic, small-sized forms do not require intervention. Liver hemangioma can be easily diagnosed using ultrasound, or cop phase spiral contrast computer tomography. An indication for surgical resection is a feeling of progressive pain in the abdomen and a size of more than 5 cm. Some patients also have giant hemangiomas with minimal symptomatic. Giant hemangiomas (>10cm) are most often manifested by symptoms and require mandatory surgical intervention. The most commonly used method for the treatment of hemangiomas today is transaortic embolization, surgical resection. But to date, there is no consensus on the best treatment for patients with symptomatic and/or large hemangiomas.

    Keywords

    hepatic hemangioma, embolization of hepatic arteries, benign tumor, radiofrequency ablation

  • WHAT SCALES SHOULD THE CARDIOLOGIST USE IN PATIENTS WITH ATRIAL FIBRILLATION? WHAT IS NEW? (Issue № 2, 2024)

    K.A. Bizhanov, A.K. Baimbetov, B.B. Baimakhanov, Sh.A. Kaniev, O.T. Ibekenov, A.B. Sarsenbaeva, G.N. Ismailova
    2024-06-28
    61–77
    Abstract

    The current treatment algorithm for patients with non-valvular atrial fibrillation (AF) includes anticoagulation to prevent stroke and systemic embolism, improvement of AF symptom control by heart rate reduction or restoration and maintenance of sinus rhythm, and treatment of cardiovascular and other comorbidities. The evaluation of patients with AF should be structured and include assessment of stroke risk, symptom severity, severity of the AF burden (type of arrhythmia, number and duration of episodes, etc.) and predisposing condition. The use of the CHA2DS2-VASc (risk of stroke), HAS-BLED (risk of bleeding), EHRA (severity of AF symptoms), and 2MACE (risk of cardiovascular outcomes) scales is important to help assess the likelihood of adverse outcomes and select the optimal treatment to protect not only against stroke but also against cardiovascular events. It should be noted that the HAS-BLED scale is primarily necessary for identification of bleeding risk factors, the modification of which allows to increase the safety of anticoagulant therapy, and a high index value according to this scale can’t serve as a reason to refuse anticoagulation in a patient with AF. New scales of stroke and hemorrhagic complications risk assessment in patients with AF on the basis of clinical parameters and laboratory biomarkers have been proposed, but their possible advantages over the existing indices need to be confirmed in special studies.

    Keywords

    Atrial fibrillation, stroke, bleeding, scales, direct oral anyicoagulants, myocardial infarction, interventional arrhythmology, cardiology

  • FIRST EXPERIENCE OF LAPAROSCOPIC HEPATICOJEJUNOSTOMY FOR BILE DUCT STRICTURES (Issue № 2, 2024)

    M. Doskhanov, A. Khajiyeva, B. Baimakhanov, S. Kaniyev, M. Seisembaev, Z. Ospan, S. Teipov
    2024-06-28
    50–60
    Abstract

    Background. Bile duct injury is a potentially life-threatening condition characterized by high morbidity and mortality, which occurs as a result of erroneous manipulation during surgical intervention, such as incorrect identification of the ducts, improper clipping, or thermal injury. The aim of the study is to investigate the effectiveness of laparoscopic hepaticojejunostomy in patients with post-cholecystectomy bile duct injuries and compare it with traditional open techniques. Materials and

    Methods. A retrospective analysis of the results of laparoscopic and open hepaticojejunostomy in patients with bile duct injuries from 2017 to 2023 was conducted.

    Results. Laparoscopic surgery was performed on 28 patients, while open surgery was performed on 57 patients. Statistically significant differences were noted in the presence of external biliary fistula, diameter of the anastomosis, duration of the operation, postoperative complications, and postoperative period. There were no significant differences in the frequency of intraoperative complications.

    Conclusion. The laparoscopic approach in treating bile duct strictures classified as Strasberg E1 - E2 is safe and effective.

    Keywords

    Bile duct injury, cholecystectomy, laparoscopic hepaticoejunostomy, hepaticoejunoanastomosis

  • FEATURES OF THE COURSE OF NON-ALCOHOLIC FATTY LIVER DISEASE INTYPE 2 DIABETES MELLITUS AND IMPAIRED GLUCOSE TOLERANCE (Issue № 2, 2024)

    B. Makhabbat, G. Myrzakhmetova, Sh. Seitkasym, A. Sailybaeva, S. Khamitov, Zh. Oralbekova, G. Daniyarova
    2024-06-28
    39–49
    Abstract

    Background. Non-alcoholic fatty liver disease and type 2 diabetes mellitus or impaired glucose tolerance are common diseases with a high risk of developing cardiovascular diseases, the leading cause of disability and death. Our aim is to develop new methods for screening, prevention, and treatment of cardiovascular diseases in patients with non-alcoholic fatty liver disease, type 2 diabetes mellitus, and impaired glucose tolerance.

    Methods and methods. This study is single-center, open-label, uncontrolled, diagnostic study. Between 2023 and February 2024, 216 patients with cardiovascular diseases and concomitant non-alcoholic fatty liver disease, type 2 diabetes, and impaired glucose tolerance were selected at Heart Center “University Medical Center” Corporate Fund.

    Results. All examined patients with cardiovascular diseases and concomitant non-alcoholic fatty liver disease showed increased liver enzyme activity. Blood lipid profile indicators were significantly higher than optimal levels for patients with cardiovascular diseases. There was also a significant increase in liver enzymes, C-reactive protein, triglycerides, and lipoproteins in patients with cardiovascular diseases and non-alcoholic fatty liver disease combined with type 2 diabetes and impaired glucose tolerance.

    Conclusion. Liver enzyme activity, C-reactive protein, glucose, and lipid profile analysis showed significant increases in these indicators in patients with cardiovascular diseases and non-alcoholic fatty liver disease, especially in the presence of type 2 diabetes and impaired glucose tolerance. All examined patients showed increased liver enzyme activity and lipid levels, indicating the impact of these diseases on the liver and metabolism.

    Keywords

    Non-Alcoholic Fatty Liver Disease, Type 2 Diabetes, Glucose Tolerance, Cardiovascular Diseases, Metabolic Syndrome

  • ASSOCIATION BETWEEN TOTAL BILIRUBIN LEVELS WITH INCIDENCE OF ATHEROSCLEROSIS: SYSTEMATIC REVIEW AND META-ANALYSIS (Issue № 2, 2024)

    M. Bekbossynova, T. Ivanova-Razumova, E. Adina, G. D. Daniyarova, S.R. Khamitov
    2024-06-28
    32–38
    Abstract

    Background. Bilirubin is a byproduct of the breakdown of erythrocytes. Bilirubin levels can potentially serve as a biomarker for cardiovascular risk assessment. In this study, we would be investigating most recent manuscripts, published in the last 5 years, that studied association of serum bilirubin level to atherosclerosis progression to elicit how strongly low level of total bilirubin can prognose the disease progression.

    Methods. Using Pubmed search engine, all articles that included

    Keywords

    Total Bilirubin Level, Atherosclerosis, Meta-Analysis

  • KIDNEY TRANSPLANTATION FROM LIVING DONOR WITH RENAL MASS: CLINICAL CASE (Issue № 2, 2024)

    B.B. Baimakhanov, I.K. Madadov, E.B. Belgibaev, E.S. Nabiev, N.T. Saduakas
    2024-06-28
    25–31
    Abstract

    Introduction. Renal transplantation is the best treatment option for end-stage renal disease, but organ demand continues to overweight organ supply. The transplantation of kidneys from donors with small renal masses represent a potential avenue to expand the donor pool. We represent the clinical case of kidney transplantation from living related donor with small renal mass and performed literature review of results of these cases.

    Methods. Саse presentation of kidney transplantation from living related donor with incidental finding of small renal mass. Mass was excised and subsequently kidney was engrafted successfully. Up to date both patients are under follow up during 8 months and any signs of recurrence were seen.

    Results. Donor kidney was procuredby laparosopic hand-assissted technique. Intraoperatively small renal mass was encountered whereas during preop evaluation renal cyst was diagnosed. Renal mass was excised fully and defect was closed with interruptive suture. Histological evaluation has revealed highly differentiated renal cell carcinoma. Postoperative period was uneventful. Patient was discharged with good graft function.

    Conclusion. Careful use of kidneys from donors with single renal masses is feasible and safe, with an overall recurrence rate of less than 1.5%. The use of such kidneys could help alleviate the organ shortage crisis.

    Keywords

    Renal Mass, Transplantation

  • EARLY ACTIVATION PATHWAYS IN PATIENTS UNDER-GOING OPEN HEART SURGERY WITH MULTICOMPO- NENT GENERAL ANESTHESIA COMBINED WITH HIGH THORACIC EPIDURAL ANESTHESIA (Issue № 2, 2024)

    E.S. Hajiyev, S.N. Ibrahimov, U.A. Rahimov, V.R. Abdulkarimov, F.E. Abbasov
    2024-06-28
    4–14
    Abstract

    Background: Early mobilization of patients in the postoperative period after open heart surgeries, significantly decreases the risk of complications, accelerates the restoration of functional capacity, shortens the length of hospital stay, and reduces treatment costs

    Materials and methods: Open heart surgeries were performed on 60 patients at Ankara "Bayındır" Hospital, Central Clinical Hospital, and Baku Health Center were included in the study. Patients were divided into two groups. 30 of them underwent the procedure with the use of multi-component balanced general anesthesia and intravenous fentanyl analgesia in the postoperative period. The other group of 30 patients underwent catheterization under high thoracic epidural anesthesia, with the administration of ropivacaine prior to induction and, in the postoperative period, ropivacaine and fentanyl. We conducted a study on central hemodynamic parameters and analgesic effects.

    Results: Thirty of them underwent the procedure with the use of multi-component general anesthesia and intravenous fentanyl analgesia in the postoperative period. The other group of 30 patients underwent catheterization of the high epidural space with the administration of ropivacaine before induction and, in the postoperative period, ropivacaine and fentanyl. We conducted a study on central hemodynamic parameters and analgesic effects.

    Conclusion: It has been established that for patients in the second group according to the Enhanced Recovery After Surgery strategy, hemodynamic support and effective pain management can contribute to early patient mobilization after surgery. Early mobilization, in turn, can expedite recovery and reduce the length of hospital stay, ultimately leading to potential cost savings.

    Keywords

    Cardioanesthesia, Epidural Anesthesia. Fast-Track, ERAS

  • Combined treatment of digeorge syndrome (Issue № 1, 2024)

    G.N. Ismailova, A.K. Khamidulla, I.A. Yakupova, I. Omarkyzy, A.D. Temirkhanov
    2024-05-21
    38–45
    Abstract

    Background. DiGeorge syndrome is a rare congenital disease associated with a deletion of chromosome 22q11.2, which is characterized by the occurrence of various anomalies, such as hypo/aplasia of the thymus and parathyroid glands, which leads to T-cell immunodeficiency and hypoparathyroidism; this syndrome is also characterized by congenital heart disease (tetralogy of Fallot), anomalies in the development of craniofacial structures are observed, in the form of non-fusion of the hard palate and upper lip (cleft palate and cleft lip).

    Results. This article will examine a clinical case of DiGeorge syndrome in a child, with the classic triad characteristic of this condition (immunodeficiency, hypoparathyroidism and congenital heart disease). The patient underwent the first stage of correction of a combined heart defect against the background of constant (monthly) immunocorrection. Due to the COVID-19 pandemic, our patient was unable to receive scheduled hospitalization for blood replacement and immunocorrective therapy in a timely manner. The key to increasing the survival rate of patients with DiGeorge syndrome is prenatal screening, timely correction of the anomaly and immunoreplacement therapy, which are actively used in foreign countries. Also, incomplete treatment of DiGeorge syndrome can subsequently lead to various other manifestations, such as autoimmune diseases, infectious diseases, etc.

    Conclusion. The prognosis of DiGeorge syndrome is that this disease has various clinical manifestations, is combined with other variants of the anomaly that are incompatible with life and lead to delayed psychomotor development and have an unfavorable prognosis.

    Keywords

    DiGeorge syndrome, thymic hypo/aplasia, tetralogy of Fallot, thymus transplantation

  • Modern biomarkers - predictors of earlycardiovascular ageing (literature review) (Issue № 1, 2024)

    M. Abdykassymova, K. Abzaliyev, Ghazwan Butrous, S. Abzaliyeva, A. Kurmanova, R. Bitemirova, D. Sundetova, U. Sagalbayeva, A. Bugibayeva, N. Baizhigitova, A. Kenzhebaeva, М. Baurzhan
    2024-05-21
    4–11
    Abstract

    An analysis of the current state of the problem of studying biomarkers of human cardiovascular ageing was carried out based on an analysis of international experience. Ageing is an inevitable, constantly progressive systemic process, which is a significant risk factor for the development of most common chronic human diseases, including cardiovascular diseases. Therefore, studying markers of early cardiovascular ageing is a logical goal for developing measures to prevent the development of cardiovascular disease and toimprove the quality of life and prolong active longevity. the intensive care unit. The application of a multidisciplinary approach to diagnose and treat a life-threatening complication as tracheal rupture in a short time allowed us to stabilize the patient’s condition and avoid the development of further complications.

    Keywords

    biomarkers of ageing, predictors of cardiovascular ageing, theories of ageing, regulation of ageing, longevity