Bulletin of Surgery of Kazakhstan is a peer-reviewed scientific journal publishing original research, reviews and clinical studies in surgery, traumatology, oncology and related medical disciplines. The journal aims to promote the dissemination of high-quality scientific knowledge and support the development of medical science in Kazakhstan and internationally. Журнал входит в перечень изданий, рекомендуемых Комитетом по обеспечению качества в сфере науки и высшего образования Министерства науки и высшего образования Республики Казахстан для публикации основных результатов научной деятельности
12. Bile Duct Atresia. Literature Review
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.
11. Cardiorespiratory Fitness And Its Role In Managing Atrial Fibrillation. A Literature Review
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.
10. Comparative Analysis Of Bisoprolol Efficacy In Patients With Normal And Altered Cardiac Anatomy In The Postoperative Period After Catheter Ablation Of Atrial Fibrillation
Background. The aim of this study was to evaluate the effectiveness of the β-adrenergic blocker bisoprolol in maintaining sinus rhythm in patients with atrial fibrillation following catheter ablation of the pulmonary vein ostia, considering the anatomical condition of the left atrium. Material and methods. A total of 50 patients were enrolled and divided into two groups: those with normal left atrial anatomy (n = 25) and those with pathologically altered anatomy (n = 25). All patients received bisoprolol at a dose of 10 mg/day for 12 months post-ablation. Results. Within the first 6 months of follow-up, no atrial fibrillation recurrences were observed in the group with normal left atrium anatomy (100%), whereas 92% of patients in the altered anatomy group experienced recurrences. In the second half of the follow-up period (months 6–12), differences between the groups were no longer statistically significant. Statistical analysis confirmed a highly significant difference in recurrence rates during the early postoperative period (p < 0.001) and no significant difference in the late period (p > 0.3). Conclusion. The effectiveness of bisoprolol in maintaining sinus rhythm is highly dependent on the anatomical condition of the left atrium in the early period following ablation. The results highlight the importance of individualizing antiarrhythmic therapy based on morphofunctional characteristics.
9. Six-Minute Walk Test As A Tool For Assessing Physical Activity In Patients With Heart Failure
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.
8. Periodontitis As A Possible Cause Of Chronic Heart Failure
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.
7. Features Of Risk Factors For The Development Of Atherosclerosis-Associated Cardiovascular Diseases In The Kazakhstani Population. Ethnonational Aspect
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.
5. The Radicality Of Pituitary Adenoma Removal In The Republic Of Kazakhstan
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.
6. An Optimized Approach To The Formation Of The Upper Eyelid Among Euroasians
Background. Blepharoplasty of the Asian eyelid is a variant of operation in which a fold of the eyelid is created. The Asian upper eyelid is characterized by a low, absent, or variable skin fold, a fuller eyelid with a smaller orbit, and a medial epicanthal fold. The presence of this fold is explained by a different attachment of the muscle that raises the upper eyelid. Material and methods. In the conditions of the NSCS named after Syzganov, between 2020–2024, we operated on 127 patients. In 101 cases, blepharoplasty was performed separately, in 26 cases in combination with other operations. Results. In the postoperative period, no general surgical complications were observed in patients, in 2 cases there was an inconsistency of the formed fold. Conclusions. Our method is a proven choice for the Europeanization of Asian eyelids, in which the postoperative scar does not extend beyond the cutout of the eyes. Low injury rate of the operation. Indirect epicanthoplasty is the method of choice for oriental blepharoplasty, since this method does not require additional incisions, therefore, the duration of rehabilitation, the number of possible complications, and the time of surgery are reduced. Only 2% of patients had an unsatisfactory result. The economic validity of this methodology: no need to stay in the hospital for a long time. This minimizes the costs of the medical facility and reduces the burden on medical staff.
4. Improving The Organization Of Early Diagnosis Of Manifestations Of Microangiopathy To Prevent The Risk Of Complications
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.
3. Clinical And Prognostic Significance Of Intra-Abdominal Pressure In Choosing A Surgical Strategy For Gastroschisis In Newborns
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.
2. A Rare Case Of Congenital Portosystemic Shunt (Abernethy Malformation Type II) In A Child. Diagnosis, Endovascular Interventional Strategy, And Follow-Up
Congenital portosystemic shunt, also known as Abernethy malformation, is a rare vascular anomaly in which portal venous blood partially or completely bypasses the liver and enters the systemic circulation. This condition can lead to severe complications such as hepatopulmonary syndrome, hepatic encephalopathy, hypoxemia, and hyperammonemia. This article presents the first clinically confirmed and successfully treated case of Abernethy type II malformation in a child in Kazakhstan, who developed severe hepatopulmonary syndrome. A detailed description is provided of the diagnostic algorithm, angiographic evaluation, the endovascular intervention technique, and the patient’s clinical course over a five-year follow-up period. Shunt closure resulted in marked clinical improvement, including normalization of oxygen saturation (from 60% to 98%), reduction in blood ammonia levels, increased exercise tolerance, and enhanced quality of life. The findings support the effectiveness of an individualized, stepwise approach in the management of type II CPSS. The importance of early recognition of this condition is emphasized, particularly in pediatric patients presenting with unexplained cyanosis, hypoxemia, or signs of hepatic dysfunction. Endovascular techniques, due to their minimally invasive nature and high clinical efficacy, represent an optimal therapeutic strategy in pediatric practice.
1. Acute Liver Failure On The Background Of Chronic Liver Disease Due To Hepatitis Virus Reactivation
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.
10. Role of extracorporeal liver support methods in the treatment of acute liver failure: a clinical case and a literature review
The liver is an essential organ in the human body, responsible for a multitude of critical tasks. Diseases affecting the liver can be incredibly serious, often endangering life. At present, liver transplantation stands as the only demonstrated successful remedy for these acute ailments. Early investigations explored non-biological treatments, employing conventional deto[Lʖcation techniques such DV ʖltration and dialysis The absence RI liver cells LQ these methods limited patient survival and failed WR sufʖciently provide essential liver speciʖF functions This prompted increasing interest LQ GHYHORSing biological therapy-based extracorporeal liver support systems, intended as a temporary measure leading to liver transplantation or as a supportive approach for a failing liver $ bioartiʖcial liver support system involves DQ H[tracorporeal device circulating plasma over living and actively functioning hepatocytes within a bioreactor. This system is designed to assist the diseased liver until it either recovers on its own or until a suitable transplant organ becomes available. This review presents a concise summary of the effectiveness of currently available liver support systems. Furthermore, it explores the progression of advanced liver support systems, assessing enhancements to critical elements like the cell source, along with culture and circulation conditions, for the maintenance RI crucial liver speciʖF functionalities '2, %6. ,, Kuandykov T.
9. Optimization of the management of patients with biliary atresia in the Republic of Kazakhstan: a clinical, epidemiological and prognostic study
Background. Biliary atresia is a rare, progressive disease of the bile ducts in infants (progressive cholangiopathy) that leads to cirrhosis and liver failure if untreated. Early diagnosis and timely surgical intervention are crucial for preserving the native liver. In the Republic RI Kazakhstan diagnostic delays remain D signiʖcant challenge QHFHVVLtating improved strategies for early detection and prognosis. Methods. A retrospective and prospective study was conducted involving 100 children diagnosed with biliary atresia Patients were divided into two groups those who underwent Kasaiportoenterostomy and those who required primary liver transplantation Clinical characteristics biochemical markers ultrasound ʖndings and genetic data were collected. Statistical analysis included correlation studies, logistic regression, and receiver operating characteristic curve analysis to assess a predictive model for Kasai outcomes. Results. The Kasai procedure was successful in 34 percent of cases. Surgery performed before days RI life signiʖcantly improved outcomes )actors associated with poor prognosis included elevated gamma-glutamyl transferase levels (above 600 international units per liter liver cirrhosis conʖrmed E\ biopsy mutations LQ the -$**(' gene, and altered expression of nuclear receptors-pregnane X receptor, constitutive androstane receptor. The predictive model incorporating these factors demonstrated 81 percent sensitivity and percent speciʖcity LQ identifying Kasai failure Conclusion. Early intervention is critical to improve survival with the native liver in children with biliary atresia. The proposed prognostic model can support individualized treatment decisions. Implementation of a national screening and diagnostic algorithm in Kazakhstan could reduce delays and improve long-term outcomes. '2, %6. ,, Yerimova N.
8. The role of the cervicovaginal microbiome and local immunity in human papillomavirus persistence and precancerous cervical changes
Background. Metabolically associated fatty liver disease is closely linked to dyslipidemia and cardiovascular disease but the role of triglycerides as predictors of metabolically associated fatty liver disease severity remains underexplored. Purpose. This study aimed to evaluate the association between triglyceride levels and hepatic steatosis and ʖbrosis LQ patients DW high cardiovascular risk Methods. A total of 284 patients with cardiovascular disease and suspected metabolically associated fatty liver disease underwent clinical evaluation lipid proʖling and non-invasive liver assessment via Fibroscan. Spearman correlation analysis was used WR H[plore relationships between triglycerides liver steatosis ʖbrosis and lipid parameters. Results. Triglycerides showed a modest positive correlation with hepatic steatosis U and D weaker correlation with ʖbrosis U Additionally triglycerides correlated moderately with total cholesterol U and low density lipoprotein cholesterol U 1R signiʖcant VH[ differences LQ liver disease stages were found Conclusion. Triglycerides may serve as accessible biomarkers for early metabolically associated fatty liver disease related liver changes in cardiovascular patients. Further research is needed to validate their clinical utility. '2, %6. ,, Bekbossynova M.
7. Distribution of high-risk human papillomavirus genotypes and their association with cervical cytology in Kazakhstani women
Background. Precancerous lesions of the cervix in women of reproductive age are an urgent problem of modern medicine. Despite progress in understanding the molecular mechanisms of human papillomavirus mediated carcinogenesis and the introduction of screening and vaccination programs, the incidence of cervical cancer remains high worldwide. The aim of this study is to identify the prevalence and distribution of different cervical precancerous lesions. Materials and method. This is a cross-sectional study based on the University cluded 403 women of reproductive age (18-45 years). Two statistical analyses were used to compare differences between groups: the Kruskal–Wallis test and the Jonckheere– Terpstra test. Results. Age of the patients, Body Mass Index, age at menarche and other variables are distributed similarly among different precancerous lesion groups, suggesting homogeneous distribution of study population among cervical cytological groups. Overall, 35.1% of patients were tested positive for high-risk human papillomavirus in our cohort. Among 12 high risk human papillomavirus genotypes, ems-16 was the most prevalent high-risk human papillomavirus genotype with prevalence of 11.4%, followed by emsRO with a prevalence of 6.6% each other and ems-33 that was present in 5.3% patients who tested positive for human papillomavirus. Conclusion. among other Asian countries and underscores the value of ongoing regional surveillance to inform effective vaccination and screening policy.
6. Relationship between age-related hypogonadism and symptoms of depression in Kazakh men
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.
5. Prognostic value of urinary albumin-to-creatinine ratio in a surgical practice
Background. The urinary albumin-to-creatinine ratio is a well-established marker RI early kidney damage endothelial dysfunction and systemic LQʗammation (levated urinary albumin-to-creatinine ratio levels are linked to increased cardiovascular risk and mortality 'uring surgical stress urinary albumin WR creatinine ratio may UHʗect vascular and LQʗammatory changes yet its prognostic value LQ surgical patients remains insufʖciently studied Objective 7R assess the prognostic signiʖcance RI urinary DOEXmin-to-creatinine ratio in patients undergoing surgical interventions. Materials and Methods. A retrospective analysis included 171 patients (98 men, 73 women aged ɇ years who underwent various surgeries DW the National ScientiʖF Center of Surgery named after ^KkK Syzganov from March 2022 to March 2025. Random morning urine samples were analyzed for albumin and creatinine, and urinary albumin-to-creatinine ratio was calculated. Measurements were performed using Cobas 303 and 311 analyzers (Roche Diagnostics). Results. The mean age was 53.2 years. Mean urinary creatinine and albumin were mmol / and PJ / with median values RI mmol / and PJ / respectively Median urinary albumin WR creatinine ratio was PJ mmol mean was PJ mmol indicating skewness 1R signiʖcant correlation was found between albumin and creatinine ƣ ɇ S $ moderate non signiʖcant inverse correlation was observed LQ the high level subgroup Q Conclusion. Although overall correlations were not signiʖcant ʖndings suggest that urinary albumin-to-creatinine ratio may have prognostic potential. Further prospective studies are needed, especially in abdominal surgery settings. '2, %6. ,, Aubakirova A.
4. Results of the analysis of the efficacy and safety of long-term anticoagulant therapy in Kazakh nationality patients after open heart valve surgery
Background. Surgical replacement of heart valves with mechanical prostheses is a life-saving procedure for patients with valvular defects. Postoperative success depends heavily RQ the HIʖcacy and safety RI anticoagulant therapy :arfarin remains the primary drug WR prevent thrombotic complications LQ such patients 'espite its HIʖFDcy, warfarin requires individualized dosing, long-term monitoring, and careful bleeding risk assessment. It is a leading cause of serious adverse drug reactions, accounting for up to one-third of related hospitalizations and deaths. A pharmacogenetic approach is increasingly important in optimizing warfarin therapy. Gene polymorphisms affect warfarin metabolism and sensitivity, making the study of these factors particularly relevant in underrepresented populations, such as patients of Kazakh nationality. However, there is limited data on warfarin response in this group. Materials and Methods. This LV the ʖrst study RI its kind among Kazakh patients It includes 310 individuals who underwent mechanical heart valve replacement and received warfarin therapy between 2015 and 2020. The aim was to evaluate the association between genotype, warfarin dose, and complication rates. Results. Patients showed variable coagulation responses with INR ʗuctuations and both hemorrhagic and thrombotic complications documented. Risk factors for adverse outcomes were identiʖHG underscoring the importance RI individualized dosing and close monitoring. Conclusions. This study highlights the need for genotype-based dose adjustment to improve the safety and effectiveness of warfarin therapy in Kazakh patients after mechanical valve replacement. '2, %6. ,, Nurbay Z.
3. Assessment of the quality of life of employed patients on hemodialysis
Background. Employment plays a crucial role in the quality of life of patients with end-stage chronic kidney disease undergoing hemodialysis, offering psychological, social and economic beneʖWV This study H[amines the impact RI employment RQ the quality of life in end-stage chronic kidney disease patients. Objective. To evaluate the LQʗuence RI employment RQ the quality RI life LQ patients with end stage chronic kidney disease undergoing hemodialysis, with a focus on physical, psychological, and social well-being. Materials and methods. This cross-sectional study assessed patients with endstage chronic kidney disease undergoing hemodialysis. Data were collected via a structured questionnaire, including demographic, clinical, and employment information. Quality of life was measured using the synthesized SF-36. Results. Out of 60 patients (mean age 58 years), 20 had high physical functioning (above 45 points), and 31 had good mental health. Only 10 patients showed high scores in both categories. Correlation analysis revealed a weak negative correlation between age and mental health U The results support the positive impact RI emplo\ment and social activity on the quality of life of patients with end-stage kidney disease. Conclusion. This study demonstrates that employment positively affects the quality of life in patients with end-stage chronic kidney disease undergoing hemodialysis. Employed patients reported higher physical and mental health scores, highlighting the potential beneʖWV RI social engagement and employment LQ this population )urther research with a larger sample size and inclusion of comparison groups is needed to explore the full impact of social activity on the well-being of these patients. '2, %6. ,, Bodessova S.
2. Assessment of frailty syndrome in patients of all CHF phenotypes during cardiac surgery
Background. With the aging population, the number of people with frailty syndromes receiving treatment for cardiovascular diseases is increasing. Diagnosis of frailty syndrome prior to complex and invasive procedures may have implications for prognosis and recovery. The aim of this study was to assess the prevalence of frailty and describe its associated clinical course and outcomes in patients referred for cardiac surgery. Materials and methods. A prospective cohort of patients over 18 years of age referred for cardiac surgery DW the non proʖW joint stock company National ScientiʖF Cardiac Surgery Center" in Astana, Department of Cardiac Surgery, from November 2022 to April 2023, was examined before surgery for the presence of frailty, determined E\ the GHʖcit accumulation model scale The analysis included clinical anamnestic instrumental and laboratory data, surgical results, development of complications and adverse outcomes in the perioperative period. Statistical processing of the study results was performed. Results. Fragility was detected in 32% of patients before open cardiac surgery. Differences were revealed LQ the intraoperative and early postoperative periods rhythm disturbances developed more often versus transient ischemic attack acute cerebrovascular accident of the ischemic type (8.3% versus 3.9%), hydrothorax (31.25% versus 11.7% and 5.8%), implantation of extracorporeal membrane oxygenation (12.5 % versus 3.9%) .In the group of patients with frailty, two fatal outcomes were recorded. Conclusions. Frailty was observed in 32% of patients undergoing cardiac surgery and was associated with higher risk of morbidity and increased healthcare utilization. '2, %6. ,, Bekbosynova M.
1. From gut to plaque: gut microbiome's impact on atherosclerosis development and progression. Literature review
Background. Atherosclerosis remains the leading cause of cardiovascular mortality worldwide. This review examines the emerging role of the gut microbiome in atherosclerosis pathogenesis. Recent advances in sequencing technologies have enabled deeper examination of complex interactions between intestinal microbial communities and cardiovascular health. Methods. This review followed jllpb guidelines, searching PubMed, Scopus, Web of Science, and Embase databases through March 2024. Search terms included "gut microbiome," "atherosclerosis," and related concepts. Studies examining relationships between gut microbiome composition and AS were included, with data extracted using standardized forms and organized into four categories for qualitative synthesis. Results. Research reveals atherosclerosis patients exhibit reduced bacterial diversiW\ and altered )irmicutes WR %acteroidetes ratios SpeciʖF WD[onomic signatures include increased Enterobacteriaceae and decreased butyrate-producing bacteria. Key microbial metabolites LQʗuence atherosclerosis development short chain fatty acids demonstrate anti LQʗammatory properties trimethylamine 1 R[ide enhances macrophage cholesterol accumulation bile acids modulate lipid metabolism and lipopolysaccharides trigger LQʗammatory cascades involved LQ plaque formation Conclusion. Understanding gut microbiome contributions to atherosclerosis pathogenesis offers new possibilities for prevention and treatment through microbiota modulation RU targeting speciʖF microbial metabolites representing D paradigm shift toward personalized approaches considering interactions between genetics, environment, and microbiome. '2, %6. ,, Issilbayeva A.
9. Social efficiency of introduction of atherosclerosis screening program in Kazakhstan. Systematic review
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.
Background. This study provides a detailed review of the interactions between the cervicovaginal microbiome, local immune responses, and human papillomavirus infection outcomes. Methods. A literature review was conducted covering the period from 2015 to 2024 using the PubMed, Scopus, Embase, and Google Scholar databases. The search included keywords such as human papillomavirus, cervicovaginal microbiome, dysbiosis, cytokines, cervical cancer, Boolean operators, and Medical Subject Headings terms for search refinement.Inclusion criteria: Peer-reviewed publications in English and Russian focusing on the cervicovaginal microbiome, immune responses, human papillomavirus persistence, and cervical neoplasia; observational studies, clinical trials, and reviews. Exclusion criteria: Non-peer-reviewed sources, gray literature, and studies unrelated to microbiome-immune system interactions or human papillomavirus outcomes. Results. Lactobacillus species, particularly L. crispatus, play a key role in maintaining an acidic vaginal environment that modulates local immunity and promotes human papillomavirus clearance. Dysbiosis, characterized by an overgrowth of Gardnerella, Prevotella, and Sneathia, leads to inflammation, disruption of the epithelial barrier, and human papillomavirus persistence. Hormonal fluctuations and environmental factors influence these processes, determining infection outcomes and disease progression. Conclusion. The cervicovaginal microbiome and local immunity are integral to human papillomavirus pathogenesis and cervical cancer prevention.
7. Clinical observation of hand function recovery using various methods of autotendon reconstruction and rehabilitation
Background. The purpose of the study was to compare objective (range of motion, hand strength) and subjective (Arm, Shoulder, and Hand Disability Questionnaire, Visual Analogue Pain Rating Scale) indicators of the effectiveness of one-stage and two-stage autograft reconstruction combined with Kleinert and SMART rehabilitation methods in hand injuries of different ages. Methods. The study included 200 patients (2021-2024) who underwent surgical treatment of flexor tendon injuries of the fingers at the Syzganov National Scientific Center of Surgery. Patients were divided into the main group (n = 80), which received two-stage reconstruction and rehabilitation according to the SMART method, and the control group (n = 120), which received one-stage reconstruction and rehabilitation according to the Kleinert method. Efficacy was assessed by range of motion, hand grip strength, Rozov's scale, Disabilities of the Arm, Shoulder, and Hand questionnaire, and visual analog scale pain scores. Results. By the 6th month of rehabilitation, the SMART method demonstrated better results in functional movement assessment (65% vs. 60%, p = 0.05), pain reduction (4.0 vs. 3.2, p < 0.05), and shorter return-to-work time (10 vs. 12 weeks, p < 0.05). However, the Kleinert method proved effective in patients with subacute injuries. Conclusion. The Stimulated Motion And Recovery Therapy hand rehabilitation method combined with two-stage reconstruction is effective in the long-term consequences of trauma, while the Kleinert method is preferable in subacute injuries. Restoration of hand function requires a multidisciplinary approach.
6. Survival analysis and characteristics of pancreatic adenocarcinoma based on msct data of 216 cases
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.
5. Evaluation of ultrasonic dissection technology in reducing post-mastectomy syndrome rates
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.
4. Correlation between apolipoprotein b/a1 and the risk of metabolic-related fatty liver disease depending on the lipid profile
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.
3. Fatty liver disease after pancreatoduodenectomy and total pancreatectomy
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.
2. Clinical case of monostotic fibrous dysplasia in a child
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.