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.
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.
Ключевые слова
fibrous dysplasia, tumor-like process, children, histiocytosis, bone tissue lesion
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.
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.
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.
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.
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.
Ключевые слова
Autograft reconstruction, hand injuries, Kleinert method, SMART Hand Rehabilitation Method, rehabilitation
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.
Ключевые слова
cervicovaginal microbiome, human papillomavirus, local immune responses, cervical cancer
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.
